The Defence Medical Services include the whole of the medical, dental, nursing, health professional, paramedical, veterinary and support personnel (about 7,000 uniformed personnel) including civilian staff, employed by the three Armed Services. These elements are responsible for providing healthcare to service personnel serving in the UK and overseas and on operations. In addition and where appropriate the families of service personnel and entitled civilians (possibly about 260,000 people). DMS also provides some aspects of healthcare to other countries’ personnel overseas, in both permanent military bases and in areas of conflict and war zones.

The range of services provided by the Defence Medical Services includes:

• Primary healthcare

• Dental care

• Hospital care

• Rehabilitation

• Occupational medicine

• Community mental healthcare

• Specialist medical care

Defence Medical Services also provide healthcare in a range of facilities, including medical and dental centres, regional rehabilitation units and in field hospitals.

The Surgeon General is the professional head of the Defence Medical Services and
responsible for the healthcare and medical operational capability. His responsibilities include defining the standard and quality of healthcare needed in both operational and non-operational environments and assuring its delivery. He is also responsible for setting the strategy and the associated (non-clinical) policies for the Defence Medical Services.

The Deputy Chief of Defence Staff - Health (DCDS(H) is accountable for the overall outputs of the Defence Medical Services.

These two senior officers oversee the work of three separate organisations:

Notes:
(1) The Defence Medical Services Department DMSD is the headquarters for the Defence Medical Services providing strategic direction to ensure delivery of defence medical outputs. The DMSD operates through the following four directorates: Medical Operations; Medical Policy; Healthcare; Finance and Secretariat.

(2) Joint Medical Command (JMC) – This is a joint service agency providing secondary care personnel to meet requirements for operational deployments. It also supports the front line units by educating and training medical personnel. The Defence Medical Education and Training Agency DMETA runs about 2,000 clinical courses (providing about 300,000 training days) to all three services.

JMC has responsibility for the following:

• MDHUs (Ministry of Defence Hospital Units)

• RCDM (The Royal Centre for Defence Medicine)

• DMRC (The Defence Medical Rehabilitation Centre at Headley Court

• DMSTC (The Defence Medical Services Training Centre in Aldershot

• The Defence Medical Postgraduate Deanery

The JMC provides a single headquarters responsible healthcare delivery.

(3) Defence Dental Services (DDS) – this is a joint service organisation employing both Armed Forces and civilian personnel that provides dental services in the UK at service establishments and to personnel on operations overseas. The DDS came under the ‘umbrella’ of the JMC from mid 2009.

Figures in early 2010 suggest the following personnel totals for the DMS:

SINGLE SERVICE MEDICAL CARE

The three armed services are responsible for delivering primary healthcare to their respective services and for providing the required medical support on operations.

Royal Naval Medical Service (RNMS)
Army Medical Services (AMS)
Royal Air Forces Medical Services (RAF MS)

Late 2008 personnel figures for these agencies are as follows:

Although the above table is about two years older than the previous table showing trained strength for the complete DMS, the total trained strength figure in each table is very much the same.

HOSPITAL CARE

In the UK, hospital care is provided at Ministry of Defence Hospital Units (MDHU). The Defence Medical Services Department (DMSD) has contracts with the NHS for provision of care in MDHUs, which are run as military units embedded within selected NHS hospitals. There are MDHUs at Derriford (Plymouth), Frimley Park (Aldershot), Northallerton (near Catterick), Peterborough and Portsmouth.

In addition, the Defence Medical Services runs a number of other units which include the Royal Centre for Defence Medicine (Birmingham), Defence Services Medical Rehabilitation Centre (Headley Court) and the Duchess of Kent’s Psychiatric Unit (Catterick). There are also about 245 DMS medical and dental primary care facilities mostly located in the UK. Outside of the UK primary healthcare, and some secondary healthcare, is provided on board Royal Navy ships and in overseas bases and theatres of military operations.

The Military Ward at the new Queen Elizabeth Hospital in Birmingham started taking patients in 2010 and service personnel are cared for in single rooms or four-bedded bays that have additional features for the exclusive use of military patients. The ward has more staff than a normal NHS ward, a quiet room for relatives as well as a communal space for military patients to gather. A dedicated physiotherapy area has also been provided close to the ward for service patients.

On operations in Afghanistan and other overseas locations Field Hospitals provide medical support that includes primary surgery, an intensive care unit, medium and low dependency nursing care beds and diagnostic support, as well as emergency medical care. These Field Hospital may be staffed by medical personnel from all three services.

Service personnel serving in Germany who require hospital care are treated in one of the five German Provider Hospitals.

ROYAL CENTRE FOR DEFENCE MEDICINE (RCDM)

The RCDM in Birmingham provides a centre for military personnel requiring specialised care, and incorporates a facility for the treatment of service personnel who have been evacuated from an overseas deployment area after becoming ill or wounded/injured. RCDM also acts as a centre for the training of Defence Medical Service personnel.

In operation since 2001, the RCDM operates on a contract between the DMSD and the University Hospitals Birmingham (UHB) NHS Trust. The RCDM is a Joint Service establishment with medical personnel from all three of the armed services wearing their respective Naval, Army, or Air Force uniforms.

DEFENCE DENTAL SERVICES (DDS)

The Defence Dental Services (DDS) is a tri-service area employing approximately 1,000 personnel from the three armed services and contracted civilians. In the majority of cases treatment is provided at Service Dental Centres worldwide. The DDS is now part of the JMC (Joint Medical Command).

DEFENCE NURSING STAFF

On operations, nursing staff from all three services deliver primary and emergency care at the front line and secondary and critical care in field hospitals. Aeromed evacuation of casualties is supported by defence nurses who deliver intensive care nursing during patient transfers both in theatre and on return to the UK working within the Critical Care Air Support Teams.

When not deployed on operations, defence nurses work within Ministry of Defence Hospital Units within NHS Trusts across the UK to maintain their clinical skills and care for the general public. In particular, Defence Nurses working at the Royal Centre for Defence Medicine in Birmingham and at the Defence Medical Rehabilitation Centre at Headley Court contribute directly to the health care provision of military personnel.

MIDLANDS MEDICAL ACCOMMODATION PROJECT

From 2010 Whittington Barracks in Lichfield has become the home of military medicine The Midlands Medical Accommodation project (MMA) will ensure that the area becomes the central focus for military medical expertise and assets. About 2,000 military and civilian staff will eventually work at the barracks when the MMA project completes in 2014.

The first phase - MMA Increment 1 - has already delivered a modern headquarters office building for the DMS at Whittington Barracks that incorporates both the Surgeon General’s strategic Headquarters and those of the Joint Medical Command, both of which are fully operational.

The second phase – MMA Increment 2 - will see the DMS elements relocate from Keogh Barracks near Aldershot to a new modern training centre at Whittington Barracks. The new complex will include training facilities, a learning centre; lecture theatre, messes for Officers, Warrant Officers and Senior Non Commissioned Officers, living accommodation for permanent staff and a new Junior Ranks’ dining and leisure facility.

Work is expected to begin on site at the beginning of summer 2011, with the relocation planned to begin at the end of 2013.

MMA1 and 2 will see around £200M invested in the redevelopment of Whittington Barracks.