They pay with their blood and limbs. Surely we owe them more than this
Until today, the plight of British troops returning home seriously wounded has largely gone unreported. But the 'IoS' has obtained exclusive access to the military wards that look after the maimed and the shell-shocked. And what we have discovered is a system that cannot cope, patchy provision of long-term health care and too few military surgeons. Ian Griggs and Jonathan Owen report
Published: 15 July 2007
All Daniel Twiddy ever wanted to be was a soldier. But his boyhood dream died when he almost lost his life in a friendly fire attack on his tank that killed two of his friends. Just two days into his first tour in Iraq, Lance Corporal Twiddy of the Queen's Royal Lancers found himself fighting for his life, riddled with shrapnel wounds and scorched, with 80 per cent burns.
"I was crawling on my hands and knees, screaming, with blood running down my face. I didn't have a clue what was going on," he recalls, "I couldn't see or hear. All I could feel was this incredible heat."
L/Cpl Twiddy, 23, was airlifted to the premier specialist burns unit at Broomfield Hospital in Chelmsford where he describes his treatment as excellent. He spent months there in treatment but, as with so many war wounded he found it very difficult being treated among civilians and away from the "army family".
"I was in a civilian hospital and the doctors didn't understand what I had been through. Military hospitals know soldiers better and morale is higher there," he said.
The problems started when it came to Mr Twiddy's long-term care and he began to feel the sense of abandonment experienced by many wounded soldiers on their return to the UK. He ended up paying £60 a week for three months for a specialist to apply creams to his burns. "The MoD refused to pay for any of it and that makes you feel bitter," he said. "That sort of thing happens to soldiers a lot. They need help but they are not getting it. The MoD has a duty of care for us but they don't honour it."
Injured two days into the war in March 2003, L/Cpl Twiddy received a medical discharge in 2005. He is scathing about how the MoD treats its discharged soldiers. "Once you are discharged, the MoD doesn't want anything to do with you and the attitude is: let's just get another number in to replace this one. They should care - they blew me up but they don't want anything to do with me."
Mr Twiddy is one of thousands of soldiers that have returned from Iraq and Afghanistan physically and psychologically scarred. Stories like his are becoming all too common as Britain faces a parallel to the Vietnam war, which left America with a generation of embittered veterans.
In Iraq, the rate of wounded is double that of last year, while in Afghanistan casualties already exceed the total for 2006. Suicide attacks, roadside bombings and fire from unseen snipers are resulting in a mounting casualty toll. Since 2001, 223 soldiers have died; 573 have been wounded in action and more than 5,000 have been airlifted out of the war zones needing urgent medical treatment.
As casualties grow in number and severity, Britain's capacity to deal with them in the long term diminishes. The closure of military hospitals in the 1990s has emasculated the MoD's capacity to cope with the mounting casualties resulting from a war on two fronts. In its place are a scattering of MoD NHS units across the country, where the numbers being treated have almost doubled from 24,000 in 2002 to 45,000 in 2004.
Liam Fox, the shadow Defence spokesman, said the Government has failed in its duty of care to soldiers returning from the front. "I think because body armour is much better, your chances of surviving a blast injury are far higher," he said. "The armed forces, the British Legion, the other support services and the general public need to come to terms with what will be a major culture change. We have an absolute moral duty to ensure that injured soldiers are properly looked after. People do not understand that we are going to see an increased number of these disabled young men as a consequence of this conflict."
The MoD admits a shortfall of almost 1,000 in medical personnel, but claims that operational care is unaffected. More than 7,500 military doctors and nurses are needed, but trained strength in this area currently stands at only 6,610. Overall, the Army has less than a third of the general surgeons it needs.
Shortages in doctors mean that Territorial Army reservists are having to fill the gap and Reserved Medical Services are 50 per cent undermanned, with only 380 doctors compared with the 770 needed. Things are so bad that the MoD has had to resort to advertising for agency staff to work in the two war zones. Advertisements in the British Medical Journal are offering £140,000 pro rata for doctors to work there.
The British Medical Association claims manning levels are significantly below requirements. "It is acknowledged that shortages are most severe in speciality areas crucial to operational capability," a spokesman said. Meanwhile, the House of Commons Defence Select Committee has started an inquiry into the medical treatment of wounded soldiers. It will report later this year, but committee members privately admit that it will be highly critical of the lack of long-term care for Britain's war wounded.
Air Commodore Paul Evans, director of health for the MoD, said he is largely satisfied with the treatment that soldiers receive. "I certainly wouldn't want to be quoted as saying the NHS aren't helping us," he said, before conceding, "They sometimes have to be reminded of that priority access that should be available to ex-service personnel with particular attributable injuries or conditions." Brigadier Robin Garnett, the former head of Headley Court, the MoD's only medical rehabilitation centre in Surrey which last week announced a new 32-bed ward, said the decision to close military hospitals in the 1990s "was a big mistake". He told The Independent on Sunday: "They saved money, but the management of the treatment of soldiers deteriorated as a result of the closures and it took a long time to recover from that."
There is little hope of a quick solution to the crisis, with MoD plans to establish a military-managed ward at Birmingham's Selly Oak hospital not due to reach fruition before 2011. But action has been taken to improve conditions at Selly Oak after the hospital came under heavy criticism for the number of soldiers contracting MRSA there. Every military patient is now designated a military nurse as a point of contact, and is seen three times a day by the military team. Work is under way to keep wounded soldiers together at one end of the ward, and the MoD is helping to meet the travel and accommodation costs of visiting relatives.
A visitor to Selly Oak last week described the scene there. "Behind a mere curtain is a world of young men without legs, without parts of their skull, with so much of their insides missing that they need colostomy bags - teenagers and young adults cast prematurely into the realm of the geriatric. More than a dozen are being treated in this ward - some quarantined in side rooms, suffering from MRSA.
"An 18-year-old whose body was shredded by two mortars in Iraq talked excitedly of beginning physio. A young marine who nearly lost a leg in Afghanistan refused chocolate because he did not want to 'let himself go'. A soldier with a severe brain injury apologised profusely as he struggled to remember the date shrapnel tore into his head. When left alone the young men chatted to fellow soldiers nearby or spent hours watching televisions they had to pay extra for.
"In Iraq or Afghanistan their bravery was fuelled by bravado, by strength in numbers, by humour and companionship. Now it had to come from within as they faced a far lonelier and less glamorous test of their courage."
Although medical evacuation times from the battlefield appear to have risen since Vietnam, when wounded soldiers arrived in hospital in 25 minutes, many soldiers say field medicine in Iraq and Afghanistan and the care they initially receive on their return to the UK is excellent. Corporal Lee Gayler of 1st Battalion Royal Anglian Regiment was shot in the groin in Helmand province in April. "When the helicopter turned up there was a doctor and a paramedic on board, and I was flown straight to theatre at Camp Bastion," he said. "There were 15 doctors and nurses waiting for me, all gloved up and ready to operate."
The NHS is meant to prioritise the long-term medical care of soldiers for their battlefield injuries, but Maria Rusling, head of the National Gulf Veterans and Families Association, is emphatic that this is not being honoured. "It's just not happening, and we are fully aware of that," she said. "Other priorities, such as cancer, often override treatments for soldiers with post-traumatic stress disorder, even though they are completely different areas of treatment."
Efforts to provide support to returning wounded soldiers, including how to access long-term care, by organisations such as the Royal British Legion are hampered by the MoD, once again claiming data protection.
"The MoD has hidden behind a screen of data protection and my colleagues are only allowed to leave information at reception in a hospital rather than see individual patients," said Lt Col Craig Treeby, of the Buckinghamshire Royal British Legion. "We are not aware of any servicemen in hospitals in our area which is inconceivable. This is a major concern because we are unable to offer our services to the people who need them."
The MoD denies that its soldiers are being left without the care they need on their return to the UK. "We provide an excellent level of care for our service personnel who have been wounded on operations," a spokesman said. "This includes life-saving emergency care in the front line, in our field hospitals and in NHS hospitals in the UK; the excellent facilities at the defence medical rehabilitation centre and our regional rehabilitation units; and treatment for those whose mental health has been affected."
Two years and 20 operations on, L/Cpl Twiddy is still going through surgery to reconstruct his face. He does not believe the MoD when it says it cares for its own. "I'm supposed to get priority but it can be a month or more to get an appointment and it takes a long time to get round to having the actual operation.
"It all comes down to money. The US has everything for its soldiers, the very best, but the MoD believes that money is more important than lives."
Additional reporting: Amy Bourke, Daisy Collins, Nina Lakhani, Ellie Wilson, Marie Woolf, Raymond Whitaker
MoD 'must offer psychological facility'
Headley Court in Surrey is the Army's flagship rehabilitation facility for wounded soldiers, but there are increasing demands for an equivalent centre to deal with psychological battle scars. Combat Stress, a charity that helps traumatised veterans, said there should be a centre of excellence and that the work should go to the charity, along with funding. "We are trying to work in partnership with the MoD to treat people with clinical need and it is starting to listen," said Robert Marsh, a spokesman. The Ministry of Defence has 15 Departments of Community Mental Health and is working with army charities to set up pilot schemes for mental health clinics for veterans in NHS hospitals. This week, the Veterans minister is expected to announce a £1m-plus increase in funding for Combat Stress.
The 'IoS' has long campaigned for better treatment of troops, not only in action, but also after service, when many still suffer the mental and physical scars of war
By Ian Griggs and Jonathan Owen
Further information: Visit Helmand: The Soldiers' Story, a new exhibition at the National Army Museum, London, from 3 August
