§ Mr. Paul Tyler (North Cornwall) (LD)
I am pleased to have the opportunity to raise this issue again. I welcome the Minister to the debate, and remind him that I have a special interest in the subject—not a financial interest—as a member of the Royal British Legion Gulf war group.
It might be helpful to hon. Members if I were to explain why I came to be involved. There is a particularly large number of veterans in Cornwall and the south-west because there is a large population of service families in the area. However, after the eventual revelation that many British troops were doused with dangerous levels of organophosphates in 1991, I became involved in the matter as chair of the all-party group on organophosphates. Significantly, for this debate and others in this Chamber, that revelation came after two years of misleading ministerial assurances to me and other hon. Members that none of our service personnel could have been exposed to such a risk.
Throughout the 12 years since the first Gulf war, I have been especially frustrated by and ashamed of the extent to which veterans and their families have been hung out to dry by the Ministry of Defence. They have not received the care and attention that those who serve the nation in our armed forces should be entitled to expect. Surely the least they should receive is consistent support and regular, reliable information. I hope later to demonstrate the more forthcoming attitude of the United States Government and Congress.
My many colleagues across parties and I hoped that lessons had been learned before the Iraq war earlier this year. That was the subject of a similar debate in this Chamber on 5 February. In that connection, I was shocked by the parliamentary answer that I received on Monday to a question that I tabled on behalf of the family of Sergeant Steven Roberts, who came from Wadebridge in my constituency. Sergeant Roberts was the first British fatality in the recent Iraq war. He was killed on 24 March, and there were several outstanding questions about his death that his widow and mother wanted answered. For example, was he ordered to pass on his reinforced flak jacket to others thought to be more vulnerable? Exactly who fired the fatal shot? Did his gun jam?
The Secretary of State told the family in September that the special investigation branch—the SIB—of the Royal Military Police would shortly report, but they have heard nothing since, or at least they had not on Monday. The Minister of State, the right hon. Member for East Kilbride (Mr. Ingram), who is responsible for the armed forces, told me then, more than eight months after Sergeant Roberts's death, that there was stillevidence … to be collected and … witnesses … to be interviewed."—[Official Report, 8 December 2003; Vol. 415, c. 276—7W.]Surely the trail must be getting cold.
We have just heard of a similar shocking case. Eight long months after the family of Marine Christopher Maddison from Plymouth were told that his death was caused by an enemy attack near Basra, the MOD has admitted that he must have been killed by so-called friendly fire. What an appalling way to aggravate such a 130WH tragedy. Those whose loved ones join the services to protect us deserve better. I very much regret that the lessons of what I might call Gulf war I appear not to have been adequately learned for the families of victims in Gulf war 2.
On the illnesses that veterans have experienced, I hope that the Minister will save time in his reply and not bother with the usual linguistic games about the alleged difference between a single Gulf war syndrome and the more general but identifiably distinct Gulf war illnesses. I always refer to the latter, and I think that most of my colleagues do. I am happy to stick with that. The treatment of veterans remains the core issue, whatever the semantics of Whitehall.
The first subject that I shall address under that heading is pensions. My hon. Friend the Member for Hereford (Mr. Keetch) recently established that the MOD has forced victims of Gulf war illnesses to quit the Army rather than being medically discharged. The latter would mean automatic eligibility for a medical pension; the former offers nothing. That system is known as manning control. The National Gulf Veterans and Families Association has claimed that at least 400 of its members have been forced out in that way. The manning control policy is intended to allow the removal of soldiers whose services are no longer required after six, nine or 12 years. Under the policy, they are supposed to be warned 12 months in advance if they are to be discharged.
The Secretary of State has admitted that the MOD' figures for the numbers that were manning controlled were distorted. In a letter to my hon. Friend the Member for Hereford, he said that more had been affected by the manning control system than was originally suggested to my colleagues. Documents shown to The Daily Telegraph reveal that MOD Ministers seem to have misled Parliament over the extent of the manning control policy. Despite claims to the contrary, those leaked documents show that lists of soldiers are still being considered for manning control and sent to their units. Shaun Rusling, to whom I pay great tribute for his indefatigable efforts on behalf of veterans of the National Gulf Veterans and Families Association, rightly described the revelation as a national disgrace.
Vaccination records are an important part in the development of the problems. I draw the Minister's attention to the questions tabled as long ago as January by his noble Friend Lord Morris of Manchester to Lord Hunt, then Under-Secretary of State for Health. Lord Morris asked about the effect of combining anthrax vaccine with other vaccines. The response was that vaccines are licensed by the Secretary of State for Health; the vaccine should be used alone, not in a cocktail. That information was included in the product summary provided to doctors. It was apparent in a matter of a few days from the evidence of Captain Beverley Green, who served in the Gulf in the Queen Alexandra's Royal Army Nursing Corps, that the vaccine was not used alone. The information given by the Under-Secretary in the other place was not helpful.
Lord Morris asked Lord Bach whether the vaccine was licensed at the time of the Gulf war of 1990–91, whether the guidelines were in place, and whether other vaccines had similar limitations. The Under-Secretary in the other place promised that a letter would be written and be placed in the Library. On 7 March, my Liberal 131WH Democrat colleague, Lord Clement-Jones, asked for a similar response and an undertaking was given. It took until 9 October for the letter to be put in the Library. I followed it up with a question in the House of Commons. It became apparent that it was only in 1998 that the instruction was given that the vaccine should only be used alone. Therefore, it obviously was not available at the time of the first Gulf war.
It was shown in a table summarising information that there was no proper co-ordination with other vaccines at the time of the first Gulf war. It was admitted, amazingly, that there were problems with vaccination records; many personnel did not carry what was described as the BMed27 forms—details recorded on either temporary nominal rolls or BMed27s—and they were often not transcribed on to F Med4s. Therefore, there were no proper records of who had been vaccinated, when vaccination had taken place and whether it was with the notorious cocktail of vaccines, simultaneously.
Perhaps most alarming, the instructions for nerve agent pre-treatment sets, the so-called NAPS tablets, which contain a special bromide, were and are not subject to restriction on co-administration. Therefore, after an eight-month delay between the original question and the answers given to Lord Morris, there was no real information about the situation in 1991 beyond the confession of ignorance and the lack of record.
That admission—the lack of adequate vaccination records—blows to smithereens the assurances given in both Houses about the effective monitoring of all those who were inoculated in the original programme before the 1991 hostilities. As the Minister knows, since 9 October Lord Morris has pursued through several other questions the discrepancies that are still apparent. I do not have time to go through them now, but I hope there will be an opportunity for a face-to-face discussion between Lord Morris, other colleagues in the Royal British Legion group and the Minister.
On the position of other official bodies in the recognition of Gulf war illnesses, the Ministry of Defence may insist that there is no inherent connection between these illnesses and service in the Gulf, but others are equally sure of the likelihood of a connection. I refer to the inquest on Major Ian Hill, the conclusion of which was reported on 25 November. While serving with the Royal Army Medical Corps, Major Hill flew to the middle east in January 1991 to help to set up operating theatres. Within four days of arriving, he was ill with flu-like symptoms. He was diagnosed with bronchial pneumonia, sent home a month later, and failed to recover. He suffered psychological profile changes: he could not sleep, he was irritable, and he had mood swings and short-term memory loss, which are common among those suffering from the Gulf war illnesses. He attributed that to the NAPS tablets that he was given before the war. Consequently, he helped to establish the National Gulf Veterans and Families Association. At his inquest in Warrington, the coroner, Mr. Nicholas Rheinberg, said that he did notbelieve it would do justice to Ian Hill to describe his death as natural causes. I am going to describe his death as natural causes to which his military service in the 1991 Gulf War campaign was a contributing factor.132WH That is just the latest example of the Ministry of Defence being out of step with other authorities that are examining the issues.
I shall briefly refer to the American experience, which contrasts with the situation in this country. I am grateful to the intern in my office—she is on loan from the United States—for all the work that she has done, and I will not be able to do it justice given the limited time. The US Department of Defence and the Department of Veteran Affairs established effective counselling services immediately after the 1991 conflict. They were concerned to ensure that soldiers' illnesses were dealt with pre-emptively rather than waiting for them to become established. President Clinton set up a coordinating board and a presidential advisory committee on the subject in 1994.
In 1995, President Clinton issued executive order 12961 and set out a clear statement that the purpose of the committee was todetermine whether the government is doing all it can to discover the causes of Gulf War veterans' illnesses, and determine whether the government is delivering quality care to those veterans who are ill.An effective programme of research, examination and monitoring of the health of veterans followed. The committee made a number of recommendations and conducted several large-scale Government research projects, eventually producing its findings in the final report of December 1996. Those findings said:Prudence requires further investigation of some areas of uncertainty, such as the long-term effects of low-level exposure to chemical warfare agents and the synergistic effect of exposure to pyridostigmine bromide and other risk factors.The final report detailed symptoms that all veterans that have suffered ill health in this country would recognise. They included stress that affectsthe brain, immune system, cardiovascular system, and various hormonal responses.
The committee recommended that theDepartment of Defence and the Department of Veteran Affairs should perform long-term mortality studies of Gulf War veterans appropriate for investigating cancer rates in the Gulf War veteran population in the coming decades",and that theentire federal research portfolio should place greater emphasis on basic and applied research on the physiologic effects of stress and stress-related disorders.It concluded with the following statement, which was posted on its website:Approximately 697,000 men and women answered the call to serve in Operations Desert Shield and Desert Storm. In many important ways—through medical care, outreach, and research—the nation has begun to pay its debt to these service members. It is essential, now, to move swiftly toward resolving Gulf War veterans' principal remaining concerns: How many US troops were exposed to chemical warfare agents, and to what degree?I wish that we had the same firm statement of purpose from the British Government.
133WH There have been suggestions in the United States that all the symptoms can be attributed to post-traumatic stress syndrome. However, Congressman Bernie Sanders wrote to the presidential advisory committee to say that that clearly was not the case. He said that there could have beenmany more signatures on that letter. I must tell you that it was not a partisan issue. Democrats, Republicans, conservatives, progressives—all responded because very few people today in the House of Representatives and I expect in the Senate as well, and I expect within the veterans community, and I expect within the United States of America, today accept the conclusion that only stress was the cause of the problems.Others in the United States have since echoed that view.
I compare and contrast the legislative action that has been taken in the States under the Veterans Benefit Act 2001 with the lack of specific legislation here and our apparent lack of urgency in dealing with the issue. The US legislation dealt specifically with the illnesses that we are considering and tried to address them meaningfully.
Members of the US House Subcommittee on National Security, Veterans Affairs, and International Relations visited the House of Commons, and I was privileged to be one of the Members from both Houses who gave evidence. It was an interesting exchange of views. At the end of it, the previous presidential candidate, Mr. Ross Perot, who was part of the team, said:This is not stress. This is troops in combat wounded by chemical agents. Our Government is now being very aggressive on this issue. But our real challenge is to get the British Government to take the same kind of aggressive attitude and get them to react.I must conclude if I am to give the Minister a reasonable opportunity to reply, and I am happy to do so. I should say that I am not alone in expressing concern about such issues. The hon. Member for East Hampshire (Mr. Mates), a fellow member of the Royal British Legion Gulf war group, is serving on a Select Committee this afternoon but wished to be associated with my remarks. Many of us, inside and outside the House, hope that the Minister will be able to give us a comprehensive progress report today.
More important, I wholeheartedly endorse the view of my colleagues in the Royal British Legion group that continuing MOD confusion, contradictions and contortions reinforce the case for some form of independent inquiry. I appeal to the Minister to agree to meet representatives of the RBL group to explore the best way for such an inquiry to be set up, and to ensure that it is expeditious and avoids the pitfalls of yet more over-legalistic bureaucracy.
§ The Parliamentary Under-Secretary of State for Defence (Mr. Ivor Caplin)
I congratulate the hon. Member for North Cornwall (Mr. Tyler) on securing the debate. I begin by paying tribute to the work of the all-party Royal British Legion group. I would be happy to attend a meeting of the group if the group's officials thought that it would be helpful and appropriate.
Without doubt, the Government have taken the issue of Gulf veterans' illnesses seriously. I do not want to reflect today on what occurred between 1992 and 1997, but I do know that the Labour party is keeping the commitments that we made to them.
134WH More than 53,000 United Kingdom armed forces personnel deployed to the Gulf in 1990 to 1991. Only a minority, albeit a very important minority, are ill. We all want to know why. However, there is still no medical or scientific consensus on the cause or causes of ill health among some Gulf veterans. In July 1997, we published a policy statement, "Gulf Veterans' Illnesses: A New Beginning", setting out how the Government would address veterans' health concerns. Many of the commitments that we made in that document have been fulfilled, and it continues to underpin our activities. First, it makes it clear that all Gulf veterans will have prompt access to medical advice from the Gulf veterans' medical assessment programme—GVMAP. Secondly, it makes it clear that there will be appropriate research into veterans' illnesses and factors that might have a bearing on them. Thirdly, it states that the Ministry of Defence will make available to the public the information that it possesses that is of potential relevance.
I shall say a little about each of those areas. The Gulf veterans' medical assessment programme was set up by the previous Government; during the past 10 years, it has seen nearly 4,000 patients, some more than once. The programme's focus was set to provide as full a diagnosis as possible to veterans concerned about their health. The majority of patients seen were well when they were seen. A number of patients referred to the programme have concerns about mental health conditions. Since July 1999, when appropriate, the programme has referred Gulf veterans to a countrywide network of specialist psychiatrists and psychologists for their expert assessment and diagnosis. Veterans who have left the armed forces will use their GP, and any treatment recommended by the medical assessment programme will therefore be carried out within the NHS.
The Ministry of Defence remains committed to the long-standing arrangement 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 as determined. I can assure the House this afternoon that my departmental officials continue to liaise with their colleagues in the health service to ensure that periodic reminders about the priority treatment arrangements are issued to hospitals, GPs and other key players in the referral process.
I am pleased to say that the responses to the voluntary Gulf veterans' medical assessment programme satisfaction questionnaires show that 96 per cent. of patients who complete them are satisfied with the service that the programme provides. I encourage all Gulf veterans who are concerned about their health to attend the Gulf veterans' medical assessment programme.
The second issue was research. There is good scientific evidence that as a group, Gulf veterans report more ill health than other comparable groups, but that the pattern of this ill health is not unique to Gulf veterans. They report the same symptoms and conditions in the same rank order as United Kingdom Bosnia veterans do, as do UK military personnel who did not deploy to the Gulf. The only difference is the increased frequency with which Gulf veterans report such symptoms. Some Gulf veterans have recognised medical conditions, but a large number of non-specific, multi-system, medically unexplained symptoms have also been reported.
135WH It is worth reminding the House that specific diseases, disorders or medical conditions and medical syndromes each have common features such as a set of physical signs and/or symptoms that distinguish them from other medical conditions. Gulf veterans do not present with an identifiable and distinct pattern of symptoms or signs. The consensus of the international scientific and medical community following extensive research on the matter is that there is insufficient evidence to enable such ill health to be characterised as a unique Gulf-related illness or syndrome. For that reason the Government's approach must be guided by the scientific and medical evidence, which is why we do not recognise "Gulf war syndrome" as a medical condition.
I accept the point that the hon. Gentleman made; I, too, refer to Gulf veterans' illnesses. However—I want to reassure him on this point—that does not stop Gulf veterans who are ill 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. At the end of June 2003, about 2,500 Gulf veterans were in receipt of a war disablement pension. That figure includes awards for both Gulf-related and non-Gulf-related illnesses.
As I said earlier, we want to find out why some Gulf veterans from the 1990 to 1991 conflict are ill. Our current research programme will cost at least £8.5 million to complete. The Medical Research Council provides independent scientific advice on the research programme. Last year my hon. Friend the Member for Kirkcaldy (Dr. Moonie) announced that we had asked the MRC to undertake an independent scientific review of all UK research work that had been carried out into Gulf veterans' illnesses in an international context, and to advise on whether there were any areas appropriate for future research. The MRC's recommendations were published on 22 May 2003.
The Ministry of Defence has taken particular note of the review's conclusions and recommendations for further research. A number of the recommendations were scientifically complex and the MOD is discussing with the MRC how they may be taken forward, the data they are expected to yield and the priorities that should be attached to them.
In that context, the Government are not convinced that a public inquiry would help answer the basic question why some Gulf veterans are ill. In the present circumstances it is only through scientific and medical research that we are ever likely to be able to establish the causes of veterans' illnesses in the Gulf.
The third strand of our approach is openness. The MOD has made a lot of information public in response to inquiries from veterans and others, and continues to do so. Information and reports are made available on our website at www.mod.uk/issues/gulfwar.
The hon. Gentleman raised the issue of my noble Friend Lord Bach's response to Lord Morris, the first paragraph of which I should like to place on the record.
Further to my letter of 17 September … I am writing in answer to your Parliamentary Question of 4 February … about the medical countermeasures used to protect our personnel during the 1990–91 Gulf Conflict. Again, I would like to say how sorry I am that you have had to wait for so long for me to do so." — [Official Report, House of Lords, 9 October 2003; Vol. 652, c. WA67.]136WH My noble Friend rightly gave an apology. However, in respect of what happened in 1991, it seemed as if something new had been revealed in some of the press coverage of that answer. In fact, there was no significant disclosure of any new information in that answer. The key points had been published some years earlier—they were not new.
§ Mr. Caplin
I hope that the hon. Gentleman will forgive me for saying that we have apologised to Lord Morris and he has accepted our apology. The point of the letter and the answer was to place on the record all those issues that had been referred to previously. That is what we did. However, it was nothing new, and nothing that had not been known before in the public domain.
I want to stress that the well-being of the personnel that we deploy is of the greatest importance to us. We have made some important improvements since the 1990–91 Gulf conflict. For example, we have introduced a new operational medical record form which is now in use and should ensure that health events while personnel are on deployment are recorded more systematically than in the past. We have acknowledged that the earlier Gulf conflict revealed shortcomings in our medical preparedness. A number of personnel were not up to date with their service standard vaccination. There is clearly a need to ensure that our forces are ready for worldwide deployment at all times. Vaccination status is an important aspect of such readiness. Our policy guidance has been modified to ensure that troops are routinely immunised, so there should be no need for personnel to receive a combination of vaccines on deployment.
We have improved the briefings that are given to personnel on health-related matters, and Permanent Joint Headquarters now commissions up-to-date medical intelligence briefings for those areas of the world where it is judged that UK forces are likely to operate. Our personnel who are deploying on operations receive pre-deployment and in-theatre briefings on health and hygiene matters, which are based on the assessment made by PJHQ. There are also briefings on the nature and management of combat stress reactions and other psychological stresses of conflict.
Arrangements to limit the effects of post-traumatic illnesses in the armed forces have been developed over a number of years, and they will continue to be reviewed in the light of medical developments in the field of stress management and treatment. Those measures have been applied, where it is appropriate, to Operation Telic. We have expanded the remit of the Gulf veterans' medical assessment programme to allow all regular and reservist service personnel, and MOD civilians who deployed during Operation Telic, to be seen by their doctor. I can tell the House that 13 veterans of Operation Telic have been referred to the programme and I have applied for war disablement pensions.
On 7 May my predecessor announced that we are to look closely at the health of personnel employed during Operation Telic. Three main studies are being conducted. First, there is a study into the physical and 137WH psychological health of Operation Telic veterans by Professor Wesseley's team at Guy's, King's, and St Thomas' hospitals. Secondly, a study is being undertaken by the Medical Research Council Institute of Environmental Health at the university of Leicester to identify, collect and analyse data on relevant exposures that might have been encountered. Thirdly, the Institute of Medicine in Edinburgh is carrying out a study to establish normative values of urinary uranium in a military population that did not deploy to the Gulf. We also intend to monitor the mortality and cancer rates of Operation Telic veterans.
138WH The hon. Gentleman asked me about the United States. Perhaps I could write to him on my discussions with Secretary Principi. I assure the House that the Government are committed to addressing this complex and difficult issue and to understanding why some veterans of the first Gulf conflict are now ill. We have made every effort to learn from the lessons of that conflict. Of course, we cannot guarantee that deployed forces will not suffer injury or ill health, but we are doing everything we can to minimise the risks. That is our duty, and we recognise the importance of that obligation.
§ Question put and agreed to.
§ Adjourned accordingly at twenty-nine minutes past Four o'clock.