United Kingdom of Great Britain and Northern Ireland
Martin CM Bricknell QHP OStJ PhD DM MA MMedSci MBA FIHM FFPH MFOM MRCGP
Defence Medical Services
Basic Task of the Medical Service
The Defence Medical Services (DMS)
The uniformed medical and dental personnel from all three Services are known collectively as the DMS. The primary role of the DMS is to Promote, Protect and Restore the health of Service personnel to ensure that they are ready and medically fit to go where they are required in the UK and throughout the world – generally referred to as being ‘fit for task’. The DMS encompass the entire medical, dental, nursing, allied health professionals, paramedical and support personnel. It is staffed by around 9,100 personnel (6,900 Regular and 2,200 Reserve) and provides healthcare to 159,630 Regular Servicemen and women. Personnel from all three Services, Regulars and Reserves, work alongside Civil Servants and other supporting units providing healthcare to Service personnel serving in the UK, abroad, those at sea, and in some circumstances family dependents of Service personnel and entitled civilians. It also provides some aspects of healthcare to other countries’ personnel overseas, in both permanent military bases and in areas of conflict.
The range of services provided by the DMS includes primary healthcare, dental care, secondary healthcare, rehabilitation, occupational medicine, community mental healthcare and specialist medical care. It also provides healthcare in a range of facilities, including Medical and Dental Centres, Regional Rehabilitation Units and in Field Hospitals as well as the RAF led Aeromedical Evacuation service.
The DMS are grouped under the Headquarters Surgeon General (HQ SG) the Director Medical Policy and Operational Capability and the Director of Healthcare Delivery and Training.
Medical, dental and related support services are delivered to Armed Forces personnel by the DMS, the National Health Service England (NHS), the Devolved Administrations’ Departments of Health, charities and welfare organizations.
Headquarters Surgeon General (HQ SG)
HQ SG is the strategic headquarters of the DMS based at DMS Whittington (DMS(W)) near Lichfield in Staffordshire. It is involved in a number of defence medical projects, initiatives, campaigns and policy areas.
The SG is the three-star Military Officer and professional head of the DMS and the Defence Authority for end to end Defence healthcare and medical operational capability. The SG is accountable to the Defence Board, reporting routinely through the Defence Audit Committee and the Defence People and Training Board.
The HQ SG is responsible for:
- Defining the boundaries and processes, in consultation with Top-Level Budget Holders, together with the organizational structures and composition of Forces, and the standards and quality needed, to deliver advice on health policy, healthcare and medical operational capability;
- Setting the overall direction on all clinical matters relating to the practice of military medicine;
- Setting and auditing the professional performance of all military medical personnel;
- Setting clinical and medical policies and standards, and auditing compliance by military organizations across Defence; Developing the science of military medicine to develop approaches and treatments that will best counter threats to the health and wellbeing of Service personnel;
- Providing deployable medical operational capability;
- Building and maintaining the medical infrastructure and cadre of people;
- Delivering a comprehensive healthcare system that provides the appropriate timely healthcare to Service and other entitled personnel;
- Ensuring coherence of health plans between Defence and the NHS; and
- Chairing the Defence Medical Services Board, the forum for providing strategic direction and guidance to the DMS.
Directorate of Healthcare Delivery and Training (HDT) is responsible for the delivery of all healthcare including primary healthcare; the placement of secondary care personnel in NHS facilities; and medical education and training. HDT employs both military and civilian staff, providing clinical and support services. The organization operates from sites across the UK and overseas to provide clinical support, academic and military education and training, ranging from new nurse and combat medical technician recruits through to hospital consultants. In order to deliver this capability, HDT is divided into four pillars: Defence Primary Healthcare (DPHC); Defence Medical Group (DMG); Defence Healthcare Education and Training (DHET); and Future Health (FH).
Defence Primary Healthcare (DPHC)
The role of DPHC is to provide and commission a safe, effective and efficient healthcare service for entitled personnel contributing to the maximization of Service Personnel fit for task as agreed with the single Services. This is achieved through the provision of an occupationally-aware primary healthcare service which includes dental, rehabilitation and mental healthcare services. DPHC provides a unified clear focus for the delivery of the primary healthcare element of Force Generation and preparation employing both uniformed and civilian healthcare staff as well as commissioned NHS services. It exploits the synergies inherent in managing the patient pathway for all three Services across general practice, rehabilitation, mental health, occupational health and dentistry. This is achieved in a culture which embraces quality and patient safety. In doing so DPHC provides the vehicle for mentor ing and training all professional groups (including those with no NHS equivalent) by those already experienced militarily and clinically from previous deployments. DPHC continues to seek greater collaboration with the NHS whilst championing new ways of working resulting in the best value healthcare, focusing on return to work and fitness for operations, rather than absence through sickness, meeting the needs of both the patient and the single Services.
Defence Medical Group (DMG)
DMG provide highly capable secondary healthcare personnel for operations and deliver the operational Role 4 patient pathway. Defence secondary healthcare personnel are ‘placed’ under contract within carefully selected NHS Trusts. Day-to-day interaction with these Trusts and operational command of military personnel embedded within them is conducted by four DMG regional headquarters (DMG North, DMG South, DMG South East and DMG South West). This arrangement ensures that our secondary healthcare personnel are optimally prepared, meeting statutory and professional needs, whilst remaining available to Defence at the required readiness.
DMG are also responsible for the Role 4 Operational Care Pathway which comprises the Royal Centre for Defence Medicine (RCDM) and the Defence Medical Rehabilitation Centre (DMRC) based at Headley Court. Both are responsible for delivering elements of specialist Inter mediate Care for which there is no equivalent capability with in the NHS.
Defence Healthcare Education and Training (DHET)
DHET commission, develop, deliver and quality assure healthcare education and training in order to meet the needs of Defence. DHET is comprised of the Deanery, which facilitates and quality manages higher professional training of healthcare professionals and Defence College of Healthcare Education and Training (DCHET) which designs, develops, delivers and assures all internal Defence healthcare (Phase 2 & 3) training and education. DHET also commission all tri-service education and training and facilitate all DMS military and civilian external clinical professional training needs. DHET also comprises the Defence Medical Library Service (DMLS), which provides a professional library service to support the medical information requirement of the DMS worldwide.
The Royal Naval Medical Services (RNMS)
The vision of the RNMS is to excel in supporting the operational capability of the Royal Navy; it provides comprehensive healthcare to ships, submarines and Royal Marine personnel. It is headed by the Medical Director General (Naval) the medical adviser to the Admiralty Board.
The mission of the RNMS is to provide a fully manned, sufficiently trained, equipped and resourced organization with high morale, capable of providing timely high quality medical support to the operational capability of the Royal Navy to meet the requirements of the Commanders.
The Army Medical Services (AMS)
The AMS provides Army medical and veterinary policy, operational capability, healthcare advice and assurance, in order to enhance and sustain the operational effectiveness of the Army. Army operational healthcare is provided through the following:
- Regular and Reserve Army Medical regiments that provide pre-hospital care; and
- Regular and Reserve Field Hospitals.
Members of the AMS contribute the largest numbers of staff to the DMS and run the majority of Field Hospital deployments, which is a key capability of the DMS. The AMS encompass:
- Royal Army Medical Corps;
- Royal Army Veterinary Corps;
- Royal Army Dental Corps; and
- Queen Alexandra’s Army Nursing Corps.
The Royal Air Force Medical Services (RAFMS)
The RAFMS vision is ‘to be a world-class medical service in support of air power’. The RAFMS is comprised of Regular and Reserve personnel who deliver an air minded approach to health and specialize in understanding how the unique attributes of the air environment affect both personnel as well as patients. The Head of the RAFMS is the professional lead of the RAFMS and is a principal advisor on the recruitment, employment and career management of RAF medical personnel.
The RAFMS contributes important capabilities to the DMS and sustains a cadre of secondary care specialists including medical officers, nurses and a number of allied health professionals. These personnel are assigned to the JMC for placement in NHS appointments and they are released on active service when required to support the deployed medical operational capability.
The RAFMS is the lead authority on Defence Aviation Medicine.
Intermediate and Secondary Healthcare
The DMS has 15 Regional Rehabilitation Units (RRUs) across the UK and Germany, 4 MDHUs embedded into NHS Trusts, the RCDM in Birmingham, and 16 military-run Departments of Community Mental Health (DCMH) in the UK with five DCMHs at the major permanent overseas bases. The Queen Elizabeth Hospital Birmingham is home of the University Hospitals Birmingham NHS Foundation Trust (UHBFT) and the host of the RCDM. This state-of-the-art hospital houses the largest single-floor critical care unit in Europe consisting of 100 beds. It is the main UK receiving hospital for military patients aeromedically evacuated from around the world.
Contained within the hull of Royal Fleet Auxiliary (RFA) Argus is a purpose built deployable hospital facility – referred to as the Primary Casualty Receiving Facility. RFA Argus effectively provides the Royal Navy, Royal Marines and other personnel ashore with rapid access to deployed hospital based care. The facility has a comprehensive range of contemporary medical equipment and extensive consultant led clinical capabilities. When required for medical support on operations and exercises, clinical staff from all three Services, but drawn predominantly from the Naval Service who work within MDHUs, join RFA Argus to allow her to deliver the levels of medical provision required.
The hospital facility was initially fitted for the first Gulf conflict in 1991. A major rebuild of the facility took place in 2001, which has resulted in the present permanent facility. RFA Argus deployed to the Iraq war in 2003 and is held at a high state of readiness to meet future Defence commitments and regularly takes part in exercises in order to test her deployable hospital capability.
In support of operations and national interests, the RAF delivers a world-wide aeromedical evacuation service for military personnel and other entitled people who are injured or seriously ill and need to be repatriated for their medical care. This service is controlled and tasked by the Aeromedical Evacuation Control Cell at RAF Brize Norton and is part of the Integrated Transport Operations Centre. Medical personnel are trained and assembled by the Tactical Medical Wing (at RAF Brize Norton to sustain, at a moments notice, a medical life line capable of reaching any destination with airport facilities). In an operational context, there is a high dependence on the tactical and strategic environment of casualties and patients. Medical Emergency Response Teams extract casualties by helicopter from the point of wounding to a Field Hospital.
Depending on the clinical condition of the casualty, Critical Care Air Support Teams or Aeromedical Evacuation teams are deployed from RAF Brize Norton by C17 Globemaster to repatriate casualties mainly to the care of Queen Elizabeth Hospital, Birmingham.