Under-Served

Abstract: The end of military operations in Afghanistan in 2014 brings to a close over a decade of significant conflict in the Middle East. The human cost of recent engagements has been great; between 2001 and 2014, 21,756 servicemen and women were medically discharged from the Armed Forces for physical and mental health reasons, with 840 sustaining serious or very serious physical injuries or illnesses in recent conflicts. Thanks to advances in medical technology, unprecedented numbers of ill and disabled ex-service personnel are returning, surviving, and doing much more than surviving – benefiting from rehabilitation, and adapting to a ‘normal’ (if very different) civilian life. But for a minority whose injuries are the most severe and whose care needs are complex, the barriers are greater. They require specialist rehabilitation and ongoing care, and some receive this (at least temporarily) in a residential setting – a care home or nursing home. While the UK’s involvement in the last 13 years of conflicts has been a source of great controversy, the need to support veterans has enjoyed a much broader consensus. This fact is attested to by the creation of new Armed Forces charities like Help for Heroes and the publication of the Armed Forces Covenant. This report concerns two groups of working age veterans (or ‘ex-service personnel’) in residential care – those who have been injured or become ill during their service, and those who have acquired an illness or been injured after their service. Veterans who become ill or are injured have specific needs, and are also entitled to the care and support provided by veterans’ charities, including veterans’ care homes. Yet connecting them to these services is difficult, for a broad range of reasons. The UK’s ex-service personnel have had a wide range of service histories, from those who served in Northern Ireland and the Falklands, to those returning from the most recent conflicts in the Middle East; from those who served for days or weeks to those whose careers spanned decades. Individuals also have a wide range of injuries and illnesses, from traumatic brain injuries to progressive neurological conditions. Many of those with physical injuries – who are the focus on this report – will also be affected by mental illness, which can be more prevalent in the veteran population. Severity of needs is not the only factor determining whether people are cared for in residential settings or in the community, though it is an important one – a fact reflected in the complex needs of the veterans we encountered. Personal choice, eligibility for local authority funded social care, and availability of informal care from family and friends all play a part. Care in its modern sense is not about being ‘looked after’ in an institution. It is about being supported to achieve what an individual wants, to live as independently as possible, even in the context of a care home. That means individuals receiving empowering, personalised care, in keeping not only with the conditions of that individual, but with their aspirations and priorities. For this small group of veterans, who have often experienced such rapid transformation in their lives, individualised and empowering care is particularly important. This report is the first detailed examination of ex-service personnel, a small, poorly understood group, and thus relatively ‘invisible’ to policy-makers tasked with planning and funding care. It looks at the care they need, the care they receive, and how they generally come to receive it. It looks at their priorities – the aspects of care they value and the aspects they would like to change – and at the challenges faced by those who seek to provide that support. Ultimately, this report presents a series of recommendations for Armed Forces charities and for government concerning how this care can be improved.