COVENANT
Healthcare and the NHS: Can the Covenant help?
Yes, No and Maybe By Jo Wilkinson, Regional Covenant Manager (South)
When we talk about the NHS, the implication is that it is one entity providing health care across the whole of the United Kingdom but the “postcode lottery”ofhealth frequently features in the media. Health is adevolved responsibility. Whilst the Department of Health provides strategic leadership for healthcare and the NHS in England, all responsibility for health in Northern Ireland, Scotland and Wales is devolved to their respective governments. Even within England “the NHS” is actually acomplicated web of national and local bodies which commission, provide or regulate health and social care. For RAF personnel and families who move on posting from one area to another this can often create issues about access to and continuity of care. As in my educational article in the last edition of Envoy,the answer to whether the Covenant can help is yes, no and maybe.
Yes The NHS Constitution sets out the principles underpinning the NHS. It was most recently reviewed in 2015 and amended to incorporate the core Covenant principle that:
“The NHS will ensure that in line with the Armed Forces Covenant, those in the Armed Forces, Reservists, their families and veterans are not disadvantaged in accessing health services in the area they reside”.
More specifically,the Covenant states that family members should retain their relative position on any NHS waiting list if moving location due to the service person’s posting, subject to clinical need.
40 Envoy Winter 2017
In practice, this has helped families where someone has been referred to hospital and is waiting for treatment but moved before it has been provided. Previously it may have been that they were then placed at the back of the queue in their new area, delaying treatment and potentially resulting in their condition worsening. Whilst there may be some hospital trusts who are unaware of their Covenant responsibilities, with support from NHS England and the RAF FF,many families have been able to receive their treatment and care without undue delay.
No The majority of families access and receive healthcare through the NHS in exactly the same way as the rest of the population. The Covenant does not confer any preferential treatment or advantage to families*. The three founding principles of the NHS, that treatment meets the needs of everyone, is free at the point of delivery and based solely upon clinical need, take precedence over the Covenant. So whilst waiting list times may be honoured, families may find that they have to wait longer in their new area as those with greater clinical need take precedence over them.
(*In certain specific circumstances and where health requirements are service related, veterans may be entitled to preferential treatment from the NHS.)
Similarly,the wording “the area [in which] they reside”has particular significance. Whilst service families may argue that they are disadvantaged by the consequences of mobility and the different availability of certain treatments in different locations, this does not fall within the Covenant commitment. For
Jo Wilkinson.
example, the Covenant cannot help families who struggle to find alocal NHS dentist on posting to anew unit because there is alocal shortage of dentists as this is an issue for all residents. What’s more, the bureaucratic system of commissioning dental services means that whilst patients may be on awaiting list to get access to adentist, this is not recognised as awaiting list, as with GP services, under the Covenant. So if a family “waits” six months to get access to aNHS dentist, but moves due to posting before being seen, this time is not taken into account.
The localised provision of the majority of NHS services means that some treatments, usually expensive and non-life threatening ones, may be less available in different areas. Awell- publicised example is IVF treatment. The National Institute of Clinical Excellence (NICE) sets guidelines for the number of
raf-ff.org.uk
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