SURGEON VICE ADMIRAL PHILIP I RAFFAELLI QHP BSc MSc MBChB MRCGP FFOM FRCP Surgeon General

1. SURGEON VICE ADMIRALPHILIP I RAFFAELLIQHP BSc MSc MBChB MRCGP FFOM FRCP Surgeon General Armed Forces and Veterans Conference Oct 2011

2. Mission The Defence Medical Services (DMS) are to provide healthcare, medical operational capability and health advice in order to maximise the fighting power of the Armed Forces. End State The Armed Forces will enjoy a level of health and well-being appropriate to the tasks they are required to perform, ensuring that the number of personnel medically unfit for operational deployment is at an irreducible minimum. The healthcare support to the Armed Services, both deployed and in Bases, will aim to be at least equal provision in the NHS and benchmark itself against our principal Allies. When personnel leave the Armed Forces they will be transferred efficiently to the NHS and continue to receive a high standard of care.

3. How do we do this? Healthcare Primary Healthcare Regional Rehabilitation Units Community Mental Health Dentistry Commissioning healthcare, fast track, accelerated access, mental health. UK Role 4, DMRC and Selly Oak/RCDM Medical Operational Capability Manpower Readiness Training and Education Research Health Advice 3

4. ‘If you don’t like change, you’re going to like irrelevance even less.’ General Shinseki Chief of Staff US Army 2001

5. SDSR/PR 11 A period of continued change – significant reductions in some areas 3CR Investment in DMS – Option 6.3 Option 3.2 Delivery of a Joint PHCS Merge Single Service Medical HQ structures Defence Reform Unit

6. Defence Reform Lord Levene Report issued June 2011 Significant changes in top level organisation Defence Board CinCs CTLB & Head Office Support/enabling organisations Joint Support Command SG to move to new Joint Force Command Exact structure of supporting pillars to be determined

7. Key Timelines 21 Oct – JF COM Working Group report to Defence Board 25 Oct – SG report on Joint Primary Healthcare to Chief Of Staffs Apr 12 – JF COM Initial Operating Capability

8. the Big Society Connecting with the Nation Enhancing Defence Capability and Utility FR 20 Cost Effective

9. Investment & Betterment proposals for DMS A Field Hospital for Humanitarian Relief in cases of civil disaster (natural or man-made) Enhancing the relationship between the DMS, Ambulance Trusts and Helicopter Emergency Medical Services (HEMS) by increasing clinical placements for Regulars and volunteering for the Medical Reserves Enhancing Hazardous Area Response Teams (HART) by increasing clinical placements for Regulars and volunteering for the Medical Reserves Supporting the Fire & Rescue Service in the event of a major or extended incident requiring CBRN decontamination by medically trained personnel The Command level planning and coordination of military medical assets in the event of a major incident, within the overall Incident Command led by the Police Providing experienced Public & Environmental Health staff to increase domestic resilience in managing potential major disease outbreaks Providing Senior Medical Leadership to health sector reform for failed or failing states, in support of DfID/FCO. DMS will also be involved in other FR20 Implementation activities e.g. the Partnership for Talent Pilot and the Cost model

10. Murrison MH ‘Fighting Fit’ Published 06 Oct 10 Positive progress on MH issues - BWW Final report on Prosthetics due shortly Initial indications are positive With the DA for consultation A force for good

11. Central Delivery MDHU – What is the future? Secondary Healthcare Training Commissioning HQ SG and DMS DNRC – Progressing Well

12. Community of Excellence DMS HQ JMC and Training Defence School of Healthcare Studies RCDM

13. National Institute for Health Research (NIHR) Centre for Surgical Reconstruction and Microbiology • Partnership between NIHR, MOD, University Hospitals Birmingham and the University of Birmingham, launched 20 January 2011, opens for business July 2011. • Military and civilian trauma surgeons and scientists together to share advanced clinical practice in the battlefield and innovation in medical research to benefit all trauma patients in the NHS at an early stage of injury. • Based at the Queen Elizabeth Hospital in Birmingham, where injured service personnel are currently treated after evacuation from the frontline in Afghanistan. • Forms a central point in England for trauma research where knowledge can be translated into real improvements in care for all NHS patients. First and only research centre of its kind in the UK. • Research themes • Research will focus initially on the most urgent challenges in trauma that with the aim to discover new treatments • Carry out scientifically robust and unbiased testing of product concepts • Evaluate novel approaches in clinical investigations • Translate findings into measured patient benefit.

14. Emerging Work Further scrutiny to come – PR12 New Employment Model Total Support Force Basing – Return from Germany DMS 20 Future Reserves 20 3 Month Review

15. Basing 5 Multi-Role Brigades (MRB) Catterick, SW England, Salisbury, Central Scotland and East of England (Cottesmore) Former RAF bases will be used to provide Army accommodation – Leuchars before 2014 All Royal Marine units to be co-located freeing Arbroath to be occupied by 2015-16 Units have yet to be identified by name to specific locations DMS needs to be agile to respond to the new basing requirements

16. Partnership Board Military Covenant – on target Transition of care – Awaiting Murrison DNRC – on target Armd Force Network – NHS Transition ongoing Mental Health – on target, BWW MoD Elective Care Commissioning – on target Technical Connectivity Programme – some risk Voluntary Sector Engagement – on target Research Programme – on target

17. People Working Group NHS MoD Coordination – on target Qualifications and Training – at risk recognition of Mil trg Personnel issues – Review of Reserve conditions of service Communications – Development of a joint communications strategy Military Covenant – on target Public Health – on target

18. QUESTIONS