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Veterans and their Families

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					General Election Manifesto

The Royal British Legion

“More should be done to make sure we receive the support we need.”

Do your bit for Veterans and their families
Veterans and their families need the next government to:
•	 Make	the	NHS priority treatment system	work	for	veterans	with	injuries	caused	by	Service	in	the	Armed	Forces	 or	consider	privately	funded	alternatives. •	 	 ackle	poverty among veterans	and	their	families	by	increasing	incomes	through: T ‚	 	 doubling	the	Personal Expenses Allowance	for	those	receiving	residential	care; ‚	 	 making	the	disregarding	of	War	Pension	payments	for	means-testing	for	Council	Tax	Benefit	and	Housing	 Benefit	a	statutory	requirement;	and ‚	 	 developing	an	automated payment system	for	Council	Tax	Benefit. •	 	 nsure	that	local	authorities	meet	their	obligations	to	provide	Disabled Facilities Grants	to	veterans	who	need	 E adaptations	to	their	homes. •	 	 xempt	all	veterans	who	require	a	Disabled	Facilities	Grant	from	the	current	means test	if	the	adaptation	is	 E needed	because	of	a	Service	related	injury. •	 	 und	comprehensive	research	and	provide	additional	compensation	for	duty	of	care	breaches	to	veterans	 F suffering	from legacy health issues,	including	Gulf	War	and	nuclear	test	veterans. •	 	 rovide	all	Service	leavers	with	an	effective mental health education	programme	at	the	point	of	resettlement,	so	 P those	at	high	risk	know	where	to	go	for	help.

NHS Priority Treatment
The	lifelong	duty	of	care	owed	to	those	who	have	served	in	the	Armed	Forces	extends	to	providing	priority	 NHS	medical	treatment	for	injuries	and	illnesses	caused	by	Service.	However,	evidence	has	revealed	 that	there	is	a	lack	of	awareness	of	the	entitlement	to	priority	treatment	amongst	veterans	and	health	 professionals	and	that	priority	is	not	being	provided	effectively.	

It’s time to do your bit | www.timetodoyourbit.org.uk

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What we’re calling for: • Make the NHS priority treatment system work for veterans with injuries caused by Service in the Armed Forces or consider privately funded alternatives.

Why? NHS priority treatment was introduced in 1953, when dedicated hospitals for exService personnel were closed and their healthcare became the responsibility of the newly created NHS. As a concession, and in recognition of their Service and sacrifice, War Pensioners were awarded priority treatment. Priority in the NHS was initially granted to veterans in receipt of a War Pension, but was extended to all veterans with a Service-related health condition on 1 January 2008. Priority treatment applies to both in- and out-patient treatment and physical and mental health issues, as long as the condition developed as a result of Service. Priority should be given to veterans unless there is an emergency case or another case demands clinical priority. Priority treatment also entitles veterans to equipment such as hearing aids and free prescriptions. In a 2009 survey of 500 GPsi, 81% of those questioned said they knew not very much or nothing at all about priority treatment. Furthermore, 85% had not informed secondary care providers of a veteran's entitlement to priority treatment in the past 12 months. A further survey of 491 War Pensionersii found that only 11% reported being treated ahead of non-emergency patients on their most recent visit to hospital for their Service-related condition compared to 10% in a previous survey carried out in 2007. Of the War Pensioners surveyed only 36% knew of their entitlement to priority treatment. Despite a significant amount of publicity surrounding the extension of priority treatment in January 2008, our surveys show little improvement in awareness or delivery of the scheme. The majority of eligible veterans are still not receiving the priority they deserve. Messages about priority treatment are not getting through to GPs and while it would seem that awareness is growing among veterans, it remains too low. It is vital that the next government finds a way to communicate the details of priority treatment more effectively to GPs and veterans and implements a scheme that actually works in practice. If this cannot be done through existing arrangements the next government should look for other options that would fulfil its commitment to providing a lifelong duty of care for those who serve. There are approximately 4.8 million veterans in the UK, around 160,000 of who receive a War Pension1. The numbers of one-off gratuity payments and people who have had their condition accepted as caused by Service but have not attracted an award are not reported, so it is impossible to say exactly how many people are eligible to receive priority treatment. Research should be undertaken to identify the number of people eligible for priority treatment, to enable better planning and resourcing of the scheme. This should
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Defence Analytical Services Agency, War Pensions Quarterly Statistics, September 2008

consider the possibility of requiring GPs to ask patients if they have a Service history when they register at their practice, linking in with a veterans’ ID card in the future or introducing a veteran’s health card.

Poverty amongst veterans
What we’re calling for: • Double the Personal Expenses Allowance for those receiving residential care.

Why? The Personal Expenses Allowance (PEA) is a small amount of money residents of care homes who receive State funding are allowed to keep from their own income to pay for personal expenses not covered by their care package. 300,000 residents of care homes are reliant on state support to pay their fees. They are allowed to keep from their own income £21.90 in England, Northern Ireland and Scotland, and £22.00 in Wales. This is to pay for everything beyond food and board. The current amount does not allow care home residents to pay for all the personal items and social activities necessary for their well being and social inclusion. These older people are now rationing essentials such as clothes, toiletries, books, leisure and recreational activities, transport and telephone calls. To maintain a sense of dignity, residents must be able to afford a decent standard of personal care and clothing, including paying for haircuts and toiletries. It is also important to a person’s sense of worth to be able to maintain choice over how to spend their money. The Legion believes that to enable these residents to retain independence and dignity in their lives the PEA should be doubled. The Joseph Rowntree Foundation conducted research in 2006 and recommended that the PEA be doubled to £39.20, to enable older people in residential care to have a better quality of life. The cost of this was estimated at £250 million. What we’re calling for: • Make the disregarding of all War Pension payments for means-testing for Council Tax Benefit and Housing Benefit a statutory requirement.

Why? Currently local authorities are required by law to disregard the first £10.00 of a War Pension when means testing for Council Tax Benefit (CTB) and Housing Benefit (HB), but have the discretion to fully disregard all such income. The Legion’s work on this has resulted in all but a handful of local authorities in England and Wales fully disregarding War Pensions. War Pensions are not an income support payment but are paid as compensation for injury, illness or loss as a result of Service in the Armed Forces. We believe this type of compensation should not be counted for purposes of means-tested benefits. This discretionary system means that War Pensioners with similar financial needs but living in neighbouring areas have a wide difference in entitlement to CTB and HB, depending on how much of their War Pension their local authority chooses to disregard.

We are concerned that in the current economic climate there is a risk that more War Pensioners will lose out in this way if local authorities, searching for budget cuts, are tempted to remove the full disregard they currently provide. The Legion believes that the next Government should legislate to make the full disregard of War Pensions a statutory requirement. This change would come at only a small cost to the public purse yet would ensure War Pensioners’ payments are protected. What we’re calling for: • Develop an automated payment system for Council Tax Benefit.

Why? The Legion believes the next government should act on the recommendation of the Lyons Inquiry into Local Government to develop an automated system of payment of Council Tax Benefit (CTB) to pensioners. It is estimated that only 55%-61% of all pensioners who qualify for CTB actually make a claim and that up to £1.5 billion of CTB is left unclaimed by pensioners each year2. A 10% increase in take-up of CTB would lift 47,000 pensioners out of poverty3. It is vital that the next government acts to ensure more pensioners take up their entitlement. Many of those who are eligible for CTB do not claim because of uncertainty about eligibility, but due to an aversion to benefits or the complexity of making a claim. Legislative reform during 2009 makes provision to pilot automated payments of Pension Credit. We believe that automated payment of CTB should also be trialled. An automated system would overcome many older peoples’ aversion to providing information for means tested benefits and remove many of the complexities that put other claimants off. Such an automated system could dramatically improve the current take-up rate amongst pensioners and help to distribute the estimated £1.5 billion of benefit that is currently not reaching those entitled to it.

Disabled Facilities Grants
Disabled Facilities Grants (DFGs) are local authority administered grants for adaptations to homes, of any tenure, to enable independent living for people with a disability. They pay for items such as stairlifts, walk in showers, bath lifts or kitchen adaptations. These adaptations can be vital in allowing many older people to continue living independent lives and remain outside the care system. As may be expected, many members of the ex-Service community have a disability and a need to have their home adapted. Unfortunately, it is very common for them to face long and unreasonable delays when using the DFG scheme. There have been widespread problems with the DFG scheme over recent years resulting in applicants waiting years for an essential adaptation to their home. This treatment fails to recognise the Service and commitment many of these people have made.

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Take up of Income related benefits-latest report, Department of Work and Pensions, 2006-07 Progress in tackling pensioner poverty, National Audit Office, 2006

What we’re calling for: • Ensure that local authorities meet their obligations to provide Disabled Facilities Grants to veterans who need adaptations to their homes.

Why? There is a legal requirement for a local authority to notify an applicant whether they are entitled to a grant within six months, and to issue a grant within 12 months, of receiving an application. Local authorities are often short of funding for grants and in many areas there can be a wait of over 12 months before an applicant even receives a decision. This is frequently followed by similar delays for actual provision of an adaptation. Many local authorities get around these statutory time limits by delaying taking a formal application until many months after the applicant initially approaches them for assistance. Whilst this may mean that they are not technically breaking the deadlines, we believe that they are not acting in good faith. These long delays cause distress to many older disabled veterans and their dependants, often leaving them unable to use certain parts of their home or forcing them to strip wash at a sink for unreasonable lengths of time. The Legion has been increasingly stepping in to provide funding for work that should be covered by the statutory DFG scheme. In 2007/08 the Legion spent over £4 million on providing adaptations. The total annual funding for DFGs is circa £220 million per year made up of central and local government funding (central Government has committed to increasing its contribution to £166m by 2010/11). The Government has reported that in 2008/9, 42,019 households received a DFG, at around an average cost of £5,000 per grant. It is clear to the Legion that this level of funding is woefully inadequate and needs to be drastically increased by the next government. The next government should ensure that local authorities are provided with enough funding and the right incentives to meet their obligations to provide DFGs to veterans who need adaptations to their homes. There may also be a need to reform the right of recourse where local authorities are not meeting the statutory requirements. What we’re calling for: • Exempt all veterans who require a Disabled Facilities Grant from the current means-test if the adaptation is needed because of a Service related injury.

Why? DFGs are subject to assessment and financial means-testing, with some people refused a grant on the basis of their income and others required to contribute towards the cost of an adaptation. As a result of this means-testing, War Pensioners can be expected to contribute towards an adaptation required for an injury or disablement linked to their Service. We believe that this does not provide sufficient respect for the contribution they have provided to the nation; nor does it satisfy the lifelong duty of care the Government holds towards our veterans. The Government has recently disregarded Armed Forces Compensation Scheme (AFCS) and War Pensions payments for the most seriously disabled from the means

test for DFGs in England and Wales. This disregard only applies to veterans at the higher end of both pension schemes. Even these applicants still have their other income assessed for a contribution towards any adaptations required as a result of injury developed in Service. Recipients of lower level compensation are unaffected by this change and are still required to have all their income included in a means test. We believe the next government should exempt all veterans who require a DFG from the current means test if the adaptation is needed because of a Service related injury.

Legacy Health Issues
Some veterans have experienced long-term health effects as a direct result of serving in the Armed Forces. Personnel who served in the 1990-91 Gulf War and those who were present at nuclear tests in the 1950s and 60s have been particularly affected, with the latter group seeing a prevalence of certain health conditions in their children and grandchildren which they believe to be linked to their Service experiences. Both groups believe the Ministry of Defence breached its duty of care towards them resulting in serious, long-term health problems and many have never received any compensation. What we’re calling for: • Fund comprehensive research and provide additional compensation for duty of care breaches to veterans suffering from legacy health issues, including Gulf War and nuclear test veterans.

Why? Gulf War Veterans 53,000 personnel were deployed to the Gulf during the conflict of 1990-91, around 7,000 of whom are in receipt of a War Pension in connection to their Service in the Gulf4. Gulf War veterans are more than twice as likely to report symptoms of illhealth, and to be suffering more severely from them, than their military contemporaries4. Until research in 1996 revealed that a considerable number of personnel and equipment had been treated with organophosphates, the Government falsely asserted that no UK personnel were exposed to these and other chemicals during the conflict. In 2008, veterans received a formal apology from the Government for their past treatment4. The US Research Advisory Committee (RAC) on Gulf War Illnesses published a Report in December 2008 which was extremely significant in further developing an understanding of Gulf War Illnesses. The US Report concluded that the use of nerve agent protection pills and exposure to pesticides were strongly and consistently linked to Gulf War Illnesses5. These findings have yet to be accepted by the US or UK Governments which are awaiting a further review by the US Institute of Medicine.
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Gulf War Group, Gulf War: a legacy of suspicion, 2007 Research Advisory Committee on Gulf War Veterans' Illnesses, Gulf War Illnesses and the Health of Gulf War Veterans, 2008

In highlighting the specific link between Gulf War Illnesses and nerve agent pretreatment (NAP) tablets and exposure to pesticides, the recent RAC Report recognised that veterans are experiencing physical illnesses and pointed to the need for future research into the effects of neurotoxins and effective treatments for veterans. The identification of these causes of Gulf War Illnesses also adds weight to the Legion’s call for a one-off ex-gratia payment for Gulf War veterans experiencing health problems linked to Service, who for many years were told that their illnesses were psychological and that they had not been exposed to any harmful toxins. This would go some way to making up for the failure of successive governments to fulfil their duty of care to this group of veterans. Nuclear Test Veterans Around 28,000 members of the UK Armed Forces were involved in 21 atmospheric nuclear tests conducted in Australia and at Malden Island and Christmas Island in the Pacific Ocean between 1952 and 1963. Around 3,000 are still alive today6. Research has shown that children of nuclear test veterans are 10 times more likely to have an inherited genetic deformity and five times more likely to die as infants than the rest of the population. Grandchildren are eight times more likely to inherit a genetic defect and twice as likely to get childhood cancer7. The adverse effects of radiation on the body were known at the time of the tests8. Film badges, to record radiation dosage, were issued to some personnel and environmental monitoring was undertaken. However, personnel present have reported being given only sunglasses for protection or being told simply to turn around, count to 20 and then turn back when the bombs were being tested. After tests, personnel were free to move around the islands, swim and eat and drink local produce, potentially inhaling dust and ingesting radiation9. Veterans have also told of naval ships and planes being ordered through radioactive clouds after explosions to collect samples. Many nuclear test veterans have long argued that exposure to radiation has adversely affected not just their health, but also the health of their children and families. They cite miscarriages and stillbirths that occurred after exposure and instances of children and grandchildren developing genetic illnesses. In April 2009, the Government responded to the concerns of nuclear test veterans by announcing a study into the health needs of nuclear test veterans and their families. It is hoped that this will lead to new research and therapies to help those experiencing ill-health. Results are expected in 2010. This is a welcome initiative, but there are other areas of concern still outstanding. The Government has said that it “recognises and is grateful to all the Servicemen who participated in the nuclear testing programme”10. We do not believe this sentiment has been borne out by action. The governments of Canada, the US, Australia, New Zealand and Russia have all recognised that there was a risk involved in nuclear testing and have made steps to compensate their Service personnel accordingly. We believe the UK Government should do the same.

Moonie, Dr L, The Parliamentary Under Secretary of State for Defence, Nuclear Test Veterans (Compensation) debate, Hansard, 4 December 2002, Column 260WH 7 Busby, C, British Nuclear Test Veterans Association/Green Audit, Children’s Health Study, 2007 8 Medical Research Council, Allowable Doses of Radiation, 1951 9 Parliamentary Inquiry, Nuclear Test Veterans, 15 and 16 October 2007 10 Jones, K, The Parliamentary Under-Secretary of State for Defence and Minister for Veterans, House of Commons, Written Answers, Hansard, 10 June 2009, Column 867W

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Nuclear test veterans face an uphill battle to receive compensation for Servicerelated ill-health. Under the War Pension Scheme (WPS) claims by nuclear test veterans are automatically rejected, forcing all claimants to go to Tribunal. This is not standard practice for any other group of veterans. Furthermore, presence at nuclear test sites is not in itself enough to guarantee an award. The veteran must be able to prove that exposure was of a sufficient level to receive an award. In comparison, in the US, presence at a site plus one of a list of conditions proven to be linked to nuclear testing is sufficient to attract an award. Nuclear test veterans and the Legion are also concerned that the WPS does not extend to children and family members who have themselves been affected by the veterans’ exposure to nuclear testing, and therefore, should be entitled to compensation.

Suicide among Service leavers
What we’re calling for • Provide all Service leavers with an effective mental health education programme at the point of resettlement, so those at high risk know where to go for help. Why? Recent research highlighted that some personnel are particularly vulnerable to suicide when they leave Service. Those most at risk are men aged 24 and under who served in the Army for four years or less, were of low rank and unmarried. The risk of suicide is greatest in the first two years after discharge. However, contact with NHS mental health services after discharge is lowest among the age groups at the greatest risk of suicide11. The reasons behind this vulnerability to suicide have not been explained or explored by the research. However, it remains that some personnel find the transition back to civilian life more difficult than others, while some might have been adversely affected by in-Service experiences or have a pre-Service vulnerability which has not been addressed. It is vital that gaps in support for vulnerable Service leavers are bridged through more effective psychological and practical preparation for the transition to civilian life. This should include greater information about recognising mental health problems and NHS services and support to access them. There must also be better awareness and assessment of the needs of young Service leavers by NHS professionals.
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Ipsos-MORI online questionnaire completed by 500 GPs across England and Wales. Fieldwork was conducted between 13-23 March 2009. Data weighted according to age, gender, region (Strategic Health Authorities in England, plus Wales), practice size and practice list size to reflect the profile of GPs in England and Wales

Interviews were conducted by Ipsos-MORI among 491 people who had been helped by the Royal British Legion (RBL) to successfully claim War Disablement Pension and agreed to take part in the survey. The sample was supplied by the RBL and consists of a database of Legion members they have helped to claim War Disablement Pension and AFCS. Prior to interviewing, these Legion members were sent a letter on behalf of RBL and asked if they would like to take part in the survey. The sample database used for the survey consists of 1,728 Legion members who did not contact RBL with a refusal to take part. Fieldwork was conducted between 27 April - 6 May 2009. Where results do not sum to 100%, this may be due to multiple responses, computer rounding or the exclusion of don’t knows/not stated. Results are based on all respondents unless otherwise stated. Data are unweighted. Kapur, N, While, D, Blatchley, N, Bray I, Harrison, K, Suicide after Leaving the UK Armed Forces — A Cohort Study, PLoS Medicine, published online March 2009
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