Recommendations from Veterans Health and Wellbeing - A Distinctive Scottish Approach, 2018

Key

Not implemented
Partially implemented
Implemented but work should continue to embed
Fully implemented
Superseded

	Recommendation	2019	2020	2021	2022
1	Establish "A Distinctive Scottish Approach to Veterans’ Health" The Scottish Government and NHS(S) should commit to establishing a distinctive Scottish Approach to Veterans’ Health at a strategic level, accept or adapt the guiding principles of this approach and work with their partners to embed it at an operational level.				-
Scottish Government update, 2019 We are working with stakeholders, NHS Armed Forces and Veterans Champions and through the refreshed Armed Forces Personnel and Veterans Health Joint Group to ensure we create the conditions for and drive forward progress towards the ‘Distinctive Scottish Approach to Veterans Health’. Our progress towards the remaining recommendations shows how we are working to achieve this. Scottish Government update, 2020 The Armed Forces Personnel and Veterans Health Joint Group will continue to keep the recommendations from this document central to its work going forward, as a directive and impetus for improvement. The SVCN via the proposed governance structures and delivery mechanisms will bring a distinctive Scottish Approach to Veterans’ Health at both a strategic and operational level. Scottish Government update, 2021 The Scottish Veterans Care Network (SVCN) has brought a distinctive Scottish Approach to Veterans’ Health. The SVCN structure provides fora, on a range of areas, for cross-system collaboration and veterans and Armed Forces family input. The SVCN has undertaken a range of mapping and consultative exercises, which will be key to fully understanding and developing the Scottish healthcare context for veterans. The Armed Forces & Veterans Health Implementation Group (IG) continues to regularly meet to drive forward progress on priorities set by the Strategic Oversight Group (SOG). The IG provided an update to the SOG in May 2021, and priorities were set. The 2021/22 priorities are a continuation of the priorities set in October 2020 – Mental Health, employability of veterans in the NHS, and Priority Treatment – plus the addition of Veteran GP Accreditation and exploring the setup of a veterans trauma network within the Scottish health landscape.
2	Improving collaboration and partnership The Scottish Government should reinvigorate senior participation in cross-border networks with a view to improved information sharing and increased involvement in collaborative working and initiatives.				-
Scottish Government update, 2019 We actively participate in cross-border networks through the MOD/DH Partnership Board and a number of sub-groups. A meeting of the MOD/DH Partnership Board will be held in Scotland in November 2019. Scottish Government update, 2020 We have established mutually beneficial relationships and networks with organisations in England and the devolved nations. During this reporting period we have utilised these to take a central role in sharing best practice on priority treatment messaging at four-nation level; with Welsh counterparts on messaging around veterans identifying their status. In November 2019, Scotland hosted the MOD / DHSC / Devolved Nations Partnership Board where we took the opportunity for the National Clinical Director and the Scottish Veterans Commissioner to address this group to highlight the Scottish landscape in terms of health, veterans and what we have achieved. This was well received and further strengthened links. Scottish Government update, 2021 We continue to reinforce mutually beneficial relationships and networks with organisations in England and the devolved nations. We continue to participate in the MOD/DHSC/Devolved Administrations Partnership Board, including continued input into the four nation Priority Treatment Working Group. Recognising the value of collaboration, we provide frequent updates to the Partnership Board and have brought papers for cross-nation agreement. We have also established quarterly meetings with the Office for Veterans Affairs and take part in cross-nation meetings centred on health IT alignment between NHS Scotland and the MOD Defence Medical Service. Scottish representatives also take part in a UK Armed Forces Clinical Forum.
3	Leadership and governance The Armed Forces and Veterans Health Joint Group should refresh its membership and remit in order to provide the vital strategic leadership that will deliver the Scottish Approach to Veterans’ Health.			-	-
Scottish Government update, 2019 The Armed Forces Personnel & Veterans Health Joint Group (AFPVH JG) brings together NHS Champions, representatives of the serving community, veterans organisations, Scottish Government officials and other stakeholders. Refreshing the structure, role and remit of the Joint Group has been a priority, as it is central to delivering a number of recommendations. In December 2018, DG Health and Social Care and Chief Executive of the NHS approved a new structure for the Joint Group, which consists of a Strategic Oversight Group and an Implementation Group. The Strategic Oversight Group will meet for the first time on 16 May 2019 and the Implementation Group’s inaugural meeting will be on 10 June 2019. Scottish Government update, 2020 Work has continued throughout 2020 and recommendation has now been assessed as fully met.
4	National Managed Clinical Network The Scottish Government and NHS(S) should establish a network on veterans’ health. The network will have oversight of delivering the Scottish Approach to Veterans’ Health, and will consider the key issues raised in this report and others it deems relevant. It should reflect current structures in the health and social care sector in its membership and approach.			-	-
Scottish Government update, 2019 NHS National Services Division are exploring a Managed Clinical Network as a potential longer-term solution to ensuring equitable and sustainable health services for veterans. The proposal has moved to stage two of their planning process, meaning a full application and a detailed work plan will now be developed before putting the proposal to NHS Chief Executives then Scottish Ministers. Scottish Government update, 2020 The Scottish Veterans Care Network has been established and will be formally launched in November 2020. Engagement with a broad range of stakeholders has enabled the Network to create a delivery strategy, setting out immediate priorities and a strategy for implementation of these. The SVCN strategy document was accepted and approved by the NHS Chief Executives Group on 4th August. This document will go to the Chief Officers Group shortly.
5	Mental Health Action Plan The Scottish Government and NHS(S), through the network on veterans’ health (see Recommendation 4), should produce a Mental Health Action Plan for the long-term delivery of services and support. Systemic issues of funding, collaboration, leadership, planning, governance and training of staff will be key.
Scottish Government update, 2019 Scotland’s 10-year mental health strategy, launched in 2017, reinforces our commitment to the Armed Forces Covenant and includes a range of actions to improve care, services and support for people with a mental health problem, including veterans and their families. In addition, we continue to work with NHS(S) in order to progress with establishing a Managed Clinical Network (MCN) for veterans healthcare. We would expect, should the network be approved through the formal NHS(S) process, that its initial priority would be to lead on the development of a Veterans Mental Health Action Plan which would complement our Mental Health Strategy. Scottish Government update, 2020 This is an immediate priority for the Scottish Veterans Care Network. Early engagement with stakeholders to inform that work is now underway. However, due to the impact of the pandemic response on capacity within the Network, and also the availability of stakeholders to engage in this work, timescales for publication may be slightly delayed until later in 2021. A mapping of stakeholders and the services provided is in progress. An integral part of this work will be involvement in the development with partners, of clear and integrated pathways for/to care for our veterans, in relation to mental health. One of the SVCN first consultations was with Scottish Government, Combat stress and Veterans First Point (V1P) as the key mental health providers in Scotland. Scottish Government update, 2021 The Scottish Veterans Care Network is continuing to work on the Mental Health Action Plan. Extensive mapping and consultation has been undertaken to gain the views of veterans, their families, third sector providers, and the NHS. The comprehensive plan was submitted in draft on 10 September 2021, with a final version expected in December 2021. It will contain recommendations for the Scottish Government and NHS Scotland. Scottish Government update, 2022 The Veteran Mental Health and Wellbeing Action Plan was published in December 2021. Dr Charles Winstanley has been appointed to lead the Implementation Board.
12	Chronic pain management The National Advisory Committee for Chronic Pain (NACCP) should consider veterans specifically as part of their work to improve chronic pain management in Scotland.				-
Scottish Government update, 2019 The National Advisory Committee on Chronic Pain (NACCP) is taking forward work to inform policy development and support NHS Boards and Health and Social Care Partnerships (HSCPs) to improve the provision of pain services across Scotland. This includes a project to develop a core dataset and a set of Quality Performance Indicators (QPIs) to measure service outcomes and improvements for people living with chronic pain, including veterans. The Director of Pain Association Scotland (PAS), sits on NACCP and has been in discussion with the MOD Clinical Adviser for Veterans about the need to recognise veterans as a vulnerable group that would benefit from tailored support for chronic pain. The Pain Association has identified a gap in the quality of support services received on leaving the forces, in comparison to those received whilst serving. We are actively engaging with stakeholders to better understand experiences of veterans. PAS are piloting a programme in Scotland after securing funding from the Veterans Association. The programme offers veterans one-to-one self-management sessions via phone or skype to discuss personal needs and outcomes. This alleviates the need for the individual to attend clinics in person, recognising attendance may be difficult due to the nature of their pain. PAS will evaluate the project after 18 months and NACCP, chaired by the Deputy Chief Medical Officer, will consider outcomes and findings of the pilot. Scottish Government update, 2020 The Pain Association Scotland (PAS) ran a very successful pilot from 2018 to 2019 on chronic pain self-management for 41 veterans. This was in the format of group meetings at Erskine House and through 1:1 sessions with 11 veterans. The pilot received excellent feedback from participants, with some describing the course as “informative, educational and interesting”, and commenting that the course has “taught me to accept, manage and deal with” pain. PAS has secured a further 18 months of funding as of March 2020, and will put the pilot findings before the National Advisory Committee for Chronic Pain with the aim of embedding the services provided. Scottish Government update, 2021 Pain Association Scotland (PAS) state that as the challenges of COVID-19 have continued, more and more people have been suffering from increased anxiety and fear, the curtailment of their usual socialising, as well as the difficulties that long-COVID now presents. PAS support for veterans has been mainly by phone on a one-to-one basis and they have a regular cohort of 36 veterans whom they provide support for their chronic pain. They are delighted to have been able to offer continued help and re-assurance during difficult times. Initially, PAS had planned that the project would involve short-term self-management training for up to 5 sessions, but during this last year they have found that some people accessing the service have very complex needs that reach beyond the pain. This cohort, often with adjustment issues and trauma, have required a different approach in which PAS have continued to work longer term looking to improve life in general, often focussing on helping them to cope better with day-to-day life. Following feedback from some veterans and those who support them, PAS have been delighted to offer an online 5 week self-management group programme. The first course started in July 2021 and they had 12 people sign up and complete the course. Due to the success of this group based programme, they have launched another 5 week course starting on 18th October 2021. Sign-up is available online.
18	Veterans Champions The Scottish Government and Veterans Scotland should build on recent work to support the network of NHS and Council champions to develop the role so that it can continue to be effective in supporting the delivery of health and social care to veterans within the new health landscape of Scotland.			-	-
Scottish Government update, 2019 NHS Champions are in place in every NHS Board, acting as a veterans’ advocate to meet the intent of the Armed Forces Covenant and the Scottish Government’s “Renewing Our Commitments” document. We recently sought feedback from Champions on the role and are working with them to consider how best to use this network going forward. Updated materials to raise awareness of veterans healthcare needs have been shared with NHS Board Champions and healthcare practitioners. This includes guidance for GPs on how veterans can share their full service medical record. Scottish Government update, 2020 Work has continued throughout 2020 and recommendation has now been assessed as fully met.