Medical watchdog criticises care of British troops

Frontline medical treatment received by British troops is "exemplary" – so much so that the NHS could learn a few things – but there are worrying shortfalls in standards back home and at some overseas bases, reports an independent investigation.

The first-ever review into Defence Medical Services (DMS) called for "unsafe" ambulances to be immediately replaced and for staff to be trained in safeguarding soldiers under the age of 18, who are still legally children.

Improvements in cleanliness and hygiene were needed in some units, long-term rehabilitation programmes for injured personnel should be examined and red tape – a constant source of complaints – eliminated, it said.

The findings, by the Healthcare Commission, the independent medical watchdog, are not legally binding on the military. However, Lieutenant General Louis Lillywhite, the Surgeon General who ordered the review, pledged that "all recommendations will be implemented in full". Rear Admiral Philip Raffaelli has been appointed to the new post of Inspector General of the DMS to oversee their implementation.

On the positive side, the report said that with its experience treating the wounded in Afghanistan and Iraq the military could teach the NHS lessons on handling trauma. It suggested that channels should be opened for this.

However, it highlighted concern over a fleet of nine ambulances based in Cyprus that came into service in 2002 but which no longer match UK or EU standards. It described them as "unsafe and needing urgent replacement. The DMS is currently modifying the vehicles. The commission considers, however, that the ambulances continue to present a risk to the safety of patients". The defects in the vehicles included stretchers which could not be properly secured and inadequate access to side doors and windows.

The MoD said that no personnel had been injured while travelling in the ambulances and it would not be logistically possible to replace the vehicles until July at a cost of around £1m.

The commission also said that the military "does not always understand that personnel under the age of 18 are still legally children. While no concerns were found relating to the practice of treating and safeguarding children, some DMS staff did not know processes for reporting matters relating to child protection and safeguarding".

Maintenance and cleanliness in some military facilities were a subject of concern, the commission said. It visited three medical centres in the UK and one in Cyprus "where primary care was delivered in unacceptable conditions.

This included very poor maintenance, inadequate facilities for clinical staff to work in and poor levels of cleanliness." Infection control and the environment were among areas where compliance with medical service standards was lowest.

The commission found that although reaction of service patients to primary medical care was generally good, there were complaints about "administration and bureaucracy which drew a consistently negative response. Of the respondents who commented on it, 97 per cent described negative experiences, although the number who commented was small overall – only 32 out of 485 comments received".