CORRECTED TRANSCRIPT OF ORAL EVIDENCE To be published as HC 762-v

HOUSE OF COMMONS

ORAL EVIDENCE

TAKEN BEFORE THE

DEFENCE COMMITTEE

THE MILITARY COVENANT IN ACTION? PART 1: MILITARY CASUALTIES

WEDNESDAY 13 JULY 2011

MAJOR GENERAL BERRAGAN, COMMODORE MANSERGH, COLONEL MASON and SURGEON COMMODORE MCARTHUR

Evidence heard in Public

Questions 347–406

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.

Oral Evidence

Taken before the Defence Committee

on Wednesday 13 July 2011

Members present:

Mr James Arbuthnot (Chair)

Mr Jeffrey M. Donaldson

John Glen

Mr Mike Hancock

Mr Dai Havard

Mrs Madeleine Moon

Penny Mordaunt

Ms Gisela Stuart

Examination of Witnesses

Witnesses: Major General Gerry Berragan, Director General Personnel, Land Command, Commodore Michael Mansergh, Director, Naval Personnel, Colonel Andy Mason, Head of Army Recovery Branch and Surgeon Commodore Calum McArthur, Commander, Defence Medical Group, gave evidence.

Q347 Chair: Gentlemen, welcome to the Defence Committee’s session on military casualties, and thank you very much for agreeing to come and give evidence. May I begin by asking you please to introduce yourselves? Colonel Mason, would you like to start?

Colonel Mason: I am Colonel Andy Mason, and I am responsible for the Army Recovery Capability.

Surgeon Commodore McArthur: I am Commodore Calum McArthur, and I command the Defence Medical Group, which comprises our five Ministry of Defence hospital units, RCDM in Birmingham and Headley Court.

Major General Berragan: I am Major General Gerry Berragan. I am the Director General Personnel at Land Command, and my responsibility includes the Army recovery capability.

Commodore Mansergh: I am Commodore Mike Mansergh. I am Director Naval Personnel, and I am responsible for the executive and welfare support for all in the Naval Service involving the recovery pathway.

Q348 Chair: Let us begin with the issue of physical care of the Armed Forces; we will come in a moment to mental care of the Armed Forces. Commodore McArthur, could you tell us what sort of challenges you face in dealing with the physical care and rehabilitation of troops when they come back home?

Surgeon Commodore McArthur: I think most of you have been to Birmingham and to Headley Court, and I am sure you have seen some of the people coming back to those units. What we have seen over the last two, three and four years is soldiers and marines coming back with increasingly complex injuries, which require a very multidisciplinary clinical approach. When a casualty-a soldier-comes back to Birmingham, various disciplines will be required to look after them: surgical care, orthopaedic care, reconstructive surgery and so on.

Q349 Chair: You are right that the Committee visited the Queen Elizabeth Hospital a week or so ago. How are the arrangements with that hospital working?

Surgeon Commodore McArthur: They are working well. I think we have learned a lot over the last three or four years. We have injected more military personnel into Birmingham, and there are now nearly 400 people working there. We have learned too to increase the welfare administrative support to soldiers, marines and airmen coming to Birmingham with increased J1 support. We have very close engagement with University Hospital Birmingham NHS Foundation Trust to make it work, and I believe it is working well.

Q350 Chair: What about the other medical defence units?

Surgeon Commodore McArthur: The other units support casualties when appropriate. Everyone comes to Birmingham in the first instance, and by and large most medical support is carried out in Birmingham. Follow-on care may be done in other military units closer to garrisons if appropriate; for example, if ongoing support can be provided at Derriford for Royal Marines in Plymouth, well and good. Similarly in Aldershot, if support can be provided at Frimley Park, well and good. But by and large, most of it is done in Birmingham.

Q351 Chair: I visited Frimley Park on Friday, but that was because it serves my constituency. Is there any intention of reconsidering the role of medical defence units?

Surgeon Commodore McArthur: We are reconsidering the way we place our secondary health care people in the NHS. We currently have five units where we try to place people, and we also have many singleton posts-about 65-dotted around the whole UK.

Q352 Chair: But is there any suggestion that medical defence units might, for example, not continue to exist, and that everything might be sent to the Queen Elizabeth?

Surgeon Commodore McArthur: No, we plan to maintain the five units that we have at the moment. As I said earlier, we have reinforced the unit in Birmingham. Our intention is to maintain the rest.

Q353 Chair: There is no study being done into that?

Surgeon Commodore McArthur: We are looking at the way we place people in the NHS. Why? We want to make greater use of the emerging level 1 trauma centres in the NHS. Ideally, our people have acquired so many trauma skills on operations that they have quite a lot to add to those units in the NHS, and we want to try to maintain the skills. We seek to place people in level 1 trauma centres where possible. Not all the military units that we have are level 1 trauma centres. That is not to say that we are going to close those units; we are not. We would only seek to disperse people more widely in the NHS, making better use of the level 1 trauma centres.

Q354 Chair: We were very impressed by Headley Court, which we also visited. There is a high level of activity, and the obvious intention to expand. Is that level of activity sustainable?

Surgeon Commodore McArthur: Yes.

Q355 Chair: Is the expansion on track?

Surgeon Commodore McArthur: Yes. We rose to 96 beds last year in response to the volume of casualties coming back; not just the volume but the length of time they spend at Headley Court and the admissions in and out. Today we have 116 beds and the intention is that by October there will be 120, and 130 by the end of the year. Ultimately, the plan is to build fuller accommodation at Headley Court, so that by summer 2012 we aim to go to 144 beds.

Q356 Chair: What happens when we leave Afghanistan, or when combat troops stop operating as combat troops in Afghanistan?

Surgeon Commodore McArthur: Some of those 144 beds are in temporary ward accommodation that was established four or five years ago and has been extended to maintain capability, but some of that accommodation will come to the end of its natural life and could be closed. The 144 beds could shrink when the current case load coming back from Afghanistan stops.

Q357 Mr Hancock: What does increasing bed numbers do for the capability of what needs to be done for people? It is one thing to increase the numbers there, but you have to have the support needed. Is that easy to maintain? Can it advance at the same level as you are expanding the bed numbers?

Surgeon Commodore McArthur: You are right, of course. Increasing the number of beds is not the entire issue. Along with that, added staff are required, and prosthetic support, gym capacity and all the other things that make up the holistic environment of Headley Court. We are doing that; we are meeting that. Part of it is met through the injection of money through the SDSR process. We are about to put £7.5 million per year for 4 years into Role 4, by which I mean Birmingham and Headley Court.

Q358 Mr Hancock: That is quite a big jump, isn’t it, from where you are today to where you will be a year from now? Could it mean that some of the personnel will have to be there longer, simply because there are not the facilities to give them the care, treatment and rehabilitation work that needs to be done? It will be done for more people but over a longer period.

Surgeon Commodore McArthur: No, we are not in that situation. The rehab pathway is a long one for many people. That reflects the complexity of the injuries. There is the need to spend time at Headley Court, go on convalescence to regain strength and come back to Headley Court, but there is no prolongation of treatment due to lack of capacity or resources. We are increasing those but it is a planned evolution. I firmly believe we are meeting the need.

Q359 Mr Havard: You said that, for some people, it is a long process. One of the great enablers of Headley Court is that they are at work. There is some ethos there that helps them through and more people are then retained in the Service. It is not so much what would be retained at Headley Court, but that more people are kept in the employ of the military far longer that way. What about the sustainability of that over time? It might not be in your immediate ambit, but it raises a question about the sustainability of the process.

Surgeon Commodore McArthur: I am sure that the General will want to comment on that. From my own perspective and that of the people of Headley Court, it is a long pathway. Over the past three or four years, the majority of people coming back with complex injuries have not yet been discharged from Service whether they are soldiers or Royal Marines. Why? Because as I said earlier, they spend time at Headley Court. They go home; they go back to Headley Court and then they might go back to Birmingham for further reconstructive surgery. We are talking about people who have lost a limb, two limbs or, in 16 cases, three limbs. It is a long process.

Major General Berragan: Your point is absolutely right, of course. The length of the clinical pathway for people with some complex injuries means, clearly, that they will stay in the Army for longer. The other point is that advances in medical care mean that some can continue serving afterwards. What does that mean? It means that we need to expand our recovery capability.

It is worth my explaining that the rehabilitation pathway is the clinical pathway, while recovery is the rest; and the rest is all about everything from mental attitude to what they can do-to challenge, to welfare and so on. That is really what the recovery capability is about. It is absolutely congruent with the rehabilitation pathway. While they are in recovery, people will go in and out of Headley Court for periods of clinical intervention and, at other times, we will make sure that their recovery pathway is absolutely in harmony. That is something that we have created in the past 18 months or so, and something that we are seeking to expand as we get a better handle on the extent of the requirement.

Clearly, as you say, eight years of two campaigns mean that we have built up a requirement over and above what we would have already. The nature of soldiering is such that is tough. We injure people and we have to deal with that. There is a steady state requirement even when we are not conducting operations such as we are at the moment.

Chair: Commodore Mansergh, do you want add to that?

Commodore Mansergh: I think that the business between the clinical pathway and the overall recovery-what we are seeing and sharing very much with the Army-is the process. Some of you may have seen at Hasler Company the ability to continue with the recovery at the same time as there are facilities to allow rehabilitation to take place in an environment where the facilities are made available. Hasler is an example of where we can continue that recovery pathway at the same time as the clinical pathway, by having facilities at a recovery centre.

Chair: We were most impressed at Queen Elizabeth Hospital, Headley Court and Hasler Company by the fact that those who have been injured treat it as part of their work to get better. That is something that we could recommend to the National Health Service.

Q360 Mr Hancock: May I ask you about mental health problems both for serving personnel and when people have left the Service? Where are you with that, and what is being done at the present time? What major problems in the mental health field are emerging?

Major General Berragan: If the Commodore starts by talking about the clinical aspects, I shall come in on the wider aspects.

Surgeon Commodore McArthur: The immediate mental health issues are those that you might expect from someone who has suffered a life-changing injury. By and large, a soldier at Birmingham and at Headley Court is very focused on recovery and trying to regain his life and to rehabilitate. We have established a 2 year screening programme for mental health issues, starting in Birmingham, and following that person all the way through the pathway at Headley Court on the recovery process and beyond. If they are discharged from Service prior to the 2 year point they would be followed up until the two year point to try to track emerging mental health issues. When a soldier is in that fairly high tempo Role 4 pathway at Birmingham and Headley Court, he is focused, as I said, on getting better.

Q361 Mr Hancock: What about the personnel who do not come back with physical injuries, but come back suffering from mental health problems? What are you experiencing? What are the treatments available? Where is the pathway for those personnel?

Surgeon Commodore McArthur: Part of it is trying to prevent those problems from happening in the first place-making sure that deploying troops get the proper mental health brief before they deploy and that when they come back into the UK, they go through a two-day decompression programme in Cyprus. It also involves them having follow-on briefs when they are back in units after they have taken their leave. Do you want to say more, General?

Major General Berragan: Of course, there are mental health professionals deployed forward in Bastion, so there is, if you like, an immediate mental health capability in theatre, and there are clearly mental health professionals within the Defence Medical Services.

I will just pick up on what the Commodore said, because we have learned a great deal from experiences of previous campaigns. What we are trying to do is to get ahead of the problem, and to do so by interventions which are non-clinical but are designed to flush out and identify where people have suffered stress or are suffering stress as a result of what they have been through in operations.

It is quite important to recognise that much of that can be done without any medical intervention whatever. It can be done by trained non-medical people-ideally, people within the cohesive unit that has undergone that experience-by, in the first instance, going through a process of talking about it.

That is really what describes the TRiM process-the Trauma Risk Management process. Since 2008, we have mandated TRiM as a capability. We have trained 5,000-odd people in conducting it, and the people we train to do it are at the sort of company sergeant-major level. They are respected people who soldiers look up to and trust, and who have been through the same things they have and understand the pressures they are under. They then train people within units to conduct this.

If I take you through an example: let’s say that on an operation there is an incident where someone is killed or wounded. The rest of that group of people involved-the patrol, the vehicle crew or whatever-will, within 72 hours, go through a formalised structured debriefing process with one of these trained TRiM professionals.

The purpose of that is to take them through their experience in the period in advance of that particular incident, and what happened during the incident and what happened after the incident. Why 72 hours? Because it takes 72 hours for people to overcome the shock and start to internalise the thing and to reflect on it. Any earlier than that is probably too soon; experience tells us that 72 hours is a good time. It is done in a structured way over a period of time with all of the people involved.

The key purpose of that is, first, to get them talking about it and their reaction among themselves, so that they feel that is okay, and secondly, to identify in that second phase-talking about the incident itself-where someone may be at risk of having an acute degree of stress. At that stage, all we do is identify that and allow them, if necessary, to go to someone like the padre or the medics to talk about it, and to allow them almost, as it were, to overcome that stress themselves by getting back into the operational routine and so on.

If we have identified them with that problem, we will do another intervention within a month to see where they are and whether that stress is being coped with as we all cope with stress over time, or whether it has not in fact been coped with and has become more acute. At that stage, we would look to involve some mental health professionals to start to help them to reduce that stress.

Q362 Mr Hancock: Is there a risk associated with that, General? Somebody who has shown emotional distress over what has gone on will, for one month, be in the same environment doing exactly the same job with that going on inside their head. Is there no risk attached to that?

Major General Berragan: It is important to know that the chain of command is aware of what that individual or that patrol has been through and will understand the pressures that they are under and watching for any signs of stress. But this is on top of what we would normally expect the chain of command of those people to do.

It is also worth knowing that we got to this point having been through the process of immediate counselling, which became fashionable about eight or nine years ago and which I think has proven to be counter-productive. If you introduce people into formal counselling-psychiatric counselling-too early, you can make the problem worse because you get them to go over it in a way that almost makes the thing worse rather than better.

We return to TRiM on the basis that the medics say it does no harm; our experience from talking to people who have been through it is that it does an enormous amount of good. It is very popular. The other thing that it does is de-stigmatise mental stress. In the past, both in the Army and across society, that has been a real problem. Now those who they see as key role models in their lives-people they look up to-talk through these issues with them. That is a hugely positive step.

Q363 Mr Hancock: How often is someone taken out of theatre because of mental health problems? Is that a rare occurrence?

Surgeon Commodore McArthur: Yes, it is a rare occurrence. For reasons that the General has described including the, deployed mental health teams in theatre. People are robust-they are doing a job; they are focused and surviving. People, by and large, are not being evacuated from theatre with acute mental health issues.

Q364 Mr Hancock: When they are back here-and this is the point of the question about the treatments and the pathway for somebody with mental health-a soldier with a physical disability could be two years in the pathways, but they are still in the Forces and so on. What would the same programme be for someone coming back with acute mental health problems? How do you deal with that? Do you maintain them in the Service for a prolonged period of time, or do you make a quick assessment about their suitability to remain?

Surgeon Commodore McArthur: It is difficult to generalise. If somebody comes back and is diagnosed as having a mental health issue, clearly, as every man and woman is an individual, they need to be assessed and treated. That will be done through the various departments of community mental health that we have on a tri-Service basis across the UK. Once that person is treated and they respond to treatment, hopefully they can carry on.

Q365 Mr Hancock: Where would they go? If you have a physical disability, you will end up at Headley Court at some time and you start off at Birmingham. Where does someone coming back with a mental health problem go in the system? Where do they get the ongoing military support? What happens to those individuals? You don’t have that sort of unit.

Surgeon Commodore McArthur: No, we have the Department of Community Mental Health.

Q366 Mr Hancock: Where is that?

Surgeon Commodore McArthur: There are regional bases. For example there will be ones in Catterick garrison, Aldershot and Portsmouth.

Q367 Mr Hancock: There are a lot of Service personnel living in my and Penny Mordaunt’s constituencies, in and around the south of Hampshire. Where is the mental health facility there? I am curious to know where it is.

Surgeon Commodore McArthur: We have one in Aldershot and one in Portsmouth.

Q368 Mr Hancock: In Portsmouth?

Surgeon Commodore McArthur: Yes, in the naval base.

Q369 Mr Hancock: In the naval base itself? A residential unit?

Surgeon Commodore McArthur: It is not residential. This is a community-based approach. Most Service personnel do not require in-patient psychiatric care. If they do, it is provided through a hosting contract with Staffordshire and Shropshire NHS Trust.

Mr Hancock: That is what I wanted to know.

Surgeon Commodore McArthur: That is a rarity.

Q370 Mrs Moon: I just want to follow up on Mr Hancock’s questions. I have a group in my constituency that has been funded by the British Legion. It is a post-traumatic stress disorder group. These are people who left the Services some years ago. When I met them, the common theme was around their distress over the discharge process. One of them had acute mental health problems as a result of his experiences in the Balkans. He was discharged with a mental health condition and felt that he was cut loose. That was some years ago, and I am sure there are different processes in place now. Can you say a bit about what the discharge processes are when someone has an identified mental health condition, and how you ensure that they are slotted into the appropriate support service once they leave the Services?

Surgeon Commodore McArthur: I think it would be unfortunate to treat a mental health issue differently from any other medical issue. If somebody has a medical problem or a mental health issue that requires them being medically downgraded, they would be treated appropriately for the condition. If they were not getting better, after a period of 12 months they would go to a medical board to be assessed. That medical board would put them into a medical category. That person would then go to an employability board to be assessed as to whether they were suitable for employment in the Army, Navy or Air Force. If they are not, they will be discharged.

You were talking about the Balkans-it is a decade ago now-and I think that, as you said, we have learnt an awful lot over the last few years. I would hope that that process would be much more sophisticated and slick now, so that a person, once he is cut loose from the Army or Navy, is properly treated and followed on within the NHS. That is partly what the new transition protocol, which has been developed between the MoD and the Department of Health, is there to do. It is to try and ensure a seamless transfer of care, into the NHS, whether it be mental health or physical.

Q371 Ms Stuart: General Berragan, I was very interested in what you said about the kind of shift from immediate counselling to that 72-hour point, which I think is quite critical in terms of channelling whether you think this is the narrowest escape or most horrible thing that ever happened to you. Just for the benefit of the Committee, is there some follow-up research-published literature-that we could look at, or is it too early for that?

Major General Berragan: It is too early at the moment. Certainly the King’s College research picked up on the TRiM process. It made the point that I made, which is that medically it appears to do you no harm and is popular and well received. Certainly in terms of anecdote, soldiers appreciate it and they think it is a good thing.

The whole approach that we take to operational stress is far more mature now, as the Commodore said, from doing the intervention in Cyprus where they are allowed to let off steam and so on right the way through to TRiM, and the post-operations stress management system that we have in place is a more mature one now.

We still have a hill to climb on stigma. We have a campaign running right now-June to September-to try to de-stigmatise mental health. I have some examples here of some of the articles and posters that we have running in Soldier magazine, Sixth Sense, Garrison radio and in and around units. This is one of my guys talking about it in a Soldier magazine article. The campaign is to get people to talk about it. In the past, the attitude has been that if you had a physical medical problem, you went to the doctor. If you had a mental health problem, people have always felt, "I’ll deal with it. If I say anything, it will affect my career prospects or somehow make me something less than my mates". Our message is no different. Whether it is a physical or mental problem, you have to treat both if necessary.

Q372 Ms Stuart: At what stage can we start to look for some analysis? I think it is quite a big shift. When do you think King’s will come up with something that the Committee can consider?

Major General Berragan: It is continuing with the same research.

Q373 Ms Stuart: What is the dateline for the research?

Major General Berragan: It is continuing with the same cohort. It reported in 2006 and it reported last year, so I suspect that we will see some follow-up research probably in the next two or three years. It is certainly very interested in the effect of trauma.

Mr Hancock: Can I ask one final question? [Interruption.]

Chair: There is a Division in the House on the ten-minute rule Bill. We shall suspend the sitting until we are quorate again.

Sitting suspended for a Division in the House.

On resuming-

Chair: Order. Although Mike Hancock has a question that he wishes to ask you, I think that he can ask it when he gets back. So Jeffrey Donaldson will ask the next question.

Q374 Mr Donaldson: Gentlemen, is alcohol abuse the major mental health problem in the Armed Forces and, if it is, what are you doing about it?

Major General Berragan: Let me start and I will probably bring some of the others in, if I may.

First, what we know, certainly from the King’s Centre research, is that alcohol dependence in the Armed Forces is not a major problem. By dependence, I mean alcoholism. Actually, alcohol abuse or misuse is a problem in the age group under 35. When we compare ourselves against broader society, we are probably twice as likely to misuse alcohol in that age group. I think that the figure for females in the Services is even higher, as well. But from the age of 35 onwards, we broadly reflect society in terms of use or misuse of alcohol.

So why is that? Here, I am speaking on the basis of 32 years’ experience rather than on the basis of hard evidence. But having spent three years running the recruiting and training division, I know who we recruit and what they are like, and having commanded soldiers for the best part of that 30 years, I know them reasonably well. I think that that research misses something, in the sense that it compares a broader societal trend against a particular group of people who are, by definition, risk takers. We recruit risk takers, we need people to take risks and often that is why people join the Services. And so they perhaps have a slightly different approach to what might be seen as hazardous behaviour than some other elements of society.

We take that group of risk takers and we put them in stressful situations; we take them away from alcohol for long periods of time, on operations; and then we return them to this country and we give them a lot of money and a lot of time off. So I think that there is a definite relationship between young risk takers who would normally expect to drink-certainly in the society they come from they would expect to drink, as it is part of the culture they come from-and the fact that we deprive them of alcohol, then put them through some stressful situations and then they come back and what might be termed "self-medicate" in terms of alcohol.

We also know that that binge drinking tends to come at a period about two months or so after the operation has concluded and then starts to tail off again as they get back into a normal training regime. So, yes, I think that we have a problem compared with broader society. It is in a particular part of our structure and it is perhaps related to who we recruit and their access, or otherwise, to alcohol. We certainly recognise that it is a problem.

Secondly, it has got a lot better. I have served in the Army for 32 years. We were talking about this before. When I joined the Army, lunchtime drinking was routine and alcohol consumption was greater across the full spectrum than it is now. That may reflect broader society-I don’t know-but it was my experience. Talking to my colleagues, their experience was similar. That is almost unheard of in the Services now. Nobody drinks at lunchtime. We used to give out prizes of cases of beer and things like that for winning sporting competitions. We do not do that anymore. We have picked up on this problem and we are taking action.

On what we are doing about it, it is another pillar in our whole strategy. The first pillar of any strategy is awareness. On a cyclical basis, we go through a process of posters, awareness and briefings on the dangers of alcohol misuse. The first point about solving any problem is giving people the facts. That is what we try to do.

Beyond that, the second stage is informal warnings and counselling. Beyond that, there is administrative action and counselling. If you like, there is a clinical intervention and a disciplinary intervention. If the problem does not go away and they fail to control it, they can ultimately be discharged from the Army. If the problem affects their operational effectiveness and their ability to do the job, the ultimate sanction is discharge.

There is a four-stage treatment process involving both the chain of command and the clinical chain. I will get Commodore McArthur to talk a little more about what we do clinically for those with alcohol problems. We also have pricing policies, where any alcohol sold in camp has to reflect local market prices, so we do not encourage people to drink by cutting prices. The pay-as-you-dine contractors have to provide non-alcoholic facilities in camp, like internet cafes or Costa Coffees, so that there is an alternative to the bar. I have talked about the inter-unit activities and alcohol prizes, but awareness is the other issue. I will hand over to Commodore McArthur to discuss what is available in the medical chain for those with a serious alcohol problem.

Surgeon Commodore McArthur: I think the General has covered most of the stuff. I would say, however, that it is about trying to prevent the situation reaching the stage where you have to put the soldier or sailor into a formal treatment programme. Education is terribly important. That is a routine thing through all units in the Army, Navy and Air Force. There is an ongoing education programme. It is about mentoring, through the chain of command on a division basis, a squadron basis or a flight basis, trying to nip it in the bud if a guy is drinking too much.

Ultimately, treatment, can be provided if required, through the Department of Community Mental Health, which I mentioned before. Not every Department of Community Mental Health can put on an alcohol treatment programme, but some do. By and large that it is a week-long programme, with group-based activities and a good success rate. I will say from my perception as a medical officer who has served for many years, that the level of alcohol abuse and misuse, as the General said, has markedly gone down.

Q375 Mr Havard: It is not just about alcohol; it is about risky behaviour. I know a chap who came back who had been in an urban environment. He would not drive a car, because of how he had driven with defensive driving and the rest of it. He knew that he had a problem and that if he got into a car his behaviour would not be conducive to his health or anyone else’s. He understood that, but a lot of other people will engage in all sorts of risky behaviour. Unless they pop up in the courts, with the police or somewhere else, how do you deal with that risky behaviour?

Major General Berragan: Part of their decompression covers that. They are shown videos on this subject, particularly on driving, where, as you say, on operations they are encouraged to, and often have to, drive without seatbelts in a particularly risky way.1

Mr Havard: He said he learned that from me, but that is not true.

Major General Berragan: We are very conscious of it so they do get briefed on it and they are made aware of it. I think it still happens. The other aspect is that they have been living on an adrenalin rush for the best part of six months. Coming off adrenalin is like coming off any other form of substance; you have to do it in a measured way. That perhaps explains why people do risky things after operations, because they are still seeking part of that adrenalin rush that they have become accustomed to on operations.

Q376 Chair: You say it is part of decompression. How long does decompression last?

Major General Berragan: They are about 36 to 48 hours in Cyprus.

Q377 Chair: That is not enough to instil a change in behaviour, is it?

Major General Berragan: It is not. Going back to what I said before, the first problem is awareness-understand it is going to happen, understand what the symptoms are, understand what the dangers are. That is really what we concentrate on, making them aware. They will also not go on leave immediately when they come back. As you know, they spend up to two weeks in camp, normally doing some routine activity to get them off the high tempo of routine that they have had in operations and get them back into a sense of normality before they go on post-operational tour leave, to help them wind down for that reason.

Chair: That is fine for the regulars.

Major General Berragan: And the TA too now, because we mobilise them for longer, and part of that mobilisation period includes POTL, they will go through the same decompression and wind-down as the regulars do. It is not always popular, of course, because the first thing they want to do is go back and see their family, but we try to keep them together as a unit. Often they will have some form of memorial service for the people they have lost. We try to keep them as a formed unit, a battle group that they formed up in, and as close together as possible until they go on post-operational tour leave. The other point is that they go back through RTMC, as they come back and come off their contract. There is a mechanism as they go through RTMC to raise concerns and issues, whether their mental health, stress, or drinking. All of those things are warning symptoms.

The other ally that we have got in this sense is the families, because when they do disperse back to families, whether Reserves or regulars, it is the families who see what the impact has been. We have done a lot of work recently in terms of providing information to families. There are two separate guides, one is for the families of deployed regular personnel, and the other is purely aimed at Reservist personnel, because the families are in different circumstances, they have different support mechanisms available and often face different challenges, so they are specifically written for the two kinds of families. Both of these are available on the front page of Army web.

We do a lot of family briefings. 16 Brigade just got back in April. Something like 1,500 family members were briefed before they went, with a further 1,500 family events across the Brigade during the tour. They then conducted post-briefings for families, which are not as well attended, and about 150 attended those. We recognise the family has a role to play here, because they clearly see the soldier or Serviceman once they come back on leave and they will see those risk factors and how their stresses materialise. Helping them to understand them is a key part of it.

Chair: Thank you very much. It would be helpful if you could leave those behind.

Major General Berragan: Absolutely.

Q378 Mrs Moon: The development of those books is absolutely excellent and I commend you for doing that. In terms of Reservists, are you doing any work with employers? If you have got this desire for the adrenalin rush, and you are going back into a more sedentary job, how can we make sure that they transfer back into that quieter, calmer job pace? Are you working with employers, so that they understand some of the difficulties on return?

Major General Berragan: We are through the RFCA and the NEAB, both of whom are our interface with employers at a regional and local level. Some of the big employers who are used to having TA or Reservists, are very good and engage with us. Some of the smaller employers have less interest in doing so, so it depends on the size of the employer and how connected they are to Reserve Service. Some of them are excellent and really good, and understand it. Others, probably because they only have maybe one TA or Reservist member in the whole company, are less so and harder to reach.

Q379 Mrs Moon: Is anyone doing any work checking the figures on people who, once they have been in theatre and come back, lose their jobs? Is that being followed at all or monitored?

Major General Berragan: I don’t have those figures, but we can come back to you with them. I am sure we do have them, but I have not got them available to me at the moment.

Q380 Ms Stuart: When we went up to the Queen Elizabeth Hospital, it became clear that some-particularly the Territorials-who are injured when they come back, may be part of a big company supply chain, for example, and think of themselves as working for large company X-but while the small unit they work for recognises them, the company itself doesn’t.

I had a conversation this morning on one case, and the guy on the small supply chain said, "Well, I didn’t even think it was appropriate for me to tell headquarters that this was the situation, and we thought we’d do it when he comes back to work." I was just wondering whether there is more work we can do to show people that it is appropriate that you tell employers.

Major General Berragan: I am sure there is.

Q381 Ms Stuart: Is there more you could do?

Major General Berragan: I am sure there is. And I think it’s something we should look at. As I say, we are connected with SaBRE, with NEAB and the RFCAs, with employers, but I am sure we can do more in terms of formalising that brief.

Ms Stuart: Could I flag this up, in relation to those who are part of a supply chain of a much larger company? The Reservists clearly thought they were part of this large company’s family, but it didn’t make its way up and therefore wasn’t sufficiently recognised.

Q382 John Glen: Can I just follow up on what happens with individuals who deploy to do precise roles, who perhaps aren’t accustomed to the sort of camaraderie that you would get as part of a unit? What provision is there for how they are looked after when they come back, perhaps on their own, with a unique experience? This is different to a group of people, who can obviously be treated as such.

Major General Berragan: Individual augmentees, you’re talking about. As you say, we do mobilise a number of those. In the first instance, they will go back for RTMC, as a bare minimum, and there is a catch-all there, as they demobilise, for briefings and connectivity. They will go back into a unit, and that unit will receive them back. That unit CO is still responsible for them, having mobilised them in the first place. So we do have a safety net still there, and I think that is based on the RTMC and the TA unit they belong to. Even if it is a CHQ, they still have a unit they belong to, who can be, if you like, the support network that they turn to.

Almost every single TA unit in the Army has now mobilised people and sent them on operations, so I think there is that experience now, of what that means, what impact that can have on people as they come back. There is a breadth and depth of experience now among the TA that enables that. At least someone in that unit knows what they’ve been through, knows what the problems might be, and so can be of assistance.

Then there is the reach-back. There is a mental health programme at RTMC for Reservists. There are about 180 of them on there at the moment, who have subsequently developed problems and have gone back through the RTMC mental health programme and are being clinically treated. So there is that reach-back. The RTMC is a gateway both ways, for Reservists coming in and going back out, which gives us an assurance that they should not get lost in the system.

Q383 Chair: I will come to you in a moment, Commodore Mansergh. On the issue that Gisela Stuart raised, about the relationship between wounded personnel and employers: we are likely to include something on that issue in our report arising out of this inquiry, so anything you can provide us with in writing before we do-about the work that is done with employers to get them to acknowledge the incredible benefit they get, and what people have done for their country when they come back wounded-would be extremely helpful. Commodore Mansergh?

Commodore Mansergh: I just wanted to add to what the General said. Individual augmentees are not necessarily Reservists; they may be from the Naval Service or Air Force. There are a lot of bespoke capabilities that individuals provide, and they go out outside a formed unit. I think we have recognised-certainly in recent years, the last two years-the importance of including them in the decompression programme. A number of them were coming back and escaping that process, so we have now tightened that up considerably.

All will come back through Cyprus. They will do decompression as part of a group. They are not put on to another formed unit, because that was seen as being actually more of a challenge for them. So they are put together as a group, they decompress in Cyprus, and then come back. The Naval Service has a mounting and dismounting centre, so they will go through a process in which we check whether they are getting the operational stress management ticks. That will then be followed up.

Further to that, on the point about employers, the commanding officers of our Reserve units know where their people have been and, where an individual is employed, they will ensure that, where possible, the information is shared with the employer through the individual.

On the individual augmentee point, we are much better than we were two years ago at ensuring that we are tracking to ensure that the commanding officer of a returning individual understands what that individual has been through and has documented proof that the individual has been properly looked after.

Q384 Mr Havard: If we could return to the recovery pathway. We understand rehabilitation and recovery, and we understand the transition that people make within it. The RAF is not represented today, but we have already taken some evidence from it on the particulars of its approach to some of these issues. May I first ask about the Army process? We can perhaps then deal with the Navy, which hopefully includes the Marines. How many people are currently on the pathway, and what proportion of them are casualties coming out of theatre?

Major General Berragan: I’ll ask Colonel Mason to pick up that question. He is well connected to the RAF, so he can probably talk about that, too.

Colonel Mason: On the overall pathway at the moment, so far as the Army is concerned, there are 600, although the number ebbs and flows a little bit. That figure of 600 represents the current capacity of the Army Recovery Capability, which is not big enough. We have done an enormous amount of work, as directed by General Berragan, the director general personnel, to define the requirement exactly and to look at the additional resources needed to deliver against that requirement. I anticipate the capacity rising to about 1,000 by the end of the year. That, if you like, is the need.

Of those who are war wounded, and those who are injured or sick through other incidents and are equally deserving of being in the recovery process, because there is a filter to ensure that the process is available to the most deserving and the neediest-

Mr Havard: You’re anticipating some of my other questions-it saves me asking.

Colonel Mason: A third of those are operational, and two thirds are through normal training-not that anything we do is particularly normal-or are damaged in ways other than being on duty on operations. Of the flow through of the Army Recovery Capability, about which I can speak in detail, two thirds transition out-our main effort is to ensure that those who come in can transition through to a civilian life-and a third go back to duty.

Q385 Mr Havard: That is interesting. Are you now capturing everyone in the process? Are you confident that everyone who needs to be in the process is in it?

Colonel Mason: The answer is that we are capturing them procedurally. We have them on the radar, but we do not yet have the capacity to take them into the process. Particularly in the current austere environment, when everything is reducing, downsizing and generally getting smaller, trying to build anything from scratch is like swimming against the tide. To do that, quite rightly, we need empirical evidence, otherwise asking for more, like Oliver, is not very helpful.

We now have evidence from the assignment boards, which bring people into the Army Recovery Capability. Just like being promoted, there are many majors and few lieutenant-colonels, so how do you get to that point? There needs to be a proper promotion board that can stand scrutiny. The assignment board for the Army Recovery Capability has to be formal and properly recorded. Because we have done the work, we now have a clear picture of those who are out there waiting to come in. That evidence is driving the enhancement that will see us go from 600 to 1,000.

Q386 Mr Havard: Is there particular support for those who return to Service, as opposed to transitioning out, that comes through the recovery process? Or is that dealt with in some other way?

Colonel Mason: The key to this is command. One of the reasons the Army Recovery Capability was established was that those who were wounded, injured and sick fell away from command, naturally, because units were focused on the next fight and, with all the complexity of dealing with those from the previous one, they tended to fall away. That is exactly what the ARC is designed to prevent. Personnel are either in a parent unit and being looked after because they are deployable or they are in the ARC because they’re not. We’re either getting them better in order to deploy again-and when they go back to units they will be at a medical grading that will see them deploy again-or, because they will never achieve that medical grading, they are to transition out. The ARC is designed to ensure that we deliver either trajectory.

Q387 Mr Havard: What is the situation as far as the Navy is concerned? Could you explain where it is slightly different and where it is similar?

Commodore Mansergh: In broad terms we have a very similar system. The Naval Service-excuse me for using that term, but it means the Royal Navy and Royal Marines because we are one organisation-have had a recovery pathway for some time. It includes everybody who is medically downgraded. In other words, if they are not able to do their job medically, or for compassionate or even disciplinary reasons, we keep all those people in what we call the recovery pathway. The Navy currently has 749 in that pathway, which is quite a large number if you compare it with the Army.

Mr Havard: You have more.

Commodore Mansergh: We do, but discipline makes up a reasonable part of that, for example people who are not employed because they are awaiting court martial. That is the difference; our recovery pathway is an umbrella over everybody in the Naval Service. It is not just medical, but also compassionate "downgrading", which we call it, though it is probably not the right term. We put people in a position where they are not able to work because they are there for compassionate reasons.

Q388 Mr Havard: What proportion is made up of those who have recently been involved in theatre, as opposed to the rest? Is it two thirds?

Commodore Mansergh: Answering the question of how many are involved through battle or operational injuries is difficult, because we have an awful lot of people who are deployed on operations who might fall down a ladder, but we’re perhaps not putting them in the same position as the focus on Afghanistan.

Mr Havard: When I go to Afghanistan, I trip over the Navy all the time. Most of the people there seem to be in the Navy, and they’re not all in the Marines either.

Commodore Mansergh: No, absolutely. At the moment we have 45 long-term battle injuries in Hasler Company-people who have complex injuries from war fighting. As you said, we have just had two naval medical assistants who were wounded in Afghanistan and have come back. One has actually returned to theatre. It is not easy to give a percentage of how many are in a wounded category. I would say that probably 10% of that 749 will have been wounded in operations.

I want to make a point about the way that the Naval Service Recovery Pathway operates. We have recovery cells, recovery troops and then Hasler Company all under the same umbrella, so we are looking at the totality of everybody who is not fit to work, for whatever reason. It is quite dangerous to make a comparison with the Army figures, which are based on slightly different criteria.

Mr Havard: Okay.

Commodore Mansergh: We have found that ensuring we have centralised control, particularly of those with complex injuries, has been of huge value in the recovery pathway. Hasler Company demonstrates how we have centralised the support to individuals. At the moment, we have 63 assigned to Hasler Company. We don’t have 63 actually at Hasler Company, but they are still being looked after. Their needs might be best addressed somewhere else in the country, or even at home, but they are being administered through Hasler Company. The important point that I want to make is that the recovery pathway is an umbrella over everybody who needs support to maximise their recovery potential so that they can come back in whatever capacity, whether it’s back to work or a transition to civilian life. That is all done under one policy and one organisation.

Q389 Chair: On getting back to civilian life, are you all using the transition protocol? How is it going?

Major General Berragan: The transition protocol that you mention is the transition of medical care from the military medical services to the NHS. We view transition much more broadly, and I will get Andrew to talk a bit about how we view transition, which, in terms of expanding the capacity and the capability of the ARC, is our main effort. I have a complicated diagram here, which is our recognised recovery picture. It shows all the components on a single piece of paper. On the left hand side, from your perspective, are those people in the pool who will potentially come into the ARC. At any one time, that could be 2,000 people. Of those, 1,000 will be short-term downgraded-a twisted ankle or something like that-who will probably never come into the ARC. The remaining 1,000 could potentially come into the ARC. Hence, as Andrew said, there is the need to establish a capacity of 1,000 for the ARC. That is the assessment process that he describes, and this figure shows how people are going through it. This describes all the personnel recovery units across the country, including Hasler Company down here. Here, on the next line-

Q390 Chair: May I stop you? There is a bit of a problem with using a visual aid in that it is a bit tricky to get into Hansard.

Major General Berragan: Sorry. I will describe it in more general terms. The next line portrays the residential capacity of the residential centres, and these are sort of things that you will have heard about. Tedworth House opened in an interim capability on Monday. The centre in Edinburgh is already up and running. We are building one in Catterick, one in Colchester and so on. Hasler, again, already has a residential capacity.

Finally, the arrows on the other side of the diagram show the flow or transition out. That-I will hand over to Andrew in a second-is where we are really starting to build capacity in terms of enabling people to transition back to civilian life, in particular, in an absolutely swept-up way.

Colonel Mason: It is fair to say that the transition protocol covering the clinical and social care aspects is not the entire solution, because we need to ensure that we have a holistic and multifaceted approach, as indeed we have adopted all the way through. The aim right from the very beginning in setting up the ARC was to try to take the clinical excellence that we were delivering out of places such as Headley Court and Birmingham and to ensure that the whole pipeline of recovery, from point of entry to a minimum of 18 months post-discharge in supported employment, was coherent. We have had to bring a raft of other experts this side of the fence-for want of a better term-to whom we would have traditionally handed the individual in transition. We would have got them better and then handed them to the Service charities and said, "Over to you." That is not the way that it is done now.

Part of the enhancement of the ARC since the last time we were before the Committee is that we have very much looked at the defence employment and opportunities team to corral all the opportunities for employment together. The Army Benevolent Fund has funded 10 expert employment advisers down at unit level, so we now have an operational and tactical level piece for employment. A transitional support team is being set up with seven in my branch to oversee it at an operational level, but, equally and importantly, at the tactical level, we have a mentoring trial starting in September out of our personnel recovery and assessment centres north and south-the PRACs in Catterick and Tidworth. We are starting that with those transitioning out to thicken up the support net as they go, so we are increasingly looking at supported employment as the cornerstone of well-being for the future for these individuals. That is a complex and difficult thing to do. It is creating impetus at the back end of the recovery pipe, which will hopefully draw people through in a more effective way, as opposed to bringing them to the gate and waving them goodbye. That is not the best way of delivering effective recovery.

We are increasingly seeing that success in transition equals success in recovery for those who will transition, so it is a virtuous spiral of activity that we need to get right on the other side of the fence. We have put together the means to do that.

Q391 Chair: Commodore Mansergh, is there anything that you want to add?

Commodore Mansergh: Just a few examples. Out of Hasler Company, eight have transitioned; they have gone into employment, for example, as a BT network engineer, a student on a physio course, or maritime security managers, site managers, mentors and motivational speakers. They have transitioned through the process and are now finding employment, where they get satisfaction outside the Service.

Q392 Chair: Is there anything that needs to be said about any differences between the transition in different parts of England, or in relation to the Devolved Administrations?

Colonel Mason: One of the tasks of the transition support team is to conduct a transitional assurance package before the guys go, really building towards that. Return from whence they came-a third-generation unemployed council house in Darlington, potentially, which is the sort of area that we recruit a lot of people from-is not necessarily conducive to their future.

Therefore, relocation is a part of our hard facts that we look at-housing, health, accommodation, relocation, and all the other bits and pieces form a checklist on transition. Relocation is quite important, because they may not return from whence they came, which means they are leaving one family but not returning to their old one. They going to support themselves in the kind of jobs that were being described earlier, so relocation as part of the transitional piece is important.

Q393 Chair: Have there been more enthusiastic responses to this transition issue from, say, Scotland, Wales or northern England?

Colonel Mason: Scotland is a case in point; it is easier to deal with a single Administration and a single NHS. It is a good microcosm and testing ground, which is why we have had so much benefit from the first centre opening there. We have learnt a lot of lessons from that, but we are trying to read those across. We are not seeing a huge number transition yet. The Navy is a tactical bound ahead of us-we don’t like saying that, because it is Royal Marines and that would upset me-and we have learnt a lot of lessons from its experience. A very good pace is being set that we intend to match-and indeed, beat, I hope.

Chair: You look very pleased, Commodore Mansergh.

Commodore Mansergh: I have nothing to add really, other than to say that we are sharing, working very closely together and getting the best practice out of both Services, so it is not a competition.

Q394 Mr Havard: I spent some time with an OPFOR training group of Marines, and they didn’t win. That is a different matter. They don’t always win. The argument about the Devolved Administrations point is clearly important, because the structures that you are dealing with are different.

My concern-this relates to a number of things with the Covenant-is that if there are declarations from the centre about a commitment to an individual for particular services, how do you ensure that that is delivered against a differentiated architecture of provision, commissioning, and so on, which will be different across the UK? It seems a big problem to me. We are just asking whether the transition protocol could be consistently applied-even though it cannot be uniformly applied-if you had the adequate arrangements. Is that where we are going, or do we need to do something else?

Major General Berragan: Let me answer the first bit of that question, if I may. In terms of liaison with the Devolved Administrations, that is the role of our regional chain of command, as you know. In the case of Wales, it is the 160 Brigade; for Scotland, it is the GOC Scotland; and in Northern Ireland, it is the 38 Brigade. So, each of those brigade commanders-or GOCs, in the case of Scotland-is responsible for liaison with the Devolved Administration.

It is also the fact that the Army Recovery Capability, or the personnel recovery units, are under the command of the regional chain, so they deliver that service in their area. The interface between, for example, the personnel recovery unit in Wales and the Devolved Administration is the person of Commander 160 Brigade. He is responsible for that and he does it across the board, whether it is about education for the Servicemen in Wales, or whatever the issue. He is the interface between the Army and the Devolved Administration.

The other Services have similar arrangements or structures-for instance, the Navy do so in Scotland, with FOSNNI. However, I don’t sense that the MoD necessarily is connected in a direct way with those Administrations in the way that you might describe.2 We find, certainly from a practitioners’ perspective, that the liaison and interface with the Devolved Administration and the regional command structure works well.

Q395 Mr Havard: Our concern is where is compliance and who is responsible should there be, for whatever reason, a difficulty at the end of the day?

Major General Berragan: That would come up back through us and into the MoD for resolution at the policy level. It is not something that we would try to do ourselves. If it cannot be resolved locally it would end up coming back into MoD main building for it to be resolved, I guess, with the appropriate Department here.

Colonel Mason: Our experience to date, I would have to say, is that there is not an issue. We are seeing real positivity across the piece. It is easier in Scotland because you are dealing with one organisation. But across the piece elsewhere our regional brigades would be reporting if they were experiencing push-back locally. They are not. They are experiencing a lot of help. They are getting out and engaging. There is very positive feeling out there that people genuinely want to help in this transitional phase.

Mr Havard: We have not heard any evidence to the contrary. But clearly there is more strategic capacity in some of the Devolved areas to do it and it is more differentiated and becoming so in England. We are concerned that a consistency can be applied.

Q396 John Glen: I want to focus on three aspects to do with those people who are medically discharged. First, could someone tell us about the housing arrangements? Where there is a need for housing how does that work?

Secondly, a lot of concern has been expressed in the various evidence sessions about the lack of or inadequacy of financial advice to those who have been severely injured and are in receipt of a large payment. What sort of financial advice is available? Thirdly, what support is there for bereaved families? Also, what support is there for the families of those who have been severely injured? Often, with all the uncertainty around their needs, some support is probably required. I do not know who is best placed to answer those questions.

Major General Berragan: I’ll lead, and I’ll bring in the Navy in support. Let me start on housing. In terms of entitlements to families accommodation, because that is what we are talking about, our policy says that those being medically discharged are entitled to 93 days’ continued use and occupancy at the same entitled rates as they were when they were serving, and that can be extendable on compassionate grounds by the local commander. So it is not a policy decision in London. It can be extendable for further periods of 93 days at a time on non-entitled rates. In other words, they would go up to a more market rent if they had to go beyond that period. Essentially there is three months almost as a given. It is extendable by another three months at local request, and beyond that if necessary.

So the first point is we don’t throw people who are being medically discharged out of their houses. Bereaved families can stay for up to two years and longer. Again, generally speaking, on a case-by-case basis, we would never move a bereaved family out unless they had arrangements in place. We take a lot of care to make sure that they move where they want to move, their arrangements are sound before such time as their entitlement runs out. We are certainly not in the business of booting people out.

That is the first point. The second is that we spend a lot of money on adapting Service accommodation for people when they are injured and making sure that it is disability compliant, in other words making sure that they can live in their house, whether it is widening doors, fitting special showers or whatever. Something like 13,000 Service family accommodations have been specifically adapted for that purpose for those people who require it. That will continue.

I will let Andy Mason come in in a minute on what we are providing for those transitioning through the ARC. But we have a lot of help from the third sector, particularly in the case of Haig Homes, who provide a number of houses that are specially adapted for disabled people to go and live in as they leave. Another charity, more localised in the south-west, is Alabaré, which also provides accommodation for us. We are starting to get involved with the third sector in housing. As Andy said, one of the key criteria in the transition assessment is housing; they need to have somewhere to live and support themselves. Andy, I don’t know if you want to add anything on housing at this stage.

Colonel Mason: It is not one-dimensional. It is not moving out of the Army and going home and that’s it. The house is an aspect, the family is an aspect and employment is clearly the aspect. Making sure that people are properly plugged into the NHS is another aspect, as well as what welfare support and mentoring is in place. Once you start to lay all of this out, it is a fairly big piece.

But you are not going to have success in transition unless you have addressed it properly as part of the plan. This is where an individual recovery plan comes in, checked at the end by a transitional assurance package to ensure that all of that is coherent and still relevant, and that the guy is completely comfortable with where he is going, allowing him to step off on the right foot.

Housing forms part of the plan, but it is no more or less important than a whole raft of other things. In many ways, home is where the work will be. Defining what a person is going to do when he leaves is pretty important. Even those with fundamental injuries, such as triple amputees, still have a lot to offer. But finding specific jobs that suit them for the future may mean that relocating is an aspect of all that. The timing of the adaptation of their house is a fairly key issue. It is specialist stuff, and we are not very good at it yet.

Chair: Commodore Mansergh, is there anything you would like to add?

Commodore Mansergh: I don’t think so, other than that it is very similar to the way the Naval Service is supported, both by the third sector and by the process we have through Hasler Company. In the phased time that people spend in recovery, they are looking at where they are going to be housed and how that is going to be taken forward.

Chair: We will come back to financial advice.

Q397 Mr Havard: Colonel Mason, you said something about supported employment, which I am interested in. My constituency offices are in a unit that has supported employment as part of it, so I have some experience of how that works. Could you say a little more about how you are going to be engaged in giving people supported employment? You have supported housing, how are you going to do supported employment?

Colonel Mason: It is very important to suggest that we are not, dressed like this; we are going to involve regional experts and those who do it for a living. Remploy is a good example. There is a Remploy member on our defence employment opportunities team. Others are engaged as experts in employment opportunity, whom we use right from the beginning, from the assessment. We are trying to join up that assessment piece with where people are going at the end. It is ensuring that as many opportunities as possible are available and that we link ability with that opportunity, ensuring that the guy is there. It is supporting employers so that they do not have to pay for employing a disabled person. It is ensuring that all of the work is done, and that placements take place and that both parties are comfortable with the arrangement. All of that is part of the plan that delivers the outcome.

Q398 Mr Havard: Are you commissioning from somewhere like Merthyr Tydfil Institute for the Blind, who also put people into employment and do what you have just said as training providers? That is just one example, and there are lots of others. Are you going to commission individual groups like that to do it?

Colonel Mason: This is where the regional placement of our personnel recovery units is key. If a guy is going to be involved in that transitional piece, there is an awful lot of work that happens at the regional level, informed by the process that will identify what the guy can do, rather than what he cannot do. That allows us to see what availability there is and, equally, to have a national view at the operational level for major providers, who have providers of their own, to ensure that we are spreading the net as widely as possible, on the understanding that a guy has to work in transition.

Q399 Chair: Financial advice?

Major General Berragan: Let me pick up on this one. First, we cannot give financial advice to our soldiers. We are not qualified to do that. It is also a tricky subject in a sense, because if we give them financial advice that subsequently turns out to be incorrect, we are potentially liable.

Q400 Chair: But you can give employment, housing and medical advice.

Major General Berragan: Financial advice is different.

Q401 John Glen: You can facilitate access to an IFA.

Major General Berragan: That is exactly my point. We recognise that, and we seek to bring in qualified financial advice. That is where the Government’s free money advice service comes in. It was set up by the Government and is run by a consumer financial education body. We give those people access and enable them to give financial advice to patients at the DMRC. That is now working well.

As well as that, and as part of the recovery process, one of the key components of the assessment course is a day and a bit of financial briefings. We use Barclays staff who are part of its Armed Forces Community Investment Programme, which is part of its CSR. They come in on a voluntary basis to the courses and provide advice on financial planning, how to invest and all the information that someone who might be leaving with a sum of money in their hands really needs. So the answer to your question is: we cannot do it, but we bring in people who can, at the right time.

I know that in the past there have been examples of soldiers who have had big pay-outs from some sort of compensation scheme or insurance, which has gone straight into an adapted Porsche or something like that, which has probably not been the best use of that money. We are now getting ahead, so that, ideally, the financial advice is available before the money hits their pay packets.

Q402 John Glen: May I briefly come back on that? I understand the constraints and your response indicates that. One of my concerns is that if you join one of the Services, in essence, many things are done for you-housing and so on. I had an Adjournment debate a couple of weeks ago on getting facilitated access to financial advice for members of the serving Armed Forces much earlier on. They need advice on access to mortgages and need to be able to make better decisions earlier on, so that the crisis points-at any point of exit and not necessarily associated with injuries-are likely to be less difficult.

Another aspect is that people are going out to serve in theatres of war and are making wills. I have come across several cases where that has not been done properly and it has created no end of problems in dealing with compensation payments and in the impact on benefits for those who have received them. I observe that there is a joined-up piece here that gives us some lessons about what you do earlier on. Has anyone got any comments on that? Has that created any thoughts around how you might adapt that?

Major General Berragan: Across the board, we have approved Army agents who are given access to provide financial briefings to soldiers and officers, and they do so on a regular basis. I remember that when I was commanding a regiment, we had them visit. They do briefings in all three messes-in the officers’ mess, the sergeants’ mess, and in the NAAFI and the junior ranks club. They focus their information around what the interests and advice needs of those three messes would be. So we do have those services, but we cannot force people to go to them.

John Glen: No, unfortunately.

Major General Berragan: Unfortunately. And we certainly cannot force them to act on that advice, but those briefings are available. I absolutely concede that our all-encompassing welfare wrapper does not prepare people necessarily well for when they come to leave. That has improved markedly for those who are serving beyond six years and are able to use the resettlement process. The financial briefings as part of the resettlement process through the Career Transition Partnership are excellent and professional. What happens to those who leave before the six-year point and have not had that financial advice is a good point. It is something that we have to keep working at.

Commodore Mansergh: The White Ensign Association, from a Naval Service point of view, is an organisation that helps to show individuals where financial advice can be sought and found. I also take the point that we do not do it early enough. We do not start an individual’s career with advice; this is when people should begin to think about resettlement, and right at the moment, of course, with redundancy being on a lot of people’s minds, suddenly there is a rush to get this support from such organisations as the White Ensign Association.

Major General Berragan: Was the third thing families?

Q403 John Glen: Yes, and then I have another question about a slightly different subject. I am particularly concerned about the families of those who are severely wounded. Your answer was around the entitlements for housing for those who are bereaved, but sometimes people are on a very uncertain path. They might want to stay in; that is unrealistic, but how do you look after those people who are in some trauma?

Major General Berragan: The first point is that part of the responsibility of the personnel recovery units-the command unit and the personnel recovery officer, who has a caseload of up to 15 and who will be regularly visiting those people under his command-is to look after the needs of the family and to ensure that the family are dealing with it. It is a really sensitive area, and funnily enough I was talking about this very subject with one of our seriously wounded only yesterday. We talked about how the impact of his injury on his family, particularly on his children, took him by surprise. His wife was with him in terms of dealing with it, but they had not realised the impact on the children.

It is an area where we continue to learn lessons, but in our case the first point of contact is the PRO, who is our interface with the family. What we need to do is to bring in the other agencies-SSAFA and perhaps some qualified social workers-where necessary to support where the family are not dealing with it very well. That is an area where we probably need to improve.

Q404 John Glen: I have another question about the charitable sector. We have seen a wonderful explosion of voluntary giving, which I imagine imposes on you some difficult decisions about how to work with the charitable sector to configure a service that you can sustain from public funding but also make use of that extra money. Could you set out how you see that relationship with the charitable sector, and what steps you have taken to ensure that it is sustainable so that when perhaps the sympathy and concern recedes in a few years-because there is not the need for it-you are not left with a situation that you cannot sustain?

Major General Berragan: You are right. The first point I would make is that we have a very long history of the involvement of the third sector in supporting serving soldiers. I think there is a myth out there that in the past we looked after serving and the third sector looked after veterans. That is not the case, and one only has to look at organisations such as SSAFA and the Royal British Legion, which have been engaged in helping serving soldiers for many years-90-odd years, in the case of the RBL.

Regimental charities also often fund a lot of activities for serving soldiers, such as welfare-type activities, support to expeditions, support to sport and support to some of the social occasions to do with the regiment. We have always had third sector engagement. We are used to it, we are comfortable with it and I think it is very much part of the norm.

What is not part of the norm, as you have said, is this tidal wave of public support and sympathy, expressed in particular by quite how well Help for Heroes has captured that mood. It has had a spin-off on other charities as well, because it has improved their fundraising too, to such an extent that we are now almost faced with an embarrassment of riches.

How do we deal with it? You probably know already from when Air Vice-Marshal Murray was here that we have set up something called a defence recovery steering group, on which I and my contemporaries in the other two Services sit. He chairs it in MoD, and Bryn Parry and Chris Simpkins sit on it, as does Tony Stables from COBSEO representing the smaller charities. We have, if you like, the top level, where we discuss what our priorities might be across defence for third sector assistance and charitable donation where we really need it.

At the next level down, we have very good embedded support within the personal recovery capability, and Andy has permanent representation from the Royal British Legion, the Soldiers, Sailors, Airmen and Families Association, the Army Benevolent Fund and others, which at operational level are making sure that the funding that they are providing to us is being put to good use and, if necessary, more funding will be available if we find a new requirement for it. At the working level, that really is very practical. If someone turns up and says, "We’ve got some money for you. How can you use it?", it will be integrated into a recovery plan for an individual, to make sure that that individual’s recovery is optimised. We deal with that at an operational level.

At the tactical level, again each of the personnel recovery units has interfaces with the local charities-be they regimental charities or local military charities. At all the three levels of strategic, operational and tactical, we are connected and get together. As well as that and, in terms of capturing what is now a vast number of defence Service-related charities-3,000 or so, if we count them all up-I hold a welfare forum twice a year. They are all invited and go into a big theatre.

We lay out what we are doing, and where we are seeking help. We get them to come back with ideas on how they might be able to help. The other knock-on, spin-off effect of that meeting is that we give them lunch and they talk to each other, which is really good as well. We facilitate their working together in some areas. We have a system in place for engaging with the charities at both the top and CO level with the operational level through the ARC and at the tactical level with the PRUs, and that is working okay.

Sustainability was the other part of the question. What happens when someone throws a lot of money at us? We build something, and how do we sustain it? We have learnt lessons from our experience of swimming pools. In every case as we go through the process, we have to satisfy both the Department and the Treasury that anything we build is sustainable in terms of support; that a component of military funding is involved, whether that is staffing it or whatever, and that that funding is secure within the Department’s resources.

Our bit of the plan is absolutely included in the Department’s financial planning and the robustness of the position of the charities must be such that we have confidence of, let us say, a 10-year-period where we know that they can provide the funding for it. At the end of that 10-year-period, if we do not need that capability any more, we have an arrangement in contract with the charities whereby we walk away from each other. That is how we do it. We have learnt lessons in making sure that any donations that are made are done on a basis that is sustainable, certainly for the mid-term.

Q405 Chair: I have one final question for each of you. I will start with General Berragan. What is your greatest challenge? It will be the same question for each of the others. It does not have to be a long answer.

Major General Berragan: Andy put his finger on it. Our greatest challenge is successful transition. Something that keeps me awake at night more than anything else-and quite a lot of things do that-is ensuring that we make a successful transition for those who need it, particularly the more complex, seriously wounded casualties. That is my greatest challenge.

Q406 Chair: Colonel Mason, do you agree with that? You do not have to, not in this forum.

Colonel Mason: For those who are staying in the Service, their life has not changed. Their recovery trajectory will see them return to duty, which is what they want. Their mum doesn’t want them home; they have a job, and they have a future. For those in transition, we have to do much better. It is new.

We are putting in an awful lot of effort, time and thought and we are drawing an awful lot of expertise from elsewhere to get it right. We have not seen the flow start yet to prove the case. Once we do-I anticipate that if we get the resources to allow the capacity and the flow to increase to 1,000 and allow it to flow from there, we will have a very capable recovery capability by this time next year because we will have proved it by then.

Surgeon Commodore McArthur: The main challenge or the main effort is always making sure that the Serviceman in that Role 4 pathway is getting the best clinical, welfare and administrative support that he or she can get. But my other challenge, of course, is to make sure that the person delivering that care is getting the support that he or she needs.

If you think about it, the folk up in Birmingham or at Headley Court have been full on now for five or six years. They are not burned out; they are all committed and they are all doing a great job. There is a great challenge to make sure that they are getting the support that they need to do that.

Chair: Thank you. We talked about that a bit at Queen Elizabeth, but it is very good that you have mentioned it again.

Commodore Mansergh: Apart from agreeing with all those other challenges, I think it is the longer term-what happens to our people when they have left the Service is, to my mind, probably the most difficult challenge to address. We have a role in that right now, in the way we are identifying exactly what our people have been through and how we can springboard them, with the support they need, to make the transition and to be able to continue for many years in a life in which they do not go off the rails and have challenges in the future-because of the way we have invested in that transition and made sure that they have got the support while they are in Service.

Chair: I am very glad you have raised that because when we were at Queen Elizabeth, and previously when we were at Headley Court, precisely that issue was raised with us by Servicemen. I am glad that you have it on board.

Thank you all very much for giving evidence. Thank you also for your hospitality on various visits to Hasler Company, Queen Elizabeth and Headley Court. Your presence there and your work today have been very gratefully received by the Committee.