§ The Countess of Marasked Her Majesty's Government:
Why no permanent medical practitioner has been appointed to lead the Gulf War Illness Medical Assessment Programme since the departure of Colonel Bhatt; and when they expect to make such an appointment. [HL1803]
§ The Minister of State, Ministry of Defence (Lord Gilbert)Following the departure of Col. Bhatt as head of the Gulf Veterans' Medical Assessment Programme in June 1997, the Ministry of Defence held an open competition for the post. Unfortunately, this competition did not produce a suitable candidate. MoD therefore decided to hold a further open competition, which is still in progress. The outcome will be announced at the earliest opportunity.
§ The Countess of Marasked Her Majesty's Government:
Whether they will publish the protocols which determined the medical and other procedures in operation for the Gulf War Illness Medical Assessment Programme together with the guidance given to both medical and administrative staff. [HL1804]
§ Lord GilbertThe examinations carried out on patients of the Gulf Veterans' Medical Assessment Programme, MAP, are in accordance with standard clinical practice and were described in general terms inA Review of Gulf War Illness by W. J. Coker OBE, published in the Journal of the Royal Naval Medical Service 1996; 82: 141–146. A copy of this paper has already been placed in the Library of the House.
Assessments by the consultant physicians at the MAP are based upon their clinical judgment, a patient's clinical history, and examination findings. There are, therefore, no set protocols which determine the nature of each assessment, although there is a standard battery of tests which evolved during the early years of the MAP and which is applied to all MAP patients. These tests are as follows:
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- Full blood count and sedimentation rate, FBC/ESR;
- Full biochemical screen, including urea, electrolytes, calcium, creatinine, liver function tests, LFT, and blood sugar;
- Immunoglobulin analysis;
- Creatine kinase;
- Thyroid function tests, TFT;
- Serological screening tests;
- Chest X-ray, CXR;
- Ultrasound abdominal scan;
- Electrocardiogram, ECG;
- Urinalysis;
- Peak-flow lung measurement, to determine the necessity for vitalography.
Further tests may be carried out as appropriate.
The MAP was subject to a clinical audit by the Royal College of Physicians in 1995, which broadly approved the procedures and tests carried out at the MAP. We plan to conduct a further audit later this year, focusing on all aspects of patient care and on the service provided, to ensure that the MAP continues to adhere to best practice.
The medical and administrative staff at the MAP are, of course, aware of the programme's aims—to provide Gulf veterans who are concerned about their health with a clinical diagnosis of their medical conditions and to collate statistical information. They are appropriately trained to achieve these objectives and are given appropriate briefing on the latest developments on Gulf veterans' illnesses issues. However, no formal written guidelines have been laid down for MAP staff.
§ The Countess of Marasked Her Majesty's Government:
Whether they will ask the Gulf War Illness Independent Review Panel to review the history and current functioning of the Medical Assessment Programme and to make recommendations for measures which would improve the research assessment and treatment regimes it offers to sick Gulf veterans. [HL1807]
§ Lord GilbertThe Independent Panel was established specifically to provide oversight of the MoD's research programme into the possible health effects of the combination of vaccines and tablets which were given to British troops in the Gulf; and any other research proposals in related areas. The expertise of its members reflects the specific task which it has been asked to fulfil. We do not believe that it would be appropriate to invite the Independent Panel to extend its role beyond this specialised task.
The aim of the Medical Assessment Programme, MAP, is to provide Gulf veterans who are concerned about their health with a clinical diagnosis of their medical conditions and to collate statistical information. The MAP is not a research programme and it is not intended to provide treatment for sick Gulf veterans. Any treatment which is necessary is arranged through the Defence Medical Services for Gulf veterans who are still in service and through the NHS for ex-Service personnel.
It remains our intention to commission an independent clinical audit of the MAP later this year. The audit will address all aspects of the service provided by the MAP.
§ The Countess of Marasked Her Majesty's Government:
Whether they will consider transferring the Medical Assessment Programme for sick Gulf veterans to an appropriate independent civilian body with a view to increasing the confidence of the veterans and improving efficiency. [HL1808]
§ Lord GilbertAll aspects of the work to address Gulf veterans' health concerns are kept under review, but at132WA present there are no plans to change the status of the Medical Assessment Programme, MAP. It is expected that the new head of the MAP, for which post an open competition is now under way, will be a civilian, as are the physicians who are currently working there.