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CORRECTED TRANSCRIPT OF ORAL EVIDENCE To be published as HC 762-iii
HOUSE OF COMMONS
TAKEN BEFORE THE
THE MILITARY COVENANT IN ACTION? PART 1: MILITARY CASUALTIES
WEDNESDAY 29 JUNE 2011
AIR VICE MARSHAL (rtd) TONY STABLES, MAJOR GENERAL (rtd) ANDREW CUMMING, COMMODORE PAUL BRANSCOMBE and CATHY WALKER
Evidence heard in Public
Questions 246 - 302
USE OF THE TRANSCRIPT
1. This is a corrected transcript of evidence taken in public and reported to the House. The transcript has been placed on the internet on the authority of the Committee, and copies have been made available by the Vote Office for the use of Members and others.
2. The transcript is an approved formal record of these proceedings. It will be printed in due course.
Taken before the Defence Committee
on Wednesday 29 June 2011
Mr James Arbuthnot (Chair)
Mr Mike Hancock
Mr Dai Havard
Mrs Madeleine Moon
Ms Gisela Stuart
Examination of Witnesses
Witnesses: Air Vice Marshal (rtd) Tony Stables, Chairman, Confederation of British Service and Ex-Service Organisations, Major General (rtd) Andrew Cumming, Controller, Soldiers, Sailors, Airmen and Families Association (SSAFA) Forces Help, Commodore Paul Branscombe, Deputy Controller (Services Support), SSAFA, and Cathy Walker, Deputy Controller (Branch Support), SSAFA, gave evidence.
Q246 Chair: Thank you very much for coming. Some of you have given evidence to this Committee in the past, and I know you have given evidence to the Armed Forces Bill Committee as well-you are all most welcome. This is another evidence session in our inquiry "The Military Covenant in action? Part 1: military casualties". We expect to finish by about 4 pm, if that is okay by you, so you will know that there will be an end to your misery. We will have lots of questions.
Air Vice Marshal Stables, may I ask you to tell us what COBSEO does?
Air Vice Marshal Stables: In its present format, it dates back to 1982. It is the Confederation of Service charities. It has a membership of about 180 and rising, as about two or three charities seek admission on a monthly basis. What are its principal outcomes? We provide a focus for dealing with Government-not only the Ministry of Defence, but other Government Departments-so we are an external focus of the defence charitable sector. We provide a mechanism whereby the Service charities can work in a more complementary way. We seek to avoid duplication of effort and to enhance the outcome of the charitable work. That, in a nutshell, is what it is about. Its work is driven by an executive committee of 13 members, who are the chief executives of the 13 large funds and charities. The major players form the executive committee, which drives the business, and my good friend the controller of SSAFA Forces Help is a member of that executive committee.
Q247 Chair: That leads us on very nicely. Major General Cumming, what does SSAFA do?
Major General Cumming: It does an awful lot, sir, and I shall try to give you the three-minute version.
We pride ourselves on the fact that we work with the Armed Forces from the time a person draws one day’s pay until the time he or she departs this mortal coil, together with the dependants they gather on the way, so we look after people both in-Service and ex-Service. Very simply, Paul Branscombe runs the in-service side and Cathy Walker runs the ex-Service side. On the in-Service side, principally, we run a number of contracts and a couple of grant-in-aid bits of business for the Ministry of Defence, providing the health and social work services for our Armed Forces overseas, broadly speaking. We also run the Royal Air Force’s Welfare Service, which is the equivalent of the Army Welfare Service, or the Naval Personal and Families Service. We run the same thing for the Royal Air Force.
Aside from that, we have a number of volunteers and in-Service committees. We contribute to victim support programmes abroad. We have carers and so on and so forth. We are an accredited adoption agency. We run a thing called the Forcesline, which is paid for by the three Services. It was originally a confidential support line, but now it is slightly broader-it has a new manifestation. We organise to pick people up if they are travelling with families from airports or whatever-that is called the Family Escort Service-to take them wherever they are going, such as if, interestingly, somebody is coming from Germany on the news that someone has been taken to Selly Oak Hospital as a result of operations.
We run a number of family support groups at the behest of the Ministry of Defence. Those groups have been going for about two years. They originally focused on those families who had been bereaved by bringing them together to enable them to talk, but they have expanded into another group for the families of those who have been wounded. Interestingly, out of that we found that the children of those who have been either killed or wounded did not want to do things with their parents but wanted their own group, so it is quite complicated with several such groups. They enable people to talk to each other, and we take them away for weekends and so on.
On the cusp of in-Service and ex-Service, we run two particular types of home. One is what we call a stepping stone home, which is for those sad occasions when families become estranged. Generally speaking, the husband is welcomed back into the bosom of the regiment and the sergeant-major hugs him, and the family is given 12 weeks to leave the quarter. Most of the time that works perfectly well, but sometimes it does not and we provide the stepping stone home-there is one in London and another in the North-to help them through that difficult stage. It is literally a stepping stone to find housing, education for the children and so on.
Another type of specialist home has been running for about three years. Again, we did this fully in concert with the Ministry of Defence. We suggested to it that we could help with the families of the wounded, if that would be suitable, and the then Veterans Minister agreed that we should do something. We raised an appeal and started two homes. One is at Selly Oak Hospital-
Chair: Which we are going to visit tomorrow.
Major General Cumming: I am pleased to hear that you are going to the one at Selly Oak tomorrow-I hope you enjoy it. I think it will be very good value.
The other home is down in Headley Court. We are working closely with the Hospital Trust in Birmingham and with the Fisher Foundation, which is doing the same sort of thing in America on a much bigger scale, to see whether we can help with an extension near Selly Oak. That is quite interesting work, and Paul can tell you more about it in a minute, if you want.
On the ex-Service side, very broadly speaking, we are the trusted agents for not only the military benevolent funds, but the civilian benevolent funds. We do the casework for those who say they are in need. Somebody in need will come to SSAFA-they go to other organisations, too, but they mostly come to SSAFA-and we assess that need. It could be anyone: an ex-Serviceman, a widow or a family member. Having done that assessment, our caseworkers will decide from where to, as we call it, almonise the money. Where will they send the assessment claim? They will send it to the regiment, the Royal British Legion, the Army Benevolent Fund or maybe the Print Workers’ Fund, if that is the trade that the person went into later in life.
Last year we shifted, if I might put it that way, some £18 million or £19 million either from benevolent funds, or from Government statutory funds, into the hands of those who needed and deserved it. There were some 47,000 cases and visits.
Chair: We will go into that sort of thing-
Major General Cumming: And a few houses and homes-that sort of thing-around the country. I think that is enough, but it is quite a big business.
Q248 Chair: As you say, you do an awful lot.
Mrs Walker and Commodore Branscombe, please feel free to come in if you think you can help us with our evidence. If you think the answers are completely wrong, just jump in.
Air Vice Marshal Stables, I will start with you. What difference do you think you have made to the co-ordination of the work that your member organisations and the Ministry of Defence do to provide help for Armed Forces personnel-both serving and former?
Air Vice Marshal Stables: I first came into this appointment some five years ago, and I would be tempted to say that the fact that we sit around a table and talk to each other is a significant improvement on what might have been before. I can say now-you had better confirm this with my good friend on my right-that there is openness and transparency across the charitable sector. There are many good examples of Service charities working together. I could cite the Royal Air Force Benevolent Fund and the Royal British Legion working to offer debt advice, and you will find other initiatives by charities working together. Other benefits include the fact that we have started to co-locate, particularly with those charities based in London. We now have five based in Mountbarrow House in Victoria. Plans are afoot, as leases expire in London, to seek greater consolidation there, which clearly brings benefits.
In terms of absolute examples, I think that Andrew referred to casework management. There is no doubt that some five years ago each charity took a rather isolated view of casework management and welfare. That has been brought together under a casework management group chaired by SSAFA Forces Help, which ensures a quality assurance for those seeking help. In other words, they are now working from the same protocol-from the same format-and they are able to transfer people from one charity to another, or to transfer funds from one charity to another to support that person.
We have done exactly the same thing with the representation of appellants before tribunals. Appellants have been represented free of charge by Service charities before appeal tribunals in respect of war pensions or compensation. Again, the level of representation was a bit patchy. The lead was taken by the Royal British Legion, and that has developed a protocol and training so that, again, there is greater quality assurance.
I think probably more recently-in the past year-we have been recognising that it is sometimes difficult for charities to work outside the boundaries of their trust. One of the great limiting factors of getting charities to work together is that they are all individual organisations that are bound by a deed of trust, with trustees who have a legal responsibility to ensure that trust, so it is sometimes difficult. A year or 18 months ago, we set up a series of topic clusters. In other words, we brought together those charities that had an interest in specific subjects. We did not prescribe a timeline or an endgame; we merely said, "Let us sit around a table and see where it takes us."
We have eight cluster groups at the moment, and I will give you three examples. The first is residential care, which is a topic that has been in the headlines for other reasons recently. There are some 17 within the Service charitable sector. Many Service charities operate a single care home, and they have been quite rightly focused on making ends meet at that single care home. Little thought has gone into where they want to be within the sector: should it be care in the home; should it be care at a home; should it be residential; or should it be nursing? The Royal British Legion took the lead on that, and it has done some extensive research into its own five homes. It shared that with me last week and will now share with the other members. I see that moving together for a very positive outcome.
We have done the same with housing, with Haig Homes chairing the cluster for housing. We have done a very successful one in resettlement, which the Regular Forces Employment Association has been running. That has up to 20 members now, drawn from way outside the Service charitable sector. They are coming together to deliver a far better transition and resettlement service. There are some very positive examples within the umbrella of this confederation of charities being able to work together, notwithstanding the boundaries.
Q249 Chair: Your funding comes from your member organisations, does it, as opposed to directly from the Ministry of Defence?
Air Vice Marshal Stables: There is no external funding. All the funding is internal from the member organisations.
Q250 Chair: Thank you very much.
Major General Cumming, how much of your funding comes from the Ministry of Defence?
Major General Cumming: The only funding we get from the Ministry of Defence is for the work we do for it.
Q251 Chair: So what proportion is that?
Major General Cumming: The turnover is about £29 million. Is that right, Paul?
Commodore Branscombe: It is of that order. We are paid for the services that we provide, Chair, but we provide those under contract. There is no subsidy to the charity.
Q252 Mr Havard: Is that grant in aid?
Commodore Branscombe: Some of it is still old-fashioned grant in aid, meaning that we are paid purely for what we do. With the one under the commercial contracts, we are allowed to make a small margin, but of course that small margin passes to the charity to fulfil our charitable objectives.
Q253 Mr Havard: So it is a mixture of the two.
Commodore Branscombe: It is, yes.
Q254 John Glen: We have heard from the MoD in a memorandum that it seeks to investigate better ways of co-ordinating and prioritising the activities of different elements of the voluntary and charitable sector. Are you familiar with that investigation, and how are you engaging with it?
Major General Cumming: The answer is no, although I have heard of it. In many ways they would be doing what is already being done very successfully, in my opinion, by COBSEO. Tony has talked very modestly about what he has achieved over the last three or four years, but prior to that, very little was going on. I really think that there is a very broad understanding now within the charitable sector about where we stand with each other, and we are also far better informed about each other’s activities, so less trespass is going on. Where we think that there might be a bit of trespass, or a bit of inadvertent treading across the line, we can use the good offices of COBSEO to straighten things up.
It is a jigsaw puzzle-the military third sector-but it works, and the pieces fit. In the way that it is being run at the moment, we are fitting neater and neater all the time.
Q255 John Glen: That seems to imply that you perhaps think that this investigation and work by the MoD is not necessary, because you are almost self-regulating the co-ordination of all your member organisations. Is that true? What are the challenges facing the MoD?
Air Vice Marshal Stables: If I may say, I think this is largely driven by the success of Help for Heroes and by the Chief Executive, Bryn Parry, saying to the MoD, "We have raised this money by public subscription for veterans of Afghanistan; what do you want me to do with it?" I think that when he asked that, there were some blank looks at the MoD, because it is not the way that we have conducted our business traditionally-and how the charitable sector conducts its business. When he first went to the MoD, the outcome, of course, was the swimming pool at Headley Court.
Certainly the view of Help for Heroes, although you would be better off asking Bryn, was that-
John Glen: We are.
Air Vice Marshal Stables: Its view was, "Ministry of Defence, please prioritise. Come up with some kind of list that you feel charitable money could assist." The rest of the charitable sector does not generally operate in the same way as Help for Heroes. If I may say, it would be better to ask Bryn and the MoD. I am aware of the initiative, which I thought at first might be some kind of wish by the Ministry of Defence to have greater control of the charitable sector. I suspect that it is not actually, and that it is a wish by Help for Heroes for the MoD to put some priority to projects that could be funded from charitable sources.
Q256 John Glen: May I come back in on that? I have talked to Bryn Parry about it. He is based in my constituency, and I certainly recognise the dynamic that you have spoken about. However, is there not a danger that, in a sense, the MoD responds to that question and undertakes this activity to deal with the issues that he has thrown up, when you seem to be saying, "We are working very well"? Is there not a danger that there will be a disconnect between the establishment, if you like, of organisations such as yours, which work quite well, and what he is doing? How will they interact well together? Is the MoD going to miss a trick if it does not look at what you do alongside what he does?
Air Vice Marshal Stables: I would be confident that the mechanisms in place at the moment allow for visibility of that. I do not see the thing actually getting out of hand. For example, Bryn Parry sits on our executive committee, not as an elected member, but in attendance. So, he is there in the executive committee.
I also meet regularly with the assistant Chief of the Defence Staff personnel. Cathy and I meet him regularly-three times a year, formally. I meet informally with him and his staff almost monthly. I think that there is a genuine openness and transparency, certainly between the personnel and veterans-sorry, whatever they call themselves this week. I think it is "patrons" and veterans, and ourselves. We meet very regularly, and I would be surprised if things were stitched up.
Q257 Ms Stuart: Why is Help for Heroes not on the executive body?
Air Vice Marshal Stables: Because our current constitution, within the Confederation, allows for between 13 and 14 members on the executive board. There are six permanent members and six are elected on a two-year rotation, by twos, if you like, so every year two change over, and they are elected at the annual general meeting. There was a view, certainly in the executive when Help for Heroes began, that this was a powerful charity, which was likely to be influential, and it was important that we included it. The only mechanism that we had to bring it within our executive at that time was to ask Bryn to be in attendance.
Q258 Ms Stuart: Have they stood for election and not been elected?
Air Vice Marshal Stables: They have not stood for election.
Q259 Ms Stuart: Are you encouraging them to?
Air Vice Marshal Stables: I am.
Q260 Bob Stewart: I think I know most of the answer, but I would like to hear your view, Air Vice Marshal, on why there has been an increase in charitable donations to Service charities. We have a general idea, but, for the record, we would like to hear what your view is.
Air Vice Marshal Stables: Can we hear from SSAFA first? Then I will come back with a general comment.
Major General Cumming: I think we all have a view on this, but there are several factors involved. If you take Help for Heroes, in particular, it is an exceedingly good fundraising organisation. It is very streamlined, it has a jolly good message and a very good strap line. It is extraordinarily energetic. It has revitalised the money-giving public, and it has found that it is able to do this at a time when the Armed Forces are, generally speaking, very popular. What it is doing is very well supported by the British public. Sorry, I do not mean that what it is doing is popular; I think it is very well supported by the British public in what it is being asked to do. There is a genuine sympathy for those who are killed, and sympathy for those who are very badly wounded, who we see quite a lot of. So, it is a coincidence of a number of things. It has helped everybody.
SSAFA per se is not a greedy organisation. It needs enough money each year to run itself. It is not a grant-giving organisation; it is a "doing" charity. We trundle on with our revenue sources, which is fine. But I do think it has helped an awful lot of other people.
Cathy Walker: I was going to say pretty much the same. Society as a whole is very supportive of the Armed Forces community. All the Service charities have benefited from the impact since Help for Heroes began by raising awareness of the Servicemen and women and their families. How long that will last remains to be seen, but certainly in the recent past we have none of us struggled with fundraising.
Q261 Bob Stewart: Does Help for Heroes cover other conflicts apart from Iraq and Afghanistan? Someone told me that it was just concentrating on giving money out for that, but not for Northern Ireland, for example.
Cathy Walker: No. Its objects allow them to help people who are sick, injured or wounded post 9/11.
Commodore Branscombe: That has been part of the reason for its success, because it has been able to focus on a very narrow theme-I do not mean narrow in any bad sense-that resonates with people right now. There is a downside to that, because much of what SSAFA and the other specialist charities tend to do is less obvious. For every visibly wounded veteran who attracts our sympathies and support, you can multiply by 10, 20 or 50 the casualties elsewhere, not least those who do not show a single mark on them. These days there are also the nearest and dearest, and sometimes the nearest and dearest are not the most obvious. Sadly, most of the killed and wounded have been between the ages of 18 and 23, and those who are most dependent upon them may not necessarily be a widow or a spouse. Many of the people whom we and others support are casualties and their extended families. They are casualties not only of war but of the stress leading up to peace. That very breadth is something that also needs to be taken into account. It is not always the most obvious target that takes the most effort and, in the end, money.
Q262 Bob Stewart: So any Help for Heroes money can go only to help people post 9/11?
Major General Cumming: Theoretically, that is so. But that is not to say that charities like ours, which are doing something very specifically for post 9/11, cannot help. For example, the two Norton houses have contributed a fair amount of money. We are about to start up another project, because we believe the Army is about to ask us to do so. We should be going to Help for Heroes with our cap in hand, saying, "Will you fund this? It very much fits your post-9/11 objects and your profile-here’s a good way to do it." We shall go to it.
Q263 Bob Stewart: I am sorry to keep on, but presumably if you get Help for Heroes money in a batch for that project, you could dedicate it to that, but it would give you more money to look beyond that-to look back.
Air Vice Marshal Stables: I get terribly concerned about this on the basis that, as I often discuss with Bryn Parry, the one-legged veteran today is the same one-legged veteran 30 years down the track. As long as you are dealing with Afghan veterans and sustaining that into the future, I am not too worried about a cut-off date.
On your original question, I agree entirely with what has been said. Help for Heroes changed the shape of the charitable sector. It most certainly raised the bar, and created far greater awareness. I am the Chairman of Trustees of Headley Court. Our trust owns Headley Court, which we lease to the Ministry of Defence for medical rehabilitation. We have never been a fundraising charity-we have never gone out to seek funds; essentially, we are a landlord, but because we have funding, we make grants and assist with rehabilitation at Headley Court. We have received a significant number of legacies in the past two years, which we have not sought. I think that is about profile, and other charities will be in the same position.
Q264 Mr Hancock: You have answered part of my question, which was going to be about whether there will come a time when you will go to Help for Heroes as a major benefactor for what you are doing. There is also a problem about where charities peak. I worked for one that was involved in a very emotive issue relating to children from eastern Europe. I understand that there was a conflict, in the end, between many of the existing charities and those that came up-a bit like Help for Heroes. In my case, the charity, which was set up to help children, creamed off a lot of the resources. A lot of good work that was done by existing charities fell by the wayside. Do you feel that there is a downside to the popularity of one particular charity? Does that create a risk for you?
Major General Cumming: That is always a possibility. We have been around a very long time and we aim to be around for a long time still, fulfilling, I hope, a task that has thus far proved enduring, for which I believe there will be a need in future. There will always be peaks and troughs of interest and popularity for the Armed Forces. With that will go the associated new charities and old charities-funds will go up, funds will go down, and so on.
If I had a mission in life, it would be to say, "We do a very good job in support-entirely-of the Armed Forces. We do not exist except to do that; that is our sole aim, and we look after people and individuals." If we are doing a good job now, my absolute intention is that we will go through this hiatus of sharp growths in the number of charities that are working for the Armed Forces doing what we do. I wish to come out at the far end, when things are going down into the trough, still doing a good job that we believe is important-so long as the Armed Forces require us to do it.
In other words, our philosophy would be that this is not the time to invent or reinvent ourselves or to say, "We should be doing a bit of this," when we know that others are doing it already. Instead, we should strive to continue to do our job exceptionally well. We should always be seeking the opportunity, should it arise or should we be required, to do something new-as we are about to be asked, which I alluded to. Essentially, we should do what we are doing and do it well-we should come out of it doing well and go on doing it well.
Commodore Branscombe: There is a difference between the long-haul 125 years and doing things behind the scenes for people. Raising funds for people who are doing things for others-in other words, services-is not an easy or popular thing to do. Raising money for high visibility but relatively temporary infrastructure projects is always much easier. So there is a downside-not that I am critical one way or another, because you clearly need premises in which to do things. But the rather more difficult things, widely broadcast, such as getting volunteers to work with individual families, wherever they may be, employing mental health social workers or paying the travel costs for someone who needs to go to see somebody are not easy things to raise money for. There is only a certain amount of money to go around. As the controller said, we have not had difficulties at the present, but when uncertain financial times come along, there may well turn out to be some kind of conflict.
Q265 Mrs Moon: It is said that organisations grow to fill a vacuum. Was there a vacuum that required filling by a new organisation such as Help for Heroes? If so, in what way has it been successful? What has it brought to your field that has generated a new raft of giving and engagement?
Air Vice Marshal Stables: Andrew referred to it. The brand caught the imagination of the nation at a time when there was a fair amount of media pressure about the inadequacy of the Government to meet what many saw as the responsibility of the Government and the state, particularly regarding the care of the wounded. One can refer to many media articles about the condition of people in Selly Oak and the lack of facilities at Headley Court.
I have to tell you that most of that was ill-informed-I say that as Chairman of the Headley Court Trust-but I think that there was a perception among the British public that people who had served their country and been wounded in that Service were not being properly cared for and looked after. To some extent, there was truth in that, but by and large, there was far more media speculation than there was fact. Nevertheless, there were some gaps. The money raised by Help for Heroes has certainly helped to fill some of those gaps in a way that we probably could not have done otherwise. I do not believe that the Service charitable sector, joined up as it may be, would have done so, and I certainly do not think that the Ministry of Defence would have done so. The whole of the recovery capability has been enabled by the £100 million raised by Help for Heroes, and we should not take that away. What it is setting up in that recovery capability is something that was not there before, which was needed, and it will enhance the quality of care and the transition of people out of the Armed Forces and into civilian life.
Chair: Before I call Mr Havard, Major General Cumming would like to come in.
Major General Cumming: Since SSAFA is here, following on from what Tony has said, I think we might just blow our own trumpet. We go about what we can do to help the Armed Forces in a very different way from Help for Heroes. It would say that it is going to raise money and build you a swimming pool; we would talk to the Ministry of Defence and ask, "What do you want?" Out of that would come a request: "Can you do something for the families?" At the same time as it started, so did we. Within 18 months we had raised what we had wanted to raise, which was about £5.5 million. We stopped at that point because that was enough to fund the two homes and run them for a fair amount of time. There are many ways of doing this business, and we are firmly of the belief that we should not be thrusting something on people, but acting in concert with them to see where it is that we can fill the gaps that are appearing.
Q266 Mrs Moon: Forgive me. I was trying to clarify whether there was a particular ethos within the fundraising of Help for Heroes that helped generate those funds and public engagement in a way that would make you look back and say, "Gosh. That is the way of doing it."
Major General Cumming: Absolutely. There were of course organisations in existence, not least the principal benevolent funds-RAF, Army and Navy. I certainly think that what Help for Heroes did was give everyone a kick up the backside and bring a new, modern and bright approach to the whole thing. That did no one any harm at all.
Q267 Mr Havard: There was an interesting discussion on the radio earlier in the week about the Round Table and the way in which it presented itself. It was exactly this debate about whether the approach of Help for Heroes raises questions for all sorts of charities about the way in which they position, brand and market themselves.
May I turn to a more prosaic thing? The Ministry of Defence internal audit recognised that there had been a step change in charitable funding. It also looked at the Department’s relationship with the charities. Given that there has been this increase in the money, how much of it is substitution for things that the Ministry of Defence should be doing?
Major General Cumming: If I may just speak from a SSAFA angle, I do not believe that we have set out to generate more funds to take over those things that the Ministry of Defence should be doing. At the risk of repeating myself, I want to reiterate that, for the very reason that everything we do is in support of what the Armed Forces need, we do not do anything unless they want us to do it. We may, from time to time, identify what we see as a gap and ask whether we can help to fill it, but they can always say no. I do not believe that we are out there seeking funds to take over something that the Government should be paying for, and I am speaking there for SSAFA.
Commodore Branscombe: I can only reinforce that. We should be putting our financial and human resources into something that Government could not, or should not, do. There is a distinction between the two. I do not believe that we should be finding a shortfall in public funding when facilities should be paid for by the Ministry of Defence, the Department of Health or whoever.
Our Norton Homes were a prime example of that. We chose to procure or to buy very high-quality houses outside the perimeter of the MoD establishment, entirely run on civilian grounds, because they were for the families. Actually, although the MoD has a responsibility vicariously for families, in practice it is not responsible for their accommodation. That is but one example. On top of that-because there are things that we believe we have the expertise to do for a population that is largely civilian-most of the problems that we are dealing with, whether they happen to be health, welfare or whatever, are the problems of people, rather than being intrinsically military.
Q268 Mr Havard: It obviously falls to us to ask the sceptical questions, which was why I asked the previous one. "Was the Ministry of Defence taking any advantage in some of this?" might have been a better way of phrasing the question. The internal audit says that "now"-in January-this is being done in a more targeted and co-ordinated way, which suggests that previously it perhaps was not. How much of this is to do with capital projects?
Major General Cumming: What-
Q269 Mr Havard: The increase in the funding and more money coming in to do these different things. What is the balance between capital projects and revenue? Is that significant? Is that something we should understand better? It might not be.
Commodore Branscombe: I can answer only for SSAFA. Our problem, as we have said, is raising costs-operating costs. On infrastructure, although, of course, we needed to raise the money to purchase the Norton Homes, the majority of what we do is funding our people, whether they happen to be paid-for staff or volunteers. It is not for me to speak for Help for Heroes, but its main thrust is to provide swimming pools and gyms, and to build infrastructure. That could be a capital programme on MoD or other property.
Air Vice Marshal Stables: Most charities-I certainly speak for the Headley Court trust because we as trustees took this view-think that they should not be a substitute for a proper call on the public purse. There are projects at Headley Court that we have refused to accept as trustees because we felt that they were a proper call on the public purse. You have to measure this with a certain amount of realism and pragmatism, inasmuch as the public purse is often empty. When charities are looking for a good outcome, and well-being and improvement to people, it actually sometimes gets a bit blurred.
Q270 Mr Havard: The reason I interrupted earlier to ask about the mixture of grant-aid money and other money is that the structure is changing. There is now much more contracting-your ability actually to pitch for contracts, the £10,000 limit and so on. I know that you now have a conference every year where you come together to discuss strategy, practices and so on. How well do you think these processes are running overall, in terms of the MoD being able to make use of the money in the proper way you describe?
Air Vice Marshal Stables: I should think that they are in their infancy.
Q271 Mr Havard: Right. What do you need to do?
Major General Cumming: I think that we probably-all of us-have our own checks and balances within our own organisations. We are a completely independent charity, and that means just what it is. It has its own board of trustees. It has its own charter and its own set of objects, and although it is of course our job on a day-to-day basis to do the devilry, to do the work, and to seek the opportunities and so on, in theory we cannot just go out and do things. We need to carry with us the board of trustees, who, honest men and women as they are, will hopefully observe the objects of the association.
Q272 Mr Havard: I was thinking more in terms of the structures that you now face-how you interface with the MoD and how you collaborate. Is the process allowing the money to be used well, or are there process issues to be addressed that could make it work better?
Commodore Branscombe: Perhaps I can answer that. The MoD is, of course, not like some of the other Government Departments in terms of spending with charities to let contracts to deliver services. It is not like health and social care, or whatever. I guess that we are kind of unique, not least because of our long history of delivering health and social welfare services to the MoD, which we originally did wholly charitably, and then it paid us for that. If the question is whether there is any kind of obstacle there, taking into account that the MoD is different, its money tends to run in a disaggregated way rather than being driven by central policy. As a person who has to deal with the MoD daily, that disconnect between central policy and the spending sections of the MoD can lead to inefficiencies.
Q273 Mr Hancock: May I take you back to the difference when getting a large capital grant towards equipment? We could use Headley Court as an example. There are long-term revenue implications for the staff who have to use that equipment and be around to help Servicemen over a long period of time. Is it compatible that you just go on taking charitable gifts of equipment and what have you, but do not ask for the long-term revenue contributions needed to maintain them? Who will pick up the price 10 years from now for the facilities that we have created because of the largesse of the British people through Help for Heroes?
Air Vice Marshal Stables: I think you have hit on one of the difficulties, which the Ministry of Defence woke up to rather late in life. In respect of personnel recovery, the Royal British Legion has of course undertaken to provide the long-term running costs of those services, so I think that, certainly 20 years out, their future is safeguarded. However, you raise a very interesting point with Headley Court, in my experience there, in terms of people’s willingness to donate equipment and then look at the long-term running costs, which clearly fall upon the Ministry of Defence. I am not sure whether the Ministry of Defence-and you should ask them, not me-actually comes to a judgment before accepting these kind offers. Certainly we in the Headley Court Trust have put in place people, such as recreational therapists, who we funded, but with an agreement with the Ministry of Defence that, were they successful, it would assume the funding within two years of starting. Every time that we have acted, we have done so with an agreement that it formally takes responsibility at a point in the future, but I am not sure that that is true of all capital equipment that has been put in there.
Q274 Ms Stuart: This is pretty much the same question, but with a slightly different outlook. Did you actually want the swimming pool?
Air Vice Marshal Stables: I cannot tell you, but I should ask the Surgeon General in the Ministry of Defence to answer that question.
Chair: I am sure that we will have the opportunity.
Mr Hancock: You could ask, but I won’t, although I will mention it.
Chair: I was not suggesting that you do.
Q275 Mr Hancock: Perhaps because of the attitude of the Ministry of Defence to what is happening at present, is there going to be an adverse reaction to you?
Major General Cumming: There could be, couldn’t there? That is why I emphasise the importance that what we should be doing as a charity is not reinventing ourselves on the back of current popularity, but continuing to do what we have done so well before, although always aiming to improve the way in which we do it.
In a slightly different way, we very quickly set up the appeal to buy these two homes for the families. Within the business plan of that, we built in the thought that we would certainly have to be running them for three, four or maybe five years, so that is all self-contained. Who knows what will happen in the future, but there is always the anticipation that the need may no longer be there in about five or six years’ time, in which case we can sell them, move on and reinvest the money into something else that the Armed Forces need. We have our own in-built flexibility. We do not expect the Armed Forces or the Ministry of Defence to pay for that.
Cathy Walker: May I just reflect slightly philosophically on some of these questions? I think that the relationship between the Ministry of Defence and the ex-Service sector broadly is slightly in its adolescence, in that it was not really until a Minister for Veterans was appointed-in 2002, I think-that there began to be an engagement with the ex-Service sector, at least over veterans.
Clearly, there had already been a relationship, and we have had a long relationship on our in-Service contracts. However, this engagement with the ex-Service sector and recognising that it includes charities-sovereign bodies with their own trustees; not agents of the Ministry of Defence that can be told what to do, which it felt like a little bit at the beginning-is a newish and an adolescent relationship.
I do not think that, corporately and historically, the Ministry of Defence or the single Services have had experience of being offered money and hearing, "What would you like us to do with this?" or, "Here’s some money; can you prioritise it; and how would you like to spend it?" It is extremely difficult for it to accept even charitable money. Tony can tell the story of the washing machine at the laundry at Headley Court, which is quite entertaining. With everything else that is happening-the restructuring and redefining, the Strategic Reviews and everything else going on in the Ministry of Defence-this relationship with the ex-Service sector and the charities is still being learned.
Q276 Mr Havard: That was why I quoted the word "now" from the internal audit in January. It states that this is "now" being targeted better, which assumes that before it probably was not. I asked the questions about the process for sustainability, because the process can change to deal with the immediate, but it may not have the longevity to deal with your questions of sustainability.
Cathy Walker: And sustainability for projects for serving personnel is obviously for the Ministry of Defence. But the one-legged or three-limbed veteran now looks-dare I say-sexy, and we can fund raise on the back of that. A Falklands veteran in a wheelchair now looks like a sad old man, and today’s Afghanistan heroes are going to look like sad old men sitting in their wheelchairs in 20 or 30 years’ time, when people around them are going to say, "What happened in Afghanistan?" That is the burden on us; it is not a burden on the Ministry of Defence.
Q277 Mr Hancock: That is a very good point, and one that our Report needs to establish clearly. You see it all the time. Living in a city like Portsmouth, I see many of the victims of the Falklands war, including members of my own family, who never recovered from it and are just as you describe. To what extent does SSAFA work with those who have been injured in current operations, if at all?
Major General Cumming: The answer is yes we do, but at the moment there are not that many of them. Most of them are still being retained in the Armed Forces, so they are mostly being looked after by the Ministry of Defence, one way or the other. Of course some have left and those who need our help have come to us. I will hand over to Paul in a second because there are some very practical examples of what we do, particularly through our health service in Germany. In fact, Paul, why don’t you pick up on that point now?
Commodore Branscombe: We do come into contact with them while they are still serving because our health services operate in the overseas bases. As we speak, there are many people deployed from British Forces Germany and sometimes from Cyprus, where we are responsible for many of the health services. We prepare them to deploy with immunisations, vaccinations and all those sorts of things in their health checks. More importantly, we look after them when they recover, whether they recover injured or fit. One of the most significant things is that we run a community mental health team in Germany that is able to respond not only to those who have returned from operations, but their families. That is a really important matter, particularly when we can look after a family as a holistic unit.
I make that point only because of the distinction between what happens in the UK and overseas. We do not, obviously, operate health services in the UK, but we have social work services, and it is for not only the Army but the RAF and others. We have direct contact with those who come back wounded. For all those who end up in Headley Court or through the very high visibility pathway, there are many with much lesser injuries. You can have all sorts of injuries short of needing a leg amputated. We deal with those from a welfare as well as a health point of view. The answer is that we see those, but equally we see their families very freshly. The first place a family goes when they get the call that their nearest and dearest is in the Queen Elizabeth Hospital in Birmingham may be the bedside, but within two or three hours they are probably being accommodated in our home, which is run by Cathy. It is not just a very comfortable place for them to sleep and rest, but a place where they get a huge amount of pastoral and professional support while they are going through that hideously traumatic experience.
Chair: Given our intention to finish at about 4 pm, I would like fairly snappy questions, if that is okay, and fairly snappy answers, too.
Q278 Mr Hancock: What do you think about the support services that have been given to those who are not injured or wounded on operational duty, but return to this country for various reasons or leave the Service with long-term health issues? Where do you think the State lets these people down? Where are the biggest problems?
Major General Cumming: I suspect that the biggest problems lie among those for whom the wound is not visible.
Q279 Mr Hancock: You meet these people, so what is the group you meet most often?
Major General Cumming: Still the people that Cathy would meet most often from the veteran community-those who have left and need help-are of the older generation. Typically, your average client is a 70-year-old male from the Army, is he not? It is hard to provide concrete evidence for this, but it seems that there are more younger people who are coming to see us. That might be just as much as a result of such things as debt as anything else. We will know only about the people who ask to come and see us. A lot of people get referred to us, but in the end it is they who come to us.
Cathy Walker: I would add that people come to us for help because of a problem that has not necessarily been caused by their Service. They will come to us because they have served and are therefore eligible to call on us for help, but it might be because they have a mobility problem in their later years. You could argue that their mobility problem was going to happen anyway because they are getting older, or you could argue that their dodgy knee was caused by the fact that they fell down a hole while they were on exercise or on operations. The situation becomes very blurred the older people get. I know one example that Paul would use of an old gentleman with Alzheimer’s. Is the Alzheimer’s attributable to his Service, or is he coming to us for help because he is an ex-Serviceman? The further away from Service you get, the more blurry the answer to that question becomes.
Air Vice Marshal Stables: May I raise two issues? The first is that there are most certainly gaps in transition. I think that we recognise that there needs to be a rather more holistic approach to the transition from the Armed Forces into civilian life. That is highlighted in the recent Howard League for Penal Reform report, which looked at veterans in prison. It highlights that transition issue. The second issue also comes from the Howard League, which looked at veterans in prison typically 10 years removed from Service. Generally, those are custodial sentences, not Service-caused or related. That is equally true of those presenting with mental health problems and with homelessness in London. The Howard League finds no reason for that 10-year gap, so we have a group of people at the 10 to 13-year point, but we also have weaknesses in the transition part. We identified that when we went to the Big Lottery Fund, and we are now hopefully a matter of weeks away from a lottery grant of £35 million, with which we will address this transitional issue.
Chair: We are just about to get on to psychological issues.
Q280 Mrs Moon: Just a thought that you might want to carry with you. As an MP, when people come to your surgery, there are two things that you usually try to clarify fairly early on: whether they are in a trade union, and whether they served in the Armed Forces. You know that if the answer to one of those is yes, there is a whole gamut of support that you can go back to that you know you can engage on their behalf.
I would like to talk about mental health difficulties and your assessment of the MoD’s capability to assess them while people are in Service. Is there a problem with people who are identified with mental health difficulties almost being passported out and that transition issue? Is the MoD is effective enough, in your view, at picking up post-traumatic stress arising because of Service, as opposed to a mental health condition that develops while in Service? Will you give us your thoughts on those?
Air Vice Marshal Stables: I will just pick up two points. I think there is an acknowledgment that the Armed Forces can do far better in transitioning people on a medical discharge with psychiatric illness into civilian life. This comes back to the holistic view. Quite often somewhere to live is the most important factor, rather than seeking psychiatric care for the condition. I do not think that the MoD has traditionally taken that view. You could ask why it should; after all, it is a war-fighting organisation, not a welfare organisation. There is a recognition of the situation, however, and I am quite sure that we will come to a better way of transitioning people through that care pathway. I am slightly more confident about that. I sit on the War Pensions and Armed Forces Compensation Appeal Tribunal, and I have to say the genuine incidence of PTSD that we see is really quite small. The Howard League makes reference in its report to the low incidence of PTSD. That is not to say that there is not a relatively high or larger incidence of mental illness; there is, but PTSD itself is relatively small.
Q281 Mrs Moon: Commodore Branscombe, you talked about the CMHTs that you operate. Do you operate CMHTs within the UK?
Commodore Branscombe: No, because overseas, in bases where families are, the MoD is responsible for the health care and we do it alongside the MoD for the benefit of the families, but of course we do not divide between the families and the serving people. To come back to your question about whether the MoD is adequately providing mental health services for serving people, I think in general the answer is yes, and it is not just from the clinical, psychiatric and community mental health point of view. Some of the self-help processes around TRiM, for example, and mutual support provided by individuals is pretty good. Having said that, there is no doubt that-I put it in written evidence-there will always be reluctance among some people to seek assistance from their medical officer when that medical officer is also an employee of their employer, if I can put it that way. I have direct experience of that. That may not be the fault of the system, but there may be some reluctance among people to seek assistance. For example, if you are a fighter pilot and you need to go and say, "I think I might be a bit wobbly", you will lose your job pretty soon, or it will follow fairly close on from that.
Transition is very difficult, because nobody knows exactly where the person is going to. But equally, although it was not part of your question, does the NHS pick up? Where it knows and it gets that handover, it works. Reservists are a special case, because they are neither fish nor fowl in that sense. The area in which I have concern and direct experience is in the mental health of families-they also serve who watch and wait at home. There is no doubt that the transmission of stress to wives and children, as a result of continuous operation, deployment, separation, uncertainty and, indeed, the worst happening, has a bad effect. Low-level mental health problems and the problems of potential domestic violence and so on, which could be said to be a by-product of these sorts of things, are difficult.
In Germany, our combined social work and mental health teams are able to work in a proactive and preventive way, and we know that we head off an enormous number of problems that would otherwise become acute. In the UK, there is a difference. Whereas the serving soldier will be looked after by the MoD mental health services, in general the families will not be, because they are NHS patients. That is not to say that the NHS locally is not very good. There are good examples where particularly therapeutic services are good, but it is a postcode lottery. If you do not fit into the norm -this is part of SSAFA’s theme-we tend to pick up the people who fall between the cracks for one reason or another. I have some concern that the holistic support for families, in a proactive and preventive way, is probably not as good as it might be. That is not because of a failure of either the MoD or the NHS. It is a matter of logistics, geography and circumstance.
I would also reflect on the statement that PTSD is not the great bogey that we think it is. It happens, but there are many other lower-level mental health conditions. Depression and anxiety are the real problem-and, finally, alcohol.
Q282 Mrs Moon: Are you happy with the range of treatments that are available to both serving personnel and those who leave the Services?
Cathy Walker: Those who leave the Services come under the NHS.
Q283 Mrs Moon: I am thinking about those who leave the Services and then need to be passported into the NHS.
Commodore Branscombe: We all know that mental health services have often been the Cinderella of the NHS. However, there are exceedingly good mental health services in different parts of the country, including therapies that are not just psychiatric services. Again, it is variable. Remember that we are not just talking about England. People pass from the Services to Scotland, Northern Ireland and whatever.
Mrs Moon: I think "whatever" is Wales.
Commodore Branscombe: Yes.
Mrs Moon: Sorry, but I am a Welsh MP.
Mr Havard: You are surrounded by Welsh MPs.
Commodore Branscombe: I beg your pardon. So, there is not a general answer, but you can be lucky. Or unlucky.
Air Vice Marshal Stables: Sitting on an appeal tribunal, I see sufficient evidence that it does not always work. In fact, in many instances, it is not working at all.
I think we have an issue with transitioning and passporting people into the Service. I think it is better, but historically, we have had a large number of legacy issues with people who have mental illness. They are parked now, medicated and contained, and that is the best you can say; their prospect of becoming fit again or being put into employment is very remote. If you were to sit on the tribunal that I sit on, you would see this almost every time we meet. We have not done well in the past, to be honest, but I would be rather more optimistic for the future. In fact, we could not do as bad as we have done before, so we have got to do better.
Q284 Mrs Moon: I think that that is true of mental health generally. How great is the difficulty of mental health problems generated because of active Service? Is active Service creating an increased problem for people developing mental health problems?
Commodore Branscombe: The King’s College research and others show that the incidence is no higher in terms of long-term effects. The incidence of PTSD, if we are going to take that as the extreme end of the spectrum, is actually less, age for age, in the serving population, whether they have been in combat or not, than it is in the general population.
Air Vice Marshal Stables: The majority we see at appeal do not have the Service causation, but then you might reasonably expect that, because it would otherwise have been accepted by the MoD as a condition and the appeal would not have happened.
Q285 Bob Stewart: General Cumming, your memorandum suggested that alcohol in the Armed Forces was exacerbating mental health problems. What do you recommend should be done to try to stop this?
Major General Cumming: Stop drinking.
Bob Stewart: I have to say that they selected me for this question, particularly that lady over there-the Welsh one.
Major General Cumming: I don’t think it’s for us to comment on that-
Bob Stewart: Not personally.
Mr Havard: Take more water with it, Bob.
Major General Cumming: There is something about casual drinking in the Armed Forces for a whole variety of reasons, not least because, I guess, for the most part, there are a lot of men and women together and that is how it goes. I would not dream of commenting on how it should be handled. The evidence would suggest that the less drink is taken, the fewer issues one has. I am not sure that I can say more than that.
Air Vice Marshal Stables: I spent 42 years as a pilot in the Royal Air Force, and I suspect that Members here who have served in the Armed Forces will recognise that it is considerably better now than it was in the past. Maybe these are just incremental changes, and you may come to a totally different culture within 10 or 15 years.
Q286 Bob Stewart: May I ask Mrs Walker that question, because she has been not only a serving officer herself, but the wife of a serving officer? Would you have any way of trying to cut down the drinking further? It is true that the culture has changed, but is there any other way of trying to encourage particularly young men to cut it down?
Cathy Walker: Crikey. Probably not, because as Andrew said, it is a bit like playing rugby. You are all chaps together after a bit of an adrenaline high and what are you going to do? If there is drink there to be had and it is under control, it’s fine. It is just when it gets out of control that it is a problem. The moment that it becomes a problem is when it gets out of control and when behaviours start to change because there has been too much drinking, or it is done privately or secretly. The character then changes. But I do not know whether that is done. It has been a long time since I served, and it has been long time since I was a Service wife. As Tony was saying, I see a difference now. For example, one does not see alcohol at lunch time anymore, certainly not in office meetings; 10, 15 or maybe 20 years ago, there might have been.
Q287 Bob Stewart: So the culture is changing and it is bringing it down because people just do not think it is acceptable.
Air Vice Marshal Stables: I cannot think of any simple measure to reduce drinking. If there were one, the Armed Forces would have taken it in the past, and they have not. Incremental culture change is probably the only way. I agree with what Cathy said. If I go back to my young day-perhaps I shouldn’t talk about my young day.
Major General Cumming: I understand that all the entertainment allowances are being reduced, so the brigadiers’ dinner party on water and orange juice may well lead the way in this respect. It has started already.
Q288 Ms Stuart: Paul Branscombe, you mentioned the postcode lottery and unevenness in provisions. To come back to community mental health support, Andrew Cumming, do you notice any specific differences between England and the Devolved Administrations?
Major General Cumming: If I may start very broadly, I will then turn to Paul, who is the expert on this. If you want to go into old age in peace and comfort, you might as well live in Scotland-it is not a bad place to be at all. It is certainly probably rather better than England and Wales, and even Northern Ireland might be better. Funnily enough, we run a branch in the Republic of Ireland, but we have not tested it yet. Scotland has a reputation for its dealings with all sorts of things, so it would appear-with health and education and the way it handles its veterans. It is a much cleaner, neater operation up there. It would be as well to be a Scot.
Q289 Ms Stuart: And of course there are far fewer of them. Tony Stables, what about members of your organisations? Do you provide support across the United Kingdom or is there a bias towards certain parts?
Air Vice Marshal Stables: No. In fact, Veterans Scotland is a member of our executive body, so we embrace it.
If I have one concern, it is the delivery of service and support of veterans by other Government Departments, because postcode lottery is compounded by Devolved Administrations. Someone said to me recently, "I lost my leg in the Service of my country, not in the Service of East Midlands, so why shouldn’t I have parity across the United Kingdom?" That is quite a political issue. The delivery is vested in trusts and other organisations-subject to Government guidelines, presumably-outwith direct Government control. For example, how do you ensure that the standard of prosthesis replacement is common throughout the United Kingdom?
Q290 Chair: We heard that as an issue when we went to Headley Court. There was a worry that although fantastic artificial limbs are given to those who are serving, they might not receive such a good service after they have left the Armed Services. Is that a concern that you share?
Air Vice Marshal Stables: It has been a concern. Together with the General Secretary of BLESMA, I called on the Minister, Simon Burns, some six months ago. He put in place a study by Dr Andrew Murrison, who will shortly report. In fact, he very kindly shared with me last week his final draft on the issue of prosthesis. He has been looking at the standard of fitting, because as you rightly point out, it is a rather more technical leg, which, frankly, the National Health Service were not trained to deal with. He has also looked at the provision of future prosthesis. Where do you set the bar in a situation that is changing technically almost by the month? It is a complex issue, but I shall leave it for Andrew’s report. The draft that I have seen is extremely good and he addresses all the issues.
It raises another interesting point about other delivery of services by Government Departments, such as the Department of Health or the Department for Work and Pensions, when there is a local issue. For example, I was talking with the mayor of Solihull recently. He said that he had recently become aware that the priority for the provision of social housing in Solihull for ex-members of the Armed Forces was equal to that of prisoners coming out of prison. He said, "Do you think that’s right?" I said, "It’s a matter for Solihull," but you realise that what is a matter for Solihull is a matter for a different council somewhere else. Priorities will be afforded differently.
Q291 Mr Havard: What do you take from that? Many of the things that will be in the Covenant might now have a more legally based authority. People will be able to ensure that they get some consistent application across an increasingly disparate commissioning and provision regime. People will be trying to deliver a central policy from the Ministry of Defence across a disparate set of organisations.
Air Vice Marshal Stables: The recommendations in Dr Murrison’s report to address that might reasonably be used as a blueprint in other areas.
Q292 Ms Stuart: Paul Branscombe, I cut you off. Sorry.
Commodore Branscombe: No, not at all.
Prosthetics is but one example of services that may need to be provided locally. One perspective of what is different about Service personnel and, to an extent, relatively newly discharged veterans, is that they are highly mobile. The postcode lottery would apply to you if you were static in one place and going to remain there. The fact is that Service families constantly have to move. Whether you need a prosthetic leg, you have a disabled child or you need to adopt a child, services will vary by local provision. The same will happen to an extent if you need mental health services or anything else later on, because Service personnel rarely end up where they are first discharged, for all sorts of reasons that should be relatively obvious.
This is not a political point, but I have to say that the situation is not helped-this relates to health in particular-by the fact that the money-spending commissioners are likely to be in a state of disarray. We are talking here about England, but we also have talked about the Devolved Administrations. We are in a position to make some comparisons between the difficulties of the north-east versus those of the south-west. There are fiscal and organisational realities. I am not that optimistic about the outturn and whether funding will be available to ensure that a particular service continues to be provided.
My only optimism is that the NHS, or the Department of Health through the NHS, has reacted pretty impressively by setting up Armed Forces forums, which, for the first time, have representatives of primary and community health care trusts, community mental health care trusts and charities. For the first time, we have truly local discussion about what the resources are. We have a visibility of the reality of the needs of the serving and the ex-Service population. I hope that those forums can continue, but they are only as good as having part-time representatives from the trusts, some of which are being abolished as we speak.
Q293 Mrs Moon: Major General Cumming, can you tell us about the work you do with bereaved families? What support do you give and how long does it go on for?
Major General Cumming: This is something that we started as a result of conversations with the Ministry of Defence-on its initiative. It asked whether we could do something to help bereaved families. As I said, several groups are involved. They run quite simply on the basis of self-help. In the case of bereaved families, the lead is someone who lost his son-he is the appointed chairman. We simply facilitate what the groups do; it is they who give the therapy-I don’t know whether that is the right word-through the conversations they have with each other to take them forward and so on.
We run the groups for as long as they are needed, but they are almost self-determining. I would rely very heavily, for example, on that chairman to judge the appropriate moment to finish. He might say, "I think we have achieved what we want to achieve." Of course, people are being bereaved all the time, so it is rather hard to say how long they would go on for. SSAFA is such that whether you specifically align this to the current operations going on, or you say there is a general need for such groups-indeed, some members of the group have not necessarily been bereaved as a result of war; people might have been killed in motorbike or car accidents, or by falling off a mountain or while parachuting-this is open to everybody and it gives them the chance to talk to each other.
Q294 Mrs Moon: Family life can be messy, and relationships are sometimes quite complex when someone dies. Who do you find yourselves working with? If it is a single young man, do you work with his parents’ families or perhaps with his girlfriend and her family? If it is someone who was married, but had separated and at the time was with a girlfriend, who do you work with?
Major General Cumming: One hears the most horrendous stories about managing the bedside manner when the boy is brought out of his induced coma. There are terrible stories such as people saying, "You can’t put them together, because he’ll think he’s gone to hell," or very complicated ones such as, "He’ll think he’s gone mad, because his parents haven’t talked to each other for 20 years." I will turn you over to Paul in a second, but we have a qualified social worker who is very experienced in these matters and is, if you like, the brains behind it-the mover and shaker, and the person who gets these things going.
Cathy Walker: Before you hand over to Paul, may I add that you might get some examples of this when you go to Norton House tomorrow, because there they are doing this all the time? They are recognising that-
Ms Stuart: I understand the problems. Some of them end up at my constituency advice surgery.
Major General Cumming: Our chairman was up there the other day, and he had been warned that there was a family there whose son had been very badly wounded, and that they were terribly angry and really out to get someone. He went with our president. The two of them went into the ward, and before long they found themselves confronted by this family, who, rather than gripping them by the throat, said, "Do you know, the very fact that we are in this Norton House has made us realise that we are not alone and there are other families we can talk to." So therapy begins quickly.
Commodore Branscombe: If I may just add to that, the answer to your question is all of those, because we understand all the complexities of the family, whether its members happen to be legally married, partners or whatever. Interestingly enough, the groups were started not necessarily for widows-in some ways, the widow, if she is the next of kin, gets the pension, all the sympathy and everything else-but for those who are not legally married, or who are the mum, the grandparents or, most importantly, the children or siblings. I made the point earlier that if you are killed between the age of 18 and 23, you are likely to have younger brothers and sisters.
As Andrew pointed out, we also recognised that you often have very subtly to separate these people. You cannot just make the assumption that when we are helping to look after the widow of somebody killed, the children will want to be in the same group, because the children want to talk to people of their own age who have suffered the same kind of experience, but they do not want mum there, because that inhibits them. It is hugely complicated, and for that reason it is relatively costly. Enabling means that we have to give them not only the social worker, who works subtly in the background, but the venue, and venues often have to be at weekends, or at times and in places that are relatively costly to organise.
Bob Stewart: The Elizabeth Cross must be a nightmare to allocate sometimes.
Q295 Mr Havard: People going into the operational theatre are asked to nominate the person they wish to be contacted-not necessarily the parent or whoever has immediate legal right-before they go. You presumably start from that process. Is that correct?
Commodore Branscombe: Yes, of course, but there is a major difference between what we can call the business of casualty notification and the legalistic stuff that needs to be done, and what we are talking about here: pastoral support to the extended family-extended in both time and space.
To answer Gisela Stuart’s question about how long, I again emphasise that it will be as long as it takes. Nothing succeeds like success. Of course, although it started with a view to those who are most freshly affected, they then brought their friends, and we suddenly had people from Northern Ireland and the Falklands, so we are just growing and growing. However, the experience is the same-or very similar-and in some ways that is a great strength. If you have already been through it, you have an enormous amount to give to the person who is not yet there. I hate using the expression "journey"-it sounds social work-like, doesn’t it?-but people are able to help each other at different stages through the journey, and that is hugely important.
Cathy Walker: May I give another example of the way we have supported bereaved families of former and current operational casualties? For many years, we provided a sort of neutral platform through the Defence Widows Working Group. We were able to facilitate discussions between the three Services’ Widows Associations and the people in the Ministry of Defence or the single Services who were responsible for what happened to people on all the nitty-gritty issues that theoretically worked well, but did not always do so in practice. That is an example of something self-effacing that we do: just helping people to get together to sort out their problems. That working group, which used to be chaired by us-the chairmanship was then handed over to the chair of one of the widows associations-is now within the MoD. There was a recognised facilitation exercise that we did on some of the practicalities, such as when you tell a person that their husband had been killed. Those are all the sorts of things that do not always work in the way you imagine that they will, such as how the visiting officer is going to appear and help. That is another example of how SSAFA has been involved historically with supporting bereavement in the round.
Q296 Mrs Moon: Can you give us an idea of how many people you have working in this field?
Cathy Walker: In the bereavement field?
Mrs Moon: Yes.
Commodore Branscombe: We have one senior social work manager who co-ordinates the groups. We also have social workers and health staff working in various places. Our volunteers are trained in bereavement and loss work. I cannot give you an exact answer, but the answer is that this is something that we take seriously and are capable of doing at every level that is needed.
Q297 Chair: Air Vice Marshal Stables, is there anything that you need to add to that, or has it all been covered?
Air Vice Marshal Stables: No, nothing.
Q298 Ms Stuart: To follow up, Cathy Walker referred to the relationship since the creation of the Veterans Ministers between the charitable sector that was giving and doing and the MoD. You said that, in a sense, both sides are learning. What would you do if you had one wish for how to improve the relationship between giving and doing on both sides?
Cathy Walker: The Data Protection Act.
Q299 Chair: What would you do with the Data Protection Act?
Cathy Walker: We do not want everyone’s data about everything, but we want to be able to help people who might need help without there being a reason given, and that comes to the Data Protection Act. I think that the Ministry of Defence is working extremely hard with us to try to allow the transfer of some data. It happens easily within the Service Personnel and Veterans Agency, but it is rather more difficult to refer someone out to the charitable sector. Through the good offices of COBSEO, in fact, we have been doing quite a lot of work with our colleagues inside the MoD to try to make this work better.
There has been a lot of ignorance over the years about what the Data Protection Act means. Historically, you hear of matrons in wards who will not allow anyone to be given any information about anything because of the Act. It is not just about the Act itself-
Chair: But the understanding of it.
Major General Cumming: To put it simply, we feel that we could do so much more to help if we had an introduction, rather than stumbling across someone who needs help later, which is what happens at the moment. We feel that an introduction from in to ex would be better for everyone.
Air Vice Marshal Stables: I think it is one of the issues that we will address in this transition piece, which we will do under the Forces in Mind Trust. The main issue that I put to the Big Lottery Fund is that while most of the components of transition are in place, the real problem is that they are not joined up. The real weakness in the whole thing is leadership and cohesion, because no single organisation has that leadership and cohesion-from the point of leaving the Armed Forces to death, almost-because some people never actually make that transition. They die and they have never made a proper transition. Most of the building blocks are in place. We have come a long way in our interface with the MoD and with other Government Departments. There has been significant progress with the Department of Health in the past three years, since we became part of the Reference Group that we referred to in our last session.
Chair: That was in a completely different Committee-the Armed Forces Bill Committee. However, we will be able to take that evidence into account in what we say in our Report on this.
Air Vice Marshal Stables: I am relatively confident. As Cathy said, there are issues with data protection, where we have not come to an agreement or an accommodation, but we are working at it. I do not think there are any obstacles.
Q300 Chair: Are there any suggestions you would make to the Ministry of Defence or to other Government Departments about how they could improve their general treatment of those who are physically or mentally injured, or the general treatment of families in relation to the Armed Forces? Are there any improvements you might suggest?
Commodore Branscombe: I think that the processes or the provisions are theoretically very good. My comments would be about process and continuity. It is true that the Ministry of Defence at all levels suffers from the almost constant movement of military personnel and civilians. That is a truism, of course, because the personnel themselves are constantly moving, but those who are responsible for their treatment, welfare and other administrative support are themselves constantly being posted, and this is an ever-increasing spiral. I will give you a practical example. A casualty notification officer allocated to be the first person to tell the family in this particular case may well move on, because it is only a temporary appointment. We keep talking about the journey. Nothing happens in snapshots, and nothing happens in comfortable two-year posting cycles.
If we could have greater consistency among the staff who are responsible for the administration of welfare, and in some cases clinical treatment, life would be much easier. One of our frustrations is that we learn to deal with the MoD at all levels, and no sooner do you strike up a relationship with a very competent and well-meaning person but you find that the next week it is somebody different. That is as difficult for us as welfare providers as it is for the people actually going through the chain, but I guess that it is the same everywhere. It is the culture and the nature of the Armed Forces. I would say that there are certain things for which you just need to have permanent staff who do not change-I am only saying that because I’m getting really old now. I served 33 years in the Royal Navy and changed my job every two years, probably because I was incompetent and kept being moved on. I am privileged to have been in my present post for 15 years. There is some merit in being in post for a reasonable amount of time.
Chair: I think that that message is being heard loudly in the Ministry of Defence at the moment.
Cathy Walker: If there was one thing I would wish for-it is about not necessarily the Ministry of Defence but other Government Departments as well-it would be that if we want to be able to help veterans downstream, we should know where they are and who they are. If the community covenant is going to work, local authorities need to know who the veterans are. The question that Mrs Moon mentioned about someone in her surgery with a trade union or ex-Service background needs to be asked and recorded.
Q301 Chair: You have to remember, though, that some veterans do not want to be traced.
Cathy Walker: I am not suggesting that we should be tracing them, but if a local authority is asked by Haig Homes if there are any people in their area who might be eligible for a particular house, it would be good for the local authority to be able to say, "Yes, we’ve got a few people you might like to approach", rather than tracing them. I know that there is another issue about national Service people who will never admit that they are ex-Service, for example, so there is a lot of complexity about what you mean by a veteran.
Air Vice Marshal Stables: There is a broader issue. If you go back 10 years, you would not have heard the word "veteran". We have created a section of society now-an identifiable group of people-called the "veteran community", and I am not sure that we have created the overarching architecture to deal with them. There is an expectation now because people say, "I am a veteran. I belong to the veteran community," or, "I am the family of a veteran," but what does that mean? We have not answered all the questions, I’m afraid, and we have not put in the architecture to deal with a group of people that we have created nationally.
Q302 Chair: Yes, and the word "veteran" implies that you are old, whereas a lot of these veterans are not.
Major General Cumming: They are very young.
Chair: Thank you all for a fascinating evidence session. You have been extremely helpful and we are most grateful.