The Welsh experience – Veteran Aware work at Betsi Cadwaladr University Health Board

Veteran Aware work at Betsi Cadwaladr University Health Board (BCUHB) is a good example of how a passionate group of people can bring about change before it becomes official executive policy.

Local Health Boards are responsible for planning and delivering NHS services in their areas. These health services include dental, optical, pharmacy and mental health. They are also responsible for improving physical and mental health outcomes, promoting wellbeing, reducing health inequalities across their population and commissioning services from other organisations to meet the needs of their residents.

However Veterans’ work isn’t yet mandated by either the Welsh Government, or the Health Board, though work is progressing; albeit led by force of personality often important in this work.

Change has been evident in the two acute hospitals that are fully recording Armed Forces community status – Wrexham Maelor Hospital and Ysbyty Glan Clwyd – but it’s also fair to say that progress has been slow-going, enough though for the team to feel it’s making a difference.

Up until August this year, BCUHB had recorded 1,223 patients with an Armed Forces Community status, while out of an organisation of 19,000 staff, only 94 staff have come forward as volunteers and self-identified as Armed Forces Community; clearly, there are more.

The Veteran Aware work, which is bench-marked on the VCHA’s eight standards, began when Veteran Healthcare Collaborative Strategic Lead, Ian Donnelly, realised he could access Armed Forces Covenant Fund Trust funding for this work in Wales. He had previously worked for the VCHA so understood the importance of its work and the changes it has helped bring in across England. The funding allowed him to create the role of Armed Forces Covenant and Veteran Healthcare Collaborative Lead, a two-year funded post, currently due to end 31 March 2024, though there is hope this will be extended.

The role was perfect for former regular Zoe Roberts. During her career, Zoe served with 39 Infantry Brigade Headquarters and Signal Squadron and Joint Communications Unit (NI) in Northern Ireland. Zoe then moved to the UK mainland where she was employed in a number of roles/units.  

Zoe completed her Army career with a posting to Gosport, Hampshire, with 33 Field Hospital (Haslar). On leaving the Army, Zoe joined the NHS in Portsmouth, where she worked in a safeguarding role aligned to the Child Death Overview Panel. Her career with the Health Board began in 2011, when she relocated back to North Wales and became a call handler and shift supervisor for the North Wales GP out of hours service.

Zoe then worked within the office of the central area’s Medical Director before becoming a Workforce Governance Manager. Prior to her role with the Veteran Healthcare Collaborative, she was the Business and Programme Manager for the Workforce directorate.

Zoe, who won the Armed Forces Covenant prize at the Armed Forces in Wales Awards in June this year, said: “When this job came up in April last year, I thought this is everything that I’ve done in the military and I’ve done in the NHS all rolled into one job description. It felt like the universe was speaking to me and I thought, ‘Oh my God, I can literally put all my skills to use and support the Armed Forces Community’.”

And this is exactly what she’s done, supported by a small but dedicated band of unpaid champions and leads covering the areas of Anglesey, Gwynedd, Conwy, Denbighshire, Flintshire and Wrexham, with executive cover provided through the Executive Medical Director, who is one of the champions and is a Veteran himself.

Describing the past 20 months as “eventful”, she says it has been hard work at times trying to move a massive organisation, through workstreams aligned to the Armed Forces portfolio. This is mainly because the work is not yet mandated – “I’ve had to really, really rely heavily on those relationships that I’ve made previously with colleagues across the clinical and non-clinical areas across the Health Board.”

This is why the team decided to start with making BCUHB’s three acute hospitals “Veteran Aware”, before moving on to focus on the other organisations across the Health Board’s geographic area.

To start the work, Zoe needed to know who was actually going to be supported, but this was tough because the Health Board were not recording or tracking Armed Forces Community status or mapping those services, which personnel from the Armed Forces Community were utilising.

Alongside this, the team quickly realised it would need Veterans leads within each acute hospital – a clinical lead and a management lead – mirroring the VCHA requirement of a dyad, taking part in regular Armed Forces Network meetings to build a champions ‘Army’ within each hospital. Getting just that one question asked about Armed Forces identity as part of the standard referral procedure was a huge undertaking; in all it took 13 months for this to be implemented.

It included the Poppy Programme, whereby those identified and referred to a ward would have a magnetic poppy attached to their bed and a poppy identifier placed on the patient electronic system. It was rolled out first at Wrexham Maelor.

The first thing staff are asked to do is to say ‘Thank you for your service’ to those identified as part of the Armed Forces Community and then to run through questions that allow them to find out more about an individual’s circumstances. Zoe points out that while conversations about an individual’s living conditions would have happened if they weren’t part of the Armed Forces Community, however being identified as such opens up different avenues for financial or non-financial support, such as stair-lifts or mobility scooters.

“The uptake was brilliant. We piloted it on the Surgical Assessment Unit at Wrexham Maelor with a lovely sister there called Gareth Arndt, who doesn’t have any ties to the Armed Forces Community, but he came forward and offered his services to springboard the programme on his ward because of the high volume of Veterans coming through that ward. It was such a success we embedded it across the entire hospital.”

In addition, feedback from patients has been positive. “Just marrying them up with like-minded people from their community has been the most rewarding for them. We’ve had volunteers from RBL and SSAFA come in to our hospitals and sit at the bedside and literally have a cup of tea with individuals from the Armed Forces Community; that alone demonstrates that like-minded personnel do go above and beyond what that patient’s expectations were for coming into hospital.

“The biggest thing we’ve had is somebody’s received a mobility scooter to get around and maintain their independence within the community. That’s not something they would have had if we hadn’t have identified them as being part of the Armed Forces Community.”

One difficulty was in clinicians’ understanding the amount of support available within the community.  This is why Zoe and the team partnered with SSAFA, the Armed Forces Charity, which agreed to take referrals from clinical teams and to marry up Armed Forces Community patients, with external Armed Forces charitable organisations.

The SSAFA input was critical to the success of the programme, which she has estimated has saved the Health Board around £97,500 for 55 patients based on a reduced length of stay on the wards due to the level of support and interventions available for members of the Armed Forces Community in Wales. This is a conservative estimate.

Issues continue to remain. As Zoe says it’s a job in itself to continue raising awareness and teaching or educating staff on what they need to do and why, given that Armed Forces community training is currently not compulsory. Once directives flow down from the executive team, combined with the power of corporate communications, then change is likely to be quicker. What can be said is the direction of travel is heading in a positive direction.

Only recently the Health Board was re-accredited by the Defence Employer Recognition Scheme (ERS), receiving gold for the second time, while last year it launched the North Wales Veterans Healthcare Collaborative (NWVHC) to ensure that the Armed Forces community across North Wales, are not disadvantaged in the care they receive and where possible, that they receive personalised care and improve patient outcomes. 

Ultimately, it is a pathfinder Health Board for Wales.

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