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Last Updated: Wednesday, 21 March 2007, 11:14 GMT
Hospitals fit for heroes?
By Joe Campbell
BBC News

Injured soldier
Concerns were raised about the care of wounded soldiers

The forces' hospitals were perhaps the ultimate insurance policy.

But like the car, holiday or home cover we buy, it is easy when times are good to see the cost of such insurance as an unnecessary expense.

The current system of caring for injured soldiers, sailors and members of the Royal Air Force in civilian hospitals - staffed jointly by NHS and military medics - was not thought up by the current government.

But critics argue the flaws they say have been highlighted by the war in Iraq have not stopped Whitehall from pressing ahead with the closure of the last military-run hospital which is to be handed over to the NHS at the end of the month.

When the military's doctors and nurses stage a ceremonial march out from Haslar Hospital, near Portsmouth, on 28 March, it will mark the end of an era.

Teeth and tail

The process of change began as the military was told to cut its frontline tanks, warships, and fighter planes with the end of the Cold War.

If the so-called "teeth" were being cut, so went the argument, there was also a need to reduce the military "tail" and that included the three hospitals at Aldershot, Gosport and near Swindon run by the Army, Navy and Air Force.

Members of the services and their families paid taxes like everyone else, the then Conservative government argued, so why should their first port of call in a medical situation not be the National Health Service hospital those taxes helped pay for?

So the plans was hatched to establish the so-called Ministry of Defence Hospital Units - in effect wards in existing hospitals where the forces' doctors and nurses could practice their skills and the military could send its sick and wounded.

System tested

The drawn out campaign in Iraq at the same time as forces are fighting in Afghanistan has been the first real test for the system, and many in the military say it has highlighted flaws they'd long warned about.

Prince Charles visits wounded soldiers
Selly Oak gets royal visit - but "hiccups" in care have been reported

The House of Commons Defence Select Committee will announce a formal investigation into the military's medical services in the next few weeks.

Among the areas it will examine is the performance of Selly Oak Hospital in Birmingham which has a specialist unit to treat casualties from war zones like Iraq and Afghanistan.

Senior medical sources say staff there have been left "feeling a little bruised" by attacks on the standard of care.

They say that with soldiers surviving with injuries that previously would have seen them die on the battlefield, they need the kind of specialist attention that can only be found in a major civilian hospital with ties to a university medical school like Selly Oak.

Whitehall also says that the military's own medics need to work in that kind of NHS environment if they're to keep their skills up to date for when they may need to use them on the battlefield.

But even those who acknowledge all those arguments accept there are drawbacks.

There will be hiccups, but Birmingham is providing ground-breaking treatment
Senior Army doctor

One high ranking military doctor said: "We know the NHS is an organisation that's under pressure so inevitably there will be hiccups when you come to routine, day to day care.

"But I'm convinced Birmingham is providing ground-breaking treatment for soldiers who a few years ago we'd have lost in theatre but are still very, very sick when we get them home."

The most seriously wounded soldiers were always treated in civilian hospitals.

Under the old system though, they went on to complete their recovery in specialist military hospitals.

MILITARY MEDICAL UNIT
Selly Oak treats all UK forces medical evacuees from Iraq and Afghanistan
6,000 military personnel have been admitted since 2001, of whom nearly 200 were hurt in conflict
30,000 military outpatients have been treated since 2001
Its specialities are trauma, orthopaedics, burns, plastic surgery and neurology

Haslar is the only one still open, but its days are numbered with the hand-over from military to health service looming. Its full closure is expected to follow once work on a new civilian hospital is finished a few miles away.

Opponents of the Ministry of Defence's withdrawal from the site say Haslar has provided a unique atmosphere, where military casualties can recover alongside others who understand what they've been through in a way civilians never can.

Local MP Peter Viggers, cites the story of a wounded Royal Marine airlifted back to Britain, who woke up to find himself in Selly Oak.

"He was in a ward with five elderly ladies while his mind was still full of the battle he'd been wounded in," says Mr Viggers.

"One of them asked what had happened to him and he just told them he'd been injured at work because he couldn't face talking about his experiences in that setting."

'Getting better'

That's not the case according to the Army's top general who has responded to critics of the care of wounded troops at Selly Oak.

In a recent BBC interview, General Sir Richard Dannatt said recovering soldiers were no longer on wards with civilians, and were able to be together.

General Sir Richard Dannatt
There was an issue, we have responded to it
General Sir Richard Dannatt

"They are bantering as soldiers like to do and they are getting better because they are together."

"There was an issue, we have responded to it, it is getting better," he said.

With the controversy over the care at Birmingham so fresh, the government's critics argue there's no justification for shutting the last forces hospital at Haslar.

They argue it will leave Britain as the only country in the developed world without a dedicated hospital for its military personnel - and at a time when the wounded continue to come home from Iraq and Afghanistan.


SEE ALSO
Continuing fight to save Haslar
30 Nov 06 |  Hampshire

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