Good enough for Nelson? The CDS RUSI speech, risk and medical entry standards.

The Chief of the Defence Staff, General Sir Nick Carter has given his annual speech to the RUSI about the challenges facing the UK today. In a speech that covered the wide range of highly successful deployments met by the British Armed Forces this year, and which rightly praised their successes, he also commented about the relationship between the armed forces and society.

In the speech he said:

People must be encouraged to lead, to build inclusive teams, and to take sensible intellectual risk in the pursuit of opportunity and delivery – we do this brilliantly on operations with our philosophy of mission command, but the moment we return home the system freezes up…

This discussion of risk was followed by wider reflection on the role of the Armed Forces in Society and how they are increasingly not understood by the public. He reflected that the armed forces need to improve their engagement with the public and be better at recruiting from the full spectrum of the UK and its cultures.

This discussion is particularly pertinent given his prior comments about recruitment and how people seemed reluctant to serve in the armed forces. It also ties into wider discussions about how difficult it seems to be to actually get into the armed forces these days. For all the debate about people not wanting to join, there seems to be a significant disparity between expressions of interest and people actually joining up.

Image by Ministry of Defence; © Crown copyright

A huge challenge seems to be the medical standards used to recruit people. The armed forces have set stringent standards on peoples height, weight, medical conditions and medicine taken to ensure that when applying to join, only physically fit people can get in. That's fine if you have high recruiting levels, but when you are 8000 undermanned, is it time to think again? (data here)

The argument seems to be that the moment you make exceptions, then what happens if someone with Condition X or medicine Y is in the field or on operations and their condition flares up and they cannot possibly do their job? Is it the thin end of the wedge that may end up getting someone killed?

There is a strong logic that if you are applying to be an infanteer, you want to recruit someone able to withstand a punishing physical fitness training programme and be in excellent physical condition. But if you are recruiting an engineer, or an intelligence analyst, then do they need to meet the same standards?

The challenge seems to be that the system seems to be extremely well designed to reject people on highly spurious grounds. There was a case mentioned on social media last week of someone who has been deemed permanently unfit for service because he was prescribed an inhaler once – that individual is now a fell runner.

CDS is right that the system prefers to rely on its intellectual comfort zone of not taking risk at home and relying on the old defence of ‘standards dear boy’ when people ask why not take a risk and let someone with a minor condition join.

This would be fine if every single person in the military was an athlete in perfect physical condition, but when you consider the sheer range of medical maladies that serving military personnel have, and are allowed to continue to serve with, you have to wonder whether the system is completely fit for purpose.

Admiral Nelson

The challenge facing the military is that it is trying to draw from a pool of individuals of varying ages and varying health conditions. Todays youth is often less fit, and possibly more prone to being diagnosed with various conditions than previous generations. This is arguably due to advances in medicine, or a wider risk averseness in doctors to avoid the worst case scenario and prescribe something ‘just in case’ (e.g. Humphreys old family village doctor was well known locally for prescribing inhalers to village children at the slightest hint of wheeziness, whether they had asthma or not).

The challenge is that the military is not moving with the times, and is instead insisting on everyone joining meeting a pretty comprehensive list of medical standards – which is ruling out thousands of potential recruits every year – many of whom are likely fit, healthy young people who just happened to have one minor issue that is easily mitigatable.

A sensible pragmatic approach perhaps also needs to be taken to rejoiners who have already accrued long medical history in the forces. At present people who leave and try to rejoin after 3 years are subject to taking the New Entry Medical again which involves a telephone triage call with a contract nurse. Unsurprisingly it is remarkably easy to fail this medical, particularly if you’ve served in HM Forces in the past and been injured or prescribed medication.

As an example, Humphrey was very keen to rejoin the Reserves after a few years away. Having gone through the long process of trying to rejoin, he has now been declared Permanently Medically Unfit to join the armed forces on the grounds that he is too short sighted and was once prescribed a very commonly taken medicine by doctors to treat a common very minor issue. This rejection is despite his having served for many years in the Services, and been considered medically fit enough to deploy to HERRICK with fundamentally the same eyesight prescription as he has today, and despite his taking the medication while serving in the military, and when military serving today are being regularly prescribed said medication without the slightest impact on their employment ability.

It feels odd to discover that having served for years across the globe with very minor issues that the system considers risks that it tolerated and treated, the system is no longer prepared to treat the identical issue the same way once you are outside. While theoretically appeals are available, spending 12-18 months of precious spare time trying to persuade someone that yes you are able to sit at a desk with perfect corrected vision and type at a PC or work in an office without being at risk, and still running the likelihood of people saying ‘no’ is just not worth it.  

For all the talk of ‘risk taking’ and attempts to blame Capita, it feels like the lack of willingness to take risk lies in the hands of those who set the medical standards. Do recruits to the modern armed forces really need good uncorrected eyesight, or is it enough to treat the risk by ensuring they always have glasses on, and a spare pair to hand if required?  

The problem the modern military has is that if it continues to set itself up as an organisation that is intentionally highly self-selective at the point of entry, then it will struggle to generate enough people to join and stay. The fact that there is significant undermanning and constant struggles to recruit suggests that more needs to be done. While amending medical standards for new entrants will not solve these problems overnight, it will help get more people into the training pipeline and then in the Services as a whole.

Has the time perhaps come to ask whether the standards are too stringent, and that instead a two tier medical is required. A basic one confirming you have a pulse, and that you are not going to undergo any long term or major operations or have substantial physical challenges that would prevent you from doing training. Then develop a role specific medical for applicants who meet the basic standard to work out what they can do in the armed forces.

Much like the recruiting aptitude tests are designed to test your suitability for different branches, could new medicals be designed that measure your suitability for roles in the military – ensuring that branches with significantly higher fitness needs – for instance pilot or infanteer remain exclusively for those with the right medical history, but not ruling out those with minor issues?

It is also worth asking whether given many of the niche shortage areas are in specialist skills like engineers and other highly trained roles, is it worth reducing fitness requirements to these roles to bring in otherwise suitably trained and qualified personnel?  

Group Captain Douglas Bader RAF

There are plenty of people who may argue that creating a two tier military is a dangerous precedent and that it would be divisive. But the reality is we already have a two tier military when it comes to health matters. There are always personnel out there on long term downgrades due to illness or fitness issues, and others need to mobilise to cover them. Likewise there are plenty of serving personnel equipped with prosthetic limbs who have remained in the Services after receiving life changing injures. The attitude appears to be that those injured or ill once inside are fine, but somehow if you have the same problems before joining, then you are permanently unfit to serve your country.

Frankly why not let people in who are in wheelchairs or have mobility or visual acuity problems? There are doubtless serving personnel missing eyes, or with restricted mobility – this is tolerated and managed. The chances of many people wanting to join is probably slim, but why not look at how it could be done sensibly if they have particular niche skills that would make them of real value to the Armed Forces?

The military is in a battle for talent and to remain relevant to the mindset of the British people. As CDS noted in his speech, many people think the Battle for Helms Deep (from the Lord of the Rings trilogy) was a real battle. If you continue to maintain standards at one all embracing level for everyone, the risk is that ever fewer people get in, and it gets harder to recruit.

The cyber reserve seems to offer a sensible model of what could be possible to address this. Here individuals who often reportedly present substantial physical fitness challenges are given waivers in order to put them in uniform to carry out very niche work. The need for their wearing uniform is important to ensure that they comply with the Law of Armed Conflict when carrying out certain tasks – this is not something that legally can be handed off to a civil servant.

Ultimately you could move to create a wider ‘General Service Corps’ that captures many people who are a bit older, or who perhaps have minor ailments that do not prevent them doing the job at hand, but which the regulations have decided rule them out of the situation. This could be used to fill some of the wider gapped posts prevalent in the system that require someone with military training, who is not going to be in the frontline as a combat arms soldier, but who could bring their wider skills to bear for the good of the country.

When the idea of lowering or changing standards comes up, the usual response is the flood of comments about how it’s a bad thing and what happens if someone gets captured / killed etc? Entirely reasonable questions to ask, but equally what happens if someone serving with the same condition that is a bar to entry now gets captured? If the Service deems a condition that requires medicine to be proscribed for it sufficiently serious so as to be a bar to entry, why does it permit people serving who then acquire the same condition to stay in service?

Challenging the ‘but we’ve always done it this way’ brigade is arguably the big challenge facing CDS and the new Service Chiefs. In a system when risk is something that many think is a boardgame, not something that is encouraged to be taken without fear of career fouling consequences, getting people into the mindset of ‘lets take a risk and admit someone’ is going to be hard.

There needs to be a move to a mentality that says ‘lets see what people with X can do, not lets assume people with X cannot do anything’ and then intelligently recruit and train them appropriately. If we were in a world of 100% manning, then you can afford to be selective about who joins, but when you are consistently undermanned, perhaps taking a risk is the right thing to do to sort your manning challenges out?

The biggest irony perhaps is that some of the most revered and decorated personnel of all three Services would fail the medical entry test. Admiral Nelson, Lt General Adrian Carton De Wiat VC, and Group Captain Douglas Bader all had challenging physical disabilities that would preclude them from joining. Today they are all remembered for their courage, skills and ability, not their disability.  Surely the time has come to take a risk, and let people serve and see what they can do, not rule them out without giving them a chance?