Veterans' healthcare toolkit
A range of guidance for GPs on the care of patients who have served in the armed forces, and their families.
Dedicated services for veterans
Veterans' mental health services
Whilst there is often an emphasis on veterans with post-traumatic stress disorder (PTSD), the actual rates are not high (around 6.2%), which is broadly equivalent to the incidence amongst civilians. More common issues include other mental health difficulties, such as anxiety and depression, as well as problems related to alcohol. However, for those veterans who deployed when serving, rates of PTSD are higher at 9% and up to 17% for those who deployed in a front-line, infantry combat role.
There is growing evidence that a range of mental health conditions may appear (or patients may present) some years after individuals have left the armed forces. These conditions may relate to combat, training or other military experiences, transition out of service or indeed pre-service vulnerabilities.
The historical issues of stigma associated with mental health and a traditional culture of reluctance to admitting to a perceived weakness or being in a position of having to ask for help means that a substantial number of unwell veterans are unlikely to access the appropriate support and services. This is further compounded by a lack of awareness amongst veterans of what services are available to them, as well as varying levels of awareness across the NHS on the health needs of this patient group. In addition, the widespread public perception, often fuelled by mainstream media, that all veterans are damaged by their military service and all of them have PTSD is not only wrong but harmful.
Op Courage: the Veterans Mental Health and Wellbeing Service
Op Courage is the new over-arching name for the three NHS veterans’ mental health services (Veteran’s Mental Health Transition, Intervention and Liaison Service (TILS), Veteran’s Mental Health Complex Treatment Service (CTS) and Veteran’s Mental Health High Intensity Service (HIS). The new name has been developed by veterans and their families and is intended to make the services easier to find and access.
Veterans' Mental Health Transition, Intervention and Liaison Service (TILS)
This is a dedicated out-patient service for serving personnel approaching discharge from the Armed Forces and veterans who are experiencing mental health difficulties. The TILS provides a range of treatment, from recognising the early signs of mental health problems and providing access to early support, to therapeutic treatment for complex mental health difficulties and psychological trauma. Help may also be provided with housing, employment, alcohol misuse and social support.
The service comprises three elements:
- Transition: service for those in transition, leaving the armed forces The service works with the Ministry of Defence (MOD) to offer mental health support for Armed Forces personnel approaching discharge.
- Intervention: service for veterans with complex presentation Service personnel approaching discharge and veterans will have an assessment within two weeks of a receipt of referral. Where appropriate, the TILS will aim to see patients two weeks after this. This will be with a clinician who has an expert understanding of Armed Forces life and culture. They may also be supported by a care coordinator who will liaise with other services and organisations to ensure a coordinated approach to their care.
- Liaison: general service for veterans Patients who do not have complex presentations, yet would benefit from NHS care, will be referred into local mainstream NHS mental health services where they will receive treatment and support.
If an assessment finds that an individual has significant mental health difficulties that are service related and have not improved with previous treatment, they will be referred to their local CTS.
Veterans' Mental Health Complex Treatment Service (CTS)
This is an enhanced out patient service for ex-forces who have military related complex mental health difficulties that have not improved with previous treatment. The service provides a range of intensive care and treatment that may include (but is not limited to) support for drug and alcohol misuse, physical health, employment, housing, relationships and finances, as well as occupational and trauma focused therapies.
The NHS Veterans Mental Health High Intensity Service (HIS) for veterans needing urgent help who are in mental health crisis has been trialled in some regions since October 2020. It is now being rolled out across the country as part of a phased approach.
Those needing urgent help will receive a same day referral.
Veterans can self-refer or be referred by their GP, a charity or family or friends to access specialist care through this single route of Op Courage see below:
- North of England services: call 0303 123 1145 or email firstname.lastname@example.org
- Midlands or East of England services: call 0300 323 0137 or email email@example.com
- London or South East of England services: call 020 3317 6818 or email firstname.lastname@example.org
- South West of England services: call 0300 365 2000 or email email@example.com
- See the NHS website for more information as well as this leaflet on veterans mental health services
More than 13,000 veterans have benefitted from specialist care for problems such as anxiety and depression and almost 2000 have received help for more complex problems such as PTSD.
Further details are available on the NHS website.
Veterans Trauma Network (VTN)
Following feedback from veterans, their families and GPs, NHS England has worked with the MOD and key military charities to launch the Veterans Trauma Network, which provides care and treatment to those who have been injured during their time in service.
Located in ten major trauma centres across England (Plymouth, Oxford, London (three centres), Birmingham, Nottingham, Liverpool, Leeds and Middlesborough), the network links with the TILS, CTS and key military charities to provide a complete package of care.
GPs can use a single email (firstname.lastname@example.org) to refer veterans to the service, where they will benefit from specialist care by military and civilian experts..
Patients using the service will have a personalised treatment plan that links to other services where required, such as rehabilitation and mental health, whilst families and carers will be supported to access services they may benefit from.
For more information or to refer a patient, email the Veterans Trauma Network
A veterans' prosthetics programme was put into place to implement the key findings of A better deal for military amputees report by Dr Andrew Murrison MP.
Dr Murrison recommended that a small number of NHS disablement centres should provide specialist prosthetic and rehabilitation support to veterans to ensure that they continue to have access to high quality care similar to that which was provided to them whilst they were in the Armed Forces. The following nine Disablement Service Centres (DSCs) were selected to provide this support although veterans are free to attend the NHS DSC of their choice:
- Bristol – Bristol Centre for Enablement, North Bristol NHS Trust
- Leicester – Leicester Specialist Mobility Centre, provided by Blatchford Clinical Services on behalf of clinical commissioning groups (CCGs)
- Sheffield – Mobility and Specialised Rehabilitation Centre, Northern General Hospital
- Carlisle – Disablement Services Centre, Cumberland Infirmary, North Cumbria University Hospitals NHS Trust
- Preston – Specialist Mobility & Rehabilitation Centre, Lancashire Teaching Hospitals NHS Foundation Trust
- Stanmore – Stanmore Prosthetic Rehabilitation Unit, Royal National Orthopaedic Hospital Trust
- Portsmouth – Prosthetic Regional Rehabilitation Department, Portsmouth Hospitals NHS Trust
- Birmingham – West Midlands Rehabilitation Centre, Birmingham Community Healthcare NHS Trust
- Cambridge – Addenbrooke's Rehabilitation Clinic, Cambridge University Hospitals NHS Foundation Trust
In addition to providing support to nine DSCs, a Veterans' Prosthetics Panel (VPP) was established in 2012. The VPP was designed to ensure that veterans could access high-quality prosthetics regardless of which DSC they attend. Applications for funding from the VPP are made by a veteran's prosthetist.
The National Prosthetics Service (NPS) is Scotland's centre for designing and fitting prosthetic limbs.
Personalised care for veterans with a long term physical, mental or neurological health condition or disability
NHS England and NHS Improvement, together with the Ministry of Defence, have published the Personalised care for veterans in England, a guide for clinical commissioning groups and local authorities, which sets out a new personalised care approach for those veterans who have a long term physical, mental or neurological health condition or disability.
This guide is for those individuals and organisations who are leading or involved in supporting this patient group through the delivery of NHS Continuing Health Care or a jointly agreed care plan. A supporting patient leaflet is also available.
Eligible individuals will have a single personalised care plan for all their health and wellbeing needs that is developed with them and a range of organisations, including health and social care and military charities. This approach will give the individual more choice and control over how their care is planned and delivered, meaning they can choose how best to live their life and get the right care and support to make this happen. It will also take into account personal preferences that relate specifically to the individual’s military service. As part of this, they may get a personal budget to pay for some of the care and support they need, as well as more support in the community, such as emotional and practical support from people who have similar health conditions or disabilities. To apply, individuals should contact their local clinical commissioning group.
Veterans Covenant Health Alliance
The Veterans Covenant Health Alliance is a network of over 30 acute hospitals that have been accredited as exemplars of the best care for veterans, helping to drive improvements in NHS care for people who serve or have served in the UK armed forces and
The ambition is to have 75 NHS providers accredited by the end of 2019, with plans to expand this important initiative to mental health and ambulance trusts. For more information please email email@example.com or visit the NHS website.
Mobility equipment support
The Royal British Legion has a Veterans' Mobility Fund, which provides specialist wheelchairs, orthotic equipment and other mobility related items for veterans who have a service related serious physical injury and whose needs cannot be met through statutory services. Eligibility for the fund requires the condition to be attributable to service and typically applicants will be in receipt of a War Pension or relevant award under the Armed Forces Compensation Scheme. To find out more, visit the British Legion website.
The Armed Forces Healthcare Navigator Service
The Defence Medical Welfare Service (DMWS) provides emotional and practical support to the Armed Forces community when they are on a health care pathway, receiving treatment in hospital, community based health care, or at home.
Assessing, identifying, and addressing welfare and wellbeing issues that are a barrier to recovery or good health and wellbeing, DMWS work with the individual, their family, carers, and health and social care partners, to find solutions and provide onward supported referrals to other organisations for services beyond the scope of DMWS intervention.
DMWS' professional and expert medical welfare service evidences reduction in delayed transfers of care, reduction in frequent attendance at A&E, enables independent living, reduces social isolation, improves wellbeing, and provides a coordinated, holistic approach to accessing the right support, in the right place, at the right time
Veterans can be referred to DMWS or can contact DMWS directly. For more information, visit Defence Medical Welfare Service website