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Veterans Health – Extension of the scope of the Medical Assessment Programme (MAP)
Announcement l Background l What does MAP do? l Who is eligible? l How do I get referred to the MAP Programme? l Future plans l Statistics l Case Studies l Frequently Asked Questions
Frequently Asked Questions
1. What is the MAP?
The MAP was established in July 1993 to examine UK Gulf veterans who were concerned that their health had been adversely affected by service in the 1990/1991 Gulf Conflict. The MAP is located at St Thomas’ Hospital, London. Its scope has since been extended by Ministers to include Porton Down Volunteers, Veterans of Op TELIC and Op HERRICK.
MOD civilians, contractors, voluntary aid personnel and embedded journalists may also attend if eligible following application to the MAP.
2. Why should a veteran be referred to the MAP?
Some GPs, Specialists and other health professionals may have difficulty understanding the background and therefore the needs of veterans who believe they are ill as a result of operational service. Doctors are encouraged to refer to the MAP any patients who are concerned that their health may have suffered as a result of their Service and who fulfil the criteria for being seen. This will allow the patient to have a thorough assessment by a doctor with considerable knowledge of veterans’ illnesses issues.
Satisfaction surveys indicate that the service provided by the Programme is well regarded by patients. The MAP doctor is happy to answer questions from health professionals and can be contacted on 020 7202 8323 or Freephone 0800 169 5401, or by email to map@gstt.nhs.uk.
3. What follow-up action is taken?
The MAP doctor provides a report to the patient, referring GP and/or Specialist including, as relevant, any diagnoses made, recommendations for treatment and, where possible reassurance.
We ask doctors to co-operate in taking forward treatment recommendations and in responding to any enquiries about a patient's progress. The MAP will send a standard follow up letter to all GPs, and others, who refer patients, asking for information on the patient's condition and subsequent treatment, usually 6 months after the MAP appointment.
4. Why does the MAP not provide treatment?
The MAP has historically not provided treatment. Its role is to assess patients and recommend treatment as appropriate. Implementation and follow-up, via the Defence Medical Services (for serving personnel) and the NHS for those who have left service, will be for the individual’s own doctor. This will continue to apply to veterans with mental health concerns.
5. Does the new arrangement not fall short of the requirement if it does not provide treatment as well as assessment?
A principal concern has been that the mental health problems of veterans are sometimes not understood within the NHS because of the lack of specialised understanding of the particular way in which military service can give rise to problems. This is particularly an issue where a serious problem may not have been exposed. The new facility addresses this requirement.
GPs can refer cases whose background they do not understand or where the particular risks arising from a patient’s military background are unclear. There will be a number of treatment options. Most of which will, of necessity, be provided locally but may also, where appropriate, be available through Combat Stress.
6. How is a patient referred to the MAP?
Personnel who are still serving in the Armed Forces can be referred to the MAP by their Service Medical Officer. Veterans who have left service and who have concerns about their health and possible links to service should contact their GP to access the MAP. Specialists may also refer patients but in all cases the patients’ GPs must be involved. Exceptionally, where GP referral is not possible (eg because the veteran has no GP) self-referral will be possible but the individual will need to give agreement to access to his/her medical records to ensure a proper assessment.
7. Does the MAP see everyone referred?
In the case of a very small number of patients referred, there is nothing to be gained from them being seen at the MAP – for example, because it is clear that their condition is being appropriately managed or they have been seen before and nothing new would be gained by a further visit.
8. Is there a long waiting list?
No. The aim is that all patients referred to the MAP will be sent an appointment letter within 5 working days. In order to get all the appropriate medical records an appointment is usually offered at a date to suit the patient 6-8 weeks after receiving the referral.
The extent of the demand as a result of the latest extension is not entirely predictable but we plan to operate to the same timescales and will take steps as appropriate if the planned capacity proves inadequate.
9. What is the cost for the patient?
The examination and clinical tests will be provided free of charge except in the case of contractors, some voluntary aid personnel and embedded journalists who accompanied deployments since January 2003 (Op TELIC). The MOD will also pay for any further tests which the MAP doctor believes are necessary for the assessment.
With the exceptions detailed above, the cost of the patient's travel to the MAP from within the UK will be met by MOD (normally we will provide rail tickets in advance). Where necessary (if the length of the journey precludes the possibility of a return trip within a single day) accommodation costs and the cost of breakfast and an evening meal at a hotel will also be met by MOD.
10. Why have MOD launched a special programme of support for Reservists at Chilwell?
In 2003 MOD commissioned research by the King’s Centre for Military Health Research into the health of military personnel who were deployed to OP TELIC. This report showed that in the 2003 deployment there was no significant increase in ill health of regular forces compared to those that did not deploy. However, the report did show that a higher proportion of Reservists who did deploy displayed symptoms of common mental health problems and PTSD compared to regulars, and reservists who did not deploy. However, in absolute terms these numbers are small.
OP HERRICK
11. Is the MOD expecting particular health problems among Op HERRICK veterans?
No. We do not expect any specific future health problems to be reported by veterans who have served in Afghanistan, but we recognise that individuals can experience health problems as a result of such an operation.
12. Why have you now decided to extend the MAP remit for wider health concerns to Op HERRICK veterans?
Extending the scope of the MAP to include Op HERRICK veterans builds upon the already extensive measures put in place to protect the health of our deployed personnel and is a sensible precautionary measure.
UK troops were first deployed to Afghanistan in November 2001. Since then around 15,000 Service personnel have been deployed and the tempo of operations has increased as NATO Forces move into the more challenging regions of the country.
Community Veterans Mental Health Pilots
13. What is the Community Veterans Mental Health Pilot?
The Government is committed to good mental health and well-being for its personnel, both in service and after they leave. For veterans, healthcare is primarily the responsibility of the NHS. With the cooperation of Combat Stress, MOD funded an independent review of the Society’s programmes by the specialist independent Health and Social Care Advisory Service (HASCAS) to ensure that the treatments offered by Combat Stress, and its place in the wider NHS Mental Health Framework was appropriate.
Following the HASCAS recommendations on mental health services, officials from the Ministry of Defence, the UK Health departments and Combat Stress have been working together to develop and implement a new community-based model to address the special circumstances that may affect the treatment of veterans with mental health problems. The aim of this work is to make available expert understanding of veterans mental health issues for health professionals. We are looking to pilot this model at sites across the UK. Discussions are well advanced in selection and setting-up of sites, which we expect to be located in a range of trusts across the UK, with the first to be launched in Autumn 2007.
14. How will this differ from the current arrangements?
There would be a series of regional clinical networks, each made up of primary and secondary NHS facilities (GP and specialist mental health practitioners), a military Community Mental Health facility and a specialist centre with an interest in psychological injury. This model would support sharing of information and expertise and would give NHS clinics treating veterans, access to the advice of the military-specific clinics.
15. How do individuals access the programme?
As with the MAP assessments, the preferred route into the programme will be an individual’s GP. Partners or family members contacting the programme will be advised to encourage the patient to contact their GP. Referrals from civilian psychiatric services (such as Combat Stress) are also accepted and, as with all specialist care, the patient’s GP will be kept informed to ensure continuity and focus. No patient will be accepted without GP registration.
16. Do GPs know about the new pilots?
Through the MoD partnership with the Department of Health, information will be passed to UK Health Authorities for wider dissemination to GPs. In addition to this we are developing project information for service leavers, veterans and health professionals.
17. What will be the role of Combat Stress?
Page Modified: 12 September 2007
