§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Clelland.]10.29 pm
§ Dr. Ian Gibson (Norwich, North)
It might be asked why we need to revisit the subject of Gulf war syndrome, given that it is more than six years since the end of the Persian Gulf war, and the Ministry of Defence is funding two epidemiological studies into the health of Gulf war veterans and their families.
The first of the studies will aim to establish whether there are unusual patterns of ill health among the veterans, and the second will examine whether they are experiencing adverse reproductive outcomes. A third study, with the support of the United States Department of Defence, will carry out a detailed epidemiological study into the patterns of illness. The studies will not necessarily identify causes and will take some three years to complete—they should be completed by 2000.
A novel investigation, promoted and planned by the Government, will be funded; it will examine the health effects of having been subjected to multiple vaccinations and chemical medications to negate the effects of nerve gases, in recognition of the possibility of synergistic interactive effects between the two onslaughts.
The reason for revisiting the problem is that we are just beginning to see the emergence of scientific research that addresses the long-term health effects on the service men and women who took part in that war. Although the information applies to studies in the United States, it is of considerable interest.
Clearly, the troops were exposed to several potentially serious physical and psychological stresses. Those included multiple immunisations, pyridostigmine prophylaxis, pollution from oil fires and the liberal use of pesticides, such as organophosphates and insect repellents. The list continues to grow.
As the war occurred in inhospitable surroundings and there was the recurring threat of exposure to chemical and microbiological weapons—possibly sarin, which was used in the Tokyo underground, and mustard gas—adverse effects on health would be unsurprising.
Overriding all the research, however, is the serious complication of defining Gulf war syndrome. A syndrome is generally defined as a group of symptoms that occur together and characterise a particular disease.
Many syndromes are known to medical science and are relatively easy to define. The recorded symptoms in the case of the veterans, however, have been so wide ranging, from depression to cognitive dysfunction, that researchers are tempted to break them down into three or four separate syndromes affecting perhaps three or four separate organ systems.
One of the scientists stated:the syndromes are due to subtle brain, spinal cord and nerve damage, but not stress."That conclusion is disputed by others. At present, as there is no clear specifically associated illness—a cancer, for example—we cannot say whether Gulf war syndrome is one syndrome.
956 It is clear, however, that so far in the new studies, which are the first to study human populations, there is strong evidence of a health problem associated with service in the Gulf. Given memory recall and poor records, it is difficult to associate any particular exposure or exposures with a defined symptom.
A body of evidence suggests that each substance in itself could cause a range of problems. Organophosphate pesticides are known to have chronic neurological effects on agricultural workers, and research into longer-term low-level exposures is suggestive, but not as consistent as studies on chronically poisoned subjects. There is some evidence, for example, of sub-clinical effects on the central and peripheral nervous systems of sheep dippers.
A worrying element in the saga appeared in today's newspapers, which reported that tents from the Gulf war, which were sprayed with organophosphates, were sold to scout troops in this country. I should be grateful for clarification from the Minister on the matter, and I hope that he can go some way towards laying to rest the concerns about that use of organophosphates.
A really interesting find, which may point to a final resolution of the problem, is that pyridostigmine can cross the blood-brain barrier and affect central nervous system function under stress conditions. It is clear that the toxicological, biochemical and congenital effects of these compounds and vaccinations, singly or together, were poorly understood before the troops from the United States and from this country were subjected to them.
Although, as a scientist, I could get embroiled for hours in deliberations on and details of the biological and medical effects, we must admit that unravelling the roles of the various factors is a complex task. It may be more important to look at the individuals who are ill—as many become ill—and decide what to do. After all, we may reach the same end effect of any particular health condition via various routes, each of which is initiated and maintained by different factors.
I thought about that matter today in the context of the controversy over the increase in cancers that people predict some groups will suffer. I thought also about the dramatic increase in prostate cancer in East Anglia and how prostate cancer became a popular study in the United States when Stormin' Norman contracted it. The Gulf war had been shown on television, and there was suddenly a great interest in that type of study. I could not help but correlate his problem with that of the Gulf veterans. I do not mean to imply that the general's prostate tumours resulted from his participation in the Gulf war, but we must know what factors are causing the increase in prostate tumours.
There is nothing sacrosanct about three years' research—studies may take a lot longer. We may find that the selection of projects is rather biased and that, for example, clinical studies on the immune response of the veterans who were exposed to multiple vaccinations and pyridostigmine are the source of relevant data. For example, it is relevant to ask: do multiple vaccinations associate with immunological abnormalities and do they produce a satisfactory antibody response—which is a marker of immunity? Developing correlations of Gulf war illness with such effects seems as appropriate a research subject as those being researched.
957 All that is fine. However, as one of the British researchers has said:all the new studies will not give us all the answers but will at least tell us where we should be going."He continues:It is a pity they were not able to start sooner".The studies at this stage are hypothesis generating and not hypothesis testing. We should also take account of a further complication, as US research defines health differences between reservists and Regulars. Britain made far less use of reservists.
Where does that leave the situation? The medical assessment programme continues to give individual attention to the vital health problems associated with Gulf war service and, although it has been criticised, it has at least blazed a trail for future surveillance strategy.
Some emerging problems in legal compensation merit our immediate attention. Hon. Members will know that there are two possible sources of help for armed forces personnel who believe that they are ill as a result of service in the Gulf war: a war pension from the Department of Social Security or a pension from the armed forces pension scheme. In practice, most of the claims from Gulf war veterans who argue that they are suffering from the syndrome relate to the DSS. Although it is true that, by May 1997, 140 of 279 claims from service men who linked their illness to service in the Gulf had been cleared—resulting in 124 awards in the service men's favour—another problem is fast approaching.
Seven years after the end of service is the cut-off point at which the burden of proof shifts to the claimant—the service man or woman. I acknowledge that, where there is reasonable doubt, the service man or woman will get the benefit of that doubt. However, as the end of the seven years approaches fast for many service men and women, the Secretary of State must show beyond reasonable doubt that the injury was not attributable to, or aggravated by, service.
There will be no problem if the research establishes a link between service in the Gulf and the illnesses of which veterans complain. However, if it concludes that there is no link or it is neutral on the subject, difficulties will clearly arise. In March 1997, the Defence Select Committee concluded:It's a matter of deep regret that so many ill Gulf veterans were left to seek compensation through potentially protracted court proceedings. We are not convinced that it is always right for veterans to have to prove negligence in respect of compensation for injuries sustained on official duty. There are other mechanisms such as no fault compensation which may be appropriate in certain circumstances."I believe that 1,228 notices of intention to claim for legal compensation under common law for causation and negligence have been filed by veterans. The Select Committee continued:For those Gulf War veterans who can establish that they were exposed to OPs"—organophosphates, pesticides—and that there is no other explanation for current illness we believe that there is a strong case for ex-gratia payment. We recommend that the Government makes such a payment."958 In the light of the uncertainties, the conclusions of the research, the time span allowed—three years—the obvious illness of Gulf war veterans and the seven year cut-off point for claims soon approaching, I wonder whether my hon. Friend the Minister is prepared to re-examine the question of payments, take legal opinion if necessary, examine previous similar problems that have been handled by the Government, and report back.
I believe that research must continue for however long it takes. It should be expanded to embrace other questions. Research should ensure that the problems to which I have drawn attention never happen again, and should lead to a more careful scientific and medical assessment of many of the compounds that pervade our lives.
§ The Minister for the Armed Forces (Dr. John Reid)
First, I congratulate my hon. Friend the Member for Norwich, North (Dr. Gibson) on his good fortune so early in his career in securing an Adjournment debate on such an important subject. There are few Members of this place who are qualified to speak with the authority that he does on this subject.
I congratulate also the two occupants of the Opposition Front Bench on their new positions. I refer to the shadow Secretary of State for Defence, late of transport and Ealing, Acton, who has transferred from bikes to tanks—the right hon. Member for North-West Hampshire (Sir G. Young)—and his hon. Friend the Member for Salisbury (Mr. Key), who is now, as I understand it, the shadow Armed Forces Minister. I welcome the hon. Gentleman to his post. It is unusual to have two such eminent members of the Opposition in their places so late at night. I can think only that they have taken the advice of the Glasgow police and decided to travel in twos on dangerous occasions.
We are dealing with an extremely important and grave matter for those who are affected by it. The Government share my hon. Friend's concern for veterans of the Gulf war who have, since their return from service in that conflict, fallen ill. We recognise that we owe them a debt of honour. Those men and women have served their country and have the right to expect us to discharge our duty as expeditiously and attentively as possible. I can assure them that the Government will be tireless in their efforts to understand the reasons for veterans' ill health.
My hon. Friend will be aware that last month, within a week of coming into the position that I now hold, I announced a package of new measures designed to address veterans' concerns. Some of those measures have been implemented. Others will take a little longer, but veterans can be confident that the Government will be a Government of action, not of words.
As a signal of the Government's determination to deal openly and honestly with Gulf veterans, I promised—I have already carried out the promise—to meet veterans' representatives, to listen to what they had to say and to ascertain how that should inform our actions. It is vital that veterans should have the opportunity to put their concerns to us directly, and it was not without a little pride that my right hon. Friend the Secretary of State and I were able to invite them for the first time through the portals of the Ministry of Defence—their Ministry of Defence, not my or the Government's Ministry. I hope that more meetings will take place in future.
959 In dealing with the concerns of veterans, I try to approach them by making it plain from the start that there are some things—three in particular—that I cannot do. I want to make it plain to the House also that I cannot do them. It is not in my gift to do them.
First, I cannot tell veterans exactly what is wrong with them. Secondly, I cannot tell them the cause or causes of their illness. Thirdly, because I cannot do the first and the second, I cannot tell them whether anyone is to blame. Those are matters that ultimately will be adjudicated upon only by those who have either the legal or medical experience to do so.
However, although we may not know the exact nature of the link between those illnesses, we know that people are ill. I cannot tell them what caused their illnesses, but I have a duty to do everything I can to unearth the cause or causes. Although I do not know whether anyone will ultimately be shown to be to blame, I have a duty to those service men and women to give them the information as openly and as fully as possible, so as to allow them to decide whether someone is to blame and to take appropriate action, as any citizen would.
§ Mr. Paul Tyler (North Cornwall)
I pay tribute to the Minister and his colleagues for responding rapidly to the problem. He knows of my interest as chairman of the all-party organophosphates group. One of its members in the other place raised this matter in a debate last night.
Will the Minister go one step further? I took to heart what he said about what he can tell veterans. Will he give a further undertaking that the Government will do everything in their power to learn lessons, so as to ensure that there is no repetition of what happened in the Gulf, and that people in other walks of life who may be exposed to the dangers of OPs are not affected? Will he give a specific undertaking that his Department and the Ministry of Agriculture, Fisheries and Food will work closely together to get to the bottom of the problem, because, as he well knows, they have not done so in the past?
§ Dr. Reid
I can give the hon. Gentleman an assurance on both counts. However, I do not want explicitly or implicitly to lead him to believe that I know that organophosphates are the cause or causes of this illness or these illnesses. There are almost as many suggested causes as there are advocates in the House of the need to support the veterans. The hon. Gentleman will be aware of them. Depleted uranium and organophosphates are suggested causes. It is contended that the use or destruction of chemical weapons could be the cause. There is a range of possibilities, including vaccines and nerve agent pre-treatment tablets. Almost every week there is another suggestion: some believe that it is hysteria, whereas a potentially important paper that was produced last week suggested that there could be an interaction between tablets and organophosphates.
I do not want to say that any of those supposed or alleged causes are, on medical grounds, more proven than others. I give the hon. Gentleman an assurance that we shall try to learn lessons, and shall work closely with the other Departments that are examining the problem.
I mentioned that I had taken some first steps. I met the veterans, and I said that we would explore the possible effects of vaccines and NAP tablets. We have made some 960 progress, and in the not too distant future I shall announce how we propose to carry out that research. I announced that we would put resources into reducing the backlog of people who were waiting for medical examinations, and we have made some progress on that. I made it clear that I would ask for a scientific explanation of the decisions taken to use injections and NAP tablets, and I shall make that public.
Those measures are under way, and I shall make an announcement to the House on them and on a number of other issues when I respond to the Select Committee on Defence in the near future. I promise the House that it will be a matter not of months, but of weeks.
During my meeting with veterans' representatives and through other channels, veterans repeatedly voiced concern about the departure from the medical assessment programme of Group Captain Coker. That matter has been raised in this House and in the other place. Many veterans fear that he was removed from the programme because of his sympathy for them. Whatever the truth of those allegations, I know that he was liked and respected by the veterans, and many wanted him to return to the programme.
I undertook to speak to Group Captain Coker, and during our conversation I invited him back to participate in the medical assessment programme. He did not want to return from the United States, for understandable personal reasons. I offered him a place on an advisory team that will work with me, and he gladly accepted. I am pleased to say that he will come back to assist and advise me, as part of a team, on our general approach. That will not only help our efforts, but send another badly needed sign of good faith to the veterans. I am glad to tell my hon. Friend the Member for Norwich, North that it has been warmly welcomed on both counts by prominent representatives of the veterans.
My hon. Friend explored in some detail the problems that surround any attempt to research the illnesses now being experienced by some Gulf war veterans. The two epidemiological research studies that the Ministry of Defence is funding, on the recommendation of the Medical Research Council, remain a vital element of our response to veterans' health concerns, because ultimately they alone will tell us whether Gulf veterans are suffering from an excess of ill health, over and above what would have been expected had they not been deployed to the Gulf. I value the MRC's supervision of the programme. The results of all other research that might have a bearing on the veterans' illnesses will ultimately need to be set in the context of the results of that epidemiological research.
However, I was not content—nor were the Government—to wait a further three years, until the results came out, before proceeding with any other relevant research. As my hon. Friend pointed out, last month I announced that new research would be carried out to examine the possible health effects of having multiple vaccinations and taking other medications concurrently. I hope that that research will shed light on the illnesses now experienced by some Gulf veterans, but it is also vital to inform any decision to use medical counter-measures should the same situation ever arise again.
I was more than a little surprised, on those grounds alone, that nothing had been done in six years to find out the effect of the vaccines involved. More detailed 961 proposals on how the research should be carried out are currently being developed, and, as I have said, I hope to be able to report on progress when I reply to the Defence Committee's paper.
§ Mr. Tam Dalyell (Linlithgow)
Can we hear some explanation of why the process took so long? Endlessly, a number of then Opposition Members—including me—asked the right questions.
§ Dr. Reid
If I may quote the old song, there are sometimes more questions than answers, and we are still asking questions. I would like to tell my hon. Friend that I have the answers, but at least we are putting his questions to the test now, and I hope that that is an advance.
As I said, there are a range of possible causes for a possible illness. One suggestion, which may be worthy of investigation, was published in The Lancet last week; I have mentioned it before.
My hon. Friend the Member for Norwich, North also raised the question of the effects of low-level exposure to organophosphate pesticides on human health, and the question whether that could be a contributing factor in the illnesses now seen in some Gulf veterans. Research is currently under way to try to determine those effects in the context of ill health claimed by some farm workers. As my hon. Friend said, it is sponsored jointly by the Ministry of Agriculture, Fisheries and Food, the Department of Health and the Health and Safety Executive.
The researchers are due to report in 1999, but the Government's present position is and must be that there is no firm evidence at this stage to support a link between low-level exposure to organophosphates and adverse health effects. I also stress that the popular image of Gulf veterans being exposed repeatedly to large quantities of pesticides was not borne out by the thorough investigation conducted last autumn, the result of which was published on 10 December. Nevertheless, we shall continue to work on that field of research, in conjunction with the other agencies that I mentioned.
Questions raised in this morning's press, and yesterday in another place, have given currency to the issue of military tents used in the Gulf that were then sent to scouts. I can tell hon. Members—including those who may have seen reports suggesting that users of MOD surplus tents risk being exposed to organophosphate pesticide that was sprayed on the canvas during the Gulf war—that the Minister for Defence Procurement gave a full answer to a question on the subject in another place on Monday. In view of the time, I do not intend to read that answer at length, but hon. Members can refer to the record.
Since that issue was raised, the scientific advice that I have sought and received on it has been reassuring. However, in view of public concern, today I asked my officials to contact the Scout Association to offer any assistance that the Ministry of Defence can provide. I am glad to tell the House that the tents that were reported as a source of illness have been identified by the association and, at its request, my officials will make arrangements for appropriate tests for the presence of organophosphate compounds. The work will be carried out expeditiously and the results made public as soon as possible.
962 While we await the results, I should like to reassure the House by reporting what was said in another place yesterday by the Minister for Defence Procurement: all the evidence suggests that, over time, the effects of organophosphates break down. That is why tents have to be continually sprayed. At the moment, there is no evidence to link any of the alleged effects to the alleged tents that were allegedly sprayed with organophosphates. Nevertheless, because of concern in the House and my own concern, we shall take them in and test them. I hope that that will reassure anyone who may be worried. The issue will be resolved quickly.
Many Gulf veterans are frustrated by what they see as woefully inadequate provision of information about what occurred in the Gulf. Medical records are incomplete, and the Government have not yet published full and frank accounts of many incidents during the conflict or of how the vaccination programme was put in place and implemented. That is precisely why I announced last month that I had asked for a full explanation of the scientific basis on which vaccinations were given to our troops.
I enter the caveat that, while I am keen to make a fresh and active start on the issue, I am adamant that I will not make promises that I cannot deliver. Some seven years after the conflict, we may have to accept that some parts of the story will never be known, some records will never be found and some may never have been compiled in the war. However, we shall honestly do everything we can. I am determined that what can be uncovered will be made public in due course in the context of the scientific explanation, although that will involve considerable effort and, perhaps in the long run, some embarrassment and pain.
The scale of the task in pulling together and collating all the information that could have a bearing on, for example, the vaccination programme is significant and it may take some time to complete. I assure the House that I have had full support from, and earnest work and almost tireless application to the task by, the Ministry's officials who have been charged with the work.
I shall deal briefly with war pensions and compensation. The issue of no-fault compensation for Gulf veterans was raised by my hon. Friend the Member for Norwich, North. All such issues will be revisited and progress reported in due course—in weeks rather than months—as part of our response to the Select Committee. I stress that many people do not appreciate that the war pensions scheme already effectively provides generous no-fault compensation to service personnel who have suffered illness or injury as a result of service of any kind.
I shall put the value of war pensions in perspective. My hon. Friend may care to note that a severely disabled single ex-service man can receive a total, tax-free war pension of more than £386 per week, including allowances. I invite my hon. Friend to capitalise that. He raised the issue of the seven-year limit. I fully understand that the burden of proof changes, seven years after the time one leaves the service. That affects only a small number of people in this case and is dealt with by another Department; I am sure that the matter will have been noted by my right hon. and hon. Friends in the Department of Social Security, which deals with those matters.
963 Many Gulf veterans who have applied for war pensions left the services only recently and the provision will apply to only a few. I know that there is great frustration over waiting times for assessment, and I hope that that has also been noted by those who deal with these matters in the Department of Social Security, where great efforts are made. However, I am sure that we can achieve more.
964 There are many leads to be followed and many questions remain unanswered. The Government are determined that no stone will be left unturned in our efforts to understand the reasons for the illnesses of Gulf veterans. My hon. Friend will appreciate that a fresh start has been made, but that it is only a start. I shall ensure that it is carried through. The country would expect us to do nothing less.
§ Question put and agreed to.
§ Adjourned accordingly at one minute to Eleven o'clock.