After a critical report on military health services, army and civilian staff at an MoD hospital unit in one NHS acute trust are soldiering on together, writes Lyn Whitfield

Nothing about the approach to Frimley Park Hospital in Surrey indicates that it has military connections.

Building work is underway, so reception is reached through a clutter of mobile offices, a displaced Women's Royal Voluntary Service tea room and signs apologising for the disruption.

There are no checkpoints or military insignia. Yet the hospital houses one of three Ministry of Defence hospital units integrated into English trusts.

The others are at Peterborough Hospital and Derriford Hospital in Plymouth.

All three were created in the wake of a thorough review of forces medical services in 1994.

The review also led to the creation of a single organisation to oversee forces' hospital services: the Defence Secondary Care Association.

And it reduced the number of directly managed units in the UK to two: Royal Hospital Haslar, Gosport, and Duchess of Kent Hospital, Catterick.

DKH has been under 'active review' for the past 18 months because GPs are reluctant to use it. Partnership with Darlington Memorial Hospital trust is being considered.

Meanwhile, ministers have another review of the whole military health system on their desks.

This was launched in the wake of a highly critical report on defence medical services produced by the Commons defence select committee. It warned that morale was 'fragile' and staff shortages were 'so serious that it is not clear whether it will recover'.

These concerns are recognised by staff at Frimley Park, although they do not give the impression of crisis created by the select committee report.

The military's presence at the hospital becomes more obvious once visitors pass the main reception desk.

Doctors in distinctive military uniforms - mainly Royal Army Military Corps in an area w ith strong army connections - walk briskly around the corridors.

And in the accident and emergency department, 40 per cent of the nurses are military personnel.

Senior nursing officer Lt Col John Quinn is clearly impressed with the 'superb' accident and emergency facilities, which were recently refurbished to include bays for children, teenagers and gynaecological emergencies.

'The only problem is when we go away on training exercises, ' he says.

'Pulling so many staff out causes quite a shudder. The trust needs plenty of warning and has to make sure its staff are not on leave for that period.'

Staff nurse Angela Donaldson says military staff see a wider range of cases in the A&E department than in purely military hospitals.

'The only problem is you do lose something of your military identity, ' she says.

This is a major concern. MDHU staff would like a 'mess' so they can eat together. Dedicated housing and exercise facilities would also be welcomed.

'We need to understand that people in the services do not just want to work in the hospital. They want to maintain their military ethos, ' acknowledges Frimley Park Hospitals trust chief executive Andrew Morris.

'We need to be able to provide messing facilities and a gym or somewhere for them to do their square bashing or whatever it is they want to do.

'We have no problems with that. If we can resolve these problems, we will have a happier bunch of people to work with.'

The MDHU has about 250 staff at the moment, including 24 consultants, 40 trainee doctors and 95 nurses.

In addition to A&E staff, the military provides theatre teams and technicians for the hospital and runs two wards - Chavasse and Martin Leake, named after double VC winners.

The wards are staffed solely by military personnel. 'That is essential, ' says Col Chris Dickinson, who runs the MDHU.

'We need to be able to transfer this organised structure into a chaotic, military situation if necessary.'

But both wards take civilian cases.

On the 33-bed orthopaedic Chavasse ward, 60 per cent of the cases are military and 40 per cent civilian 'until Friday night, when the military electives go home and we fill up with people from A&E'.

The 27-bed Martin Leake ward is supposed to be a surgical ward, but it ran as a medical ward when Frimley Park came under pressure last winter.

A nurse admitted this meant staff were largely looking after elderly patients 'we would never see in a military setting' in order to 'help out the NHS'.

On the wards, staff have fewer problems maintaining their military identity, but staff shortages show up clearly.

The MDHU is under strength by 44 per cent for anaesthetists and 46 per cent for orthopaedic surgeons - a particular problem when military training produces a lot of limb injuries.

The MDHU should also have 150 nurses. The shortage means a third ward it is contracted to run cannot be opened, but Mr Morris is sanguine about this.

'This is an area where unemployment is below 7 per cent, so it is difficult for us to recruit staff, ' he says.

'If they (the military) can bring people in, it helps us out in some specialties.'

The trust sees the MDHU as 'a great success' and says it has been good for patients, who have more consultants and A&E cover than they would otherwise. Older patients also appreciate the orderly atmosphere of the military-run wards.

But Mr Morris says thought should now be given to future contracts. 'The army could move the MDHU at the end of the five-year contract, ' he says. 'We would like more stability, so issues like accommodation could be resolved, with adjustments through annual service-level agreements.'

Lt Col Gerald Dineley, from the Army Medical Directorate, says: 'The MDHU was a good idea and we feel it has worked well within the terms of the contract drawn up.

'The question is whether that contract was quite right, and that is why we welcomed the review.'

He and Col Dickinson are also hoping that the MoD's strategic defence review will reverse some of the cuts imposed under the last government, so longterm recruiting problems can be addressed.

'The select committee report found MDHUs were sound, but needed tinkering with, ' concludes Col Dickinson.

'We believe the MDHU concept has been confirmed and the sites chosen have been confirmed.

'We really do hope there is now going to be evolutionary change rather than more revolution.'