Hidden struggles: veterans' experiences of NHS care

According to the 2021 Census, nearly four per cent of the population of England previously served in the UK Armed Forces. 

The Armed Forces Act 2021, which came into effect in November 2022, imposes specific duties on the NHS and other public bodies to adhere to the principles of the Armed Services Covenant ‘when carrying out certain functions in healthcare, education and housing.’

In England, the NHS has adopted the Armed Forces Covenant into the NHS Constitution. It has developed specific services for veterans' needs, including Op COURAGE and Op RESTORE, which provide specialist mental health support and physical health services for ex-service members. 

Meanwhile, the Royal College of GPs (RCGP) and NHS England manage a veteran accreditation scheme for GP practices and NHS Trusts, designed to help GP practices provide better care for veterans.

So, are these commitments and services helping veterans to access the care they need?

Adjusting to life after serving in the armed forces

All healthcare services are provided to personnel while they are serving in the armed forces. However, when people leave the military, they become responsible for coordinating their own healthcare arrangements.

Healthwatch Essex undertook research in 2021 on the experience of veterans leaving the forces. This research touches on some of the problems that veterans experience, including leaving a tight-knit community where everyone is looking out for each other.

"In the civvy world, you might have to wait or chase for it, and you're just not used to that."

- Story shared by Healthwatch Essex

Veterans also struggle to adapt to differences in the availability of basic health services outside of military settings. This includes adjusting to the poor availability of NHS dentistry services, as veterans would have had access dental care prior to being discharged from the armed forces. 

"The dental side, that's horrific. When I left, I had to get a doctor, but I didn't have to get a dentist, so I went to the back of the queue like everyone else. From being able to go and see a dentist at camp whenever I needed to, when I left, that wasn't there. It sounds like nothing, but it's massive and overlooked. I've been forced to go private now, and cost-wise to replace my teeth is about £2,100; I'm not doing it.

-Story shared by Healthwatch Wakefield

Accreditation schemes

The Veteran Friendly accreditation scheme run by the RCGP helps GPs to understand and act on the unique needs of veterans. The 2023 Government report on the Armed Forces Covenant found that 71% of Primary Care Networks now include a veteran-friendly practice. 

However, we heard that veterans weren't aware of accreditation schemes. For example, recent research by Healthwatch Wakefield found that only 11% of veterans surveyed knew that their GP surgery had veteran-friendly accreditation. Whereas research by Healthwatch Somerset about access to GPs found that veterans wanted clearer communication about GP practices with veteran-friendly accreditation.

Veterans and patient records

Government guidance encourages people to let their GP know if they are veterans, to ensure they get the proper care for conditions they might have developed during their service. When this goes well, veterans get excellent care:

"Surgery is fantastic. They know he is a veteran and give him every health check, and he is well looked after. He feels he doesn't need anything else as they look after him so well."

-Story shared with Healthwatch Warwickshire

However, we heard from veterans who weren't aware this was possible, and GP surgeries hadn't asked them about their military background. Consequently, their current health records weren’t flagged to state that they were an armed forces veteran. Even when they asked health services to flag their records, veterans experienced problems:

“Never been asked if I was a veteran by my GP surgery or hospital outpatients. When raising the matter, I was told there was nowhere on the computer to add that. I even provided the HM Government codes. As my main health issue results from my military service and I receive a war pension, I was keen to have my records marked accordingly. I am not sure whether my records are now endorsed with the fact I am a veteran and have medical issues that result from service.”

-Story shared with Healthwatch England

We also heard that veterans couldn't be sure all their records would be made available to their GPs and other healthcare professionals. Veterans who needed care for multiple conditions found that they had to tell each hospital about their service history to ensure it was flagged on every record.

Even when their records were correctly flagged, veterans told us that GPs and hospitals might not join the dots and identify that some conditions that they experienced stemmed from military service:

“As an armed forces veteran with physical and CPTSD, I made my GP aware of this. I applied to the hospital to get on their online pain management program. The practice received paperwork requesting my medical history; this sat in the office for one and a half months. After a two-hour discussion with the hospital, they recommended attending a face-to-face pain clinic. After some time, I made an appointment to see my GP to find that they hadn't referred me. They then made a referral. After some time, I checked to see what was happening. The letter had been returned with no reason given to me. When I asked which hospital they had sent it to, they answered, "I don't know". Have you informed the hospital that the referral is due to a service injury? " We said you were a veteran." It's not the same thing.”

-Story shared with Healthwatch England

Veterans with mental health needs

The NHS provides veteran-specific mental health care via OP COURAGE. This service is provided by healthcare professionals who understand the specific needs of the armed services community.

As Healthwatch Cornwall found when they researched the specific mental health needs of diverse communities, veterans require specialised support to help them manage service-related traumas that affect their mental health. They wanted veteran-specific support.

Veterans reported that some GPs didn't know about Op Courage, and referred them to mainstream mental health services instead, which were not suitable for their needs. Some expressed concerns about becoming overwhelmed when chasing up referrals or appointments with healthcare services and wanted help from other organisations to help them through this process:

“Nothing’s gone well so far. Op Courage have said I need to be reviewed by a psychiatrist for diagnosis and to see what medication I need. They even wrote to my GP telling them to refer me for this. Yet lo and behold, the GP has no idea what Op Courage is (they are registered as veteran aware) and has instead sent me for counselling again.”

-Healthwatch England

We also heard of instances when veterans with PTSD displayed symptoms brought on by their traumas, such as outbursts and aggression. As such, some veterans experienced being threatened with deregistration, and in some cases were actually deregistered from GP surgeries, because they became aggressive with staff when triggered in certain circumstances.