Defence Medical Services: A review of the clinical governance of the Defence Medical Services in the UK and overseas
Abstract: This report is the product of a fruitful collaboration between the Department of Health and the Ministry of Defence, and between the Healthcare Commission and the Defence Medical Services. It owes much to the leadership and commitment of the Surgeon General, Lieutenant General Louis Lillywhite and his predecessor, the late Surgeon Vice-Admiral Ian Jenkins. They took the view that it would be beneficial to the Defence Medical Services if its services were exposed to the scrutiny that the Healthcare Commission applies to the performance of the NHS. The Healthcare Commission, in line with its primary statutory duty to encourage improvement in the provision of health and healthcare, was pleased to accept the invitation. The Defence Medical Services provides care for about 250,000 people – Service personnel and their families. All concerned felt it right that their healthcare should be subject to the same scrutiny as that of others in England. The picture that the report paints of the Defence Medical Services is varied. There are areas of outstanding performance that the NHS could profitably learn from, not least the organisation and operation of trauma services. There are other areas where improvements need to be made, for example, getting universal standards in place across all services, and addressing maintenance and cleanliness at some medical units providing services away from the front line. These needs for improvement are recognised and it is pleasing that actions are already being taken to address them. It is important that progress is monitored and reported on regularly.
Abstract: U.S. Air Force remotely piloted aircraft (USAF RPA) personnel face diverse stressors negatively affecting psychological health and military readiness. Prior research in diverse populations supports predictable impact of the COVID-19 pandemic on occupational stressors, burnout, and more distal outcomes. Extending earlier studies linking broad variables (e.g., COVID-19 threat → work stress → burnout), the current study tests and refines an expanded mediation model based on multiple distinct pandemic concerns, occupational stressors, and burnout facets as antecedents of psychological distress mid-pandemic in RPA personnel (N = 496). Differential representation of demands, resources, and rewards evident across distinct occupational stressors in light of job demands/resources theory guided specification of mediated pathways. SEM analysis yielded moderate fit. Following removal of non-significant paths and addition of two interpretable direct paths, fit was improved, yielding seven dominant pandemic concern → occupational stressor → burnout → psychological distress pathways. In support of domain specification, five 'hub' variables (pandemic-driven change, personal stressors, workload, leader communication, and exhaustion) emerged as key intervention targets in mitigating distress in the USAF RPA community and similar populations during future pandemic-related crises.