Gulf Veterans: Medical Tests (Hansard, 2 March 1998)

§ The Minister of State, Ministry of Defence (Lord Gilbert)

The text of the letter referred to is set out below:

"On 16 December you tabled a Written Question which asked what tests and medical examinations have been conducted by the Ministry of Defence's Medical Assessment Programme. MAP, on Gulf veterans since its inception, on what dates any changes were made, whether the Ministry of Defence intended to incorporate any new tests into the programme and, if so, which.

Past changes to MAP tests and examinations

The medical programme which became the MAP was set up in July 1993 in order to examine veterans who were unwell and who believed that their illness was related to their service in the Gulf. The intention was to provide a diagnosis wherever possible and to document all illnesses in veterans who were referred to the programme. Any veteran who was referred to the programme was examined by a Consultant Physician and a number of tests and examinations were carried out. This essentially remains the case today. The MAP was originally located at the Princess Alexandra's 136WA RAF Hospital at Wroughton. It was transferred to the RAF Central Medical Establishment in London in December 1995. In October last year it moved to new facilities in the Baird Health Centre at St. Thomas' Hospital, London.

When the programme was first established, Wg Cdr, now Gp Capt Coker, who ran it until December 1996, initially carried out those tests that he felt were necessary on clinical grounds to establish a diagnosis. When the number of patients referred to the MAP increased, he carried out a number of screening tests, similar to those used by the US Department of Defense's Comprehensive Clinical Evaluation Programme, the US DoD's equivalent to the MAP. Any other tests considered clinically necessary would also be performed, these additional tests varying from patient to patient. This system of investigation was in place at the time of the clinical audit which was carried out by the Royal College of Physicians, RCP, in 1995.

The RCP's subsequent report, published in July 1995, endorsed the MAP's professional independence and integrity, and put forward recommendations concerning the future direction of investigation into Gulf veterans' illnesses. These recommendations ultimately led to the Medical Research Council commissioning the two epidemiological research studies currently being carried out by teams led by Professor Nicola Cherry and Dr. Patricia Doyle. The Report also made specific comments on how the Programme could be improved. However, with the exception of their recommendation concerning psychiatric assessments, on which I comment below, the RCP did not recommend any changes to the tests and examinations carried out by the MAP. A copy of the RCP's report and its appendix, which lists the tests being carried out by the MAP at the time of the audit, are attached.

Psychiatric assessments

The RCP did comment unfavourably on the prior discontinuance of psychiatric testing for non-serving veterans and suggested that there was a need for all MAP patients to have a psychiatric assessment. This comment and recommendation were carefully considered by the Ministry of Defence at the time, but, ultimately, were not accepted for a number of reasons. First, a psychiatric testing programme was available at RAF Wroughton for Gulf veterans who were still serving. However, this programme required two or more visits to Wroughton and, for those who had left the Services, it was considered more appropriate for any assessment to be undertaken locally by the National Health Service, which would also be responsible for any follow-up treatment. Gp Capt Coker had recommended such an assessment to veteran GPs when he believed it to be clinically appropriate.

Secondly, you will be aware that the provision of health care and treatment for veterans who have left the Services is the responsibility of the Department of Health and not of the MoD. At the time of the RCP audit, MoD had been assured on several occasions by both the Department of Health and the President of the Royal College of Psychiatrists of the competence of 137WA the NHS in dealing with Post Traumatic Stress Disorder, PTSD, and other psychiatric conditions.

At an early stage of the MAP consideration was given to undertaking psychiatric assessment on a wider scale, but it soon became clear that the numbers involved, the need to couple assessment with treatment, and the fact that the few ex-Service cases, which had already been assessed, had psychiatric conditions which were well recognised in the NHS, did not make this a feasible proposition. These arguments were reconsidered in the light of the RCP's report and found to remain valid.

Tests currently carried out on MAP patients

A list detailing the baseline tests currently carried out on MAP patients, by St. Thomas' Hospital on the MAP's behalf, is attached. I should stress that these are only baseline investigations. They will be added to, or modified, depending on a patient's clinical history and examination findings. As you will see, the current list is similar to that from 1995.

Additional investigations

Additional investigations and/or referrals to other consultants/specialists are sometimes required, and further tests and examinations may, therefore, be carried out if appropriate. For example, some patients have been, and continue to be, referred to Dr. Kocen, a consultant neurologist at the National Hospital for Neurology and Neurosurgery in Queen's Square, London. You may recall that, when new information about the use of OP pesticides in the Gulf came to light in October 1996, a number of Gulf veterans, whose symptoms could be consistent with exposure to OPs or where there was evidence that they had been exposed to pesticides, were invited to re-attend the MAP and, where considered medically appropriate, were referred to Dr. Kocen. The results of the tests which any particular patient has been given are recorded on his or her case file and remain available to the doctors responsible for that patient's treatment.

Future changes to MAP tests

No specific changes to the baseline tests listed on the attachment are envisaged for the immediate future. However, as you are probably aware, the Ministry of Defence plans to conduct a thorough audit of the MAP during the course of the year, focusing on all aspects of patient care and on the service provided by the MAP, including the range of tests and examinations currently undertaken.

MAP report

Doctors at the MAP have now examined over 2,000 patients and there is naturally considerable interest amongst veterans and the public at large as to what the MAP has been finding. You will be aware that the Government has undertaken to publish detailed diagnostic results from the MAP. A paper is currently in the final stages of preparation and will shortly be submitted to a medical journal for peer-review and possible publication.

A copy of this letter, and its attachments, has been placed in the Library of the House. I assume that, like me, you will wish the text of this letter also to appear in the Official Report. I understand that the only way in 138WA which this can happen is in response to a Question for Written Answer. If you would like to table a Question to this effect, I will be glad to oblige."

Following are the attachments referred to: