Gulf War Illnesses (Hansard, 15 July 2003)

HL Deb 15 July 2003 vol 651 cc823-37 823

§ 7.17 p.m.

§ Lord Morris of Manchester
rose to ask Her Majesty's Government what new help they are considering for service men and women with Gulf War illnesses.
The noble Lord said: My Lords, I declare an interest—not pecuniary—as honorary Parliamentary Adviser over many years to the Royal British Legion, as Vice-President of the War Widows Association, and as a co-opted member of the United States Congressional Committee of Inquiry into Gulf War Illnesses.
This debate is one of high importance to many thousands of men and women who were prepared to give their lives in the service of this country in the most toxic war in Western military history and to the dependants of those who did so. I know that my noble friend Lord Bach appreciates this and am most grateful to him for his abiding courtesy in speaking for the Government on Gulf War illnesses. I am grateful also to the noble Earl, Lord Attlee, and the noble Lords, Lord Burnham and Lord Clement-Jones, for being here this evening. They, too, are much respected by the ex-service community.
None of us here wants to see the afflicted and bereaved of the first Gulf conflict made to suffer the added stress and demeaning indignities of' preventable delays in dealing with their concerns. There were no delays in their response to the call of duty in 1990–91. Nor should there have been any delay in discharging our duty to them. Yet that is the charge made, 13 years 824 on from Iraq's brutal invasion of Kuwait, by the ex-service community; and it helps neither Gulf veterans and the bereaved families nor Ministers for Parliament to ignore that charge. After all, there is no higher duty for parliamentarians than that to those afflicted and bereaved in the service of this country.
The Gulf War Veterans and Families Association speaks of tortuous and hurtful delays in handling cases raised with them. They report a "widespread feeling" among their members of being, treated by officialdom as yesterday's people". Speaking for the ex-service community as a whole, the Royal British Legion has expressed deep concerns about the, seemingly endless haggling in tribunals and courts with Gulf veterans, some of them terminally ill, over war and service attributable pensions; and the distress of widows, many of them now in broken health, who would have been better treated had their husbands been in the United States and not the British armed forces". These are not undocumented concerns. They are exemplified by the experience of veterans with medically unexplained illnesses whose cases were still unresolved when they died. One is that of the late Major Ian Hill. Speaking to him prior to the debate I opened on Gulf War illnesses in your Lordships' House on 15th January 2001, he was in no doubt whatever that his undiagnosed illnesses were caused by the multiple immunisation programme of which the noble and gallant Lord, Lord Bramall, said in that debate: one glaring question stands out above all others. Was the cocktail of inoculations … liable to cause, in some individuals. a harmful chemical or physiological reaction that would lead to a loss of future Immunity?—[Official Report, 15/1/01; col. 1014.] Reverting to that question two weeks ago, the noble and gallant Lord, Lord Bramall, asked how the Ministry of Defence could be so insistent, that there are no attributable medical conditions specifically emanating from service in the Gulf when the tests on what are most likely to bring about such conditions—the cocktail of inoculations—have still to be completed?"—[Official Report, 2/7/03; col. 873.] I last spoke to Ian Hill three days before he died. He had then become registered blind and his condition was medically described as one of "total burnout". His wife Carol, on whose devoted care he relied crucially both day and night, was also severely disabled with a "crumbling spine". Yet in the final week of Ian's life, over 10 years after the conflict, they were left trying to cope in grossly inappropriate housing.
Another case raised with me by the Legion was that of Hilary Jones, a former senior army nursing officer in the Gulf. Terminally ill and living alone, she was deeply hurt and distressed by delays in dealing with her war pensions appeal. As in Ian Hill's case her entitlement to a 100 per cent war pension was conceded only after she died. Both Hilary and Ian went to their graves with a deep sense of injustice having succumbed to illnesses that were never medically explained.
It is cases like these that led the Royal British Legion to describe delays in dealing with Gulf War pension appeals as "nothing short of shocking". Anyone contesting their assessment should read the much 825 stronger criticisms of veterans themselves. Shaun Rusling, an officer in the Parachute Regiment, returned from the Gulf with medically unexplained rashes, numbness in his feet, pains in joints, frequent micturition, kidney infection, sweating/fever and chest infection. His case was contested by the MoD—at what cost to the taxpayer we still do not know—all the way to the High Court, where it was finally resolved in Shaun's favour last month. Speaking after the High Court's ruling, he said of the handling of his case: The treatment Gulf veterans have had is outrageous. Iraqi casualties were treated with more care and compassion than my fellow sufferers and I were treated here. Once we had won the war they didn't care. Stronger language was used by another Gulf veteran with multiple illnesses, the Reverend David Peachell—an Anglican vicar in Norfolk—who served with 16/5 Lancers and now suffers from diabetes, auto-immune and depressive disorders, neurological diseases and post-traumatic stress disorder (PTSD). Reacting to having had his case medically recognised as one of "Gulf War Illness", David Peachell said: I was not prepared to crawl away and die like a poisoned rat. America has come clean about it. Here no government has been good enough even to say sorry". This in part is the background to my having sought this evening's debate; but its timing was informed by a recent further development. Earlier this year Beverley Green, who served in the Gulf as a Captain in the Queen Alexandra Royal Army Nursing Corps, raised with me her concern about a Parliamentary reply from my noble friend Lord Hunt, then a Health Minister, on 20th January 2003. I had asked the Government if they could state whether the Centre for Applied Microbiology and Research at Porton Down is content that combining the anthrax vaccine with other vaccines and protective measures could not involve harmful long-term effects.
My noble friend's reply on 20th January stated: The Centre for Applied Microbiology and Research, a special health authority, which reports to the Department of Health, manufactures anthrax vaccine. The vaccine is licensed. The vaccine licence holder is the Secretary of State for Health. The product licence summary of characteristics states that the vaccine should be used alone. This information is included in the product summary provided to doctors with the vaccine. The patient information leaflet also asks patients to inform their doctor If they are taking any other medicines".—[Official Report, 20/1/03; WA 79.] Captain Green's letter to me contrasts the reply of the noble Lord, Lord Hunt, with her experience of how the anthrax vaccine was used in 1990–91—when it was most certainly not used alone—and indeed how it was administered in her own case, of which she has full records.
On that basis, I tabled last January the following further Question: Further to the Written Answer by Lord Hunt of Kings Heath on 20 January (WA 79), whether the anthrax vaccine used for troops deployed to the Gulf was licensed in 1990–91; whether the guidelines for its use referred to by Lord Hunt of Kings Heath were in place in 1990–91; if they were in place, why they were not followed; whether any other vaccines administered to troops in 826 1990–91 had similar limitations on their use; and whether the instructions for the taking of pyridostigmine bromide tablets had and have now any similar limitations regarding their use". Responding to that Question, the noble Lord, Lord Bach, said on 4th February: I will write to the noble Lord and a copy of my letter will be placed in the Library of the House".—[Official Report, 4/2/03; WA 26.] The noble Lord, Lord Clement Jones, pursuant to that reply, then asked the Government whether, as well as placing the letter I had been promised in the Library of the House, they would also publish it in the Official Report [HL1910], to which the reply on 7th March was the single word: Yes".—[Official Report, 7/3/03; col. WA 134.] Yet since then, unbelievably, the letter I was promised in reply to my Question of last January has still not appeared, either in the Library or in the Official Report; and Captain Green wrote to me again recently to say: You know how appalled I was that the letter promised in reply to your Question of last January on vaccines used in the first Gulf War was to appear only in the Lords' Library. Now, six months later, to find that not even this has been done, leaves me and other Gulf War veterans with a feeling of deep distrust about the whole process. Such is our concern that we are considering litigation and this letter is being copied to an eminent solicitor who has sympathy with our case. Her letter was copied to Patrick Allen of the solicitors Hodge, Jones and Allen, who I understand have now been instructed by Captain Green to advise her and to take this matter up with the MoD.
A second Gulf conflict has taken place since the promise I was given on 4th February of a reply by letter to my parliamentary Question of last January; and the continued failure to answer that Question is made all the more serious by reports of new cases of undiagnosed illnesses among our troops now returning from Iraq. Hence the strong and repeated representations from the ex-service community for a definitive response to my still unanswered Question.
On 11th December last, my noble friend Lord Bach spoke of improvements in immunising our troops since and on the basis of what was learned in the 1991 conflict. He said: we have learned a lot of lessons since then".—[Official Report, 11/12/02; col. 225.] This acceptance of faults in the arrangements for the first Gulf conflict that have now been improved does not, of course, help veterans suffering from adverse health effects of the multiple immunisation programme as it was administered in 1990–91. But It does strongly underline the justice of their claim to all the help we can provide and our responsibility—as a moral imperative—to ensure that they are not left to suffer the consequences of what went wrong alone.
Meanwhile it has to be recognised that the trials at Porton Down cannot match the conditions under which the 1990–91 programme was administered. For example, was pyridostigmine bromide administered at the same time as the vaccines used in the marmoset trials—and those with mice that preceded them—as it was to Gulf veterans? It has been reported that in the marmoset trials 827 only four vaccines have been used simultaneously, whereas troops deployed to the Gulf in 1990–91 had up to 14 programmes at the same time, often involving 28 inoculations. Has this at any time been replicated in the trials at Porton Down? If not, what possible credibility can the results of the trials have in establishing whether the multiple immunisation programme—as it was administered in 1990–91— was or was not safe?
Moreover, were the vaccines used in the marmoset trials administered strictly in accordance with the protocols applying to each vaccine and not in the way in which they were used in the case of Beverley Green?
There is now a growing consensus that the multiple immunisation programme and the way it was administered damaged, in some cases gravely, the immune systems of many veterans of the first Gulf conflict. That would explain why such a wide diversity of symptoms are being presented without an apparent cause. What research has been done in this area? Is my noble friend aware of the studies carried out in the United States by Dr Robert Hayley indicating that there is significant and objectively measurable brain damage found among Gulf veterans? What action is being taken to replicate Dr Hayley's work here or to collaborate with him in joint research, which I know from my contacts with him he would warmly welcome?
It is also widely accepted now that some Gulf War illnesses were caused by the way in which pyridostigmine bromide was used; the release of toxic substances at Khamisyah; the heavy use of organophosphates; massive air pollution after the firing of Kuwait's oil wells; and the use of depleted uranium in our own and in Iraqi munitions.
I understand from the Royal British Legion that to date some 2,405 veterans have received war pensions for illnesses that relate to service in the Gulf. They were approved on the basis of reasonable doubt; but from 2005 it is intended to base awards only on the balance of probability. This, the Government acknowledge, will mean far fewer awards and that there will be more discontent among future veterans. It is strongly opposed by the Royal British Legion and I urge the Government urgently to reconsider their position.
Most of all, I hope the Government will heed the wise counsel of the noble and gallant Lord, Lord Craig, as I ask them, as he did on 22nd May, to consider making ex gratia payments in settlement, without further commitment, rather than, drag out endlessly expensive litigation. Surely, he said, a little magnanimity now would not only be cost-effective but would also serve to relieve the continuing anguish of veteran sufferers and their families?".—[Official Report, 22/5/03; col. 935.] The vast majority of the British people want this whole question to be settled on the most generous possible terms for those afflicted and bereaved. Our debt to them cannot be measured in money; but lack of money inflicts demeaning indignities. In the spirit of the plea of the noble and gallant Lord, Lord Craig, let it now he resolved that the best way of showing our regard and admiration for those who served this country with such distinction and gallantry in the two 828 Gulf conflicts is to meet in full what I know your Lordships' House sees as an undoubted debt of honour.

§ 7.33 p.m.

§ Lord Burnham
My Lords, I apologise to the House for speaking in the gap. It is a question of timing which has caused me to come in at this moment.
The noble Lord, Lord Morris, has been involved with the problems of the disabled in one House or another for 29 years and with the illness of Gulf War veterans since the first Iraq war. It is therefore distressing that he should have had this question down for many months and that he has consistently failed to get satisfactory replies to questions from a line of Ministers, culminating in the noble Lord, Lord Bach, for whom I, and I think the whole of the Armed Forces, have the highest respect. I hope that he can satisfy us in this matter by giving an actual reply to the questions in principle, both in personal cases and in general.
The noble Lord, Lord Morris, detailed a number of very sad cases, some of whom I have seen at the Royal British Legion Gulf War Committee as their health gradually declined and as in the end they died. There is no doubt that their deaths, the deaths of others and the illnesses of many more result from the group of Gulf War diseases, many of them arising as a result of treatment deliberately administered in the form of inoculations.
This is not a new problem, although most of the jabs are. In the Boer War, more than 100 years ago, there were 70,000 cases of "soldiers' heart", for which pensions were paid. "Soldiers' heart" later became shell shock, then PTSD and now it is generally known as Gulf War illnesses.
It is reasonable to ask the Minister a direct question. Since the number of illnesses is finite and there can be no suggestion of setting a precedent, why can the Ministry of Defence not be generous in a settlement for all established cases? At present, these men and women have served and have suffered. There is no reason why they should not be compensated with ex gratia payments for their suffering. Let us just hope that it does not happen again with this last Gulf War. Let us also ask for a full inquiry into all the problems arising from the diseases of both wars.

§ 7.36 p.m.

§ Lord Clement-Jones
My Lords, I have mixed feelings about today's debate. On the one hand, I congratulate the noble Lord, Lord Morris, on securing today's debate and on continuing his long-standing campaign for compensation for Gulf War veterans. On the other hand, I am sad that despite his efforts for 12 years the MoD has remained so intransigent on the matter.
There have been a number of important developments since we last properly debated the issues relating to Gulf War illnesses. In particular, we have seen the outcome of the Izett case before the War Pensions Tribunal, which was not appealed against by 829 the MoD. It decided that there was a link between the cocktail of vaccinations given to troops before the 1991 conflict and Mr Izett's osteoporosis. It is particularly interesting in view of the fact that Mr Izett did not actually go to the Gulf.
We saw in June the outcome of the appeal by the MoD against the War Pensions Tribunal's decision in the case of Shaun Rusling, which determined that his claim was tenable that his ill health could be caused by Gulf War syndrome.
We also, on a more positive note, have had the decision by the MoD to include those who have recently been involved in the most recent Gulf War in the Gulf Veterans' Medical Assessment Programme.
Throughout all these developments, the Minister has valiantly maintained that MoD liability rests on whether such a condition as Gulf War syndrome can be established. He seems to be saying that ill health must be characterised as due to a new illness, condition or syndrome. It is also clear that in contrast to the war pensions situation, the MoD, in the compensation cases, is relying on the fact that the onus of proof is on the Gulf War veterans. Despite that, the Minister stoutly maintains that the MoD is being "magnanimous".
If that were not bad enough, it appears that lessons leant from the first Gulf conflict, as the noble Lord, Lord Morris, pointed out, have not been applied to the most recent conflict. It appears that, prior to their service, soldiers were once again given multiple doses of a cocktail of vaccinations against chemical and biological attack. In May they were reported as suffering symptoms similar to those of the original Gulf War veterans. That is despite ministerial assurance that these would not be administered in this way.
On 2nd July the noble Lord, Lord Morris, rightly talked of concern about, endless haggling in tribunal and courts with veterans".—[Official Report, 2/7/03; col. 871.] Is it not time that the MoD swallowed its pride and accepted that it is enough that these servicemen's illnesses were caused by service in the Gulf, whether or not there is something which can be specifically labelled "Gulf War syndrome"?
As I have pointed out to the Minister on a number of occasions, I find it quite extraordinary that the Government's own medical adviser, Professor Simon Wesley of King's College, London, head of its own assessment programme said: 'There is irrefutable proof that going to the Gulf has affected the health of some UK servicemen'".—[Official Report, 2/7/03; col. 872.] If so, why have we had the quibbling by the MoD? All this moreover, is in stark contrast to the way that the US Department of Defense has dealt with the matter.
All that the Government have done over many years is commission endless medical research into the condition of the veterans, which never seems to reach a practical conclusion to the benefit of those veterans. 830 There are now more than 2,000 legal claims by ex-service people on foot against the MoD. Veterans have had enough to deal with following their service without that being added on top.
Why the obsession with the label. "Gulf War syndrome"? The Izett case, in particular, has put the spotlight on the question of use of multiple vaccinations. The case of Captain Green, cited by the noble Lord, Lord Morris, is important for that reason. That raises the question of whether the guidelines for the administration of vaccines were followed in 1991. If not, why not? Despite, as noble Lords have heard, probing by the noble Lord, Lord Morris, with a little help from me, we have still not received a letter from the Minister or the MoD. let alone copies placed in the Library.
This is a continuing sorry tale. As the noble Lord, Lord Morris said, it is all the more serious in view of allegations of multiple vaccination causing problems during the current conflict. I hope that the Minister's reply will be more satisfactory than on previous occasions.

§ 7.41 p.m.

§ Earl Attlee
My Lords, before speaking to the debate, I remind the House of my peripheral interest. We are grateful to the noble Lord, Lord Morris, for at last securing a date for this debate this evening. There is little doubt that during the past few years, the MoD has made some effort to improve matters for those Gulf War veterans who are suffering from illnesses picked up from their service in the Gulf War 1. On these Benches, we have every sympathy with those veterans and want a fair and rapid conclusion to the existing problems. Twelve years is a long time.
There is now good evidence that UK Gulf veterans report more ill-health than other comparable groups, but the same symptoms have been seen in UK military personnel who did not deploy to the Gulf—although they may also have received another cocktail of inoculations for some other overseas deployment. The difference is that veterans of the 1991 conflict report having more of the symptoms and are suffering more severely from them.
Some Gulf veterans have recognised medical conditions, but a large number of non-specific. multi-system, medically unexplained symptoms have also been reported. The current consensus of the international scientific and medical community is therefore that there is insufficient evidence to enable that ill-health to be characterised as a unique illness or syndrome. The Medical Research Council, which published its review on 22nd May, came to the same conclusion.
It is important to note that that does not prevent Gulf veterans who have left the Armed Forces and are ill from claiming a war pension. War pensions are awarded not for a list of disorders but for any disablement that can be accepted as caused or made worse by service, whatever that disablement is called. As at 31st December 2002, 2,330 veterans of the 1991 Gulf conflict were in receipt of a war pension.
831 However, there is a problem. Recently during Starred Questions, the Minister referred to the agreement to pay war pensions to some Gulf veterans adversely affected by Gulf War illnesses. What worries me is that a junior non-commissioned officer—a lance corporal or corporal—would receive a junior NCO's pension. However, his long-term potential in the Armed Forces might be to be a warrant officer 1 or even to get a commission, quickly rising to the rank of captain or major. But the disabled junior NCO and his family would be stuck with the low standard of living of a junior NCO. That is a terrible risk for a young man or woman to take and might, on top of all the other challenges of being in Her Majesty's Armed Forces at present, encourage him or her to apply for premature voluntary release.
Can the Minister confirm that the MoD has now taken steps to avoid a recurrence? These are: first, that improved medical record-keeping through the introduction of the new operational medical record form is now in use. Secondly, ensuring that troops are when possible immunised routinely, so that there should be no need for personnel to receive a combination of vaccines upon deployment. When I deployed for the Gulf I received only two immunisations. I cannot remember what one was, but it was routine; the other was against anthrax, but received only the initial anthrax inoculation, not the booster, so that expensive inoculation was wasted.
Thirdly, personnel deploying on operations must receive pre-deployment and in-theatre briefings on health and hygiene matters. The fourth step is that health and safety instructions have been given to the crews of vehicles that carry the extremely effective depleted uranium ammunition, and to the units that support them. I hope that the Minister never withdraws depleted uranium ammunition simply for reasons of political pressure. If he withdraws it because there is something better, that will be fabulous; but he must never withdraw it just because of its name. The fifth step is that a new and comprehensive joint service guidance on the use of pesticides has been introduced and is kept under review.
I turn briefly to inoculations and vaccines. Porton Down has been carrying out various tests on combining different vaccines. Porton Down has issued a preliminary report, which claims that overall those preliminary results indicate that there were no adverse immune consequences following vaccine and pyridostigmine bromide administration—what I call nerve agent pre-treatment sets (NAPS)—that were detectable in that model. The longer-term outcomes will be reported when the studies are complete at the end of 2003. However, the Medical Research Council warns that the lack of substantiated vaccine exposure data means that it is unlikely that existing study groups will yield any more useful information.
The issue of Gulf War illness has continued for the past decade, involving a great deal of worry for veterans and their families. A substantial amount of time and money has been expended by the MoD in investigating it; no doubt there has also been considerable expenditure on legal advice. Although 832 recognising that there may be a generic Gulf War illness, there is no such thing as a syndrome: there are just several different illnesses. Given that judgment, the Government must now make a formal statement about how they intend to process future claims and to what extent they will continue with the research programme. They should make a Statement before Parliament goes into Summer Recess. Above all, the MoD must fulfil its obligations to veterans.

§ 7.47 p.m.

§ The Parliamentary Under-Secretary of State, Ministry of Defence (Lord Bach)
My Lords, the House will be grateful to my noble friend Lord Morris of Manchester for once again providing an opportunity to debate the Government's approach to Gulf veterans' illnesses. His active interest in the subject and all issues concerning disability are well known. He has a proud record and I welcome his involvement. I am grateful to other noble Lords who have spoken this evening—although let me say straight away that, with the notable exception of the noble Earl, Lord Attlee, there has been a degree of huffing and puffing and overstating of cases that may appeal to those who listen to our debate but does not necessarily add much to the serious issues that the topic raises.
I want to make clear from the outset that Gulf veterans' illness issues remain a high priority for the Government. In case the noble Lord, Lord Clement-Jones, is in any doubt, I repeat what I said to him in answer to an oral Question as recently as 2nd July. We have repeated that on countless occasions We acknowledge that some veterans of the first Gulf conflict are ill; and that some, alas, have died. The question surrounding the ill-health reported by the veterans of that conflict remains a priority for us. If we did not acknowledge that, why have we paid out so much in war pensions?

§ Lord Clement-Jones
My Lords, surely the Minister knows perfectly well how the onus of proof works. The ministry does not have to acknowledge that in order for the war pensions to be paid out.

§ Lord Bach
My Lords, it is absolutely clear that we acknowledge it. It is very misleading to pretend that we do not. I do not accuse the noble Lord of doing so, but some people outside pretend that we do not.
I want to make it clear that Gulf veterans' illnesses issues remain a high priority for us. I believe, and I think the evidence shows, that the Government have demonstrated their commitment to addressing Gulf veterans' concerns openly, honestly and seriously, and we will continue to do so.
In 1997, this Government made it clear that they had adopted three guiding principles when dealing with the concerns of Gulf veterans: first, there will be appropriate research into veterans' illnesses—even though that research apparently is attacked—and factors that might have a bearing on those illnesses; secondly, all Gulf veterans will have prompt access to medical advice from the Gulf Veterans' Medical Assessment Programme, and, thirdly, information of 833 potential relevance to the issue would be made available to the public. A great deal has been achieved since then and the three guiding principles continue to underpin our approach to the issue.
I remind the House of what is being done in respect of scientific research—I address this remark to the noble Lord, Lord Clement-Jones, in particular—because it is only through such research that we are ever likely to be able to establish the causes of Gulf veterans' illnesses. Noble Lords will recall that a great deal of scientific research has been carried out here and in the United States into Gulf veterans' illnesses. What has emerged is that significantly more Gulf veterans report more ill health than non-Gulf veterans. However, Gulf veterans do not all have the same symptoms, nor are their symptoms different from those of non-Gulf veterans. The same range of symptoms is seen in both groups; the difference is that Gulf veterans report more of the symptoms and suffer more severely from them. However, because the range of symptoms is so wide, the scientific and medical community does not accept the existence of a unique "Gulf War syndrome". Our position as a Government—and, as I said previously, that of any responsible government—must be guided by those findings from the scientific and medical community. That is why we do not recognise Gulf War syndrome as a medical condition.
We continue to monitor Gulf veterans' mortality and to publish that data every six months, as we promised. Our most recent data were published today, so the debate is very timely. The data show that the total number of deaths among Gulf veterans was 600 compared to 613 in a matched group of service personnel who were in the Armed Forces on 1st January 1991 but did not deploy to the Gulf. I hope that those figures provide at least some reassurance to Gulf veterans concerned about their health.

§ Earl Attlee
My Lords, I am grateful to the Minister for giving way. Does he have any comparable figures for disablement?

§ Lord Bach
My Lords, I do not have such figures with me, but I shall see whether I can find some before the end of my speech. If I cannot, I will be in touch with the noble Earl.
At our request, the independent Medical Research Council has recently carried out a thorough review of research to date. Its report was published on 22nd May. Perhaps I may outline the main points that the Medical Research Council concluded. First, there is no unique Gulf War syndrome. Secondly, there is little evidence that vaccination was a cause of veterans' illnesses. No commonly accepted mechanism could account for immune system related symptoms more than 10 years on. Thirdly, the UK's research programme into Gulf veterans' illnesses was highly regarded internationally and has made, a critical contribution to international understanding". 834 The report contains recommendations for future work. Some are highly complex, and we have sought further advice from the MRC on how best to proceed. When that advice is available, we will consult with veterans and other stakeholders before we respond.
Our portfolio of research into Gulf veterans' illnesses is expected to cost at least £8.5 million to complete. It currently includes two major epidemiological studies; a programme of clinical tests; research to investigate the possible adverse health effects of the combination of medical countermeasures that were used to protect UK personnel against the threat of biological or chemical warfare agents, and a systematic review of research literature, as published worldwide. Important work has been published in the peer-reviewed scientific literature; some is complete, awaiting publication, and some is ongoing.
Medical assistance continues to be available to Gulf veterans through the Gulf Veterans' Medical Assessment Programme, which has been running since 1993. In that time more than 3,370 patients have been seen, some more than once. The programme was set up to provide as full a diagnosis as possible to veterans concerned about their health. Veterans who have left the Armed Forces will normally have a GP as their doctor and therefore any recommended treatment will be carried out within the NHS. We remain committed to the long-standing pledge that war pensioners should be given priority in NHS hospitals for examination or treatment relating to their pensioned disablement, subject always to the needs of emergencies or other cases that demand clinical priority.
Based on the feedback received through completed patient survey questionnaires, the service that the GVMAP provides is welcome. As of 30th June this year, 96 per cent of patients were satisfied with their GVMAP experience. Noble Lords may know that we have expanded the Gulf Veterans' Medical Assessment Programme's remit to allow all regular and reservist service personnel who deployed to the Gulf during Operation Telic to be seen. I confirm to the noble Earl, Lord Attlee, the changes made between the first Gulf War and Operation Telic that he outlined and asked me about directly. I urge veterans of both deployments who have any concerns about their health to take advantage of the help available through the GVMAP. We plan to publish an updated version of the information pack about Gulf veterans' illnesses later this year. The current version was sent to all GPs in the UK as well as other interested health professionals, including those in the Defence Medical Services. We will ensure that the new pack is widely publicised.
As well as medical help, financial assistance is available to Gulf veterans. No-fault compensation for all former service personnel disabled as a result of their service is provided through the war pensions scheme. The scheme applies to all those who have served in the UK forces. Disablement pensions are provided on the basis of disablement, not individual diagnosis. As at 31st March this year, 2,405 veterans of the 1990–91 Gulf conflict were in receipt of a war disablement pension.
835 The noble Earl, Lord Attlee, asked a question about that. He knows that the scheme provides no-fault compensation for all ex-service personnel disabled as a result of their service. All pensions and allowances are tax-free, index-linked and include a basic war disablement pension based on the degree of disability. War pensions legislation does not take account of financial losses due to a curtailment of an individual's possible career progression, but in common law negligence cases they are taken into consideration.
The figure of 2,405 that I mentioned includes awards for both Gulf-related and non-Gulf-related illnesses. In addition, the Armed Forces pension scheme—in effect, the occupational pension scheme—and the Reserve Forces (Attributable Benefits etc.) Regulations provide enhanced injury and death benefits to regular and reservist service personnel whose injuries, illnesses or death were attributable to their Gulf service. All that is in addition to all the normal social security benefits to which service and ex-service personnel may be eligible.
Advice and information on a wide range of veterans' issues is available through the Veterans' Agency. I encourage veterans who require assistance to contact the agency via their free-phone helpline. The agency's welfare service is available to veterans who require help. Welfare officers are specially trained to offer advice and assistance on a range of issues, not just war pensions.
Reference has been made to the effect of vaccinations, and I am conscious that the question in the letter that has been mentioned has not yet been answered. The noble Lord, Lord Morris of Manchester, rightly asked whether anthrax immunisation followed the appropriate protocols. I am very aware of the interest in this House and elsewhere, but I am afraid to say that I am not yet in a position to answer his Question of 4th February. However, I will write to him and place a copy of my letter in the Library as soon as I am able. The House should be aware that the new Secretary of State for Health, Dr John Reid, who also has experience in the Ministry of Defence, is personally engaged in this matter. I am aware that it has been a long time, but it is important that we get the answer right.

§ Lord Morris of Manchester
My Lords, I rise on a point of fact. My Question was not dated 4th February. That was the date of the reply, which stated that a letter would be sent to me and placed in the Library. I tabled my Question on 22nd January.

§ Lord Bach
My Lords, I stand corrected by the noble Lord, Lord Morris of Manchester, as I often am. However, I want the noble Lord and other Members of the House to understand that their interest in this matter is not forgotten. I thank noble Lords for their patience.
Before I sit down, I want to mention the marmoset tests to which the noble Lord, Lord Morris, referred. The immunisations given to the marmosets were administered in a way that replicated the way in which immunisation should have been given to those who served during the first Gulf War. I emphasise that this 836 research has been overseen by an independent panel of experts, two of whom represent the veterans. Research by the Ministry of Defence shows that most veterans received a total of seven immunisations—two against cholera, two against anthrax, two against pertussis and one against plague. The tests are likely to represent the experience of many of those who were deployed.
I have nearly finished—

§ Lord Clement-Jones
My Lords, before the Minister sits down and considers his peroration, I wish to ask a question based exactly on what he said during his speech. At the beginning, he said that the Ministry of Defence accepted that, in certain cases, service in the Gulf had caused illnesses among veterans. Later on, he said that he and the Ministry did not accept that there was such a thing as Gulf War syndrome. However, the point at issue is not whether or not there is a syndrome, but whether the veterans were affected by their service in the Gulf. Why cannot the Ministry of Defence accept that they were and pay compensation on that basis?

§ Lord Bach
My Lords, we do pay compensation when—

§ Lord Clement-Jones
My Lords, the Minister himself pointed out that, in negligence cases in court, loss of future earnings of the type described by the noble Earl, Lord Attlee, could be paid out, but they could not be paid out under the war pensions scheme.

§ Lord Bach
My Lords, is the noble Lord, Lord Clement-Jones, suggesting that it is Liberal Democrat policy that, instead of the war pensions scheme, there should be a policy that states that every unfortunate member of the Armed Forces who is injured in the course of war should be paid a loss of earnings element in compensation? Perhaps he should reflect with some of his colleagues before he goes that far.
As I pointed out, we have paid 2,405 veterans of the 1990–91 Gulf conflict. We have paid a war disablement pension to them that is tax-free and index-linked. We have done our duty under the existing legislation. The criticism that we have not is unfairly based. We will continue to do our duty by the very brave men and women who put themselves in danger's way in the first Gulf conflict. Of course, we will do the same for those involved in Operation Telic this year.
The criticism that is made that the Ministry of Defence somehow does not care about these people and is not paying the compensation to which they are entitled is false. It is something about which those in this House who talk about such matters should be more careful.
I end by thanking the noble Lord, Lord Morris of Manchester, for his interest and for bringing this matter before the House. I know that all the comments made by noble Lords have been heard by the Minister responsible for these matters. 1 have no doubt that he and I will react to them in due course in this House.

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§ Baroness Crawley
I beg to move that the House do now adjourn during pleasure until 8.17 p.m.
Moved accordingly, and, on Question, Motion agreed to.

§ [The Sitting was suspended from 8.6 until 8.17 p.m.]