Agile Warrior

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Exercise Agile Warrior and the Future

Development of UK Land Forces

Mark Phillips

Occasional Paper, May 2011

www.rusi.org


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The views expressed in this paper are the authors own, and do notnecessarily re ect those of RUSI or any other ins tu ons with which theauthors are associated.

Comments pertaining to this report are invited and should be forwarded to:Mark Phillips, Head, Land Warfare and Opera ons Programme, Royal UnitedServices Ins tute, Whitehall, London, SW1A 2ET, United Kingdom, or viae-mail to [email protected]

Published in 2011 by the Royal United Services Ins tute for Defence andSecurity Studies. Reproduc on without the express permission of RUSI isprohibited.

About RUSI Publica onsDirector of Publica ons: Adrian JohnsonProduc on Editor: James Fidler

Paper or electronic copies of this and other reports are available bycontac ng publica [email protected].

Cover image: UK MoD Crown Copyright, 2010.

Printed by in the UK by Stephen Aus n and Sons, Ltd.


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Contents

Introduction 1

The Understand Demands of Future Land Operations 3

How Much Figh ng Capability Do We Require of the Army in the Future:Is Combined Arms Manoeuvre the Right Approach? 15

Medical Support for Future Operations 23

The Armys Approach to Risk Management on Operations 33

The US Army and Future Conflict: Preparing for a Complex andUncertain Future 45Robert Gates


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Exercise Agile Warrior and the Future Development of UK Land Forces2

the medical echelon system

4. Whether the armys approach to risk management on opera ons ishindering mission command and the manoeuvrist approach, and if so, what can be done about it and learnt from other sectors.

Some of the ndings and recommenda ons might make uncomfortablereading, but it is a welcome development that the army is willing to have itsthinking and ideas exposed to a wider range of people, and in par cular itspartners across government.

The current resource environment will demand greater inter-agency workingand collabora on. As a result of Agile Warrior , the army will hopefully have

gained a be er understanding of the capabili es of other departmentsand agencies. Other departments and agencies will also, in turn, hopefullyhave developed a be er understanding of the requirements of the army. AsForce Development and Training Command prepares for its next round of experimenta on and opera onal analysis, it should build on this emergingrela onship and involve partners from across government should in scopingthe work as well as tes ng its ndings.

The nal chapter in this Occasional Paper reproduces a speech given to theMilitary Academy at West Point by the US Defense Secretary, Robert Gates,on 25 February 2011. The speech looked at the future of con ict and itsimplica ons for the US Army. Both UK and US land forces have becomemission speci c and bespoke as a result of opera ons in Iraq and Afghanistan.They now have to transi on to meet future tasks and many of the challengesin doing so are shared. Exercise Agile Warrior is the UK na onal equivalentof the US Armys Uni ed Quest programme and many ideas and concepts onboth sides of the Atlan c can and should be shared. The defense secretarysspeech provides an insight into the thinking of a key partner on many of theissued looked at in this paper, par cularly on the need to ins tu onalisediverse capabili es through the combined arms approach and changehow the Armys people are recruited, trained and empowered to counter a

risk-averse culture. All of this must, of course, be done within a ordabilityconstraints. The West Point speech brings together poli cal, strategic andopera onal perspec ves, and will be valuable reading for UK counterparts.

Mark PhillipsFebruary 2011


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The Understand Demands of Future Land

Operations

T he Na onal Security Strategy (NSS), Strategic Defence and SecurityReview (SDSR) and the Ministry of Defences (MoD) work on the FutureCharacter of Con ict (FCOC) all imply that Understand is a pressing task forthe military and other instruments of na onal power. In outlining a new setof Na onal Security Tasks, the NSS and SDSR iden ed the need to be ableto iden fy and monitor na onal security risks and opportuni es througha co-ordinated approach to early warning and horizon scanning; strategicintelligence on poten al threats to na onal security and opportuni es for

the UK to act; co-ordinated analysis and assessment of the highest priorityrisks; and intelligence assets to support the core military, diploma c anddomes c security and resilience requirements and UK economic prosperity.

Furthermore, the FCOC concluded that the congested, clu ered, contested,connected and constrained ba lespace will require:

An in-depth knowledge of an adversarys military capabili es, andalso their culture and decision-making

A shi of emphasis from pla orms and command and control nodestowards be er human understanding, especially where targetsignatures are small or ambiguous

The ability to exploit newer environments such as space and cyberspace.

The need to Understand is implicit in every opera on, as understandingprovides the context for making e ec ve decisions, applying powerand managing associated risks and subsequent e ects. However, recentopera onal experience demonstrates that this requirement to acquireand develop knowledge to such a level that it enables insight (knowing whysomething has happened or is happening) and foresight (being able to iden fyand an cipate what may happen) has tended to be taken for granted.

The Development, Concepts and Doctrine Centres (DCDC) work on JointDoctrine Publica on (JDP) 4 recognises this gap, but is largely conceptual;the prac cal implica ons of the Understand func on need to be workedout. Key ques ons include: How does defence t into cross-governmentUnderstanding? How does the Understand func on apply at the strategic,opera onal and tac cal levels? Following from these points, what demandswill be placed on a deployed force by the Understand func on in di erenttypes of opera on (con nuous engagement versus con ngent), and whatare the implica ons for force genera on and structure?

This chapter addresses each of these points in turn, and their implica onsfor force development and genera on.


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The Armys Rela onship with Other Departments and Agencies:

Scoping Its Role in the Understand Func onAt the moment there is inadequate awareness about how defence should orcan engage with other departments and agencies to meet its requirementsfor the adequate understanding of an area of opera on. There is li leclarity about whether the army should be a contributor to the Understandpiece, a user of the understanding created by others, or both. Part of theproblem is that the intelligence and wider na onal security machinery is notwell de ned. Responsibili es and ownership of func ons are not clear, soanswering the ques on of how the military ts into a na onal e ort at eachof the strategic, opera onal and tac cal levels is di cult.

Opera ons in Iraq and Afghanistan iden ed gaps in rela on to theUnderstand demands of land opera ons which the Army needs to ll:there is a view that the strategic intelligence and understanding 1 developedin Whitehall is insu cient for the requirements of a military deployment, asit lacks the granularity that a force commander requires for theatre entry.

That said, it is possible that the army is unaware of the poten al of the capabili es held by other departments and agencies to meet thisrequirement. For example, it is assumed that the intelligence and securityagencies concentrate on contribu ng to the strategic-level assessmentsand understanding of the government. But the capabili es and sourcesthat contribute to strategic requirements can also be employed at thetac cal level. 2 An example of the capacity and capability of the intelligencecommunity that is not exploited fully by the military is its ability to surge atvery short no ce (twenty-four hours) in response to a crisis or during the pre-deployment phases of military opera ons. This can provide the army with atleast part of the Understanding it requires at much earlier stages, given thelonger lead mes for deploying military assets. 3 The army itself, of course,might consider deploying intelligence, surveillance, target acquisi on andreconnaissance (ISTAR) assets much earlier in the run-up to an opera on or inresponse to a crisis and most frui ully alongside the intelligence community

to ensure there is su cient mass and coverage.4

Further, the Foreign O ceand Department for Interna onal Development should have signi cant localarea knowledge from their in-country footprints and projects, which themilitary should draw on.

The extent to which the army is capable of exploi ng capabili es held byothers requires detailed examina on. The army needs to scope its role in theUnderstand task properly by:

Understanding the capabili es of the intelligence agencies and howthey can be applied and exploited at di erent levels

Understanding the body of knowledge that departments such as


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Mark Phillips 5

the Foreign O ce and DfID already have through the projects they

undertake in-country Being clearer about its requirements as a customer Facilita ng opportuni es for joint training and educa on with other

organisa ons Undertaking further work to iden fy if it is possible to translate

strategic products into ones which provide the level of granularity thearmy requires at the tac cal level.

Overall, there is also li le guidance about how much Understandingis enough, which in turn hinders the development of the Understandfunc on. A problem of informa on overload already exists and there is

probably a threshold at which no further value is secured by collec ng andassessing more informa on (notwithstanding the ambi on for completeunderstanding of any given situa on). Arguably, more should be done toextract value from exis ng data. Furthermore, a be er ques on for the armyto use as a benchmark might be: How li le understanding is not enough?

The Requirements and Opportunities of Continuous ModulatedEngagementThe Understand func on and demand will vary according to di erentMilitary Tasks. The NSS and SDSR placed emphasis on tackling the rootcauses of instability; exer ng in uence to exploit opportuni es and managerisks; and helping resolve con icts and contribute to stability. These tasks areencapsulated in the term Con nuous Modulated Engagement (CME). CMEencompasses a range of ac vi es and deployments that can support the UKslong-term engagement strategy with countries of strategic interest wherethe government wants to achieve in uence and e ect, including securitysector reform and defence diplomacy. A dis nc on must be made betweendeveloping understanding before a force has been deployed and developingunderstanding a er a force has been deployed: these ac vi es are useful forcontribu ng to long-term UK interests, but also present an opportunity tobuild up understanding over a sustained period of me, which can be used

to inform both training and unexpected con ngent opera ons.5

The key challenge in inves ng in CME is that neither the military nor otherdepartments and agencies will invest su ciently in low-priority countriesand targets. Furthermore, no priority system will be able to cover all thingsthat could go wrong. The military and intelligence community are verygood at surging quickly and can learn lessons from Iraq and Afghanistanto improve this capacity. But it takes approximately ten years to build up aproper understanding from which the UK can operate e ec vely. In otherwords, no ma er how many resources are thrown at an issue at any givenme or how quickly the UK is able to surge, this does not change the fact thatit does take me to develop proper understanding. This was the case vis--


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vis the Soviet Union and is arguably the case with Afghanistan, and points

to the importance of long-term and ongoing engagement rather than justperiodic analysis.

Taken together, these factors point to:

1. The need for greater clarity about priority countries and regions, inline with na onal interests, of defence and other departments andagencies. The Na onal Security Risk Assessment provides a goodstar ng point, but needs more of a geographical as opposed to justfunc onal focus

2. Linking horizon scanning and intelligence collec on priori es together

much be er than to date3. Bringing together (and sustaining) knowledge from a range of

previous and current deployments and opera ons. For example, theUK engaged in a range of ac vi es in Iraq from the 1980s onwards,yet it is not clear that defence and wider government drew on thisexperience su ciently in planning for Opera on Telic in 2003. Thevalue of all-source fusion centres in respect of CME (covering bothred enemy and white popula on/government/economic ac vity)is self-evident.

For defence, those mechanisms that have been used to achieve a base-level of knowledge over a lengthy period of me (such as the defence a ach/liaisonnetwork and Defence Intelligence Sta ) have tended to be underinvestedin or cut at the rst opportunity. It is worth reinves ng in a proper militaryliaison network and career structure, not least because it takes on averageve years of living in a country to become an expert. Other mechanismsfor building and sustaining knowledge over me might include developingforeign area specialists within the military, anchoring special forces in areaswhere there is li le diploma c coverage, and recrui ng to ensure that thearmy is representa ve of certain communi es and therefore already hassome understanding and empathy (an approach used by the police service

for the purposes of the domes c counter-terrorism PREVENT Strategy).

The types of ac vi es personnel engaged in CME undertake must berefocused: there is a tendency to focus on understanding elites in a countryrather than the needs and priori es of communi es. The value of communityinforma on and intelligence is underes mated at present; lessons can belearnt from the UKs community policing approach in a domes c context fordeveloping people with the skills to develop community intelligence abroad.

However, developing in-house specialists in addi on to the exis ng militaryliaison network and deploying individuals or units to engage with communi esis resource intensive. From police experience of community engagement


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Mark Phillips 7

within the UK, it requires resilience in terms of personnel numbers to allow

for signi cant physical presence while catering for training, leave and so on.Even NGOs which operate over longer me frames than government do notinvest in developing specialists on a just-in-case basis. There are alterna vesources to draw on and poten al ways of bringing in specialists just-in- me:

The army can develop rela ons with NGOs, voluntary groups and journalists abroad to help develop understanding in areas where theUK has a small (or no) footprint. The police partner with voluntarygroups and local authori es in a similar way for the purposes of domes c counter-terrorism. The challenge is ensuring the integrityof partners and developing criteria for deciding with whom to engage

Interna onal organisa ons, par cularly the UN, have a wealth of knowledge and understanding, which is not used or tapped into

Buy-in specialists when needed by recrui ng foreign na onals(overcoming ve ng issues), people who have lived in countries forlengthy periods, and making greater use of academic ins tu ons

Exploit police knowledge of diaspora communi es and recruit sourcesfrom within those communi es. The Defence Informa on Requirementsare not well-developed or expansive enough in rela on to UK communi es

New forms of social media such as Twi er might provide informa onabout communi es and poten al risks.

These approaches would not negate the need for the army to have a minimumlevel of knowledge and presence, which it can build upon. But they do meanthat CME could be rela vely low footprint and low cost, while providing aninfrastructure that can be ramped up in a crisis.

Enduring Lessons from Iraq and Afghanistan for Con ngent Opera onsIt cannot be assumed that CME will develop a knowledge-base for con ngentopera ons given the challenges with the UKs priority system. Moreover,even when the UK has a long-term presence, there will s ll be a need toassess current levels of understanding and develop new understanding

rapidly once a decision is made to intervene. As a result of experience in Iraqand Afghanistan, lessons have been learnt about the type of capabili es thatshould be developed in-theatre for con ngent opera ons and the demandsthat will be placed on individual soldiers in an area of opera on.

The default se ng on future con ngent opera ons will be for the majorityof capabili es to be decentralised from the division to brigade level (withthe ability to re-centralise if necessary). However, it is not clear whether thislevel of decentralisa on will be su cient. Ongoing opera ons in Afghanistanhave iden ed problems with the exis ng rela onship between brigadesand ba alions/companies in rela on to capabili es that contribute to theUnderstand requirement. 6


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Companies and ba alions have li le awareness of the full spectrum of

collec on and produc on capabili es/pla orms that can be made availableto them by brigades, or tasked by brigades on their behalf.

Even when companies and ba alions are aware of these capabili es, brigadesare some mes reluctant to task collec on and produc on pla orms on theirbehalf or make them available.

Brigades (and their fusion centres) over-emphasise intelligence andunderstanding for force protec on and strike missions, which drives a focuson red ac vity concerning the enemy at the expense of the collec on andanalysis of popula on-centric informa on. But the la er is more useful at

the tac cal level. While at the ba alion level and below intelligence o cersknow a great deal about their local area, they are generally too understa edto gather, store, analyse and disseminate this knowledge.

Exis ng intelligence set-ups, including company-level intelligence cellsand brigade-level fusion centres, are geared towards tradi onal, classi edsources of intelligence rather than non-tradi onal sources such as NGOs.

Fusion centres struggle to link into decision-making at the tac cal level: thevalue of their product and its meliness is ques onable. An excep on to thisis the Land Intelligence Fusion Cell (Afghanistan) which has deep exper seand a high standard of connec vity with theatre, providing the link betweenthe strategic and the tac cal level. This may not be the case, however,for other fusion centres such as the Geospa al Intelligence Fusion Centre(DGIFC). In structuring fusion centres in the future, the key criterion will bewhere the fusion of intelligence needs to take place. Some issues will needto be dealt with in a mely way and so should be done in-theatre, at lowerforma ons, whereas some analysis will be of slow-burn topics which, withsu cient connec vity and bandwidth, can be done rear based.

Company-level intelligence set-ups are o en under resourced, do not have

specialist sta and do not have the IT infrastructure for access to top-secretinforma on or networks.

It follows from these points above that ba alions and companies would bebe er supported on future con ngent opera ons if in developing tac calunderstanding the following principles were adopted: 7

1. Make every e ort to adver se and improve educa on on intelligence/ISTAR collec on and produc on capabili es, thereby making theseavailable at the tac cal level

2. Send addi onal people who are specialised in collec on and analysisdown to augment ba alion and company-level intelligence teams,


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Mark Phillips 9

even if only on a rota ng basis. This is being done in Opera on Herrick

with COISTs and BGISDs, but the approach needs to be pushed intostructures for F/COE opera ons. The size of the addi onal collec onand analysis capability will depend on the type of opera on (combinedarms manoeuvre versus con nuous engagement) and thereforewhere fusion is best achieved

3. Increase IM/IX capacity at the ba alion and company levels4. In addi on to developing fusion centres in-theatre to co-ordinate

human intelligence (HUMINT), signals intelligence (SIGINT) andcovert real- me surveillance for strike opera ons, develop centresto produce products (including from non-tradi onal sources) thatcover the white ac vity of popula on, economy, development, and

government. This is being done in Herrick but the approach needs tobe pushed into structures for F/COE Opera ons; how the requirementis met and over what mescales will vary depending on the type of opera on (combined arms manoeuvre versus con nuous engagement)

5. There is also an argument for resourcing the company level withorganic ISTAR capabili es and the ability, therefore, to fuse HUMINT,SIGINT and surveillance assets. One of the biggest advantages thearmy has on expedi onary opera ons is technology, but there hastended to be an ins tu onal reluctance to allow this technology tooperate at a low level. This is beginning to change and doctrine nowneeds to make clear where and how these assets sit: for con nuousengagement such as COIN the assets need to be pushed down,whereas for combined arms manoeuvre on con ngent opera ons theyare best placed higher up a forma on. All personnel need to have abe er understanding of what technology can do and the opportunityfor regular training and exercising with high-end capabili es.

Each of these steps would increase capacity at the tac cal level and meetthe double burden faced by those on the frontline of being, at the sameme, the most important customers of informa on and the most importantsuppliers of informa on. This double-burden is faced as much on COIN and

other CME opera ons, where the focus is on the popula on, as on combinedarms manoeuvre where the focus is on the adversary, as the common featureof any future opera ng environment is the uidity and decentralised natureof all actors.

As ISTAR and collec on systems are both increased in number and devolved,so their (technical) vulnerability to disrup on increases. Brigades and lower-level forma ons will need to develop the following skills to assure theintegrity and reliability of these pla orms:

Informa on Management Informa on Assurance


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Basic network monitoring and defence

The ability to undertake basic internet opera ons (through specialistteams).

Implica ons for Training and CultureThe Understand requirement has a number of implica ons for generaltraining and the development of army culture. Recent opera ons haveshown that those on the front line are both the most important customersand suppliers of informa on. The approach of the police service is relevanthere: every police o cer has an intelligence func on when performingdu es such as neighbourhood policing, but is supported by specialists infunc ons such as counter-terrorism and serious organised crime. The army

should take a number of steps, including:

Joint educa on and training with a wider range of departments andagencies at all levels. This needs to be resourced properly and thereneeds to be enough slack in the system to allow this training withoutit being detrimental to deployed opera ons

Clearer direc on from the command structure about what unitsshould know

Regular training and exercising with a full range of ISTAR collec onassets and covert capabili es (but this needs to be managed in such away that it does not prevent a surge in response to a crisis)

Educa on and training to allow people to cope with collec ng,processing and dissemina ng signi cant quan es of informa on

The checks and balances of the intelligence communitys assessmentprocess should be taken into general command and sta training

All soldiers need to be trained and provided with an analy cal frameworkthat allows them to ins nc vely collect and assess informa on.Techniques such as crea ve and cri cal thinking and challengingassump ons should be explored for inclusion in general training

The army needs to educate its people with a founda on inanthropology. Too much emphasis is placed on history and poli cs,

and not enough on how socie es func on (that is, a methodologywhich can be applied in di erent loca ons)

Educa on and training to allow people to accept a level of risk withthe informa on and understanding they have at any given me.Special forces are more mature and educated about the poten aland limita ons of Understanding than regular forces and there arepoten al lessons from their experience for training and exercising.Sta s cal weigh ng can also be a ached to assessments to helpcommanders understand the level of risk they are accep ng from anygiven product

The military hierarchy and command structure must accept andencourage alterna ve views at all levels. There is a tendency for


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Mark Phillips 11

groupthink because junior o cers and soldiers are not always

encouraged or incen vised to challenge or red team conven onalthinking and wisdom. Mavericks that is, those people who will notgo in for group or corporate thinking, but have an ins nct about doingthings di erently must be cherished. Construc ve contrarian teamscould also be created. The issue for the Army will be doing this in away which does not destroy discipline.

In rela on to developing specialists, it is ul mately a resourcing decision as towhether or not the army invests in foreign area specialists, though it shouldbe noted that there is an ins tu onal and cultural reluctance to developspecialists. The military is star ng to iden fy individuals who are currently

serving with the skills and experience necessary for the Understand func onby developing a competence and training framework that can be applied tothe Joint Personnel Administra on system, but this is retrospec ve and adhoc. There is however also a ques on about whether military personnel arebest suited to this specialist task or more civilians should be recruited for thispurpose; there is a growing view based on opera onal experience that morenon-military sta should be put into J2 fusion centres. For example, an a erIraq ac on report by the US XVIII Airborne Corps noted that: 8

Intelligence analy cal support to COIN opera ons requires a higher levelof thinking, reasoning, and wri ng than conven onal opera ons. Ingeneral, neither enlisted nor o cer personnel were adequately trainedto be e ec ve analysts in a COIN environment ... In an overall intelligencesta of 250, CJ2 leadership assessed four or ve personnel were capableanalysts with an ap tude to put pieces together to form a conclusion.

This review iden ed how far training for the military in Understand-relatedfunc ons s ll had to go; it will require signi cant investment and changesto career structures and planning to develop a cadre of specialists withinmilitary ranks. If the army cannot invest in developing a career stream forspecialists, the gap might be mi gated in part by drawing on alterna ve

sources across government (as discussed above, or through mechanismssuch as secondments) 9 and areas such as academia, NGOs and journalism.

Conclusion and SummaryThe need to Understand is implicit in every opera on. However, recentopera onal experience demonstrates that this requirement has tended tobe taken for granted. In developing this func on the army must take intoaccount the below.

There is also li le guidance about how much Understanding is enough. Abe er ques on for the army to use as a benchmark might be: how li leUnderstanding is not enough? The army should educate and train people to


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accept a level of risk with incomplete Understanding.

The capabili es of the intelligence agencies and other organisa ons whichcontribute to strategic understanding in Whitehall can also be exploited atthe tac cal level. The army needs to scope its role in the Understand task byunderstanding these capabili es be er, being clearer about its requirementsas a customer by genera ng CCIRs and facilitate joint training and educa on.

A dis nc on must be made between developing understanding before aforce has been deployed and developing understanding a er a force hasbeen deployed. As a result of experience in Afghanistan, lessons have beenlearned about the type of capabili es that should be developed in-theatre

for con ngent opera ons and the demands that will be placed on individualsoldiers in an area of opera on. The military and intelligence and securityagencies are good at surging in response to events, but they can do more todevelop a joint capability in this respect.

However, the army also needs to get ahead of the game by developing aknowledge base before opera ons. Understanding at a strategic level canfacilitate this by direc ng investment in par cular areas and countries.Lessons can be learned from the con nuous engagement of communi esby the police and NGOs for CME. This engagement is resource intensive,however, and it is uncertain whether the army will be able to sustain thelevels of investment required. Therefore the army must be willing to developspecialists (with implica ons for career structures and management) andalso engage with other, o en non-tradi onal sources of informa on andorganisa ons, building an infrastructure upon which to surge.

Defence has an ISTAR and fusion capability which un l recently has not beenexploited at the tac cal level as much as it could (and should) be. The fusedproduct from brigade-level assets at least needs to be pushed down to thetac cal more e ciently and that is more relevant to the requirements of ba alions and companies. The army could also consider developing organic

ISTAR capabili es at the tac cal level (for example, ISTAR fusion capacitysuch as ISTAR Tac Groups at BG/Coy level).

The army needs to develop a culture which accepts and encouragesalterna ve views at all levels.

Notes1. There is some unease across Whitehall about the use of new terminology (Understand),

which implies that intelligence assessments are narrow products. Intelligence draws onan increasingly wide range of sources and, when assessed, contributes to understanding.Intelligence is therefore a necessary condi on of understanding, but not a su cientone. People also need to know how to use those assessments.


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Mark Phillips 13

2. The employment of the capabili es of the intelligence community at the tac cal level

is growing: agencies are increasingly expected to not just provide intelligence to informdecision-making, but to act upon that intelligence in order to in uence events.

3. However, if the surges are aimed at reinforcing the capability of the intelligence servicesto feed the UKs strategic-level requirement, the army could only bene t indirectly asthe level of granularity required might not be provided. The intelligence agencies shouldadopt a more doctrinal approach in suppor ng the military in future expedi onaryopera ons, as there is a tendency for the level of support it is able and willing to provideto be ill-de ned and for the agencies re-invent the wheel every me a deploymentoccurs.

4. At the moment there is an ins tu onal reluctance to allow certain capabili es (covertand fused) from across government to be used or developed at the tac cal level.There are challenges to dissemina ng classi ed materiel across the ba lespace and toba legroup level and below, which need to be iden ed and addressed.

5. This is par cularly important if con ict is viewed as cyclical rather than linear in nature in other words, as a con nuous process of contest of varying degrees of intensity,which government needs to be aware of and respond to in di erent ways, dependingon the intensity at any given me.

6. See, for example, Michael T Flynn, Ma Po nger and Paul Batchelor, Fixing Intel: ABlueprint for Making Intelligence Relevant in Afghanistan (Center for a New AmericanSecurity, Washington DC: January 2010).

7. Ibid .

8. Center for Army Lessons Learned, 06-27 XVIII Airborne Corps/Mul -Na onalCORPS-Iraq, available at .

9. However, even across government a joint and integrated approach has challenges.

Organisa ons are o en reluctant to accept that they cannot develop exper se in-house, or have a cultural bias against other parts of the system. A prominent exampleof the la er was DfID refusing to accept secondments from the intelligence communitywhen it required the use of rare language skil ls, even though the agency in ques on wasthe only part of government with sta who spoke the language.


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15

How Much Figh ng Capability Do We Require

of the Army in the Future: Is Combined ArmsManoeuvre the Right Approach?

E nduring opera ons in Afghanistan and Iraq have dominated the armyand its force development over the past decade. The army has becomebespoke and specialised through Urgent Opera onal Requirements, mission-speci c training and mission-speci c changes in structure and doctrine,all designed to meet the challenges of high intensity counter insurgencycampaigns. However, while there are important and enduring lessons fromIraq and Afghanistan, it should not be assumed that these opera ons are the

way future con ict will be manifested: adversaries constantly adapt and it isalso likely that the range of adversaries the UK might face will increase.

The army recognises that it is unbalanced as a result of ongoing opera ons.It also recognises that the way land forces have specialised must notexclusively determine the balance of what will be required in the future.As part of Future Force 2020, the army is therefore structuring and trainingitself to meet a wider range of poten al adversaries and types of ac vi es.It is rever ng back to the combined arms manoeuvre approach, embodiedprac cally in the mul -role brigade concept by which the armys vebrigades will be composed of one each of armoured reconnaissance, heavyarmour, armour infantry, mechanised infantry and light-role infantry, withpermanently a liated ar llery, engineer and logis c regiments.

Combined arms manoeuvre posits, rstly, that the de ning feature of successful military opera ons is the integrated and synchronised use of capabili es to gain advantage over an enemy. Secondly, it posits that thearmy should maintain a full mix of light, medium and heavy forces, supportedby specialist troops and enablers, so that land forces are con gured todeliver the full range of military ac vi es from peacekeeping opera onsto the applica on of lethal force. The employment of combined arms is, in

this sense, an enduring characteris c for any army that needs to manoeuvreto a posi on of advantage in a range of situa ons situa ons which couldincrease in tempo (and vice versa) at very short no ce. It is based on anopera onal analysis of a wide range of con icts, including the 1991 Gulf War,peacekeeping opera ons in Bosnia and Kosovo, Iraq and Afghanistan.

Cri cs argue that the combined arms thesis makes certain assump ons aboutthe characteris cs of poten al adversaries and opera ng environments, andin par cular where and when the UK will intervene, which do not necessarilyre ect poli cal or strategic direc on and appe te; and ignores the expenseinvolved in maintaining generic capabili es as opposed to adap ng tocon icts as required.


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It would be di cult for anybody to claim that the army is unaware of the

resource challenges facing the Ministry of Defence and armed forces atpresent. Moreover, it is the armys professional advice that the DefenceStrategic Direc on and the Military Tasks that ow from it require aninvestment in combined arms manoeuvre, if the army is going to be ableto meet the full range of tasks government might demand of it in a coste ec ve and mely way.

However, if the army is to make the argument for combined arms manoeuvre,four gaps in its current thinking need to be lled:

First, the need for further evidence than that provided by the IDF/

Hizbullah con ict Secondly, the requirement for the UK to operate in a coali on con-

text, and how a combined arms capability will contribute to or twithin a coali on

Thirdly, how combined arms manoeuvre can contribute to the home-land security and resilience demands that are likely to be placed onthe armed forces in the future

Fourthly, how to sustain a combined arms force across all theDefence Lines of Development, and in par cular in terms of logis cs,procurement and joint enablers.

The Future Character of Con ict and the Ra onale for Combined ArmsManoeuvreThe armys planning is currently based on the emergence of hybrid threats,where states and non-state actors choose to exploit all modes of warsimultaneously using advanced conven onal weapons, irregular tac cs,terrorism and disrup ve criminal ac vity. Two arguments are made insupport of this. First: adversaries are capable of signi cant adapta on. Whileadapta on itself is not a new feature, the rate of adapta on and the rangeof capabili es adversaries have access to are. Second: non-state warfare willbecome characteris c even between states (but states will also maintain

high-end capabili es). A case-study o en cited in this respect is Hizbullahs2006 con ict with the Israeli Defence Forces. It is argued that Hizbullah wasable to achieve strategic shock by elding a range of capabili es previouslythought to exist in the state realm only, including networked air defence,communica ons and electronic warfare. Previously, Hizbullah employeddesperate suicide bombings; it acquired more advanced capabili es throughthe support of North Korea, Iran and Syria.

Further analysis of the Hizbullah/IDF con ict also, it is argued, iden eslessons for how the army is employed on opera ons. The use of groundforces by the IDF was deemed ine ec ve due to three primary factors.


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Mark Phillips 17

1. The adop on of novel planning process (systemic opera onal de-

sign) resulted in orders that were not understood by those who werecharged with the execu on of the opera on2. The campaign relied ini ally on a doctrine of air power that failed to

emphasise the importance of air/land integra on3. Over-specialisa on in constabulary and counter-terrorism style

opera ons meant that the IDF were not trained or prepared for jointforce and manoeuvre opera ons, and in par cular co-ordina ngdi erent capabili es and movements at brigade level and above.Manoeuvre training was isolated to ba alions and companies but inthe speci c context of the Occupied Territories.

Israeli failure must however be considered alongside the success of theHizbullah defences. Sophis cated weaponry was well sited in ring posi onsthat were concealed from view and protected from the e ect of stand-o a ack. The cellular organisa on and decentralised control exhibitedby Hizbullah also gave them far greater tac cal exibility than their IDFopponents. Furthermore, it could be argued that Hizbullah had investedmore in understanding their enemy than the Israelis had. 1 Observa ons fromopera ons in the occupied territories allowed Hizbullah to accurately predictthe manner in which the IDF would react. Conversely, the IDF should nothave been surprised by the range and types of capabili es that Hizbullahbrought to bear.

From this analysis the army concludes that IDF failure re ected:

A lack of understanding of the adversary Disinvestment in combined arms manoeuvre training and structures Adherence to a discredited Eects Based approach to planning and

direc ng opera ons which ignored the fact that it is the synergycreated by e ec vely synchronising capabili es in me and spaceand at tempo that is the key to success.

It follows from this the army should:

Invest in understanding the nature of the problems it will face not just to have situa onal awareness, but applied knowledge of social,poli cal and other factors 2

Maintain a range of capabili es, including su cient repower.Adap ve adversaries mean the UK needs to avoid over-specialisa on.

More detailed analysis of poten al areas of opera on con rms thisapproach. Future areas of opera on are likely to be congested and clu eredenvironments, characterised by density of obstacles such as improvisedexplosive devices or structures such as buildings. For example, signi cant


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propor ons of the worlds popula on will live in urban conurba ons in

the future. Urban opera ons are therefore increasingly likely and will bea demanding requirement for land forces not just working in a complexterrain, but needing to understand poli cs, tribes and communi es andto be propor onate and discriminate. Furthermore, opera ng in ci es willpose challenges for the use of enabling assets such as airpower and requireauthority and key enablers such as ISTAR to be decentralised and dispersedin order to achieve e ect with the popula on and allow all commanders andsoldiers to exercise appropriate judgement in complex situa ons. Arguablythe mul -role brigade will allow this while s ll maintaining a commandand control capability at divisional level in order to integrate these tac calac vi es and integrate with other government departments.

However, the analysis above is incomplete because it does not consider anumber of factors that featured in both the Hizbullah/IDF con ict and otherrecent con icts:

Hizbullahs extensive use of media opera ons: the army should notfall into the trap of gh ng a force-on-force ba le when an adversaryhas decided to conduct an informa on ba le; the UK needs to de-velop a proper informa on capability

Hizbullahs use of electronic warfare to great e ect. Does the armyneed to develop a similar capability?

How the army was able to achieve low collateral damage in Basra,which is a dense urban environment. Was it the result of be er ar-mour or be er use of air power and ISTAR?

The lessons from the 2008 Russia/Georgia con ict are not included It is not clear how the reconstruc on capability which has been used

extensively in theatres like Afghanistan ts into the combined armsmanoeuvre construct

It is not clear whether the combined arms approach would meetpoten al threats in regions like Africa, where small arms and otherlight weapons are predominant.

The army needs to undertake further opera onal analysis of recent andongoing con icts if there is to be a su cient evidence base and argument

for combined arms manoeuvre and how mul -role brigades should bestructured.

Cri cs also counter that the combined arms manoeuvre thesis does not re ect:rst, the priori es outlined in the Na onal Security Strategy and StrategicDefence and Security Review, such as con ict preven on and homelandsecurity and resilience. The army needs to provide force development adviceto government in these areas: how might the combined arms approach andmul -role brigades contribute to both?; second, the clear lack of poli cal


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Mark Phillips 19

willingness to be commi ed to protracted, complex and costly interven on

opera ons over the next decade. Some senior gures have said that the typeof con ict envisaged in the Future Character of Con ict work is destruc ve,enduring, urban, and therefore una rac ve to decision-makers; and third,argument that the military should focus on the highest-priority risks/tasksand work with others to ll gaps. Formal interna onal partnerships post-SDSR have greater importance and need to be developed.

There is of course a debate about whether these assume a degree of discre on which is not proven and con ate una rac ve opera ons withunlikely opera ons. Clearer poli cal direc on on levels of ambi on isrequired. Clearer direc on is also needed about what role the government

envisages for the UK in coali on and alliance opera ons. It is not clear whythe UK should contribute to these opera ons through having combinedmanoeuvre capabili es: will other countries not provide this, and should thearmy focus on how it links more specialised capabili es with the capabili esof partner countries to develop a combined-arms approach?

The alterna ve to maintaining a generic range of capabili es (which isexpensive and di cult in the current nancial situa on) would be for thearmy to rely on the UKs investment in strategic intelligence to allow it totransform from one major opera on to another. 3 However, the armed forcesare required to be agile and adap ve by government, which expects melyresponses to crises or requests. The 1998 Strategic Defence Review (andarguably also SDSR) missed the extent to which all opera ons will be enduringand require the signi cant deployment of forces. Experience has also shownthat there is no real clarity about the outcomes needed from opera onsbefore deployment, so the military is delivering to di erent outcomes atdi erent points. In this sense future con ict is what the armed forces aredoing already and the UK must be able to adapt rapidly. The combined armsapproach arguably overcomes challenges to the armys ability to adapt andbe agile.

The Military Role in Homeland Security and ResilienceWhile the Future Character of Con ict work goes into quite a lot of detailabout the characteris cs of the future ba lespace, it only hints at anincreased military role in domes c tasks. Yet the Na onal Security Strategyplaces signi cant emphasis on the homeland: homeland security makes upfour of the er one risks in the Na onal Security Risk Assessment and isiden ed as non-discre onary.

Part of the problem is that homeland security has never been a force driverfor the armed forces. The military has never been integrated fully intothe Na onal Risk Assessment which iden es gaps in civilian respondercapabili es and arguably the Military Assistance to the Civil Authority


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framework is too restric ve. The net result is that the military has been neither

forward leaning nor re cent in responding to requests for assistance; thearmed forces have contributed in a reac onary way to crises which requirecapabili es that civil responders do not have or cannot deploy adequately(such as the Gloucester oods), or to assist in catastrophic events.

However, recent Na onal Security Council discussions iden fy an increasedwillingness for other government departments to consider military op onsmuch earlier when threats and hazards arise and the prime minister hasalready directed the military to increase its contribu on in certain areas,accep ng the risk that this will have for other opera ons abroad. Morerecently the MoD has taken a more posi ve approach in rela on to its

contribu on to the 2012 Olympic Games; 1,000 personnel will be provided(but no func on has yet been de ned for them by other departments andagencies), and explosive ordnance disposal and CBRN assets are beingearmarked and trained so that any requirement in these areas during theGames does not impact on opera ons in Afghanistan.

The army therefore needs to think through the (poten al) poli calexpecta ons for it in the homeland. Previous assump ons that it will take alengthy period for threats and hazards to emerge in the UK or that risks canbe prevented or tackled overseas before they reach the UK no longer hold.It is unlikely that providing residue capacity and capability for homelandtasks will be su cient or acceptable and homeland security and resiliencerequirements could well become a force driver for the military. The militarywill be valued for its command and control, situa onal awareness and licapabili es in the context of high impact events including: Mumbai-stylea acks; bio-terrorism; large-scale ooding; and large-scale disrup on toinfrastructure. Some of these high impact events should be force drivers(for example, Mumbai-style a acks); others will not be force drivers butthe military will be useful during the crisis and expected to contribute (forexample, ooding); and there is a choice over what contribu on to make toother events.

It is not clear how the combined arms approach and its prac cal manifesta on(mul -role brigades) will contribute to these requirements and the armyneeds to make this argument. In principle mul -role brigades are agile andadaptable, and therefore should be exible enough to meet these demands

but the detail needs to be worked out and explained. They poten allyalso ll the command and control gap created by the decision to removethe armys regional HQ structure they are deployable headquarters whichcould be used in a domes c context.


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Mark Phillips 21

Sustainability of the Combined Arms Approach: Industry and Jointery

Agility and adaptability ul mately depend on how e ec vely a brigade issustained. The combined arms approach needs to be explored across each of the Defence Lines of Development, namely training, equipment, personnel,informa on, concepts and doctrine, organisa on, infrastructure, logis cs andinteroperability. While the combined arms approach exists in headline andopera onal analysis has shown its organisa on and personnel requirements,work remains to be done to determine if the approach can be resourced atreadiness and in a sustainable way.

Agility and adaptability (and therefore the combined arms approach) dependon appropriate and mely procurement, training and doctrine to get the

right equipment and force structures in good me and seize the ini a vefrom the enemy.

Although the issues surrounding procurement go wider than the army,the army should place the combined arms proposal in the context of theemerging Total Support Force work. The Total Support Force includes apresump on of increased contractor support to the military both at homeand on opera ons through a pre-planned mix of civilian and military sta ,industry and others; the army needs to consider whether mul -role brigadeswill only consist of organic assets or whether it is prepared to take the riskof contractors providing certain elements. 4 If it is willing to take this risk, itneeds to iden fy which elements should be ring fenced and whether TSFshould allow MRBs to be scaled back up to military only if required by apar cular situa on. If not all assets are organic, this could reduce costs andmake the combined arms approach more feasible and a rac ve from abudgetary point of view.

The human conceptual and moral component is vital. Combined armsmanoeuvre is arguably more dependent on a tude and culture, andtherefore training and doctrine, than equipment. People are also rela velycheap to maintain compared to buying a full range of kit. The training and

educa on demands need to be explored in greater detail.

In rela on to sustainability, there are two issues:

1. Post-SDSR it is unlikely that the UK will be able to operate at a highintensity. Moreover, whatever the tempo of future opera ons, it isclear that no single service component will be su cient to meet op-era onal requirements and demands by itself. The army needs toconsider how to manage the loss of joint service enablers which hadno single service owner during SDSR, including theatre-entry capa-bili es (as a result of a lack of land-amphibious integra on), and itneeds to refocus on air-land integra on. Rebuilding these joint capa-


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bili es will be essen al to future opera ons and should inform the

combined arms thinking, so the army should involve other servicesin its force development work. When these capabili es are rebuilt,much more thought will need to be given to joint spectrum manage-ment. Lessons can be learnt from the experience of JTFHQ and JointHelicopter Command in this respect.

2. Combined arms manoeuvre needs to be de ned in terms of supportand logis cs.

ConclusionEnduring opera ons in Afghanistan and Iraq have dominated the army andits force development over the past decade. The army has become bespoke

and specialised and therefore unsuitable for the demands of the FutureCharacter of Con ict. Recognising this, the army is rever ng back to thecombined arms manoeuvre approach. However, if it is to make the argumentfor combined arms it must:

Iden fy how and why it is cost e ec ve and provides value for money; Provide further evidence from the opera onal analysis of a wider

range of con icts; Assess how mul -role brigades will contribute to coali on opera ons; Explain how mul -role brigades will contribute to the homeland secu-

rity and resilience demands that are likely to be placed on the armedforces in the future;

Explore the thesis across all the Defence Lines of Development, and inpar cular in terms of logis cs, procurement and joint enablers.

Notes1. See Chapter 1 of this occasional paper.

2. It is worth no ng that adversaries are a ected by culture and have indigenouscharacteris cs. This provides an advantage that can be exploited in opera ons providedthe military understands that culture. See also Chapter 1 of this paper.

3. This point about the rela ve expense of maintaining generic capabili es versustransforming the army according to the requirements of each opera on deservesto be explored in greater detail. For example, what is the cost of Urgent Opera onalRequirements which allow an army to transform to meet the requirements of apar cular deployment? What capabili es in addi on to those contained in mul -rolebrigades might be required at short no ce to meet the demands of future con icts, andwhat is their likely cost?

4. The army should also consider how to integrate the Reserves into command structuresand mul -role brigades as part of the Total Support Force concept.


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Medical Support for Future Opera ons

O pera ons in Iraq and Afghanistan have dominated the armed forces forthe past decade and driven a number of changes to, and innova onsin, the provision of medical support to deployed personnel. This medicalsupport is widely regarded as excellent; for example, the NHS has learntextensively from military experience and adopted a number of techniquesand procedures used on the frontline in developing its own trauma caresystems. Public expecta ons will be high following the UKs experience inAfghanistan, though somewhat tempered by their understanding of, andsupport for, opera ons. The expecta ons of pa ents regarding standards of care will certainly be high many have come to expect that the medical

support they receive will allow them to con nue with their careers as willthe expecta ons of medical sta who have had access to a wider range andhigher standard of equipment in Afghanistan. It will be important to maintainpublic con dence in the quality of support and care, as this is an enabler of military force and does aid public tolerance of deployments.

Medical support to and on military opera ons tradi onally consists of anumber of discrete levels of integrated care delivery, commonly known asthe echelon system, each delivered by a combina on of manning and skillsfrom across the Services. UK military planning is predicated on the 1:2:4hour rule within this echelon that is, advanced rst aid within one hour,resuscita on surgery within two hours and de ni ve surgery within fourhours. However, the environmental condi ons in Iraq and Afghanistan meantthat it was di cult to move up the echelon system in a mely way par cularlyfor signi cant trauma cases. As a result, there was a need to improve pre-hospital care and the melines for ge ng casual es into hospitals, and theequipment and capabili es of deployed hospitals.

Helicopter-borne Medical Emergency Response Teams (MERT) and MERT(enhanced) teams, for which the RAF have the lead and provide the majority,have a racted signi cant public a en on and praise. However, there is no

sta s cal evidence to prove that MERTe in isola on increases survivability andresearch is ongoing in this area. MERTe does contribute to the unexpectedsurvivor rate and there is strong anecdotal evidence from subject ma erexperts to suggest its importance primarily because of the reduced me toadvanced/haemosta c resuscita on which allows quicker decision-makingand earlier care. The US is par cularly interested in this approach and twostudies are comparing MERT with PEDRO and DUSTOFF to iden fy di erencesin survival between the evacua on pla orms in use in Afghanistan.

However, in deciding the level of military support that should be providedon future opera ons, it is important to realise that the principle of MERTis applicable to land and sea as well as air; the demands of the opera onal


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Mark Phillips 25

future medical support by developing and formalising medical Lines of

Development.

An Assessment of MERT and MERTe

MERT and the Echelon SystemMedical support to, and on, military opera ons is tradi onally made up of echelons. Each echelon has the same capabili es as the echelon before it,but adds a new treatment capability that dis nguishes it from the previousechelon (see also Annex 1):

1. Role 1, which provides primary health care, specialised rst aid, triage,

resuscita on and stabilisa on. Examples include sick bays a oat, unitaid posts and medical sec ons

2. Role 2, which conducts triage and advanced resuscita on proceduresup to damage control surgery through light manoeuvre. Role 2 isconsultant-led and deployed closer to combat ac vi es than Role3. An enhanced Role 2 is a basic secondary care facility built aroundprimary surgery, ICU and beds with nursing support. Role 2 is generallydeployed where there will be di culty, as a result of topography,casualty numbers, extended lines of communica on and so on, inproviding de ni ve hospital care within the 1:2:4 hour principle

3. Role 3, which is the provision of theatre secondary health carethrough a medical treatment facility of scale. In other words, Role 3is deployed hospitalisa on but tailored to the nature and stage of anopera on

4. Role 4, which is the provision of specialist or prolonged in-pa entcare, de ni ve treatment and rehabilita on by the NHS in the UK.

The joint nature and manning of the deployed military capability across eachof these echelons should be noted: all services contribute to the delivery of capabili es.

A number of condi ons in Iraq and Afghanistan, including the di culty of ( mely) ground transporta on over hos le and inaccessible terrain andthe dispersion of forces throughout extensive areas of opera on, fosteredrecogni on of the need to improve both pre-hospital care and evacua onmelines. During planning for Opera on Herrick 4 by 16 Close SupportMedical Regiment, it was further noted that there would be extendedmelines to hospital care even with the use of helicopters. The sustaineddeployment of forward medical care, such as Field Surgical Teams, to allparts of the province was not possible. Given the restraints on the care thatcan be administered at point of woundingit was decided that it would bedesirable to bring cri cal care forward to the pa ent. 2 This resulted in notonly a reliance on, but also a progression of, the high-readiness Incident


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Response Teams (IRT) and RAF forward aeromedical evacua on developed

in Opera on TELIC and previous opera ons through Medical EmergencyResponse Teams and later enhanced teams, whereby cadre clinicians withan interest in forward cri cal care joined Emergency Response Teams delivered by the RAF through air assets. The inten on was to provide an agileenhanced medical response to replace or complement forward echelonsof medical support by providing tac cally aware, trained and experiencedteams which were deployable by any means and could provide cri cal careskills, clinical excellence despite environmental austerity, and rapid deliveryof casual es to the most appropriate loca on.

MERTe teams in Afghanistan are physician-led and include an Emergency

Medicine Nurse and two paramedics. This make-up is designed to preventphysiological deteriora on and act as an enabler of later medical support byproviding a conduit for informa on between forward areas and the hospitalor medical command. The IRT which accompanies MERTe can have otherelements such as an interpreter, force protec on and explosive ordnancedisposal, as required.

The evidence for and against MERT Despite the high pro le of helicopter-borne MERT and MERTe, there is noconcrete evidence to suggest that this innova on improves survivabilityrates and other pa ent outcomes in isola on. This is, however, part of abroader problem of data collec on in rela on to medical support and itssuccess in reducing casualty rates. There are no studies directly addressingthe issue of what is an acceptable meline from point of wounding to surgicalinterven on; the threshold has tended to be determined by personal opinion,tac cal and logis cal impera ves rather than clinical demands, though somerecent work has suggested that this is between two and three hours for allcasual es. 3 Without this evidence, the merits are largely intui ve:

Reduc on in me from point of wounding to advanced haemosta cresuscita on and provision of in- ight diagnos cs, which then allows

physician-led decision making on cri cally unstable casual es, whichin turn allows an expedited straight move direct to the opera ngtheatre or direct transfer to a regional centre

A signi cant contribu on to pa ent morale.

Defence needs to collect and produce a more de ni ve data set from exis ngopera ons to inden fy op mal medical interven ons, and might need toemploy informa on specialists for this purpose. The data set should includedata from interna onal partners and civilian organisa ons to increase thedepth and breadth of the evidence-base and therefore act as a benchmark.It would be worth the US and the UK developing common or joint theatreregistries. There are welcome steps taking place at the moment: the UKs


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Mark Phillips 27

Joint Theatre Trauma Register has existed since 1997 and was upgraded in

2003 to contain informa on on melines, including procedures carried out atall phases of the chain of evacua on. The rebuild of JTTR is almost completeand it will be linked with the US Joint Theatre Trauma System to share moredata on a regular basis. Furthermore, there is a project to develop a NATOTheatre Register. The more comprehensive data sets that are producedshould be able to be manipulated to examine medical interven on op onsin poten al future opera ng condi ons; there is, therefore, a requirementfor greater investment in informa on and modelling specialists.

Is There a Future Requirement for MERT? In addi on to a proper evidence base, in considering whether or not to use

MERT as a default for future con icts there should be: 4

[A] pragma c approach to assessing the need for MERT or MERT-E levelof capability. Where there is a high intensity of opera ons, a substan alpopula on at risk and prolonged melines then the requirement to projectforward advanced resuscita on is intui vely jus able. With shortmelines, low intensity opera ons and a small popula on at risk then MERTwithout enhancement is arguably appropriate. This debate is integrallylinked with the debate regarding the op mal geographical placement of surgical teams in the Ba lespace.

The UK can arguably learn lessons from the Israeli zero-echelon approachfor low intensity opera ng environments with air superiority. However, themore fundamental point remains that the level and type of medical supportwill di er according to the nature of the opera on and deployment. In futurecon icts:

There are likely to be fewer air assets (an implica on of SDSR) 5

Even where air assets are in place, using aircra in contested airspacescould be di cult

Air superiority cannot be assumed in the future

The Army is increasingly likely to operate in urban and li oral areas,which means that new means of delivering medical support andevacua ng casual es should be developed. Pre-hospital care mayhave to be delivered through other means in the future, including bysea, on foot or in vehicles

Deployment of MERT puts valuable assets at risk which could be alimi ng factor from strategic-level commands in the future (seeChapter 4 on countering risk aversion at the tac cal level. It is alsoworth no ng in rela on to risk aversion on the part of individuals,that personnel have become accustomed to high readiness medicalsupport as a result of service in Afghanistan which might not beavailable in the future).


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Although it is too dangerous to consider anything other than air movements

in Afghanistan, the MERT concept must therefore be explored acrossother assets and domains (land and sea) in an cipa on of future opera onaldemands. Defence also need to develop a process of intelligent tasking,whereby quick assessments are made between both medics and operatorsas to the most appropriate assets and components that should make up theevacua on route. The evacua on route is likely to be more variable in futureopera ons than in Afghanistan. This process, which would introduce clinicalelements to a previously opera onal-only decision, should be embedded indoctrine and structures, taking forward the example of the SO2 post that wasestablished in Headquarters Regional Command (South West) in Afghanistanin July 2010.

The Future of the Echelon SystemMERTe is tasked according to need and priority; it may therefore be re-tasked mid-mission to collect more seriously injured casual es. This is thecurrent prac ce in Afghanistan and will con nue to be so in the future; itshould therefore in uence the minimum level of medical capability acrossthe echelons.

There is an argument for having Role 3 facili es as the default for trauma care,as evidence shows that survival is be er in hospitals that are fully resourcedand specialised for the treatment of the injured in terms of infrastructure,blood, climate control, knowledge and sta ng levels. Indeed, some have goneso far as to suggest that stopping elsewhere en-route to these larger centres (akey element of the echelon system) is of uncertain bene t. However, resourceconstraints, including logis cs support, readiness states and manning, andtac cal demands could limit this approach which is more applicable to a largeforce with high expecta ons of casualty rates. Therefore all elements of theechelon system (including MERT) will s ll have a role.

The requirement might be met by greater use of tailored Role 2 enhancedfacili es that is, a eld hospital with the physical infrastructure of a Role

3 facility, including possibly a CT scanner, but with a reduced capacity andlimited surgical disciplines given logis cal and readiness constraints. The keywould be to ensure that the surgical disciplines meet the dis nct opera onalrequirement.

This points to the requirement for be er casualty es ma on before adeployment. Given the wide range of tasks the Army can expect to undertakeas a result of Defence Strategic Guidance and the Military Tasks outlinedin the Strategic Defence and Security Review, including con ict preven on,stabilisa on, counter insurgency and a military role in homeland security andresilience (see Chapter 2 on the speci c requirement for military support inthe homeland), this must include:


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Mark Phillips 29

Es mates of the demand for medical support from the host na on,

par cularly as medical forces can (and should) contribute to con ictpreven on, stabilisa on and COIN tasks both by winning heartsand minds by providing medical support and building an indigenousmedical capability in host na on forces. This poten al contribu on of medical sta has been neglected to date medical support to COINand stabilisa on is not included in exis ng doctrine, and there is nospeci c medical doctrine for COIN and stabilisa on but needs to beincluded in doctrine, training and opera onal plans. A balance willhave to be struck between the direct provision of medical capabili es,which could undermine local health provision by crea ng dependency,and medical engagement to provide support and improve the capacity

of local agencies through training and logis cs rather than the directdelivery of care. This balance could vary in each stage of an opera onor deployment.

Es mates of the demand for medical support as a result of enemycasual es.

Es mates of support will have to cover not just trauma but a widerrange of risks, such as disease, non-ba le and psychiatric injuries,depending on the type of deployment undertaken

Guidance on what demands are likely to be placed on the military inthe homeland context from a health perspec ve, notably in rela onto risks such as CBRN a ack for which the Olympic Games in 2012 arearguably already a driver. (Note that the capability to deploy in and dealwith CBRN a ected areas is also likely to be a requirement abroad).

The need to deal with disease, non-ba le and psychiatric injuries aswell as trauma.

This all needs to be formally input into the Es mates Process and Opera onalAnalysis. A related issue is the need for a be er (and more formal linkageand rela onship) between medical advisers, commanders and opera onsand planning sta : anecdotal evidence suggests that poor rela onships havetended to be a stumbling block in the past, to the extent that commanders

have reduced the pace of opera ons because they do not feel they haveadequate es ma ons. In turn this points to a requirement for the Armyto assess whether medical sta should train within their professionalcommunity or with the forma on they deploy with. Arguably more trainingshould be done with forma ons, as this allows medical sta to understandtheir requirements, select the right tools and in uence the percep ons of soldiers. The Army should embed the recent prac ce of having SO2 Medswithin every deployable Brigade and ensure their importance within thechain of command.

Furthermore, in rela on to elements of the echelon system other thanRole 3, lessons have shown far forward interven ons to be e ec ve. As


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part of developing the echelon system Defence should, therefore, consider

specialising pre-hospital care (see Sec on IV below) by undertaking furtherwork on the pay-o between the requirement for units to remain light, witha small logis c footprint, and the desire to maximise treatment capacity andcapability at unit-level, which will in turn de ne the make-up and requirementfor Forward Surgical Teams; and also inves ng high-end medical skills sets ina wider number of soldiers. This might also help overcome the signi cantdemands of medical force protec on.

Overall, it is clear that the level of medical support provided needs to beexible enough to meet the requirements of di erent types of deploymentand the demands of di erent stages of opera ons (in terms of tempo and

tac cal obstruc ons). This exibility should be the value of a well-constructedechelon system and be er casualty es ma on enables a tailored approach. Itmight, however, be be er termed a hub and spoke approach as individualsneed not progress through the en re echelon.

Medical Support and the Defence Lines of DevelopmentThe analysis above suggests that medical support needs to be considered (if notembedded) across each of the Defence Lines of Development, namely training,equipment, personnel, informa on, concepts and doctrine, organisa on,infrastructure and logis cs. This has been neglected to date: medicine is notseen as a core enabler. The Army should also ques on whether the currentdivision/groupings of Combat Support and Combat Service Support areadequate to encapsulate and incorporate the medical func on.

Post-Afghanistan there will be some par cular challenges in rela on toinfrastructure and training lines of development which Defence will need tomanage:

Most equipment has been introduced through Urgent Opera onalRequirements. The medical profession need to know whether theywill have access to (and be able to train with) large-scale transfusion,

CT scanners, ITU support and so on. The Army should develop acompendium that informs policy-makers of the level of supportprovided by di erent capabili es (and the training requirements forthose capabili es), to ensure informed decisions are made in planningrounds

It is easy to maintain the skills of medical sta in the high opera onaltempo of Opera on HERRICK, but how will they be maintaineda erwards? At the moment there are seven opera ons a day fortwo to three surgeons in Afghanistan, with mul ple surgeons (upto ve) opera ng on one casualty in Afghanistan. 6 And how will theArmy develop the skills set to deal with a wider range of people (forexample, in host na on countries)? There are opportuni es for joint


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Mark Phillips 31

training with organisa ons like the London Ambulance Service which

should be explored Maintaining skills and experience is important also in rela on tocri cal care, as decisions and diagnoses pre-hospital have to be madeon the basis of incomplete informa on. It is therefore a mixture of knowledge, experience and intui on that ma ers.

Specialising pre-hospital care by iden fying the skills set for all pre-hospital clinicians and ensuring that pre-hospital care is considered amainstream speciality

Ensuring consistency across the three Services given that hospitalsare tri-service. At the moment there are Single Service trainingprogrammes and pre-deployment pathways, with di erent tour

lengths. There need to be standard approaches Improving baseline knowledge of the echelon system, and in par cular

approaches to medical evacua ons, by all soldiers. There have beeninstances where ba legroup commanders are distracted by direc ngMERT rather than recon guring their manoeuvre campaign; companycommanders and even corporals should be able to focus on theformer.

ConclusionThe analysis above suggests the medical support to future opera ons needsto be tailored through adequate es mates processes, understanding of thedemands of the future character of con ict and the developing of intelligenttasking. The analysis also suggests that medicine needs to be viewed asa core enabler by the Army and embedded across the Defence Lines of Development. In developing a exible echelon system for the future, Defencemight also nd it useful to develop medical-speci c lines of development toframe its thinking and analyse how the Future Character of Con ict a ectseach component of medical doctrine and structures, including:

1. Force health protec on2. Pre-hospital

3. Hospital on deployment4. Medical evacua on5. Medical C36. Medical logis cs7. Medical training8. Host na on development

These lines of development should be considered across the range of tasksDefence is likely to undertake in the future, including stabilisa on, con ictpreven on and homeland security requirements.


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Annex 1: The Military Medical Echelon System 7

PRE-HOSPITAL RESUSCITATION

First aidArmy Team MedicProfessional Medic

Ba le eld ATSMERT

ED RESUSCITATION

PRIORITY SURGEY

FIELD INTENSIVE CAREField Hospital

Cri cal Care Air Support Team (CCAST)

DEFINITIVE CARESurgery

Cri cal CareWard Care

REHABILITATION

Each echelon is enabled by appropriate training, and the en re echelon isenabled through a coherent governance system

Notes1. T J Hodge s and P F Mahoney, Military Pre-Hospital Care: Why is it Di erent?, Journal

of the Army Medical Corps (Vol. 155, No. 2), p. 4.

2. D OReilly, T Knig and N Tai, Field Trauma Care in the 21st Century, Journal of the ArmyMedical Corps (Vol. 154, No. 4), p. 260. Current tac cs and procedures support delivery of astepwise clinical interven onal capability, which is inversely related to the level of threat.

3. See, for example, N R M Tai, A Brooks, M Midwinter, J C Clasper, P J Parker, Op malClinical Timelines A Consensus From The Academic Department Of Military SurgeryAnd Trauma, Journal of the Army Medical Corps (Vol. 155, No. 4), pp. 25356 and PaulJ Parker, Casualty Evacua on Timelines An Evidence-Based Review, Journal of theArmy Medical Corps (Vol. 153, No. 4), pp. 27477.

4. Hodge s and Mahoney, op. cit., p. 7.

5. It is worth asking whether the UK can or should dual-role aircra for medical support,as the US did with search and rescue aircra in Afghanistan under PEDRO due to a lackof air assets. Note, however, that the US is moving away from this approach due toproblems with the quality of support this approach provides.

6. There is certainly a ques on over whether or not this is sustainable. It is driven by thecomplex amputa ons that need to take place and, if this risk will be a feature of futurecon ict, the army must take this into account in its resourcing decisions.

7. Adapted from Hodge s and Mahoney, op. cit., p. 6.


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The Armys Approach to Risk Management on

Opera ons

T he Army Doctrine Publica on (ADP) on Opera ons, which was publishedin November 2010, raised the issue of risk prominently and for the rstme in higher level doctrine. ADP explored the nature of risk, the place of risk within opera ons and how commanders and individuals should deal withrisk. Based on ADP it is clear, rstly, that risk is neutral and acceptance of it canpresent both real opportuni es and the poten al for grave consequences.Secondly, that it is necessary to take calculated risk (by balancing a range of di erent factors) in order to exploit opportuni es and achieve success in the

eld.

Research by the army suggests that despite this emphasis on the militarynecessity of taking calculated risk, tac cal commanders have becomeincreasingly risk averse. The army is worried that risk aversion is hindering itsunderlying philosophy and approach to opera ons, namely the philosophyof mission command, which advocates centralised, clear intent fromcommanders, but decentralised execu on with signi cant freedom of ac on to meet that intent. It also threatens the manoeuvrist approach,which emphasises understanding and targe ng the conceptual and moralcomponents of an adversarys gh ng power as well as a acking the physicalcomponent, and is dependent on seizing the ini a ve, organisa onal agility,the ability to iden fy threats and vulnerability, and being prepared todecentralise and take risks to achieve objec ves in the most e cient andmely way.

It is argued that a number of factors are contribu ng to risk aversion. Inpar cular: a feeling that the weight of regula on is growing, including therange of inquests and inquiries that individuals might be subject to as aresult of mistakes during training, exercises and on opera ons; freedom of ac on being reduced as a result of changes in chain of command ownership

of opera ons, and in par cular a tendency for strategic-level headquartersto interfere with tac cal decisions because of the strategic impact frontlineac ons can have; and UK-based in-barracks and training procedures whichhave become unnecessarily bureaucra c and s e risk-taking judgement,not least as a result of the loss of Crown Immunity within health and safetylegisla on.

However, there is only anecdotal evidence to suggest that this is the case.These views are not universal, and the anecdotes relate to the balance of force protec on, rather than problems with gallantry and cowardice. Thearmy should collect evidence of risk-averse behaviour to determine if thereis actually a problem.


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There are a number of external factors that a ect the cost/bene t analysis

of individuals and organisa ons factors which the army command needsto be aware of but these do not indicate risk aversion per se, and can beaddressed through e ec ve training, educa on and the exis ng Orders andEs mate processes. Further risk-assessment processes are not needed.

The real issue lies not with people on the frontline but how the strategic,opera onal and tac cal levels of decision-making interact, and in par cularhow the strategic level interferes with frontline decisions. Commanders needto develop a be er understanding of how risk at the poli cal strategic levelinteracts with decisions taken at the tac cal level (and vice versa). The armyneeds to push for absolute clarity about responsibili es and accountabili es

within chains of command.

Taking these steps is vital, because future adversaries will make an es mateof the risk appe te of deployed forces, from the strategic through to thetac cal levels, and this presents a poten al vulnerability unless risk isadequately understood.

Is There a Growing Risk-Averse Culture in the Army?When looking at the issue of risk, it is important to dis nguish between how(and why) organisa ons manage risks on the one hand, and whether andhow individuals take risks on the other. Much discussion tends to focus onhow organisa ons manage risk. This is certainly an important component,and in turn has a bearing on how individuals behave, but the army leadershipmust also be aware of the factors that a ect individual cost-bene t analysisand decision-making.

Individual Decision-Making and Cost-Bene t AnalysisThere is li le evidence of risk aversion on the part of individual soldiers, asdemonstrated by the signi cant number of gallantry honours and cita onsthat are awarded. There is a sugges on, however, that the majority of gallantry awards have been made to individuals who have reacted well,

or extremely well, to dangerous situa ons in which they found themselvesas opposed to individuals decorated for proac ve gallantry (with severalsigni cant excep ons). However, there are a number of external factorswhich are known to in uence decision-making. These factors re ect theprevailing social and strategic context (of which risk is a func on) andinclude the fact that we live in:

An instant media age, with 24/7 coverage An age of public scep cism about military deployments. A notable

example is the public a tude towards ongoing opera ons in Afghani-stan: poli cal debates will increasingly in uence the decisions indi-vidual soldiers make, as they will be told by families and friends that


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understanding or guidance from a poli cal level on the aims and objec ves

of an opera on.3

What is clear, however, is that the same factors which a ect individualdecision-making and cost/bene t analysis also a ect higher levels of command but in di erent ways. Headquarters forma ons increasinglyinterfere at the opera onal and tac cal levels because ac ons on thefront line now have dispropor onate e ects at the strategic and poli callevels. The army needs a be er understanding of how the importancea ached to risk at these levels impacts on the tac cal level and how riskis de ned at these levels. O en risk is managed and ruled on by peoplewho do not have opera onal or frontline experience, and therefore who

do understand the nature of military opera ons or the context for frontlinedecision-making; the army needs to educate these individuals (and thewider public) about the demands of opera ons and also in uence them. 4 One example is provided by the Permanent Joint Headquarters (PJHQ)making decisions about the level of armour individuals are required to wearversus the requirement for agility, probably because of the strategic e ectof fatali es and even casual es even though it cannot, as a headquarters,own that risk.

What Should the Army Do?There are two broad approaches to managing risk. The rst is to apply aprocess of risk assessment, and, if necessary, improve it. The second is toiden fy who owns di erent levels of risk.

Does the Army Need a Risk Assessment-Process? A number of mechanisms for assessing risk already exist, including:

Rules of engagement that balance risk to individuals with the widerrisks to opera onal success (for example, placing emphasis on mini-mising civilian casual es in a counter-insurgency campaign, limi ngthe use of air power)

The Es mate Process which itself represents a risk assessment The Combat Es mate, which has been updated recently to includeconsidera on of risk as part of Mission Analysis.

These processes include di erent levels of command, from the poli cal tothe tac cal, and also the opportunity to secure waivers to certain restric ons.However, risk assessment is largely implicit within them: there is nothingexplicit to force a commander or his sta through assessing risk and mi ga ngits e ects. A key ques on is whether or not this is adequate should it bekept as an intui ve process, or become formalised , or recognised that thewhole process contributes to this?


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command and the manoeuvrist approach. In part this is dependent onbe er guidance from the strategic level; while at the tac cal level extendingor developing new processes will have no bene t, arguably more should bedone at a strategic level to understand risk before forces deploy (to na onalinterests, costly pla orms and so on) in other words, when campaignac vity is being designed if this results in a be er expression of commandintent to forces on the ground. 10 Where adequate direc on and guidance islacking, the military leadership should push government to provide it.

The army also needs to take steps to develop a culture in line with its missioncommand philosophy and manoeuvrist approach, including:

Bureaucra c length: Safety Cases and

Agile Warrior

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