A serving Royal Navy sailor was forced to wait five years for specialist NHS treatment after being told that the Armed Forces Covenant did not apply to them — a case MPs say illustrates how the Covenant is “falling short” across government.
The case, submitted anonymously to the Defence Committee’s inquiry, was included in today’s report on the Covenant, which found the system to be inconsistently applied and lacking enforceability, despite being enshrined in law.
The service member had spent two years on a waiting list in Scotland for treatment for a specific medical condition. When they were posted to the south of England, they were told their place in the queue would transfer with them under the terms of the Armed Forces Covenant.
But that promise was broken.
“I received a letter from the local trust stating I had been transferred to their waiting list, but my position was once again at the back of the list and at three years again,” the sailor wrote.
When the individual and their military doctor challenged the decision and quoted the Armed Forces Covenant, they were told bluntly by the trust: “They didn’t recognise and therefore follow the Armed Forces Covenant.”
Despite repeated efforts to resolve the matter, no mechanism existed to formally challenge the decision. As a result, the sailor waited an additional three years – five in total – to access the treatment they had already been waiting for.
The Defence Committee said this case underscores serious flaws in how the Covenant is implemented across public services. “It is surprising that government departments (in this example NHS) are able to opt-out of the Armed Forces Covenant,” the anonymous submission concluded.
In response, MPs are calling for the Government to expand the Covenant’s Legal Duty to include all Whitehall departments and devolved administrations, and to ensure those expected to implement it are given the resources and accountability required.
“We heard evidence of personnel being financially disadvantaged, unable to access necessary medical care, or unable to find an appropriate school for their children, due to their service,” said Committee Chair Tan Dhesi MP. “When the Covenant works – it works well… but this is a lottery, made worse by the unpredictability and mobility of service life.”
The report makes clear that legislation alone is not enough — government must now embed awareness of the Covenant across institutions and ensure it is backed with both guidance and enforcement. Without such changes, the promise of fair treatment for those who serve will continue to depend on postcode and chance.
Institutional changes need to be made, but also that decision-maker needs to be fired and their pension scheme should not be recognised.
The institution that needs to change is the MoD and the government, the covenant is a PR gimmick that never existed. Why should the MoD as an employer be entitled special NHS treatment vs any other employer.
The main thing anyone should I take from this is what is anyone in the UK having to wait 2 years in one waiting list then 3 years on another.
Skipping military personnel to the front of lists is not a solution.
If the MoD needs to relocate people it can take responsibility for ensuring their medical needs are taken care of like any other employer not simply expect someone else to worry about it.
Why didn’t the military pay for this treatment, once this occurred and invoice the offending nhs trust + interest +penalty. Shocking how we treat serving and ex military in this country
Unfortunately you can’t do that under the NHS Act – otherwise loads of people would do it!
This is terrible.
We need our service people fit and well….to serve….
Clearly the military medics got this but NHS had opted out of reason, legislation and common sense as is its usual mode.
“Clearly the military medics got this”
What do you mean by that?
Military medics don’t got this.
They don’t treat all conditions; if a serving member of the armed forces has a medical issue, especially a chronic one as seems to be indicated by this, then they get NHS treatment.
I wonder whether access to private medical care, similar to how some employers do discounts for private medical insurance, could be a good answer. It would allow serving personnel to jump the queues and get treated faster – making them fit and combat-ready sooner.
I couldn’t see in the article what this treatment was for, but waiting 5 years is a long time that this individual is potentially out of action for. Offer private medical insurance and he/she could have been treated within weeks and back to 100% much sooner than waiting on NHS, even if their position in the waiting list had been honoured.
In a very basic sense this is why I was asking for clarification. That being said there are structures within the Military to handle chronic issues. That’s why the Military maintains it’s own Doctors and Nurses, as well as Frimley Park Hospital and it’s relationship with the Role 4 in Birmingham (it also has it’s own Physiotherapists etc for continuing care).
Just to think back when we actually had BMHs for our servicemen! Treatment given and back to work a damn sight faster than now!
Even if we had one now surely it would pay for itself in the long run?
The government of the day stated that service personnel would be given priority NHS treatment to justify the closures of military hospitals. During the latter part of my military career (and since), I have never been given priority for anything. Currently in a two year waiting list for ‘counselling’ to help with severe tinnitus. Successive governments (and the population) have little respect for the military or veterans.
Jacko. The BMHs also treated local civilians.
W/O had one child in BMH Rinteln and one in RAF Ely👍
Service personnel are treated as second class citizens – Living in accommodation that is unfit for immigrants. And… HMG wonder why they have a problem attracting and retaining personnel?
Waiting for Jonathan on this, but seriously, depending on the treatment needed, this is just the reality of the NHS.
The new Labour SoS Health Wes Streeting has taken an axe to the hugely expensive QUANGO NHS England, their CEO Amanda Pritchard (who was in charge during the pandemic) has been forced to step down. A “government source” is quoted by the BBC indicating NHS England would in due course be a smaller organisation – meaning a lot of quangocrats are going to lose their jobs. Streeting has extended the cull of duplication and middle-management admin empires in the NHS to include the Integrated Care Boards – another part of the disastrous 2012 Lansley “reforms”
Streeting should build on his excellent start and clear the middle management empire-builders from a few floors in our hospitals, turning them into wards. Getting acutely ill patients off trolleys in corridors looks like a better use of resources than spending money on nice carpeted warm offices and desks for admin middle managers.
The NHS headcount reduction following the scrapping of the QUANGO NHS England (12,000) and the next round (35,000) is now 47,000. The total budget for NHS England’s administration and programme alone was £3.2bn in 2023/4, around 2% of the total NHS spend.
Slashing 47,000 duplicated NHS jobs will save at least $800 million in staff pay each year, to which one can add an estimated £2.9bn going forward in reduced pension costs.
None of Streeting’s job losses will involve clinical staff, doctors, nurses or lab people. Hopefully, by next winter those severely ill patients currently languishing on trolleys in corridors will be accommodated in new wards vacated by NHS admin, with a big reduction in waiting lists. Hopefully the Armed Forces Covenant will be honoured, now that a lot of faceless NHS quangocrats have been bin
Perhaps they should get on one of the rubber ‘Cross Channel ferries’. Then it is front of the queue for health treatment, hotels, food, etc. All paid for gratefully by the British tax payer. No problems!
There seems to be a mentality among MPs that merely passing laws somehow solves problems- no further work required.
A few important points:
First what is the covenant well it’s a set of principles in law, but without any real set in stone actions that must be taken or undertaken.. it’s not a speed limit.
So it’s principles
1) Those who serve in the Armed Forces, whether Regular or Reserve, those who have served in the past, and their families, should face no disadvantage compared to other citizens in the provision of public and commercial services.
1)Special consideration is appropriate in some cases, especially for those who have given most such as the injured and the bereaved.
What that boils down to is for point 1) nhs organisations should be treating service personnel in the same way as they would someone with protected characteristics who may be disadvantaged. Essentially it adds an extra protected characteristics.. but that only means levelling the playing field..so if you are moved around making sure you don’t get disadvantaged etc. But there are 9 other protected characteristics in law which comes first, Also nhs organisations are bound first by what is in their contract and individual professionals are always bound first by need not who deserves it ( if I had two people bleeding out on a street I would only be looking at who’s going to die first.. then I just might if it was a child vs an adult go for the child first if it was close that’s as far as my professional practice would allow me to choose) Point 2 is a bit more interesting as that really means someone who has suffered a lot in service should get preferential treatment.. but there is no definition of what that really means ( is it being a bit deaf in one ear after working on the flight deck of HMS eagle or losing and arm and a leg.. or something in between) and exactly what preferential treatment do they get and how far do you take it.. (do they get a hospital bed to sort an elective issue that can wait.. while an old lady dies in a trolley in a corridor? Because we cannot professionally or legally allow that )
Finally the wording of the individual organisations obligations the organisation must take due regard for the principles.. I can assure you all as a senior leader responsible for life and death of lots of people that was stretched to the limits and failing many, things that required “due regard” essentially go almost no regard.. because what the hell is due regard ? Especially when the EDs you oversee for quality have people waiting 24 hours on trollies and your ambulances are taking 4 hours to get to potentially critical patients..
Finally and this is the bit most people cannot get their heads around the NHS as you think you know it does not exist it’s not a service.. it’s around 50,000 completely independent organisations that all have contracts with around 50 commissioners ( these are organisations that hold the funds for around 1 million people, plan, issue procurements and then buy the care from a number of those 50,000 independent organisations). Essentially each commissioner with maybe 100-200 staff controls and oversees a few billion pounds, spreed over many hundreds of contracts that have potentially 10 million + interactions to be reviewed and analysed for contract compliance or failure.. those 100 people will be chasing the big issues like 4 hour ambulance waits.. GP practices handing back their contract and leaving 10,000 people without care.. etc etc.. so the chances of that commission trying to enforce a profoundly vague set of principles that only need due regard is remote.. when actually the conversations that are really happening are “how many people died today who did not need to”.
But in this particular case there was clearly no regard and all that was needed was to level the field by inserting them a year into the list… but there may be two sides to the story and it’s probably more about miss communication.. because I cannot see any nhs organisations leaders ever saying “we don’t do the covenant “ why the hell would they.. all they have to do is say “we have taken due regard and at present we are only able to see you in three years as every individual on that specialist list is covered under the protected characteristic “disability “ and therefore we must consider each case with due regard”
In the end the covenant is only really worth the paper is written on if a service is well resourced and is able to have the pleasure of allocating resources beyond the “ try to stop so may unnecessary deaths” and at the moment we are living through an epidemic of unnecessary deaths.. so the covenant fails because it does not come before life and death.
So what would I do
For the NHS is very simple.. the department of health needs to take responsibility for the “due regard bit” and inform commissioning organisations what that actually looks like in the context of a contract and what KPIs are required.. because a contract cannot monitor a principle. So the DOH must turn it into a set of KPIs that are measurable outcomes for a contract ( so say service personnel wait no longer than 6 months for treatment of a service specific injury).
But the balance argument is you need to be careful as the morality of healthcare in the nhs is all about clinal need not about who “deserves” or bend of the service…nhs staff don’t get faster treatment even if it would benefit the service.. that critical doctor who is off waiting for treatment does not get jumped up the list even though other lists are suffering without them being at work….when I put my back out preventing a lovely crazed man from killing somebody else .. I sat on the waiting list along with everyone else.. even though ED was down a senior clinician because clinical need comes first I and all my colleagues accept that moral principle..so you have to be a bit cautious about saying x deserves y because of z… because then everyone starts on about “deserve.. and that’s a slippery road.. do you want your ED charge nurse to decide who gets treated first and last on his personal view of who “deserves” it, not on his professional view of “clinical need”…the answer is no you really don’t.
Knew you’d have a good post on this.
Also, it’s so hard to say anything about this because the headline is so sensational, and we know nothing about the condition, procedure, or really anything about what the Sailor needed.
Indeed, without the clinical need context is just a bit of a political point scoring argument not a serious conversation.
Quite.
But the Board had decided it wasn’t a part of the Covenant which is the point?
The whole thing never got as far as principles?
Nobody should be fast-tracked. If you are ex-military, why should you go ahead of the queue? And if you are ex-military, you should not be penalised.
You didn’t get more than two words into the article did you?
I can just imagine the type of NHS manager and their attitude that made this poor soul go to the back of the queue.