Health

01   Putting your health first overseas

Are you travelling overseas to visit friends or family this summer? No matter how familiar the destination – even if you have previously lived there – you may no longer have any immunity to diseases common in that location. What’s more, if your children have never lived there, they definitely won’t.

Here are some top tips from the Defence Public Health Unit to stay healthy while overseas:

• Seek travel health guidance from your GP, nurse, pharmacist or travel clinic at least four to six weeks before travel, but even if time is short it’s not too late to get advice.

• Some vaccines can be given at short notice and antimalarial tablets, if needed, can be started just before travel, or in some instances on the day you travel.

• If you’re travelling to an area where insect-borne diseases such as sandfly fever, sleeping sickness, malaria or dengue fever exist, use an insect repellent covering exposed areas of skin, and sleep under a bed net.

• Illnesses spread by contaminated food and drinks, like travellers’ diarrhoea or more seriously typhoid, are common in some countries. Only eat or drink from assured sources and wash your hands, especially before eating or drinking.

• If you’re ill with symptoms such as fever, flu-like illness or persistent diarrhoea after you get back, seek immediate medical advice and tell your doctor where you’ve travelled.

• For travel in Europe, carry your European Health Insurance Card (EHIC) and for more distant locations get comprehensive travel health insurance.

For more information about looking after your health abroad, visit www.nhs.uk or contact our Health Specialist Karen on additionalneeds@aff.org.uk.

02   Health and social care provision in Northern Ireland (NI)

AFF has received a number of enquiries regarding healthcare provision and NHS waiting list times in Northern Ireland. As a result of these enquiries, we have complied some specific information about health and social care provision in Northern Ireland.

Prepare for your assignment to NI

1. It is important to register your family member’s specific health or additional needs requirements (including acute and chronic illness, mental health and any specific medication being taken) to ensure the chain of command is aware of the support or provision your family member may need. This can be done by:

• Reading JSP 820 and AGAI 108 and completing the Career Management Notification Proforma at Annex A.
• It is also important for the serving person to include this information on their Assignment Preference Proforma, so that any specific information is available to the chain of command before an assignment is offered or agreed.

2. It is important to research the health and social care available in NI (see the information below) ahead of requesting or accepting an assignment. Although NI has a NHS, some healthcare provision isn’t available, including some drugs for cancer treatment. For other healthcare provision, there may be longer waiting lists than you are currently experiencing.

3. When transferring ongoing care or treatment it is advisable to:

• Speak to your current healthcare professionals for referral across to equivalent care or provision
• Ensure you have copies of your current patient records
• Ensure you have enough medication to tide you over until you have registered with your new GP

Who provides health and social care in Northern Ireland?

HSC Trusts

Belfast Trust is one of five Health and Social Care (HSC) Trusts that provide health and social services across NI. While the board commissions services, it’s the Trusts that actually provide them ‘on the ground’. Each Trust manages their own staff and services and controls its own budget. The other four Trusts in Northern Ireland are:

• Northern Trust
• South Eastern Trust
• Southern Trust
• Western Trust

Ambulance services in NI are provided by the NI Ambulance Trust. For more information, visit www.niamb.co.uk

Access to information

• Belfast Health and Social Care Trust
• Click here to find an NHS GP in NI. The HIVEs in NI can also give advice on GP practices and how to register
• You may also be eligible to register with a doctor at the Defence Primary Healthcare medical centre in Aldergrove
• If you have an issue with finding a GP practice, or wish to make a complaint about NHS healthcare provision, click here
• Patient and Client Council

Awareness

Some procedures may be offered to be performed in the Republic of Ireland as this is an EU country and therefore funding has, in the past, been available to reduce waiting lists in NI. If this were offered, advice would be given through 38 (Irish) Brigade Central Risk Assessment Cell (CRAC) team reference personal security.

Healthcare provision that is not available in Northern Ireland

Termination of pregnancy

The law in NI is different from that of Great Britain. In NI, it is lawful to perform a termination of pregnancy only if:

• it is necessary to preserve the life of the woman, or
• there is a risk of real and serious adverse effect on her physical or mental health, which is either long term or permanent.

It is for a medical practitioner to assess, on a case-by-case basis, using their professional judgement as to whether the individual woman’s clinical circumstances meet the grounds for a termination of pregnancy in NI. Termination can be made available for serving personnel through the medical centre who will refer to the MPAC system; however, it does require travel to England and on advice only given by MPAC for non- serving personnel.

Enhanced Screening for Pregnancy is not available due to the Abortion law. If this is required, it may result in the individual returning to England to access this procedure.

Bariatric surgery (gastric band surgery)

Bariatric surgery is not available in NI. Again, it would be advisable to discuss your options with your GP or consultant in England before planning a move to NI.

Cancer drugs

Certain cancer drugs are not available in NI. Advice would be to discuss with your oncologist, before leaving your current location, availability of your treatment plan in NI.

For more information on what you can do if cancer drugs are not available, click here.

NHS waiting list times

NHS waiting list times vary in NI to those in your current location. The advice would be to discuss options and seek advice with your current GP before leaving your current location.

Different healthcare provision

Assisted conception and In Vitro Fertilisation (IVF)

This is available in NI for both heterosexual and same sex couples. One cycle of IVF is available on the NHS in NI, even if you have a child. For more information, click here.

Prescription charges

There is no charge for prescriptions for anyone in NI.

Dental services

There is no local variation within NI for dental services. Orthodontic treatment is provided at certain dental surgeries. It is important to research the provision available and whether ongoing treatment can be continued in NI, before leaving your current location. Click here to find a dentist in Northern Ireland.

Mental health

Mental health treatment and counselling is available on the NHS in NI but there is also other support available to Armed Forces families. Families requiring mental or emotional support can be referred to Staffcare. Staffcare are external to the military and are all qualified counsellors. Staffcare is unique to NI and is provided in support of the Army Welfare Service (AWS) due to it not always being appropriate for people to make use of all the civilian agencies that would be an option in England.

An individual can refer themselves or can be referred by welfare agencies, doctors or other healthcare professionals with the individual’s permission. The AWS Intake and Assessment Team (IAT) will usually refer to the AWS Personal Support team (this is a team of four, two military, and two civilian trained Army Welfare Workers). They are there to help single and married personnel and their families. They are based in Lisburn, but cover all of NI and can do home or office visits as appropriate. They are trained in counselling skills and can deal with most matters, but can also refer to Staffcare.

All requests for help and advice should go via the Intake and Assessment Team (IAT) on 01904 882053 or 882054 or email AWS-HQ-IAT@mod.uk

Some families may have concerns about their current treatment and future assignments and may need to consider one of the following:

• Geographical stability if undergoing assisted conception treatment
• Retention of Service Families Accommodation in your current location if your healthcare or additional needs cannot be met in NI
• Discuss transferring care with your healthcare professionals before accepting an assignment to NI

Contact AFF: Karen Ross, Health and Additional Needs Specialist at additionalneeds@aff.org.uk or Annabel Ingram, Regional Manager North at rmnorth@aff.org.uk

03   Organ donation in Wales

In December 2015, the Welsh Government changed the way people choose to become organ donors in Wales. These changes will affect Army family members aged 18 years or more, who have lived in Wales for at least 12 months.

Regular soldiers posted to Wales as part of their Service will not be affected.

For more information, click here.

04   The NHS Constitution

The NHS Constitution establishes the principles and values of the NHS in England.

AFF consulted on this process and is delighted that the Armed Forces Covenant has been recognised and included in this document. Keep talking to us and let us know if you experience disadvantage as a result of Service life.

05   NHS Choices Healthcare for the Armed Forces Community

AFF assisted the Department of Health with developing the NHS Choices Healthcare for the Armed Forces Community Armed Forces families page. We hope you find it helpful and welcome your feedback.

06   Registering with a GP

All serving personnel are registered at Defence Primary Healthcare (DPHC) Medical Centres. You and your family may be able to register at a DPHC medical centre, depending on where you live.

DPHC medical centres and access to services may differ slightly from NHS GP practices. At a DPHC medical centre, you will receive treatment from a mixture of Service and civilian healthcare specialists. You can choose to register at a NHS GP practice if you prefer to.

Top Tips for finding a GP practice right for you

1. Your local HIVE should have information on the local GP practices available in your area and whether you can register with a DPHC medical centre. Or, speak to friends and other people who live locally to see which practice they recommend
2. To find a GP practice near you in England visit NHS Choices.
3. To find information on registering with a GP in NI visit NI Direct, Scotland visit NHS Scotland or NHS 24 and Wales visit – NHS Direct Wales.

Temporary GP Registration

For children at boarding school:

Most children who attend boarding school should be registered with a GP practice local to their school, but this will only usually cover them in term time. This is because there is often a significant distance between the child’s school location and home, so the GP practice would not be able to cover emergency visits.

Also, if your child were ill, you wouldn’t necessarily want to travel long distances to visit their GP. If your child requires medical treatment while they are at home in the holidays, they can be registered as a temporary resident at your local GP practice. You are able to see a temporary GP for up to three months (if you require longer than this you will have to re-register with the practice). The temporary GP will pass on any treatment details to your child’s permanent GP to add to their medical records.

For more information on temporary GP registration visit NHS Choices

Visiting from Overseas:

If you are living overseas, you should be able to register as a temporary resident if you need medical treatment whilst in the UK. For more information visit the CAB Advice Guide

For more advice or if you have had problems finding or registering with a GP please contact Karen Ross at additionalneeds@aff.org.uk

07   Registering with an NHS dentist & orthodontist

AFF understands that some families have experienced or will experience problems with accessing NHS dental care. We are also aware that orthodontic treatment can involve long waiting lists and is subject to local area variations. This can result in disrupted care provision due to frequent moves. Please remember we are here to help.

Some issues we are aware of include:

Boarding school children’s access to NHS dentists & orthodontists – if your child attends boarding school in the UK, it is expected that they will be registered with a dentist close to school or near their legal guardian’s home. In some overseas locations, where their parents are living, children can access DPHC dental treatment, but not orthodontic treatment

Waiting list times for orthodontic treatment – we are aware of some families experiencing long waiting list times for orthodontic treatment. There have also been issues with transferring waiting list times on moving.

Continuity of orthodontic treatment – some families have experienced problems with continuing the orthodontic treatment their child is having when they move to another area

What are you entitled to?

In NI, visiting dependant children are entitled to emergency care under the NHS, provided the Dental Practitioner is willing to take them on under temporary registration. Their UK medical card should suffice as evidence of entitlement or if their parents are registered at the same practice.

You do not have to access a dentist in the area you currently live in, so you can remain with a dental practice you have previously used.

If your child requires emergency dental care and is too far away to visit their own dentist, you can contact your dentist, local area team or call NHS 111.

If your child is visiting you at an overseas location, contact your own dental practice and see what treatment they can offer (there may be a charge for treatment).

The issues with accessing orthodontic treatment, such as waiting lists and continuity of care, are not straightforward, so are best dealt with on an individual basis. Please contact Karen Ross at additionalneeds@aff.org.uk

When looking for an NHS Dentist you might find these links useful:

• NHS Choices
• NI Direct
• NHS Scotland
• Wales NHS

For information on accessing orthodontists and treatment, visit NHS Choices.

If you are struggling to find an NHS dentist that will take new NHS patients, or if you are having issues with orthodontic provision, please let us know. We use this information to help you resolve your problem, but also effect change for others.

08   NHS waiting list times

The Armed Forces Covenant has a commitment that any time waited on an NHS waiting list should be transferred.

AFF is aware that NHS waiting lists in the Devolved Administrations may be longer than those in England, so this may affect the waiting list time. We would really welcome your feedback on any issues you are having with NHS waiting lists, particularly when you are moving from one area, or country, to another.

For information on waiting list times in:

England
NI
Scotland
Wales

09   NHS and DPHC Complaints Procedure – a simple guide on how to complain

Try local resolution by talking to your GP or practice manager

• If you are not happy with the outcome or prefer not to raise the issue locally then you can raise it with your local CCG or contact NHS England at england.contactus@nhs.net making sure you put ‘For the attention of the complaints manager’ in the subject line
• For hospital and other NHS services write to NHS England
• NHS Choices has more information on the complaints procedure
• The Parliamentary and Health Service Ombudsman can be contacted if you have contacted either your CCG or NHS England but you are still not happy with the outcome of your complaint
• Patient Advice and Liaison Service (PALS) offers confidential advice, support and information on health-related matters. They can also help you if you want to make a complaint.
• You can also contact the health and additional needs specialist at additionalneeds@aff.org.uk, particularly if you are unsure about making a complaint or if your issues are complex
• To raise a complaint in the devolved administrations visit NI Direct, Scotland and Wales

DPHC Complaints – a simple guide

• Every DPHC medical centre should have a local medical complaints policy and a medical complaints manager (MCM)
• You can make a verbal (or informal complaint) to the MCM to see if there can be a local resolution
• Or you can make a formal written complaint if local resolution isn’t possible. Include the names of the people involved and any witnesses to the event. Also state you desired outcome
• You should receive acknowledgement within 2 working days and a full response within 10 working days
• If you are still not happy with the outcome your complaint can then be sent to the Regional Clinical Director who has a further 30 days to investigate
• If it still can not be resolved it will then be forwarded to HQ Defence primary healthcare for further consideration

10   Have your say and get involved

It’s really important to get involved in feedback. This is because it shapes the services available in your area but you can also help other Army families access good services. Healthwatch is an initiative where the NHS must consult with the public on how their local health services are run. As a Service family they would really like to hear from you because your experiences of frequent moves and transferring healthcare can provide a unique perspective. It will help them provide a service structure that supports you.