UK currently has ‘no plan’ to mobilise NHS for mass casualties

The Chief of the Defence Staff, Air Chief Marshal Sir Richard Knighton, has told MPs that the UK does not yet have a complete national plan for mobilising the NHS in the event of a major war producing sustained mass casualties.

Speaking to the House of Commons Defence Committee, Knighton said Defence Medical Services would have to plug into the National Health Service during an Article Five conflict, and that while the two systems work closely day to day, the wider mobilisation framework is still incomplete.

The issue was raised by committee member Derek Twigg, who said he had dealt with defence medical problems as a minister in the late 2000s and wanted a clear sense of today’s risks. Twigg noted that Defence Medical Services and the NHS handled the flow of casualties from Iraq and Afghanistan effectively, but argued the health system now faces heavier pressures than it did then.

He asked whether Knighton had concerns about the ability of Defence Medical Services and the NHS to cope if casualties were significantly higher than those seen in previous campaigns.

Knighton said his concerns fell into two areas. “I think I’d lay out my concerns in two buckets,” he told MPs.

First, he said there were current gaps in specialist skills. “In the short term, we have a number of gaps in specialist skills,” he said, adding that hard to fill roles across Defence were not limited to medical posts. “High demand, highly skilled roles are difficult to fill. Cyberspace, specialists, engineers and some in the medical profession.”

He said work was underway to address that short-term problem through recruitment and retention measures. “The work that the head of the medical services and the head of cyber and specialist operation command is doing around financial retention incentives, to improve recruitment, all of those is about how we’d address that,” he said.

Second, Knighton pointed to the scale of demand that would follow an all-out NATO war. “If we ended up in an all out conflict under NATO Article Five and sustained mass casualties, the defence medical system is not set up to do that, it would have to plug into the National Health Service,” he said.

Knighton linked that assessment to lessons he said had been visible in Ukraine, where civilian health systems have had to absorb and support large-scale military casualty care. “It’s exactly what we saw happen in Ukraine,” he said, adding that he had spoken publicly about the need to think through national-level responses and to align government levers for such a scenario.

While placing confidence in the people involved, he warned that planning and structure were not yet complete. “At the moment, we don’t have a full plan for how we would do that,” he said. “I have every confidence, given the way the NHS and the brilliant people in the NHS and in the defence medical services responded historically that we would do that, but right now, we don’t have a complete plan for how we would mobilise the National Health Service in the event of armed conflict and a NATO Article Five.”

Twigg pressed for timelines, arguing that service personnel need assurance that the best possible care will be there if they are wounded, and that urgency should be visible across government, not only inside the Ministry of Defence.

Knighton said Defence Medical Services already work closely with the NHS, including through the way clinicians are integrated into civilian settings. “The National Health Service and our defence medical services already work very closely together,” he said. “Quite a lot of majority of our specialists actually work inside the National Health Service, even though they’re in uniform.”

However, he said more work was needed, and suggested the lead for the wider national framework sat outside Defence. “There’s a wider piece of work run by the Cabinet Office, which is about developing our national defence plan and structure,” he said, adding that it would be “right” to direct questions on that to the Cabinet Office.

Asked when a fuller plan might emerge, Knighton pointed to an indicative timeframe rather than a fixed date. “I think that over the next year, 18 months, we’ll start to see that evolve,” he said, before restating the current gap: “We don’t have a holistic national plan for how we would mobilise the National Health Service in times of all out war in Europe.”