A PROMISE to provide priority treatment on the NHS for veterans of the armed forces is "meaningless" and should be revisited, according to the man appointed to speak up on their behalf.

Eric Fraser, the Scottish Veterans' Commissioner, said the pledge, which offers priority care to veterans for health problems caused by their service to their country, makes little difference to decisions about clinical priority and should be revisited.

Instead, he said the emphasis should be on the excellence and accessiblity of treatment.

The comments came as he called for a wider debate about veterans' health and wellbeing in Scotland.

Since 1953, under a long-standing arrangement, war pensioners are given priority for NHS treatment for any conditions they suffer related to their Forces service. However this does not apply if another patient needs emergency treatment or has "greater clinical need".

Because the vast majority of decisions in the NHS are made on the basis of clinical need, the ex-forces status of a patient rarely makes a significant difference, Mr Fraser said.

"This promise has been taken by some veterans to mean they will be further up treatment waiting lists than anyone else. But the caveat about clinical need means that is often not the case, and the vast majority of veterans agree with that," he said.

"This needs a fresh look. Rather than looking at priority as a place on a waiting list, what we need to do is make sure people get the right quality and accessibility of care."

In a paper submitted to the Scottish Government, Mr Fraser admits the view is controversial, but calls for a debate about the concept of priority treatment and whether the current emphasis on waiting lists provides a meaningful way of measuring it.

"My growing conviction is that this may no longer be valid and I see far greater benefit from focusing on the principles of excellent, accessible and sustainable treatment and care for all veterans," he writes.

The priority treatment ideal was part of the Armed Forces Covenant introduced in 2009, and reinforced by the Scottish Government's Renewing Our Commitments policy last year, which guarantees fair treatment to those who have served in Afghanistan and other previous conflicts.

The report says these promises must never be "forgotten, ignored or diluted", but the Commissioner adds: "for some time now I have sensed the need for a review of how we fulfil the pledges of the Covenant made to the men and women who defend our nation, sacrificing civilian freedoms and regularly putting themselves in danger to do so."

Scotland is home to an estimated 230,000 veterans ranging in age from teenagers to nonagenarians. While Mr Fraser says their rate of poor health and in particular poor mental health is exaggerated, the needs of those who suffer injury or illness in protecting the UK demand they are cared for appropriately.

The principle of getting the right treatment at the right time is more important, he told The Herald. "These people have served the country and there's a very distinct promise form Government and the NHS that they will be looked after .

"The important thing is that they get the right care at the right time and they need to know it is there for the long term. A 25 year old amputee today when he gets to his 60s, will have completely different needs. It is important the commitment from the country is still there. Making sure care is there for the long term is the biggest concern that those who have serious and enduring injuries have."

Mr Fraser said he had no reason to doubt the quality of care veterans are receiving but the report was the first of three examining the health and wellbeing of Scottish veterans and seeking to open a debate about their treatment.

Subsequent reports will focus on those with severe and enduring conditions, wounded, injured or sick as a result off their service, and on he wider health of veterans in general.

PoppyScotland Chief Executive, Mark Bibbey said he welcomed the Veterans Commissioner’s conclusions. "As he highlights, NHS priority treatment (or care) for veterans dates back to 1953," he said.

"While existing NHS provision combined with the range of support provided by Poppyscotland and other third sector organisations is very good, it is quite right that we closely examine future needs and ensure these services are fit for purpose.

"We owe it to those who are left injured, wounded or sick as a result of serving their country that their health and wellbeing needs are met fully today and in the years ahead. Poppyscotland looks forward to engaging in the coming debate."