§ Baroness Cox asked Her Majesty's Government:
§ Whether they are satisfied that the provision of medical and nursing services for the Armed Forces is adequate at present; and whether it would be adequate in the event of any outbreak of hostilities.
§ The Minister of State, Department for Education and Employment (Lord Henley)
My Lords, we have made adequate provision to meet our present levels of commitment. We are, however, in the process of reviewing the Defence Medical Services to ensure that they are appropriately manned and equipped to meet any necessary level of medical support for future operations. The Defence Medical Services are currently supporting United Kingdom military operations in Northern Ireland, the Falkland Islands and Bosnia and United Kingdom air operations in support of the southern Iraq exclusion zone.
§ Baroness Cox
My Lords, I thank my noble friend for that apparently encouraging reply. However, is he aware of the very great concern over serious shortages in both the medical and nursing services? For example, in the national contingency force, the number of surgeons in the RAF is at only one-third of full deployment potential and the comparable figures for the Army and Navy are only 60 per cent. and falling. Does he agree that this must surely have serious implications for the quality of care for our Armed Forces, which they are surely entitled to expect from a nation that they serve so well?
§ Lord Henley
My Lords, I shall have to look very carefully at my noble friend's figures. I am aware that there are shortages in certain key areas, particularly among surgeons, anaesthetists and operating theatre nurses. But as regards the figures that my noble friend quoted, I am advised that we would be able to make good that shortfall by the use of reserves, if required. As at 1st April this year, the shortfall of surgeons in the RAF will be five against a requirement of 28; in the Army the figure is 13 against a requirement of 45; and in the Navy I understand that there is a shortfall of four against a requirement about which I shall have to write to my noble friend.
§ Lord Walton of Detchant
My Lords, will the Minister accept that the progressive closure of service hospitals has had an adverse effect on the recruitment and retention of medical and nursing personnel within the Defence Medical Services? It is of course true, as the 1760 noble Lord suggests, that the reserve forces are likely to make an outstanding contribution in the event of a major national emergency. Here I must declare an interest because more than 30 years ago I commanded No. 1 Northern General Hospital (TA). Is the Minister aware that one of the problems is that, despite the passage of the Reserve Forces Act, certain NHS trusts are proving reluctant to release medical personnel for reserve forces training?
§ Lord Henley
My Lords, I and my colleagues in the Ministry of Defence are aware of the last concern that the noble Lord has raised. As regards the first part of his question and the effect on morale of the closure of a number of hospitals, I point out that the rearrangement of the Defence Medical Services and the creation of MoD units within certain hospitals have created many advantages for the Services and allow much broader training than might otherwise be available. There are certainly gains to be made within the Defence Medical Services as well as the losses to which the noble Lord referred.
Lord Campbell of Croy
My Lords, is not one of the factors that in peacetime conditions medical officers look after young, fit servicemen while in periods of war or during other hostilities more doctors and nurses are needed for anticipated casualties? For example, Territorial Army medical units were sent to the Gulf in Operation Granby, where I understand they carried out their role admirably.
§ Lord Henley
My Lords, it seems fairly obvious that there will always be a greater need for medical personnel in times of war than in peacetime. As I understand it, that is why great use has always been made of the Territorial Army in providing medical support. That obviously will continue to be the case in future. I echo the tribute that my noble friend paid to the work of the medical units in the Territorial Army in Bosnia, as at present, in the Gulf and in other operations.
§ Lord Carver
My Lords, does the noble Lord agree that there is considerable concern among senior officers in all three armed services and their medical services about the present situation, not only as regards the capability to provide medical cover in operations, but also in relation to the unsatisfactory situation of personnel in the Armed Forces medical services serving in military district hospital units in NHS hospitals where they are being treated as cheap labour? Can he say how many of the 112 bed-generating consultant posts which Defence Course Study No. 15 said was the essential minimum to maintain a uniformed service are at present held by uniformed officers?
§ Lord Henley
My Lords, I shall have to take advice on the last point raised by the noble and gallant Lord. I certainly offer to write to him in due course. I am aware of the concern expressed by him and many others, including many senior officers. Ministers within the Ministry of Defence are also concerned about the shortages in certain areas. That is why they are 1761 reviewing the situation and why they also believe that it is necessary to review the pay and terms and conditions of service for all personnel in the Defence Medical Services.
§ Baroness Park of Monmouth
My Lords, is my noble friend aware that in May last year the Armed Forces Pay Review Body expressed deep concern about unprecedented low morale, a falling retention rate, severe overstretch and heavily reduced promotion and career prospects? Is he further aware that it went on to say that conditions had so far deteriorated that the Defence Secondary Care Agency would not be able to carry out its task in peacetime? Further, can my noble friend comment on the fact that the Select Committee on Defence, which visited Bosnia at the same time, also reported a shortfall of 33 per cent. in the number of surgeons needed there and that that was also a peacetime operation? Finally, I understand that the Government are meditating a defence medical training agency. Does my noble friend believe that there will be anyone left to train?
§ Lord Henley
My Lords, I do not believe that the situation is quite as serious as my noble friend makes out in the last part of her question. I am aware of the concerns that have been expressed by the Armed Forces Pay Review Body. I can advise her that a paper, which includes proposals for what I understand are described as "Separate analogues for consultants and general medical and dental practitioners" has been submitted by the Ministry to the review body as part of this year's evidence on medical and dental officers' pay. Obviously, that will be something which the Armed Forces Pay Review Body will have to take into account.
§ Lord Bramall
My Lords, will the noble Lord at least pass on to the Minister responsible that everything we have heard this afternoon on this Question represents a disaster area in peace and war? In view of the warnings that the Government have had, that is largely self-inflicted. Is the Minister aware that, if something is not done soon, the damage to the medical and nursing services of the Armed Forces may be irreparable?
§ Lord Henley
My Lords, I hoped that I had made it clear to the House and to the noble and gallant Lord that I was aware of the concerns and that my colleagues within the Ministry of Defence are also well aware of them. That is why they have agreed to review such matters and in particular, as I have made quite clear, to review the pay, terms and conditions of service for all such personnel. Obviously, I can do no more than again reassure the noble and gallant Lord that I shall take these concerns back to my noble friend and to other Ministers in the Ministry of Defence.
§ Lord Williams of Elvel
My Lords, will the Minister pay attention to the word used by the noble and gallant Lord, Lord Bramall, when he said that the present inadequacy of provision could be "irreparable"? If the Minister does not understand the figures quoted by his 1762 noble friend the noble Baroness, Lady Cox, perhaps he would consult the British Medical Association which will provide the Ministry of Defence with the appropriate figures. Does the Minister further understand that relying on reserve forces when our troops go into battle is an inadequate solution because NHS trusts will not necessarily release those who are overburdened and overworked in the NHS as it is? Is it not the case that when our Armed Forces go into battle they should have—and they deserve—the highest quality of medical support?
§ Lord Henley
My Lords, I agree absolutely with the noble Lord on his last point. However, it will always be the case that there must be some reliance in these matters on reserve forces. It would be quite wrong throughout peacetime to equip the Armed Forces with the sort of level of medical services that they require in wartime because that would be a wasteful use of doctors. The point made by my noble friend Lord Campbell of Croy was a very good one in that respect.
In terms of the figures that I quoted, I made it quite clear that we accepted that there are shortages in certain areas. I referred to surgeons, anaesthetists and operating theatre nurses. I should like to look at the figures which my noble friend Lady Cox quoted. I quoted the figures from the department which showed that in those areas the shortages did not look quite as severe as my noble friend seemed to imply.
§ Lord Campbell of Alloway My Lords—
The Lord Privy Seal (Viscount Cranborne)
My Lords, I hope that your Lordships will agree that we have had quite a good run on this Question and that we should perhaps move on.