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Martin Bricknell, Paul Cain

Original languageEnglish
JournalRUSI Journal
Publication statusPublished - 2020


King's Authors


The provision of healthcare for military personnel and Veterans is an important component of the covenant between the state and its armed forces. Whilst most emphasis is placed on the field medical system, the majority of clinical activity and healthcare costs arise from healthcare in garrisons and for Veterans. This paper proposes a high level concept for the whole of a military healthcare system that encompasses both operational and non-operational health services – the Defence Healthcare Cycle. This illustrates the care pathway for Defence patients from joining the Armed Forces as a recruit; though garrison-based community health services and care on military operations; to hospital and specialist clinical services; and finally transition to being a retiree or Veteran. The paper examines the unique opportunities for integrating clinical services, clinical and managerial information, and health, welfare and support services for Defence patients compared to citizens’ services. It also examines two structural tensions: the first between the numbers and skill-mix required to deliver garrison health services versus the requirements to support military operations, the second between supporting the current force and the duties to provide long-term care for those injured or sick from previous conflict. We hope that the Defence Healthcare Cycle will generate debate about the development of concepts and medical doctrine that encompass the whole of military health systems. This will be important as countries re-evaluate their defence expenditure as a result of the Covid-19 crisis and consider the costs and capabilities of each element of their armed forces.

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