The AMS has recently looked at the three regular Field Hospitals with the aim of standardising exactly what each one holds and the facilities it will provide. The aim I am told, although I have seen nothing in writing, is to be able to set up a facility which will treat casualties for a period of 30 days. During this 30 days a second âtier twoâ facility will be constructed and the medical unit will move into that. This is a good idea in theory, however, it is my opinion that the way that this has been gone about is completely wrong and as such the Field Hospitals, and consequentially the AMS will not be best placed to support the Field Army in the future. The restructuring and standardisation of the Field Hospital is long over due, and as part of the Improved Medical Support to the Brigade (IMSB) study it was decided that the Field Hospitals should have two roles. Firstly they should have small manoeuvrable hospitals which are able to be tactically placed within the Bde area, ensuring that medical timelines are met within the moving battle space. Part of the study suggested that 2, 50 bed facilities would be able to âpepper potâ forwards (or backwards) ensuring that one is always open and able to provide care in a suitable location. Secondly there should be a larger field hospital within the rear area manned by the Territorial Army, this larger hospital could equally well be met using Strategic Air or Sea Assets and transporting personnel back to the UK and will not be considered futher here. As part of the restructuring of the Field Hospitals, 2 Med Bde initially felt that they should provide direction to the 3 Regular Field Hospitals. This was protested and consequentially the Field Hospitals were allowed to combine their knowledge and decide on what they felt was the best lay out of a Field Hospital as part of the IMSB study. The result was a Hospital of increased size, loosely based on the current tier two facilities in Iraq and Afghanistan. The design has been recently trialled requiring a lift of approximately 50 ISO containers and a flat area of approximately 100 x 150m for construction. The trial also showed that it took approximately 3Â½ days to construct and equip the hospital. This is certainly not something that is designed to be in keeping with the manoeuvreist approach that drives the other Arms and Services and should also drive the AMS. The fact that the design of the Field Hospital has been driven by the Regular Field Hospitals and not AMD or even 2 Med Bde has led to a narrow, almost isolationist approach to the problems faced. There has been no âbuy inâ by any of the following: Engineers. At this scale a vital requirement to prepare the land, provide water and electricity to the Hospital. They are also required to install a system to remove the waste water. Logistics. At its current size the hospital is not planned to move once placed. However, moving 50 ISO containers to the right place at the right time raises serious concerns. Is this really achievable considering the amount of lift that may be available during a fast moving battle? Although Medical assets are important, they need to be weighed up against the requirement to move Ammunition, food and water to the front line. Manoeuvre Brigades. The Manoeuvre Bdes must be able to support their Field Hospitals, they must also see the Hospital as an Asset that they can deploy and not a hindrance to their Scheme of Manoeuvre. In order to ensure that the Field Hospital is the best that we are able to provide for âa Warâ, rather than âthe Warâ we must ensure that the proposed solution fits with as many Principles (most suitable here are the Principles of Logistics) as possible. I will now consider each of the principles in turn (less Foresight): Economy. Approximately 90-95% of the capability that can be provided by the IMSB Field Hospital could be provided by a much smaller facility (approximately 25% the size). This would provide sufficient medical capability for the first 30 days of an operation. Any specialist equipment such as a CT Scanner would need to be procured specifically for the operation and is extremely difficult to support in a Manoueverist environment. Physio, Welfare, CPN and GU Med do not necessarily need dedicated areas in the first 30 days of an operation as they will be mostly employed elsewhere if required at all. These facilities should however be included in the tier two build. The reduced size ensures that there is less construction required allowing the Hospital to be ready to receive casualties in a matter of hours rather than days. A smaller facility would also have less requirements for power and water. It is also my opinion that the facility should be planned to operate without the need for plumbing, at least for the first 30 days. Such a facility would also be less of a burden on the logistic chain allowing more efficient placement, there is also the potential that a facility can be dismantled within a reasonable period of time. This would allow the facility to be ârecycledâ in a moving battle, reducing the waste of deploying an entirely new Field Hospital. Simplicity. The larger and more complicate the facility and the more equipment that is deployed the more there is to go wrong. Such a facility requires a larger logistical footprint for just day to day support. The smaller and consequentially simpler that we can make the facility the better. Cooperation. A study should be made into the other NATO countries to ensure that we are moving in the same direction. We should aim to provide a similar range of facilities (to NHS standards where possible). Then with an Joint Allied Deployment, Operational Commanders at the highest level would understand what they were deploying with. The Other Arms and Services should also be spoken to ensure that we are providing the facility that they expect from us and are able to support. Flexibility. A smaller facility can be potentially supplied and maintained at a lower cost (in both monetary and manpower terms), as such there would be potential for a greater number of Field hospitals to be in place which can be deployed to support a wide range of situations. This would also bring into play the Economies of scale and could potentially provide a saving in the long run. WHAT SHOULD HAPPEN NEXT In my opinion the current work towards the IMSB should be stopped immediately before more time and effort is âwastedâ on something that may not be the best solution to the current problem of Medical Support. A high level meeting then needs to take place at AMD, who should be the lead on the matter. The meeting should decide on the Effects that IMSB wishes to have on the Battlefield. Following this, all Defence Consultant Advisors (DCAs) should be tasked to work on how best they can achieve these Effects. They should produce two pieces of work, the first being the minimum level of resources required to achieve each Effect (representing the initial entry Hospital), and the second being the resources required to meet the gold standard (representing the Tier two build after 30 days). Once these pieces of work have been completed a conference should be convened with at least the following attendees: 2 Med Bde DCAs Each Regular Fd Hosp Representatives from the Med Regts (to ensure interoperability) REME (MDSS Representation) RLC Manoeuvre Bdes Royal Engs (STRE) Over the conference, a Field Hospital should be considered which fits best within the Principles of Logistics, both for the initial entry hospital and subsequent tier two build. This can then be refined over a period of trials. Instigated now, the whole project may take between 12 and 18 months. However, it will only be by going through this process that we ensure that the AMS is moving forwards and developing its doctrine in the best possible way.