Joint Casualty Treatment Ship (JCTS)
(formerly Primary Casualty Receiving Ship (PCRS))

(Archived March 2007.  This project was effectively cancelled in 2005, the requirement will
be partially met by RFA Argus, which will now remain in service until 2020)

Type Designation: Hospital Ship, AHWG

One estimate made in 2001 against the URD indicated the following specification:

Displacement, tonnes:  20,000 full load (estimated)
Dimensions, feet (metres):  ?
Main machinery: ? 
Speed, knots:  18
Complement:  Over 350 crew and medical staff, 200 patients 
Helicopters: Flight deck facilities (no hanger) for operating one Chinook or two Sea Kings HC.4 or Merlin HC.3

Notes:
Project designation:  URD 2007
Status: Under review.  The project passed Initial Gate and entered the Assessment Phase on 20 December 2001, however the integrated project team was disbanded on 15 July 2005.  
In Service Date:  No official date. 2012 was the last date apparently used for planning purposes.

The Joint Casualty Treatment Ship (JCTS), formerly Primary Casualty Receiving Ship (PCRS) is required to provide a global, maritime medical treatment capability that will deliver medical care for casualties across the spectrum of military tasks and conflict, in all types of climatic conditions.  The requirement was mandated under the 1998 'Strategic Defence Review' and the first of two ships was originally expected to enter service by 2005, but a lack of funding has repeatedly delayed the project.  It is still theoretically hoped that one ship will be built and enter service probably in 2012.  However the new build option appears to have now been ruled  and the IPT was disbanded in mid-2005 due to costs and lack of funding. 

Other options such as converting one of new Bay-class LSD(A)'s to a JCTS configuration were also considered, but it's now planned that RFA Argus will remain in service for some time to come (until 2020) and JCTS as originally conceived as a dedicated casualty ship seems to have been effectively cancelled.

Characteristics
The Concept of Employment (ConEmp) and User Requirement Document (URD) for the JCTS were always officially "being developed" but the later draft user requirement documents apparently indicated a likely medical requirement of:

• 150 Beds
• 30 Intensive Therapy Unit (ITU)
• 50 High Dependency Unit (HDU)
• 4 Operating Theatres (each with 2 tables)
• Triage Area
• 4 Resuscitation Bays
• Laboratory
• Imaging (X-Ray, CT Scan, Ultrasound)

and platform requirement of:

• Large flight deck (e.g. 2 x Chinook spots)
• Good access into and through ship for patient movement
• Accommodation for Medical & Ship’s complement
• Large fresh water requirement
• Nuclear Biological Chemical (NBC) protection

The ships were expected to be be new-build or converted, and of about 20,000-tonnes full load.  They will each have more than 350 crew and medical staff.   The ships will have a large helicopter deck with one landing and one parking spot.  A side ramp will aid embarkation and disembarkation of casualties while alongside a pier.  Early indications were that the vessels would  be based one each at Portsmouth and Plymouth. 

Operations
A JCTS would have had the medical capability of a hospital ship, but differ in the way in which it was deployed.  A hospital ship is declared to the International Committee of the Red Cross under the provisions of international law, which restricts its use in military situations, e.g. for refuelling armed helicopters or transporting military stores.  A JCTS would not be not subject to these restrictions, being able to operate forward in a combat area and not being excluded from recycling treated personnel into combat.   Experience from recent UK military operations suggested that a hospital ship does not provide the capability underlying the requirement for the JCTS.

When on MoD duties, it was expected that the medical staff on the JCTS would be mostly medical personnel of the Royal Naval Reserve, the Territorial Army and the Royal Auxiliary Air Force.  It was envisaged that a major overseas operation of the scale of the British contribution to operations in the Gulf in 1990/91 would involve the compulsory mobilisation of reserve medical personnel.

One JCTS would have been kept at 5 days readiness, and it was expected that she would operate about 8 weeks a year with the MoD for exercises and then be available for civilian healthcare duties the remainder of the time, subject to any operational requirements.  Plans for a second ship at one years notice were dropped by 2003 at the latest.

Approximately a third of a JCTS capacity, including 50 of the beds, was to have been the responsibility of the RNR Medical Branch.

Procurement Process
The project was initiated by the Strategic Defence Review in 1998 which identified shortfalls in personnel and equipment which have reduced the ability of the Defence Medical Services to support substantial deployed operations effectively. To resolve this, SDR announced the "procurement of a 200-bed primary casualty receiving ship, with a second one available on contract at longer notice if required". 

In October 1999 the requirement was amplified:  "The SDR recommended the acquisition, by 2005, of a Primary Casualty Receiving Ship capability based on two 200-bed capacity ships, one to be at high and the other at low readiness.  The MoD specification for the ships is currently being developed and is expected to be complete by the end of 1999.  The Requirement will then be passed to the Defence Procurement Agency where an Implementation Team has already been formed and a Project Manager appointed.  The in-service date remains at April 2005 for both ships.  Options on how best to use the ship available at high readiness when not required by the Defence Medical Services are being examined and include possible shared use with industry, the NHS or private medical providers. An exploratory meeting with the NHS Executive has already taken place and this will be pursued at further planned meetings when the MoD specification has been developed."

Further statements made in January and March 2000 said that a range of procurement options for the PCRS were still being considered, including a full Private Funding Initiative (PFI) service in which a private company would own, manage and perhaps even crew the ships, providing them to the MoD as contracted service.  The service requirement is still based on the provision of two ships at different states of readiness, each capable of carrying a 200 bed hospital.  It was hoped to place a contract in 2002 with the ships being available from 2005. 

In an effort to make providing a PFI service more attractive to suppliers, considerable efforts have been made to interest the National Health Service and other prospective organisations (including Charities and UN bodies such as the WHO) in leasing the service of the PCRS ships when these are not required by the MoD.  For example one option being favoured by the MoD was to moor the the ships at the Portsmouth and Plymouth naval bases and allow the owning company (or a leasing company) to organise contracts with NHS hospitals to take patients.  The MOD has also considered whether it could use the civilian owned Hospital Ship Africa Mercy as a PCRS.  However her facilities and capacity fall short of the MOD's requirements (she only has 80 hospital beds) and she lacks essential military features.  Also her planned civilian usage would make it very difficult for the ship to leased by the MOD as needed for training and operational requirements.

There are clearly practical difficulties involved with the "shared" concept given the requirement that at least one ship is available for military duties at short notice and it appears that the MoD's efforts to attract funding from such sources met with no success as in March 2001 the following statement quietly appeared on the MoD website concerning the PCRS:

"The PCRS project is funded within the MoD's Equipment Programme.  Funding will need to be re-Profiled this year to reflect realistic procurement options.  It is intended to provide more information on funding later in 2001.  Initial Gate is planed for Autumn 2001.  ISD is likely to be 2007." and later quot;Given the limited peacetime usage, early thinking envisaged a PFI solution, with a service-provider making use of spare capacity to generate third-party revenue. However, studies have demonstrated that there would be no genuine likelihood of risk transfer, nor could third party revenue be generated from non-governmental sources. The Project is therefore proceeding as a conventional procurement, although investigations are continuing into using spare capacity once JCTS is in-service to generate third party revenue."

Stage I of the Assessment Phase to identify practicable technical concepts was finally begun in December 2001, immediately after Initial Gate Approval on 20 December 2001.  A contract was let with BMT DSL to first generate a generic hospital layout, as a baseline for considering how such a facility might be deployed afloat. This was then considered against a range of potential types of host hull.  Consideration was given to using an existing naval ship and making it capable of taking a modular hospital when required, it was determined that no vessel would be available and such a solution has been found to be high risk.  The work concluded that a purpose-built vessel, based on a proven commercial hull design should produce the best value for money solution to the requirement.

Lack funding then again delayed the project, and the next main development was the renaming of the PCRS in April 2003 as the Joint Casualty Treatment Ship (JCTS)! 

Stage II commenced in July 2003 when Atkins Aviation and Defence Systems won a one year contract to develop a detailed System Requirement Document (SRD) for the renamed Joint Casualty Treatment Ship (JCTS), following on from earlier assessment activities exploring generic platform and medical complex options. At that time planning envisaged Invitations to Tender for the Demonstration and Manufacture Phase being issued around the end of the 2004/5 financial year.  However, this schedule was subject to revision due to continuing budgetary and by early 2004 it was not expected that the JCTS order would be placed before 2007, with construction work starting in 2008 for an in service date of 2010.  Despite the results of the early study work, no final decision had actually been taken as to whether the JCTS should be a conversion or a new-build platform, although industry pressed the MOD for explicit guidance on this issue.

As guaranteed peacetime usage of JCTS was limited to some eight week's training per year, during 2004 the whole approach was again reconsidered, in particular serious consideration was given to combining JCTS with another capability.  Options considered included:

• A dedicated new-build vessel (the previously selected approach);
• Using a modified Landing Ship Dock (Auxiliary) vessel;
• Converting a new or existing roll-on, roll-off (ro-ro) or container ship.
• Adapting an existing naval platform;
• A combination of the JCTS with another capability such as the proposed forward deployment of aviation (aka ASS) in one hull.

To the surprise of many observers it was concluded that JCTS could not be successfully combined with another project, a conversion was not considered optimal, and therefore the dedicated requirement remained - although it was decided that the exact form that the ship took should now be left to industry and bidding consortium.  The timescale again slipped in December 2004 as budget was not going to available as early as hoped.  The latest schedule (which even DPA officials admit that is "subject to review") is:

   July 2005 - Release of Capability Based Questionnaire (CBQ) to industry
   June 2006 - Two consortia selected to participate in a Risk Reduction Stage (RRS)
   August 2008 Main Gate approval and winning consortium announced for D&M Phase 
   2012 - In Service Date [Unofficial].

Officials suggested in late 2003 that the estimated value of the demonstration and manufacture order would be about £30 million. However this seems to be far too low as industry submissions have apparently suggested that a new build ship able to fully meet user requirements would cost £120-150 million. The maximum available budget is known to be below £100 million and budgetary issues are clearly a source of project delays.

Industry as a whole is being kept informed of progress or delays to the project by regular publication of updates to the SRD.

In May 2005 it was reported that Swan Hunter had submitted a proposal to the MOD to convert and complete RFA Lyme Bay in to a Joint Casualty Treatment Ship (JCTS) configuration at cost of £50 million.  The proposal would allow the MOD to have a JCTS in service as early as 2008, rather than currently projected 2012, and at much lower cost than a dedicated new build vessel.  The conversion would also enable Swan Hunter to keep open its Wallsend shipyard and retain a core workforce until construction work can start on a superblock for the new aircraft carrier HMS Queen Elizabeth - now expected to occur in the 2008 timeframe.   Babcock Rosyth apparently subsequently submitted a rival proposal.  The MOD is believed to be seriously considering the proposals and is reviewing its JCTS requirements and budget, but it's uncertain whether a contract award is actually imminent.

Creeping cancellation of the JCTS Project

In April 2005 a page about JCTS on the official DPA website was amended to include the statement: "Funding and planning assumptions are under review as part of the annual planning round."  It now seems that adequate funding for the JCTS was not included (for probably the third or fourth time in a row) in the then latest Equipment Plan 2005 (EP05 - approved March 2005).  Industry submissions had indicated that a new build ship meeting the likely system requirements would cost about £150 million, but the MOD could not find even a quarter of that amount due to other higher priority requirements.  A key factor was surely the lack of casualties for a JCTS facility during Operation Telic in 2003 - precisely the type of operation that the JCTS had been conceived to support. 

Without funding commitments it was again (for perhaps the fourth year in a row) impossible to establish a project schedule and route map to Main Gate.  Another bid could not be submitted until summer 2006 and the dedicated Integrated Project Team had already over worked the Assessment Phase due to previous funding delays - the project was also rapidly ceasing to have any credibility with industry. 

On 27 June 2005, an answer to a Parliamentary question revealed that RFA Argus would now remain in service until 2020 as a Primary Casualty Reception Ship (PCRS) and Aviation Training Ship (ATS).

The small remaining Integrated Project Team was finally disbanded on 15 July 2005, and the project was transferred to the Future Business Group.   In August 2005, it appeared that they were still studying modularised hospital capabilities suitable for fitting to a Bay-class Landing Ship Dock (Auxiliary) or Ro-Ro vessel. 

By late 2005 the JCTS project had ceased to be mentioned on official MOD websites, or in major reports such as the Defence Industrial Strategy published in December 2005.

In early January 2006, Secretary of State for Defence Mr Ingram confirmed that the project was under review, "The review of the Joint Casualty Treatment Ship programme was established to look into the options for delivering maritime deployed medical capability; taking into account the existing capability provided by RFA Argus.  The review is expected to complete in April 2006."
 

Current PCRS/JCTS Capability
It's worth noting the current situation as this may now persist until 2020.

The MOD medical concept of operations (or CONOPS) is similar in concept to the U.S. echelons of care system. Role 1 is that of the field medic who provides immediate life-saving care on the battlefield or onboard a ship. Role 2 is the first point where the patient sees a physician.  A surgical team, roughly capable of tending to 25 surgical beds, may be at a Role 2 location. Role 2 is similar in concept to the U.S. battalion aid station. Role 2 also includes British Army Field Ambulances. A field ambulance is a front-line medical treatment facility with organic medical evacuation (medevac) assets. These medevac assets provide transport to Role 3 facilities. Role 3 is the field hospital/hospital ship.  Role 4 is fulfilled by the British National Health Service, and offers comprehensive fixed medical treatment facilities.

The Royal Navy (RN) plans to provide Role 2 medical support through the three Invincible Class CVS carriers and two Auxiliary ships (the Fort Class AOR's).  The ships primary health care medical personnel will be augmented by a surgical team and supporting medical and nursing personnel. The CVS have 11 beds available, and the AORs have 12 beds each. RFA Fort George was fitted with a 12 bed surgical capability in 2309091 and Fort Victoria will receive similar in 2002. 

The RN currently has no dedicated hospital ships in service nor are they planned, although the PCRS's will physically have many features in common with such.  During the Falkland Islands conflict, the RN used a STUFT (ship taken up from trade) to create the hospital ship Uganda. 

The RN provides Role 3 medical support in the form of hospital ships and Primary Casualty Receiving Ships (PCRS) such as100 bed RFA Argus when she's tasked in this role.  Neither of these functions can, at present, be considered as a standardized system.  However, in the near future, as MOD plans are implemented, the modules will be standardized. Presently, they are one-of-a-kind systems developed in response to specific needs. 

During the first Gulf War conflict, the RN elected, for tactical reasons, not to use a hospital ship.  Rather, it converted one hanger of the aviation support ship RFA Argus to serve as a modular 100-bed hospital facility housing 4 surgical teams.  Another 100 beds can be accommodated in the hospital module under "austere conditions" (i.e., on litters).  Conversion was achieved using open-plan prefabricated modular office building construction units, assembled in two stories, and affixed in the ship's forward hanger.  The hospital unit is self-contained, including its own CBR air filtration system.  RFA Argus has a large, flat deck that can accommodate large medevac helicopters.  RFA Argus was refitted in 2000-1 to improve her permanent medical facilities and enable her to be quickly tasked as a 100-bed PCRS/emergency hospital without additional work.  Theoretically, it is possible to restore the hanger to aircraft storage by removing the hospital module.  

Present plans call for one additional 100-bed hospital module with 4 surgical teams to be kept ready for use in a PCRS STUFT in the event of a conflict.

The full medical equipment set for RFA Argus is presented in RN MECCA form I 1 248-83 (Medical Equipment Set, RFA ARGUS in a PCRS Role).

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