The AFC is a promise by the nation to ensure that members of the AF&V community are not disadvantaged by their service.  It has been signed up to by many public, private and third sector organisations.   

It is also a legislative duty for public sector organisations that deliver education, health and housing. 

The Armed Forces Coven​ant’s three principles are that:

• Regard should be paid to the unique obligations of, and sacrifices made by, the Armed Forces.
• The Armed Forces community should not face disadvantage compared to other citizens in the provision of public and commercial services in the area where they live.
• Special consideration is appropriate in some cases, especially for those who have given most such as the injured and the bereaved.

The AFC Duty came into effect on 22 November 2022.  It is a statutory duty for specific bodies in the areas of health, housing and education.  

The bodies subject to the Duty are expected to consciously consider and pay due regard to the Covenant when developing, delivering and reviewing policies and decisions which may impact the Armed Forces and Veterans community and help improve their access to public services. ​​​​​​​​

The Armed Forces Covenant Duty covers:

• currently serving members of the His Majesty’s Forces (Regular and Reserve)
• currently serving members of British Overseas Territories’ Armed Forces, who are subject to UK Service law
• veterans, who are ordinarily resident in the UK
• relevant family members.

Although the legislative duty covers only those who serve or have served in HM Forces and their families, NHS Highland recognises the sacrifices made by Merchant Naval Seafarers, the Royal Fleet Auxiliary, the Royal Naval Auxiliary Service and their families as well as the confusion that a two-tier system may cause healthcare professionals.  Where possible, the whole AF&V community should be considered under the duty. ​​​​​​​​​​​​​​​​​​​​​​

Veterans are defined as anyone, who has served for at least one day in the Armed Forces (Regular or Reserve) or Merchant Naval Seafarers, who have seen duty on legally defined military operations.

Not everyone identifies as a veteran; some may wish to forget their service due to negative experiences; others may say that they 'only completed National Service'; others may feel they don't fit the picture of a veteran as they have moved onto another career.  It doesn't matter who they served with, where they went, what they did or how they left.  If they served, they served.

Who are the Armed Forces and Veterans (AF&V) community?

The AF&V community covers a very broad demographic; male, female, non-binary from 0 to 110+ years, with an even greater breadth of need.

The AF&V community is made up of:

• His Majesty’s Forces (Regular and Reserve)
• British Overseas Territories’ Armed Forces
• Veterans, who are ordinarily resident in the UK
• Service Families, including service children and dependent adults, who live with the service person.
• Veteran Families, including children and dependent adults, who live with the veteran.
• Former spouses and civil partners of serving personnel or veterans or former partners from a committed relationship.

Research from organisations such as The Scottish Veterans Health Research Group, King's Centre for Military Health Research, Veterans and Families Institute and the Forces in Mind Trust highlights that military service can have an impact on physical and mental health.  The impact may be very different to, more pronounced than or occur earlier than their civilian counterparts. 

Although the list of examples below is not exhaustive, the physical and mental health of veterans and their families may have been adversely affected by exposure to:

• sustained physical exertion carrying heavy equipment over difficult terrain in challenging situations, often in extreme weather (hot, cold and/ or wet).
• prolonged or impulsive noise in excess of the recommendations for regular exposure.
• sustained use of alcohol, tobacco and prescription painkillers.
• the UK Government's nuclear weapons testing between 1952 to 1967.
• the use of asbestos in many military vehicles between 1940 to 1990's as well as exposure to damaged buildings containing asbestos in the Bosnian, Kosovan and Iraq conflicts.
• the use of disused industrial buildings for accommodation in the Bosnian and Kosovan conflicts or the use of burns pits to destroy waste in most conflict zones.
• frequent deployments to combat zones, peacekeeping missions or in support of disaster relief.
• witnessing distressing events during operational deployments and training exercises, or being unable to prevent injurious events to colleagues, partner forces or the local population, especially the vulnerable.
• secondary trauma.

There are also a number of barriers and challenges that may prevent the AF&V community from accessing healthcare from practical issues such as not understanding the NHS system or the unavailability of medical notes to the sense of shame or stigma that they may feel about being injured. 

Many of the AF&V community have brushed sometimes significant injuries under the carpet so as not to let the team down, in order to complete their task or because of the stigma of being injured; they may not easily recognise the signs and symptoms of injury or illness.  Others may significantly under-represent their symptoms.  Family members may not be aware of the signs of secondary trauma or may be too committed to supporting service person or veteran that they do not find the time to look after themselves as well.​​

• Ask
  if patients have ever served or if anyone in their immediate family has served.
• Consider
  asking them about their role and what tasks they undertook; for example, if they served in engine rooms, as ground crew or in a combat role such as the infantry, it could prompt a discussion about their hearing.
• Also
  consider asking if they ever undertook any tasks that were not routine to their role; for example, if they were normally an administrative clerk but deployed as a female searcher on patrols during an operational tour, it could potentially provide relevant background if they are experiencing physical or mental health issues.

Where possible, record the information using the READ code:

• Veteran: 13Ji
• Reservist: 0Z7
• Member of a military family: 13WY

And mention military service when referring a patient for further treatment.

The wording below can be copied and pasted into a referral summary/letter and adapted as appropriate: 

This patient is a veteran/ reservist/ a member of a service family/ a member of a reservist’s family/ a member of a veteran’s family (please delete as applicable)

For details of the Armed Forces Covenant and Duty see: https://tam.nhsh.scot/clinician-patient-resources/new-armed-forces-and-veterans/

(For new referrals)

The condition is directly/ most likely (please delete as applicable) attributable to military service.

They are being referred in line with the Armed Forces Covenant Duty, which commits to priority access for conditions arising from military service when compared to non-Service patients with the same level of clinical need.

(For transfer between waiting lists on re-location)

Military service has demanded their re-location whilst they were on a waiting list for ….
They have already waited … (days/ weeks/ months).
In line with the Armed Forces Covenant Duty, we should consider the total time spent on waiting lists, both in their previous NHS board and in ours, and ensure that the patient keeps their relative place.

(For resumption of treatment on re-location)

Military service has demanded their re-location whilst they were being treated for ….
In line with the Armed Forces Covenant Duty, we should consider how treatment plans can continue with minimal disruption, and continuity of care can be maintained.

​The NHS Highland Armed Forces Champion is Jo McBain, Director of Allied Health Professionals.  The AF&V email address is ​nhsh.armedforceschampion@nhs.scot.

For further information please access the Armed Forces and Veterans page (see resources) for information including: 

• GP training information and read codes
• Self-management sign-posting and resources
• Case studies, reports and policies

MOD

• Veterans UK is part of the Ministry of Defence. They help ex-service personnel get support from government, local authorities, independent bodies and the charity sector
  Veterans UK helpline: 0808 1914 218
  Email: veterans-uk@mod.gov.uk
• Veterans Welfare Service comes under Veterans UK. They focus on providing assistance following a change in situation that may have resulted in a welfare need. (Lifelong support)
  Tel: 0141 2242709
  Email: veterans-uk-vws-scot-ni@mod.uk
• Defence Transition Services come under Veterans UK. They provide information and support for those service leavers and their families, who are most likely to face challenges as they leave the Armed Forces and adjust to civilian life. (Support for 2 years post discharge.)
  Email: DBSVets-DTS-Central@mod.gov.uk
• Army Welfare Service provides comprehensive welfare support to serving Army personnel and their families. https://www.army.mod.uk/people/health-wellbeing-welfare-support/welfare-support/the-army-welfare-service-aws/
  For Personal support, please contact 01904 882053 or RC-AWS-IAT-0Mailbox@mod.gov.uk
• Royal Navy Family and People Support provides comprehensive welfare support to serving Royal Naval and Royal Marine personnel and their families. royalnavy.mod.uk/community-and-support
  For support, please contact Freephone: 0800 145 6088 or 02392 728777 or navynps-peoplesptrnfpsptl@mod.gov.uk
• Personal Support & Social Work Service (via Soldiers, Sailors, Airmen and Families Association (SSAFA)) provides comprehensive welfare support to serving Royal Air Force personnel and their families. https://www.ssafa.org.uk/get-help/raf-personal-support-and-social-work-service
  For support, please contact 03000 111 723 or psswsRAF@ssafa.org.uk

Third Sector

Further information from the Third Sector can be found on the Armed Forces and Veterans intranet page (see Resources then Armed Forces and Veterans).  

• His Majesty’s Forces / HM Forces: Armed Forces.
• Armed Forces: Royal Navy, Army, Royal Marines and Royal Air Force.
• British Overseas Territories’ Armed Forces: Forces such as the Royal Bermuda Regiment. (This is not the same as British Forces Overseas.)
• British Forces Overseas: HM Forces stationed overseas; for example, in Cyprus, Germany or the Falkland Islands.
• Regular: Full-time.
• Reserve: Part-time.
• Veteran: Someone, who has served one full day in uniform or in exceptional circumstances, a Merchant Naval Seafarer, who has been employed in support of a specific UK military operation.

• Armed Forces Covenant Duty – Statutory Guidance https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1116148/Armed_Forces_Covenant_Duty_Statutory_Guidance.pdf