Wednesday, March 21, 2007

The Selly Oak Saga

The neglect of care for even one wounded soldier is unconscionable, the Defence Medical Sevices (DMS) and the NHS in Selly Oak should be ashamed. However, this sorry incident should not lead to the re-writing of history. There are those who hold that this alleged failure of care for wounded soldiers, is a symptom of a much deeper and serious problem, the demise of military hospitals. The reality is that for many years, up to the Defence Review of the early 1990’s, the DMS were ‘hollow’ at every level, including military hospitals, and the reason was not simply a lack of money.

The modern military comprises a relatively small number of fit young men and women who do rather well at not getting hurt or sick and is a veritable desert for medical practice. Consequently, for forty years at least, it had been very difficult to recruit, train and retain clinical specialists, or indeed any medical professional, because they could not obtain the breadth and depth of clinical practice and training necessary to qualify and compete in the civilian professional arena. The system reached critical proportions in the late 80s when the DMS was so short of expertise, individual consultant surgeons were taxied round the military hospitals of the British Army Of the Rhine (BAOR).

Deployed medical units had to be cobbled together in a system called ‘Robbing Peter To Pay Paul’, starting from the Regimental Aid Post and working back. The Navy closed its hospitals to man one hospital ship in the Falklands War and the still had to be reinforced by the Army and RAF. In the first Gulf War, one Army Field Hospital in the UK Order of Battle (ORBAT) comprised thirty different cap-badges. When the 1992 Defence Review offered the military medical services an opportunity to reorganize, many within sighed with relief.

The first role of the DMS in peace is to train and organize for war. Future military operational concepts required that we [the DMS] support a smaller military, based at home, deployed in relatively small numbers for specific operations. Moreover, combat power no longer measured by ‘bayonet strength’ – numbers of men on the ground. The DMS did not need to be organized, equipped and manned to managed the predicted casualty estimates for industrial war.

Once a soldier was injured and out of the fight fight he/she needed to be out of harms way. Moreover, we didn’t have just one casualty, his/her mum/dad/wife/husband/kids etc were also casualties, at least until they sat by his'her bed. Everything pointed then, and does now, to getting ‘Tommy’ home, quickly, to his/her family and to the best definitive care available. That care, is best provided by medical teams experienced in trauma care and its long-term management. The Defence Services had, since the early 60’s only had such expertise in the Reserves, drawn from the NHS.

The logical conclusion was to bring the wounded to those experts in the NHS. In this scenario, the increasingly anachronistic military hospitals were redundant. A military medical organization was designed from the frontline combat soldier through hybrid military/NHS UK hospitals to The Joint Services Rehabilitation Unit at Headley Court. Manpower deemed essential in peace and war was designated Regular or Active DMS, the balance to come from the Reserves, TA and individual reservist.

The result, today’s DMS, is a more balanced organization better able to manage the complex missions of modern war. I have no doubt that the current organization is a work in progress, as it should be. Neither do I doubt that there are real faults to be fixed. However, we should not contemplate going back to the days of the Cold War. As to the siren voices of the military hospital lobby, I offer a comment from [I think] Basil Liddle-Hart “There is only one thing more difficult than getting a new idea into an Officer’s head, and that is getting an old one out’.

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