Supporting Our Veterans: A Consultation - Response

The Office for Veterans’ Affairs called on UK veterans and organisations to share their views and experiences in a consultation to help shape the future of veteran policies.

As part of my role at the King's Centre for Military Health Research I wrote the response to Chapter 13. I'd like to share the response, and some extended thoughts.

Introduction

This was not part of the submission. But I'd like to outline who the King's Centre for Military Health Research (KCMHR) is.

KCMHR is a leading research group specialising in the health and well-being of the UK Armed Forces Community. KCMHR operates independently of the Ministry of Defence, the Office for Veterans' Affairs, and the military chain of command. This independence is key in our role of delivering objective, evidence-based research focusing on the mental and physical health of both serving and ex-serving military personnel and their families.

We are involved in several long-term research initiatives, including a study investigating the health and wellbeing of UK military personnel who were deployed to Iraq and Afghanistan, large data linkages and the development of novel digital therapeutics for Defence and the wider Armed Forces community. Our extensive research and wider expertise enable us to provide a response to the consultation.

Our submission to this consultation primarily addresses Chapter 13: Data Collection and Statistics. We view this as a crosscutting theme that intersects with and influences all other consultation areas outlined. By addressing it, we aim to provide new perspectives on various aspects of the consultation. We intend to provide an overview of the work KCMHR is currently undertaking and highlight future opportunities for the community.

Our primary stance is that entities such as the Government agencies, healthcare providers, third sector organisations, and academic institutions should be motivated and rewarded for analysing and exploiting their existing data. Furthermore, they should be encouraged to link their data with other sources to enhance its value and share it with other organisations via Secure Research Environments, like the ONS Secure Research Environment, for instance.

Overview of Our Relevant Work

KCMHR has already undertaken the first steps in creating linked administrative datasets for analysis. For example, we linked our Health and Wellbeing Cohort Study (2004 to present) to secondary healthcare records of England, Scotland and Wales. This enabled us to analyse service utilisation and move beyond just self-report. Key outputs arising from this work are listed hereafter. 

Integrating Electronic Healthcare Records of Armed Forces Personnel: Developing a framework for evaluating health outcomes in England, Scotland and Wales. Daniel Leightley, Zoe Chui, Margaret Jones, Sabine Landau, Paul McCrone, Richard D. Hayes, Simon Wessely, Nicola T. Fear and Laura Goodwin. International Journal of Medical Informatics, 2018. 

Hospital admissions for non-communicable disease in the UK military and associations with alcohol use and mental health: A data linkage study. Laura Goodwin, Daniel Leightley, Zoe Chui, Sabine Landau, Paul McCrone, Richard Hayes, Margaret Jones, Simon Wessely and Nicola Fear. BMC Public Health, 2020.

Mental health problems and admissions to hospital for accidents and injuries in the UK military: A data linkage study. Zoe Chui, Daniel Leightley, Margaret Jones, Sabine Landau, Paul McCrone, Richard D. Hayes, Simon Wessely, Nicola T. Fear and Laura Goodwin. PLoS One, 2023.

Focusing solely on administrative data and in partnership with Oxford University and Lancaster University, KCMHR currently manages the Porton Down Veteran Cohort Study. This study seeks to assess the impact of chemical and biological testing on service personnel during the 1960s and 1990s compared with those who didn’t undertake such testing. Thus far, this has enabled us to ascertain that veterans who were tested on during Porton Down experiments are at no greater increased risk of developing cancer than those who didn’t. Although this is an evolving picture. 

Cohort Profile: The Porton Down Veterans cohort study. Gemma Archer, Thomas J Keegan, Katherine M Venables, Lucy M Carpenter and Nicola T Fear. International Journal of Epidemiology, 2022.

Mortality and cancer incidence in UK military veterans involved in human experiments at Porton Down: 48-year follow-up. Gemma Archer, Thomas J Keegan, Lucy M Carpenter, Katherine M Venables, Nicola T Fear. International Journal of Epidemiology, 2023.

We have also conducted linkages of administrative data between the national criminal records registry and military service records to examine patterns of offending behaviour over a lifetime. The primary goals of this research are to investigate the risk and protective factors linked to offending behaviours at various stages of military service, including pre-service, during service, and post-service periods.

Risk and protective factors for offending among UK Armed Forces personnel after they leave service: a data linkage study. Deirdre MacManus, Hannah Dickson, Roxanna Short , Howard Burdett, Jamie Kwan, Margaret Jones, Lisa Hull2 Simon Wessely and Nicola T. Fear. Psychological Medicine, 2019.

Other academics works which highlight our skill in this area are as follows.

Personalised Digital Technology for Mental Health in the Armed Forces: the potential, the hype and the dangers. Daniel Leightley and Dominic Murphy. BMJ Military Health, 2022.

Response to Consultation

There is a broad consensus on the obligation to assist those who have served our nation. This responsibility has gained considerable focus from the Government since the War in Iraq and conflict in Afghanistan, as exemplified by initiatives such as the Armed Forces Covenant. However, a major challenge confronting the community is the extensive collection and management of data (commonly known as administrative data) by diverse groups such as the Government, healthcare providers, third sector organisations, and academic institutions.

Although this data plays a vital role in supporting the health and well-being of the Armed Forces community, its utilisation is currently limited, compartmentalised, and lacks coordination across the sector. The true strategic value of administrative data emerges when it is effectively leveraged through initiatives in areas like health, policy, welfare, and criminal justice specific to this community. We believe that the key to fully utilising this data involves linking datasets, facilitating data sharing via collaborative Secure Research Environments, and actively involving the Armed Forces community in these processes.

Our response to relevant specific questions in Chapter 13: Data Collection and Statistics are as follows: 

Consultation Question 248: Do you think a veteran question should continue to be asked in any future censuses?

Response: Yes. 

Consultation Question 249: How could we improve the collection or recording of data to better understand veteran status and requirements?

Response: Improving the collection and recording of data to better understand veteran status and requirements can be achieved through several approaches. The overall aim of these approaches is to promote a national commitment with local excellence:

1. Standardised data collection: Establish uniform standards for collecting data on veterans. This includes defining key metrics and ensuring consistency in how data is gathered across different organisations, systems, and nations.
2. Comprehensive data integration: Encourage and incentivise data sharing and integration among Government agencies, healthcare providers, third sector organisations, and academic institutions. This would create a more holistic view of veterans' needs and experiences.
3. Enhanced data accessibility: Implement Secure Research Environments modelled on the Office for National Statistics (or similar) to facilitate secure data sharing and analysis. This allows for broader access to data using hypothesis driven approaches while protecting sensitive information. These systems should be accessible for accredited researchers (note: the term researcher should be seen in the broadest sense).
4. Longitudinal studies: Conduct long-term studies to track veterans over time, providing insights into how their needs and circumstances evolve. These analyses can be repeated over time and quickly. Notably, it is also important to acknowledge time spent prior to, and in-Service as each stage plays an important role later in life.
5. Inclusion of qualitative data: Beyond quantitative data, gather qualitative insights through interviews and focus groups with veterans, and the wider Armed Forces community. This provides a deeper understanding of their experiences and needs and provides humanistic context to data.
6. Technology utilisation: Leverage advanced technologies like AI and machine learning to analyse large datasets more efficiently and uncover patterns or trends that might not be immediately obvious. In addition, use digital health technology to deliver health innovation such as DrinksRation app (an alcohol reduction app).
7. Feedback mechanisms: Create channels for veterans to provide feedback on services received and challenges faced. This direct input can guide improvements in data collection methods so long as it is acknowledged and fed back to veterans.

By implementing these strategies, a more comprehensive, accurate, and actionable understanding of veterans' status and requirements can be achieved, leading to better-targeted and more effective support services, academic research, and Government policy.

Consultation Question 250: What steps could be taken to improve data sharing between organisations working to support veterans?

Response: There is notable apprehension surrounding the sharing, transferring, and linking of data among organisations. Academia, in particular, is required to undertake thorough consultations, reviews, and application processes. Improving data sharing between organisations that support veterans involves several key steps: 

1. Standardise data formats: Ensure that data is collected and stored in standardised formats that are compatible across different systems. This makes it easier to share and integrate data from various sources.
2. Implement secure sharing platforms: Use secure, centralised platforms or databases for data sharing. Platforms such as the Secure Research Environments ensure that sensitive data is protected while being accessible to authorised organisations.
   1. Opportunity: It is vitally important to recognise the unique needs to Northern Ireland Service personnel and work should be undertaken to support this population. Administrative data linkage could be one solution to overcome security concerns.
3. Collaboration and partnerships: Foster strong partnerships and networks between government agencies, regulators such as the Information Commissioner’s Office, healthcare providers, non-profits, and academic institutions. Collaborations foster a more coordinated approach to data sharing to support veterans.
4. Training and capacity building: Provide training for staff in data handling, privacy laws, and the technical aspects of data sharing. This ensures that all parties are equipped to manage data responsibly. This allows organisations to effectively leverage data for the benefit of the community.
5. Develop a common framework: Create a shared framework or set of guidelines for data sharing that all organisations can follow. This can include exemplar protocols for data access, usage, and sharing, as well as taking into ethical and legal considerations.
6. Leverage technology: Utilise advanced technology solutions like cloud-based systems, blockchain, or API integrations to facilitate seamless and secure data exchange.
7. Encourage a culture of transparency and trust: Build a culture where data sharing is seen as a collaborative and mutually beneficial. This includes being transparent about how data is used and the benefits it brings. There is a need to accept risks associated with data sharing but bold leadership is required.
8. Policy advocacy: Work towards influencing policies that support and enhance data sharing initiatives. This includes encouraging organisations to leverage support from the Information Commissioner’s Office and use the Digital Economies Act 2026 to facilitate data linkages.

By taking these steps, organisations, Government, academia can create a more cohesive and efficient ecosystem for sharing data, ultimately leading to better support and outcomes for veterans.

Consultation Question 251: Do you have views or experience on how to improve data integration across different data systems to help reduce the burden for veterans to tell their stories several times before getting the services or support they need?

Response: No comment. We do not operate in this area and therefore can’t comment.

Contact Information

Further information can be obtained from Dr Daniel Leightley (daniel.leightley@kcl.ac.uk).