A curious letter was sent out by the Department of Health the other day to GPs and the Chief Executives of various health authorities, trusts, and so on. The full text is available online, but here’s the nub of it:
ACCESS TO HEALTH SERVICES FOR MILITARY VETERANS – PRIORITY TREATMENT
The purpose of this letter is to advise you of the guidance in place to ensure that military veterans receive priority access to NHS secondary care for any conditions which are likely to be related to their service, subject to the clinical needs of all patients. […] GPs are asked, when making referrals relating to a military veteran for diagnosis or treatment, where they are aware of the patient’s veteran status, to record that status as part of the referral. If the patient does not want the GP to record their veteran status the information should not be included. If GPs consider that priority treatment might be appropriate because the condition to which the referral relates is likely to be related to the patient’s time in the services, GPs are asked to include details in the referral.
The ongoing deployment of UK armed forces means it is now more important than ever that the NHS works closely with military services to ensure that the health needs of the Armed Forces, their families and veterans are appropriately met. In particular, it will be important to provide priority treatment, including appropriate mental health treatment, for veterans with conditions related to their service, subject to the clinical needs of others.
I automatically bristled when I saw the headline, because it’s hard to argue against anything done on behalf of “veterans” without sounding like the commanding officer of the 6th Armoured PC Brigade; so, with that caveat, I’m going to give it a go…
I don’t get it. Obviously, if someone is in need of medical attention, I don’t begrudge them it. But it’s hard to see why having been in the forces makes a difference. Being a member of the forces is, in the end, just a matter of having a job of a particular sort; and it’s a job for which you volunteer and get paid. Presumably the risks are clear. To this extent, the same applies to everyone: soldier, Dyno-Rod engineer, philosopher. (Granted, it’s hard to see how anything too awful could happen to a philosopher – “The tests reveal anomalous monism. I’m so terribly sorry…” – but stick with me.) Obviously, if a soldier is injured, he or she ought to get treatment. But the same applies to everyone. It’s not clear to me why special attention has to be drawn to the needs of veterans in comparison to anyone else. There’s no obvious justification for the special treatment there.
(The possible reply that members of the forces have made a special contribution and therefore deserve special treatment doesn’t seem to me to be all that powerful. For one thing, as I mentioned, it’s a voluntary job for which people get paid. In other words, becoming a veteran is something you choose. Maybe infantrymen need to be paid more – I don’t know – but the case for that isn’t answered by making provisions in terms of NHS priorities, since that would be inequitable to those who don’t get injured, and it’s not clear that the NHS is the place to remedy allegedly poor pay for some members of the forces anyway. Note, too, that some members of the forces are very well paid indeed, so their claim to priority would presumably evaporate if that were the ground. For another thing, the idea that members of the forces make more of a contribution than you or I would seem to be an empirical claim; I have no idea how you’d measure it, but it’s not self-evident to me.)
Moreover, a squaddie injured in the course of being a squaddie is already entitled to exactly the same benefits and support as a non-squaddie; it’s hard to see why someone born without legs should be expected to cede priority just by virtue of never having had the chance to lose them to an IED. Ex-squaddies aren’t any worse off than civvies with comparable problems, and it’s hard to see why they should, on this basis, be given priority. Of course, if a squaddie’s needs are greater than a civvie’s, then that’s straightforward – but, again, being a squaddie makes no difference at all here; it’s the gravity of the need that does the moral work.
For example, consider the Dyno-Rod engineer who gets a mouthful of sewage while doing his job. It seems odd to say that he ought to go to the front of the queue at A&E because his needs were incurred in the course of an unpleasant job that you or I would rather not have; rather, we’d say that, if he has a pressing need, it’s because he’s just ingested a load of crap. His needs can be assessed without any reference to the mechanism by which they arose. And the same seems to apply to members of the forces, too – unless we accept that they are de facto more important, which is exactly the supposition that I’m attacking here.
And, naturally, we might want to say that the benefits and support for any disabled or injured people are insufficient and ought to be bumped up, and that seems fine to me. But the military aspect thereby vanishes. Being a veteran makes no difference. Either you’re treated adequately by the state, or you aren’t. Again, though, the help that the state ought to give seems not to have anything much to do with the process by which your needs arose.
Bluntly, I don’t see that being a veteran makes any odds at all. But, curiously, on a second reading of the letter, it seems that neither does anyone else. One phrase from the letter stands out:
… to ensure that military veterans receive priority access to NHS secondary care for any conditions which are likely to be related to their service, subject to the clinical needs of all patients.
…for veterans with conditions related to their service, subject to the clinical needs of others.
There’re two ways to read that. The first is that, given two patients with identical needs, one of whom got those needs as a result of being in the forces, merely having been in the forces ought to count in his or her favour when it comes to priority-setting. As I’ve just suggested, that seems arbitrary and unjust at first glance. The other way of reading it is that veterans should get priority treatment unless there’s another candidate for the resources required – in which case, though, we’re talking about a straightforward and workaday problem about priority-setting. Indeed, to say that anyone has much of a priority in this sense is to use the word “priority” in a fairly vacuous sense.
A curious letter indeed…