Introduction

The history of the UK military medical services has been one of transformation. Just as the armed forces themselves have changed from the massed forces that trained to face the Warsaw Pact across the North German Plain, the UK military medical services have also changed.

From virtually autonomous single services that ran their own hospitals in the 1980s, to a more or less consolidated joint Defence Medical Service (DMS) today where the patient is the focus, which is part of the wider medical community, and which collaborates far and wide to ensure that evidence based, cutting edge medicine and treatment are embraced.

The armed forces are moving increasingly to harmonised policies, processes and structures.  The medical services of the armed forces are not immune to this unitary concept.  Although some limited variation between services will be allowed to continue for environmental requirements, this will be the exception and only to ensure overall effectiveness and efficiency.

Role

The primary role of the DMS is to ensure that service personnel are medically fit to deploy where and when required in the UK and overseas. This is generally referred to as being ‘fit for task’.

Integration with the National Health Service

The last dedicated military hospital in the UK, the Royal Hospital Haslar in Gosport, Hampshire, closed in May 2007. This was the final stage in a radical change in the delivery of health care for armed forces personnel.

The change saw the opening of Ministry of Defence (MOD) hospital units, across the UK, which are fully integrated within the NHS. The Royal Centre for Defence Medicine, located in Birmingham alongside the University Hospital Birmingham Foundation Trust, is a well-known example.

Structure

The uniformed medical and dental personnel from all three services are known collectively as the Defence Medical Services (DMS). The DMS are grouped under the Headquarters Surgeon General (HQ SG) and includes:

• The Assistant Chief of the Defence Staff (Health);
• The Joint Medical Command;
• Defence Dental Services;
• Army MedicalService;
• Royal Navy Medical Service; and
• Royal Air Force Medical Service.

From April 2013 DMS will also include Defence Primary Health Care, a joint organisation under SG’s command. This will be formed from the three single service primary healthcare organisations and will include responsibility for healthcare in the permanent overseas bases.

Surgeon General

The Surgeon General (SG) is the 3* professional head of the DMS and the process owner for end-to-end Defence healthcare and medical operational capability. The SG is accountable to the Defence Board, reporting routinely through the Service Personnel Board. The SG delivers functions in support of the Head Office as the military medical officer with responsibilities for policy making and provision of high level medical and strategic advice to ministers, the Defence Board and Chief of the Defence Staff (CDS). The SG’s responsibilities include:

• Providing specialist advice to ministers and head office;
• Development of defence medical policy;
• Process owner for end-to-end healthcare and medical operational capability;
• Provision of joint operational medical policy and operational medical advice;
• Provision of health advice to the Deputy Chief of the Defence Staff (Personnel & Training) to enable him/her to discharge his/her responsibilities for the health, well-being and welfare of Service Personnel;
• Advising Service Chiefs on the promotion and maintenance of health and prevention of injury and disease, assurance of the quality of healthcare, and oversight and governance policy to the single Services;
• Departmental external engagement with other governmental departments, professional and regulatory bodies and internationally; and
• Defence Primary Healthcare across Defence.

The Surgeon General is accountable to the Commander Joint Force Command for the outputs of his/her area and for the efficient and effective management of the budget and resources. This also includes in delivering their role as the senior responsible officer for the Defence Health Change Programme, the use of resources in discharging leadership of the DMS and for assuring external and internal medical training and education.

Range of Services

A range of services are provided to armed forces personnel by the MOD, the NHS, charities and welfare organisations, and include:

• Primary healthcare;
• Dental care;
• Hospital care;
• Rehabilitation;
• Occupational medicine;
• Community mental healthcare; and
• Specialist medical care.

DMS provides these services from a range of facilities, including medical and dental centres, regional rehabilitation units and in field hospitals.

The DMS has 15 regional rehabilitation units (RRUs) across the UK and Germany, 5 MOD hospital units (MDHUs) embedded into NHS acute trusts, the Royal Centre for Defence Medicine (RCDM) in Birmingham, and 15 military run Departments of Community Mental Health (DCMH) in the UK with 5 DCMHs at the major permanent overseas bases.

Staffing

The DMS is staffed by approximately 10,000 regular uniformed and reserve medical personnel drawn from the healthcare spectrum and includes medical, dental, nursing, allied health professionals (AHPs), paramedical and support personnel.

Working alongside civil servants and other supporting units, the DMS provides medical care to service personnel serving in the UK, abroad, those at sea, and in some circumstances family dependants of service personnel and entitled civilians; approximately 260,000 people.

It also provides some aspects of healthcare to other countries’ personnel overseas, in both permanent military bases and in areas of conflict.

Joint Medical Command

The Joint Medical Command (JMC) provides medical operational capability, healthcare, education, training and research in order to maximise fighting power and medical excellence within the Armed Forces.  The JMC includes:

• Defence Dental Services: (see below).
• Defence Medical Group (DMG): responsible for providing secondary personnel to meet operational exercises, placing staff into the NHS to maintain clinical skills and the Role 4 pathway (the treatment of operational casualties from arrival at RCDM through to rehabilitation at Headley Court),
• Defence Medical Services Training Group (DMSTG): responsible for the design, development, assurance and provision of internal medical training for DMS personnel and the Front Line commands.
• Defence Postgraduate Medical Deanery (DPMD): (see below).
• Directorate Healthcare: responsible for the commissioning of general secondary healthcare from the NHS and/or the independent sector for service personnel, primarily through the MDHU’s
• Medical Director: through academic teaching, research and clinical policy development provide input to strategic, operational, equipment and research matters.

Defence Dental Services

The Defence Dental Services (DDS) is a tri-service organisation employing just over 1000 personnel from the Royal Navy, Army, Royal Air Force and civilian sector who are trained dentists, hygienists, technicians or dental nurses as well as critical support staff. Most treatment is provided at service establishments (dental centres) in the UK and overseas.

The DDS has its headquarters at DMS (Whittington) in Staffordshire and facilitates control via 12 regional headquarters each headed by a Principle Dental Officer, located in Germany, Cyprus and across the UK.

The DDS also provides dental services to personnel on operations throughout the world in order to maximise the operational effectiveness of the armed forces by making armed forces personnel dentally fit for their task.

Defence Postgraduate Medical Deanery

Since its inception, in Gosport in 1996, the Defence Postgraduate Medical Deanery (DPMD) has been the main focus for postgraduate training not just of doctors but also nurses, dentists, vets and AHPs. The main remit of the DPMD is to oversee, quality assure and at times provide training that meets both the needs of the services and the relevant national bodies.

Defence Medical Rehabilitation Centre (Headley Court)

Due to operations in both Afghanistan and Iraq the most well-known element of the UK military medical services is the Defence Medical Rehabilitation Centre (DMRC) Headley Court.

The DMRC has been located at the same site near Epsom, Surrey for over 60 years. Originally founded as RAF Headley Court after the Second World War, for the treatment of injured RAF Aircrew, it is now part of the Joint Medical Command (JMC).

With a staff of over 360 service and civilian personnel, the DMRC provides a range of rehabilitation services from outpatients through residential courses for those with sports, exercise and industrial injuries up to those with complex life changing trauma injuries including amputation and brain injury.

The DMRC has 135 hostel rooms for force generation patients and 96 in-patient beds to support those who need more nursing support.

The DMRC is divided into five divisions which include:

1. Nursing Division;
2. Rehabilitation Division;
3. Education, Training and Research Division;
4. Executive Officer Headquarters Division; and
5. Administration Division.

Another important aspect of the DMRC is Battle Back. Battle Back is an adaptive sport and adventurous training programme for wounded, injured and sick personnel from across the armed forces, including mobilised reservists.

Battle Back programmes are designed to build confidence and independence and help accelerate physical, psychological and social recovery (mind, body and soul), inspiring the wounded, injured and sick to focus on those things that they are able to achieve.

DMS Medical Scientific Expeditions

The military has a long association with medical research which is supported through funding from the Joint Services Expeditions Trust and the Drummond foundation.

In the recent past successful expeditions have taken place in 2007 (to Aconcagua 6959m) and 2009 (Everest Base Camp EBC and Island Peak, Nepal, 6300m). These expeditions have introduced many DMS personnel to the Joint Services Adventurous Training (JSAT) scheme and generated significant data on acclimatisation to high altitudes.

Advisory Group on Military Medicine

The Advisory Group on Military Medicine (AGMM) provides specialist advice to the MOD, as required, on the medical aspects of defence against chemical, biological and radiological threats. The AGMM is an advisory non-departmental public body of the MOD.

References

MOD (Ministry of Defence) (2012) The New Operating Model: How Defence Works. Version 3. London: MOD. pp.64-65. Available from World Wide Web: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/69149/216820130108_new_operating_model_v3_final_u.pdf [Accessed: 28 March, 2013].

CQC( Care Quality Commission) (2012) Defence Medical Services: A Review of Compliance with the Essential Standards of Quality and Safety. London: CQC.

Further Reading

Healthcare Commission (2009) Defence Medical Services: A Review of the Clinical Governance of the Defence Medical Services in the UK and Overseas. London: Healthcare Commission.

Braithwiate, M., Nicholson, G., Thornton, R., Jones, D., Simpson, R., McLoughin, D. & Jenkins, D. (2009) Armed Forces Occupational Health – A Review. Occupational Medicine. 59, pp.528-538.

Burgess, J. (2010) The Army Primary Health Care Service: From Foundation to Future. Journal of the Royal Army Medical Corps. 156(3), pp.185.188.

Finnegan, A. & Finnegan, S. (2007) Assessing the Effectiveness of the British Army’s Mental Health Service. British Journal of Nursing. 16(12), pp.725-730.

Cordell, R. (2011) Defence Recovery Capability and the Transition of Healthcare. Birmingham. Defence Medical Services. Available from World Wide Web: <http://www.armedforceshealthpartnership.org.uk/media/43798/05%20DRC%20and%20the%20transition%20protocol%20cordell%2014%20Nov%2011.pdf&gt; [Accessed: 27 March, 2013].

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