Armed forces and veterans (Resources)

TAM (Treatments and Medicines) NHS Highland
NHS Highland

Audience

  • All NHS Highland
  • Primary and Secondary Care. 
  • Adults Only

As at 06 January 2026 Update:  The Armed Forces Covenant Duty is due to be extended beyond the policy areas of housing, education and healthcare (enacted November 2022) to include the following: 

    • Social care
    • Childcare
    • Employment and service in the armed forces
    • Personal taxation
    • Welfare benefits
    • Criminal justice
    • Immigration
    • Citizenship
    • Pensions
    • Service-related compensation
    • Transport

The date for enaction is not yet known.

Objectives 

To support healthcare staff to:

  • identify the Armed Forces and Veterans (AF&V) community and
  • understand the barriers and challenges they may face when accessing healthcare

So that all staff can:

  • support AF&V patients,
  • signpost to appropriate AF&V-specific support and
  • refer to secondary and tertiary care using the Armed Forces Covenant(AFC)to best effect.

 

 

​​​​​​​​​​​​​​​​​​​​​​​​​​​The AFC & Duty

The Armed Forces Covenant (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 AFC states that due regard should be paid to the unique obligations of, and sacrifices made by, the Armed Forces:

  • Principle one: 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.
  • Principle two: Special consideration is appropriate in some cases, especially for those who have given most such as the injured and the bereaved.

The AFC Promise covers:

  • currently serving members of 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, including Royal Fleet Auxiliary or Merchant Naval Seafarers, who deployed on legally defined UK military operations
  • relevant family members

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 AFC 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 but not Royal Fleet Auxiliary or Merchant Naval veterans
  • 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 veterans, 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.

Who is a veteran?

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 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.

Why is identifying military service important?

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.​​

What should you ask a patient?

  • 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.

Read codes

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.

Suggested paragraph for referral summaries or letters

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 military-connected family (please delete as applicable)

For details of the Armed Forces Covenant and Duty see:

https://www.gov.uk/government/publications/armed-forces-covenant-duty-statutory-guidance

(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 Veterans In-Service Injury Network (VISIN)

Launched in August 2025, The Veterans In-Service Injury Network (VISIN) is a Scottish Government initiative that NHS Highland have been asked to host. 

VISIN provides independent, expert clinical review of and veteran-specific recommendations for, military service-related physical health conditions, illnesses or injuries, which remain a concern despite treatment, either previous or current; for example, amputations, scarring, respiratory or skin issues, or conditions that have developed earlier than expected due to military service; for example, MSK or hearing issues.

VISIN is a targeted pathway for UK veterans only.  It differs from the Armed Forces Covenant, which stipulates prioritised access to specialist services in line with clinical need for physical and mental health conditions, injuries or illnesses that likely link back to service, and is for the whole Armed Forces and Veterans community.

Please contact nhsh.visin@nhs.scot for further information or visit the webpage at:

Veterans In-Service Injury Network | NHS Highland

Where to go for advice or help within NHS Highland

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 undertake the TURAS Learn AF&V-specific training or access the NHS Highland Armed Forces and Veterans page  for information including:

  • Self-management sign-posting and resources
  • Case studies, reports and policies

Where to go for advice or help outside NHS Highland

MOD

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.)

Information about Third Sector support for veterans and military-connected families can be found on the NHS Highland Armed Forces and Veterans intranet page the Veterans Assist Scotland website

Training resouces

Information for healthcare professionals

References

Useful terms

  • 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.

Abbreviations

AF&V: Armed Forces and Veterans
AFC: Armed Forces Covenant
HM: His Majesty’s
MOD: Ministry of Defence
RAF: Royal Air Force
RFA: Royal Fleet Auxiliary
SSAFA: Soldiers, Sailors, Airmen and Families Association

Editorial Information

Last reviewed: 30/06/2025

Next review date: 31/01/2028

Author(s): Armed Forces Champion & Corporate Services.

Version: 2

Approved By: TAM subgroup of the ADTC

Reviewer name(s): K Magee, VISIN Manager..

Document Id: TAM546

Related resources

Further training and information for Healthcare Professionals