Constant change and lower rates of pay than the NHS have destabilised defence medical services and caused serious problems for trusts, according to an influential committee of MPs.

A defence select committee report says severe understaffing and poor morale raise serious doubts about the ability to cope with a major ground conflict.

'Thankfully, the UK forces did not have to undertake a ground invasion of Kosovo earlier this year, but should they have had to do so it is not clear to us that they would have had adequate UK medical support.'

The report says the Defence Secondary Care Agency 'consistently failed to meet' its hospital performance targets.

And partnership arrangements, whereby military medical staff occupy units at NHS hospitals and treat both military and civilian patients, have caused serious problems for both sides.

MPs say host trusts in Plymouth, Frimley Park and Peterborough were aware of a 'conflict of interest' between the NHS's objectives and the defence medical services' goals of fast-tracking service patients and providing a military working and training environment. But Peterborough Hospitals trust said there would be 'a number of areas where we would struggle to provide a service without Minstry of Defence staff '.

In June, the regular defence medical services' strength was 5,972 against a target of 8,528 - a 30 per cent shortfall.

It had only 50 per cent of the doctors needed and 75 per cent of the nurses.

Dr John Ferguson, chair of the British Medical Association's armed forces committee, said: 'The government must take immediate action to raise morale by ensuring that military doctors have a significant pay advantage over their NHS colleagues.'

MPs say the MoD recognises the problems in Defence Medical Services: a strategy for the future , 'although it has yet to demonstrate its commitment to implementing its plans'.

The review calls for an upgrade to one ship, the purchase of two casualtyreceiving ships, the formation of a regular ambulance regiment and an extra air evacuation flight.

It also calls for the establishment of a centre for defence medicine, already planned following the closure of the UK's last forces' hospital in Portsmouth.

Armed forces minister John Spellar said measures had been put in place to improve recruitment and retention, supported by 'substantial extra funding.'

The Strategic Defence Review: defence medical services.