Introduction

The Royal Naval Medical Service (RNMS) promotes and maintains the health, fitness and well-being of service personnel in order aid operational capability and effectiveness.

RNMS personnel operate across the full range of RN assets and locations, including land establishments, surface ships, submarines, the Fleet Air Arm and the Royal Marines. In addition to their medical training personnel also receive special to arms training to prepare them for the military role in which they are to deploy.

The Royal Naval Medical Services are currently divided into six areas:

1. Medical Assurance;
2. Medical Healthcare;
3. Medical Operational Capability;
4. Medical Support;
5. Naval Nursing Services; and
6. Institute of Naval Medicine.

Medical Assurance

The Medical Assurance Team is responsible for providing internal assurance of medical care provided to service personnel in all of the RN’s facilities.  The team visits each facility on a two-year rolling programme using a peer review process (consisting of current clinical experts from the RN, RAF and Army).

Assurance in the RN is ultimately a process-based system to protect the patients, minimise risk, and promote healthcare quality improvement. It ensures that care is provided in a safe and effective manner, risk is identified and managed with associated quality improvement, thus maximising the operational capability of the RN and the Royal Marines.

Medical Assurance has now fully encompassed the Care Quality Commission’s (CQC) requirements in to the Defence Medical Services paperwork and processes. Although the armed forces do not have to be externally audited by the CQC, unlike the NHS who do, the CQC was invited to provide external assurance to the armed forces. As part of this process CQC conducted a review of the armed forces care provision during 2011/2012 (CQC, 2012).

Medical Healthcare

Medical Healthcare is the RN’s version of primary healthcare. RN medical centres, based at RN land establishments, are staffed by a variety of personnel including doctors, medical assistants, and nurses. In addition to the normal team found in any NHS GP surgery, RN patients also have enhanced access to physiotherapy, mental health specialists and to experts in wound management.

RN medical centres and ships are assessed periodically against agreed NHS standards, and regularly visited and supported to ensure that systems and training are in place to not only match but generally exceed those standards.

Medical Support and Operational Capability

Within ships and submarines medical operational capability equates to primary care and is provided by medical assistants who deliver day-to-day clinical treatment and preventive medicine, often in isolation from a medical officer. Medical assistants also deploy with the Royal Marines to assist the commando unit medical officers in the provision of routine medical support.

When operations dictate, additional surgical elements may supplement the clinical capabilities of the medical squadron of the Commando Logistic Regiment to form Commando Forward Surgical Groups. These groups are lightly equipped and mobile, enabling surgical support to be provided to commando units close to the forward edge of the battle area.

Dental care in peacetime is achieved by deploying dental officers to Royal Marine units and some amphibious ships, with temporary mobile teams deployed to other ships as requested in order to maintain oral health at high levels. In conflict, such care would be enhanced with the deployment of additional mobile teams, each of which would provide support for a small group of ships.

Naval Nursing Service

The Queen Alexandra’s Royal Naval Nursing Service (QARNNS) was founded in 1902 and provides nurses (male and female) to the RN across the range of assets and locations, in both medical and non-medical settings.

The QARNNS currently has nurses employed across the spectrum of specialities, including the most recently introduced in Burns and Plastics, Orthopaedic Trauma and Practice (Primary Care) Nursing.  The Director Naval Nursing QARNNS is also the matron-in-chief and responsible officer for the Medical Assurance Team.

Institute of Naval Medicine

The purpose of the Institute of Naval Medicine (INM) is to optimise the operational capability of the RN and UK Defence by the provision of robust medical and scientific outputs. The INM is a world class centre in occupational health, particularly in problems associated with work and operations in maritime and climatically hostile environments. The INM’s principal areas of business include:

• Providing well informed advice and information, on maritime and military health and safety, based on expert knowledge, long experience and an international network of expert colleagues, to fulfil customer requirements.
• Where required knowledge is not available, undertaking occupational health research and surveys to improve operational effectiveness in all environments where RN personnel may be required to serve.
• Training operationally deployable specialist medical and scientific staff, notably in diving, submarine and radiation medicine and having specified numbers available to meet operational requirements.
• Delivering specialist training in maritime medicine, health and safety and radiological protection to medical and non-medical personnel to agreed standards or to meet operational requirements – provided principally by on-site specialists and acting as customer agent of the Defence Medical Education and Training Agency.
• Providing clinical opinions and treatments, as required, to appropriate professional standards.
• Providing central medical administration services, including managing the Naval Service’s Medical Boards of Survey to determine the correct medical employability category so that Naval personnel may be employed to best effect.  Additionally to provide medico-legal advice, medical resettlement, and to process the medical records of those who have left the service, including the provision of copies of documents when requested.
• INM work in close association with colleagues in the Environmental Sciences division of the Defence Science and Technology Laboratory, whose Radiological Protection Services are co-located on the INM site.

Career Roles

Within the RNMS there a range of different roles for both offices and other ranks, as illustrated below:

Officer Roles

• Nursing Officer: alongside your clinical work, they are also responsible for training student and junior nurses. There are opportunities postgraduate training in areas such as intensive care, theatre nursing, orthopaedics, burns and plastic surgery, A&E nursing, primary care and critical-care nurse.
• Medical Officer: can serve at sea or on shore, specialise in a major discipline, practise occupational medicine, or submarine, diving, aviation and radiation medicine.
• Environmental Health Officer: when deployed with the Royal Marines or joint operations, the environmental health officer will manage a team of technicians securing safe water supplies and sanitation in the field. They are also in charge of environmental health policy and practice on board ships and submarines.
• Dental Officer: work in a variety of environments and there are opportunities to pursue a number of specialist disciplines.

Soldier Roles

• Medical Assistant (General Service): providing day-to-day healthcare for the ship’s crew, trained in advanced first aid and life-saving. On larger ships, medical assistants are part of a medical team, while on smaller ships they may be the only medic on board, providing health education and first-aid training as well as medical care. Medical assistants also work in the sick quarters of RN and Royal Marine shore bases.
• Medical Assistant (Submariner): as well as clinical duties, submariners also carry out specialist tasks unique to the submarine environment (such as monitoring air and water supplies, and carrying out vital health and environmental safety checks).
• Naval Nurse: In peacetime and conflict, Naval Nurses are central to keeping everyone fit, healthy and effective. Entry can enter either as a student nurse or after qualifying.
• Dental Nurse: work alongside the dental officer and are responsible for preparing materials and instruments, making appointments and maintaining surgery stocks.
• Dental Hygienist: are responsible for running, restocking and maintaining their own surgery and have control over their own diary. Although it is mainly a clinical job, there is also an educational angle. A dental hygienist is expected to give advice on oral hygiene, diet and nutrition to everyone from new recruits to families and children of fellow personnel.

References

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