1. Armed Forces Health Commissioning Arrangements
Melanie Iredale
Head of Armed Forces Commissioning
Tuesday 11th November 2014

2. Armed Forces Commissioning
Cement the “No disadvantage” requirement as specified in Armed Forces Covenant and Government’s Mandate to the NHS
A single, national body commissioning for the serving armed forces with one set of commissioning policies
Build commissioning capability in the new system so as to credibly build networks and relationships
Standard operating procedures for Armed Forces personnel in development

3. NHS England - Armed Forces Health
NHS England Board
NHS England Operations Directorate
CCGs
Reservists, Veterans’ & Families Commissioning
Armed Forces Commissioning
Design Principles :
Retain: Knowledge, expertise, capability, continuity, skillsets, credibility
Ensure: Momentum, partnerships, linkages, AFNs, practical configuration and delivery
Area Teams – x 3
CCGs - Veterans, Families, Reservists, Armed Forces Networks lead
Health and Wellbeing Boards, AFNs, Community Covenant and partnerships
Armed Forces Commissioning
Interface between MOD and Providers
(Securing Excellence – Military Health)
Veterans’ and families commissioning
Transition management
Veterans, reservists and families

4. Armed Forces commissioning responsibilities
Serving Armed Forces in England
Serving Armed Forces overseas
Armed Forces Families registered with DMS med centres in England
Armed Forces Families registered with DMS med centres overseas
Armed Forces Families registered with NHS GP Practices
Reservists while mobilised i
Veterans (inc. reservists when not mobilised)
Primary Care
DMS ii
DMS
NHS England
&
NHS England iv
Community Mental Health
CCGs
Secondary acute & community care
CCGs iii
MOD Enhanced pathways
N/A
i - Reservists have access to DMS care whilst mobilised
ii - Serving personnel can access local GPs on an emergency basis if needing to access care whilst away from the military address
iii - The NHS England will commission specialised services for veterans, e.g. limb prostheses,
iv - While overseas, serving personnel and families can access DMS-commissioned healthcare where such provision exists, or may be provided with non-DMS healthcare by local Host Nation or other contracted arrangements, or have right of return for NHS England-commissioned NHS care in England

5. Armed Forces commissioning responsibilities: Structures post-April 2013
NHS England
COO
DoC (Corporate)
Ann Sutton
NHS North
NHS Mildands
NHS South
NHS London
Hd PH, Armed Forces and Offender
Kate Davies
DoC
Julie Higgins
DoC
Catherine O’Connell
DoC
Sue Davies
DoC
Simon Weldon
N Yorks &Humber AT
Hd of Spec AF Melanie Iredale
Comm Mgr –North Jim Khambatta
DoC
Julie Warren
Notts & Derbs AT
Hd of Spec AF
Alison Treadgold
Comm Mgr - Mids Ann Berry
DoC
Vicky Taylor
Bath, Swindon & Wilts AT
Hd of Spec AF Jenny Kirby
Comm Mgr -South Sharon Greaves/Karen Beckett
DoC
Debra Elliott
Head of Public Health, Armed Forces and Offender Health Commissioning
Alison Frater
Kenny Gibson
AF Network Lead/Transition
Richard Swarbrick
Asst Hd Military
Andy Bacon
Armed
Forces Networks
Wayne Kirkham National Lead
National Veteran Mental Health Network
Comm Mgr – James Carter
CCGs - Link to JSNA and H&Wb Bds

6. Armed Forces Governance Structure
External Assurance Groups
External Partnership Groups
NHS England Internal
Oversight & Assurance
structures
Operations & Delivery structures
NHS England Board
Armed Forces Partnership Board
DMS/NHS England Joint Commissioning Group
Directly Commissioned Services Committee
Clinical Priorities Advisory Group
ETM
Health Partnership Working Group
Armed Forces Oversight Group AF
CRG
Operations SMT
Internal Delivery Groups (Armed Forces)
Screening & Immunisations Delivery Group
Patient & Public Voice Forum
Armed Forces Networks
Defence Recovery Steering
Group
Veterans Mental Health Network
CRG sub- groups as required
AF Joint
Commissioning Task & Finish Groups

7. DH Future Roles Policy Governmental and inter departmental business
2 Murrison Reports
Mental Health Provision:
Veterans MH Network
Big White Wall
Prosthetics:
National Funding of Veterans Prosthetics
Improved Disablement Support Centres
Veterans Information Service

8. MoD/Joint Medical Command
MoD (Chief of Defence Personnel) deliver (support):
Tri-service welfare and recovery
Chain of Command looks after/owns service
personnel under their command (Single Service or Tri
Service)
Transition
Recovery
MoD (Joint Medical Command) still
commission/provide (supporting) healthcare:
Operational Care
Primary Care
Rehabilitation
Community Mental Health
Inpatient Mental Health (NHS Provided)
n.b. note supporting/supported tension that we understand
Joint Medical Command

9. Obligations
“The NHS and its public sector partners need to work together to help one another to achieve their objectives. …. This includes, in particular, demonstrating progress against the Government’s priorities of: upholding the Government’s obligations under the Armed Forces Covenant;
The Covenant says:
The Armed Forces Community should enjoy the same standard of, and access to, healthcare as that received by any other UK citizen in the area they live.
Personnel injured on operations should be treated in conditions which recognise service needs
For family members, primary healthcare may be provided by the MOD in some cases (eg when accompanying Service personnel posted overseas). And … should retain their relative position on any NHS waiting list, if moved around the UK due to the Service person being posted.
Veterans … should receive priority treatment where it relates to a condition which relates to .. their service, subject to clinical need
Those injured in service should be cared for in a way which reflects the Nation’s moral obligation …with professionals who have an understanding of Armed Forces culture

10. NHS England England (not whilst Overseas), or Devolved Administrations
Direct Commissioning:
Post Operational Health Care (non-recovery)
Community Care
Hospital Care (also for MH not in main contract)
Specialist IVF
IVF on Moves
Indirect Commissioning:
CCG Assurance
DMS – NHS IM&T Connectivity
NHS England Other: Dental, “Specialised”, Offenders, Immunization, Vaccination and Screening

11. Armed Forces Networks All Local Stakeholders:
Regional Armed Forces Structures
PRUs
Local NHS – Commissioners and providers
Local Authorities
Charities
Veterans Organisations
Currently 9 in England mapped closely to Brigade structure
NHS
Armed
Forces
Charities
Local Authorities

12. Planned Improvements Continuity of Care
Pathway redesign (especially roles of
1ry/2ry)
Improved Choice
Recording and Performance monitoring of quality
Referrer Involvement
Patient and Carer involvement

13. Issues Very poor data: £15M or £170M? Philosophical Differences:
“The Armed Forces Community is entitled to appropriate recognition for the unique Service which it has given, and continues to give, to the Nation, and the unlimited liability which the Service person assumes” AF Covenant
“Only clinical features taken into account: The NHS CB must make decisions fairly about funding treatments and not on the basis of age, sex, sexuality, race, religion, lifestyle, occupation, family status (including responsibility for caring for others) social position, financial status etc. unless these directly affect the expected clinical benefit that an individual will derive from a treatment” NHS England Interim Standard Operating Procedures

14. So what does this mean for CCG’s
Involvement in Armed Forces Networks
New North East, Yorkshire & Humber AFN
CCG stewardship
Rotating chair
Multi-agency representation
Veteran’s Awareness
Identification at practice level
RCGP e-learning tool
Staff training

15. Continued ….. Veteran Mental Health Services Outreach services
Big White Wall
Combat Stress residential

16. Thank you!
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