INTRODUCTION

  1. The Government has considered carefully the Defence Committee's report, conclusions and recommendations concerning the Ministry of Defence's handling of the illnesses being suffered by some veterans of the Gulf War. Its observations on the report's principal points are set out in this memorandum.

PRINCIPLES

  2. The new Government believes we have a debt of honour to those who have served their country in the Armed Forces and has been determined that a fresh start will be made in dealing with this difficult and complex issue. Accordingly it is adopting three principles which will guide its handling of this subject. First, that all Gulf veterans will have prompt access to medical advice from the MoD Medical Assessment Programme (MAP). Second, there will be appropriate research into veterans' illnesses and factors which might have a bearing on these. Third, the MoD will make available to the public any information it possesses which is of potential relevance to this issue.

  3. A central element of the Government's approach is to be open and honest with the Gulf veterans, to listen to what they have to say and to engage in a dialogue. Representatives from the main Gulf veterans groups have already met MoD Ministers and officials, with further meetings planned for the future.

  4. Further details of this new approach are set out in a statement "Gulf Veterans' Illnesses: A New Beginning", which is being published separately. A copy has been sent to the Committee and will also be placed in the House of Commons Library.

  5. The Government's detailed comments on the Committee's report are contained in the following paragraphs.

CONCLUSIONS AND RECOMMENDATIONS

  6. The Government welcomes the Committee's continuing interest in this difficult subject and its thoughtful suggestions on the way forward. It believes that the new approach now being adopted is in harmony with the Committee's views and that, with one significant exception, it is able to agree in general terms with the Committee's comments, conclusions and recommendations.

  7. The Government's specific comments on each of the Report's conclusions and recommendations are set out below.

"We welcome the establishment of the epidemiological studies announced in December 1996." (Paragraph 8).

  The Government is grateful for the Committee's support for the MoD­funded epidemiological studies announced in December 1996. This research is fundamental to establishing whether there are any patterns of unusual ill­health amongst Gulf veterans. Both teams are currently undertaking preliminary work using pilot questionnaires, with the full scale research questionnaires scheduled to be sent to Gulf veterans starting in September this year.

"We believe that this research [further medical research, particularly in the fields of neurology and immunology] is worthwhile in its own right and that the Government should assist in the provision of appropriate funding" (Paragraph 11).

  The new Government has already announced that it will be commissioning new research into the possible health effects of the combination of vaccines and tablets which were given to troops in the Gulf to protect them against the threat of biological and chemical warfare. The results of this work will both provide scientific data with which to address Gulf veterans' concerns and also inform the Government's policy on the future use of such medical countermeasures. Further details of this programme, including the independent panel of experts to oversee its work, are being announced separately in the policy statement "Gulf Veterans' Illnesses: A New Beginning".

  As regards further research into the many other suggested aspects of Gulf veterans' illnesses, the Government is following closely the wide range of research being carried out in the US. Suggestions for further work to be undertaken in the UK must be treated impartially and this can only be achieved by having their scientific merit assessed by an independent and expert review body. The MoD is very grateful to the Medical Research Council (MRC) for its past assistance in this respect and for agreeing to review any new proposals which are put forward. The Government encourages those with interest in this subject to submit proposals for further high quality, non­epidemiological research work to the MRC for consideration. If the MRC believes that a particular proposal is of sufficient scientific merit to justify being taken forward, then MOD will look favourably upon any recommendation to this effect.

"We recommend that the Ministry of Defence commission from the Medical Research Council (or another appropriate body) every six months an assessment of significant research published in this country and abroad on Gulf­related illness and lay it before the House." (Paragraph 15).

  In commissioning the MoD research programme, the Medical Research Council (MRC) was made aware of and took into account all relevant research into Gulf veterans' illnesses, as well as other information such as details of the anti­BW vaccination programme and the use of organophosphate (OP) pesticides in the Gulf War. MoD continues to draw the MRC's attention to published research so that, on the basis of its assessment of this work, MRC may make recommendations concerning the nature and direction of the UK's research programme as it considers necessary.

  However, the MRC's advice is that the only appropriate channel to report any assessment of published research is in the peer­reviewed scientific literature. The MRC does not comment publicly on the scientific validity or relevance of individual papers. Moreover, the Government is concerned that the MRC's impartiality as the coordinator of the MOD­funded research programme might be called into question, albeit unfairly, if it were to comment publicly upon other research. For these reasons, the Government is reluctant to invite the MRC to publish assessments of research and understands that the MRC would not wish to do so. Since the MRC is recognised as the UK's independent national authority in this area, if the Government were to commission assessments of published research from another source - for example from an academic department - these would be unlikely to be perceived as impartial.

  The Government proposes to pass to the Committee, on a regular basis, copies of relevant published papers, together with articles in the scientific literature where these comment on such published research. A bibliography of published works regarding Gulf health issues, produced in June 1996 by the US Naval Health Research Center, has already been passed to the Committee and a copy placed in the Library of the House. Copies of recently published research papers will be passed to the Committee separately.

  MoD stated in written evidence to the previous Committee that it was awaiting a review of US research carried out by the MRC before commenting on the research by Dr Haley (Answer 7 on p50 of the Report). The MoD is unable to provide the Committee with the MRC's opinion of this research for the reasons stated above. The Committee is, however, referred to the editorial by Philip Landrigan, a member of the US Presidential Advisory Committee on Gulf War Veterans' Illnesses, published in the same issue of the Journal of the American Medical Association on 15 January 1997. The Government considers that this article makes a number of important points about Dr Haley's research.

"We are still curious as to why French forces in the Gulf have apparently avoided any long term medical after­effects. Their experiences represent an interesting contrast to those of the US and UK and, if properly evaluated, could provide a useful control group of the epidemiological studies currently under way." (Paragraph 16).

  Use of French troops who served in the Gulf War as a control group for the current epidemiology studies is not appropriate. The key to epidemiology is finding a control group which resembles as closely as possible the population under scrutiny. Accordingly, control groups for the two MoD­funded epidemiological studies will come from some 60,000 UK service personnel who did not serve in the Gulf.

"We conclude that on access to medical records - an issue of wide public interest and with direct influence on the health of some Gulf veterans - the Ministry of Defence was not implementing its stated public policy and advice to Ministers and was not enabling them to tell Parliament what was really happening." (Paragraph 32).

  The Government's policy is that the medical records of former service personnel are available to their doctors and that service personnel themselves are entitled to copies of their own records dating from 1991 onwards on payment of a standard scale charge.

  The Ministry of Defence has apologised for past difficulties in ensuring that Gulf veterans were able to obtain access to their medical records and accepted that there had been two cases where veterans were given incorrect advice on the release of information about vaccinations. No other cases of incorrect advice have been identified so far. The Government acknowledges that the provision of incorrect advice in these cases was inconsistent with the Department's stated public policy and reflected a failure to communicate that policy effectively to the staff concerned.

"We find it incredible that the Services did not apparently know what quantities of which pesticides were taken to the Gulf, let alone used there, and that it has proved so difficult to establish these basic facts subsequently. If nothing else, this episode has revealed serious flaws in the areas of logistic support, record keeping and environmental health during the Gulf War." (Paragraph 41).

  What is now known about the use of organophosphate pesticides during the Gulf War was set out in the OPPIT report published on 10 December 1996. The Government believes that appropriate documentation would have existed in 1990/91 to establish with reasonable precision how much pesticide was shipped to the Gulf theatre of operations and probably how much was bought in theatre. However, by the time the investigation team came to try to answer these questions in 1996, such records were no longer available.

  As regards records of the use of pesticide during the Gulf War, the investigation could only identify one type of record which might have contained relevant information, the Field Hygiene Section logs. These also were not available in 1996. It is accepted that this was a deficiency and procedures are now being put in place to document pesticide use in future, as a result of amendments to the Joint Services Manual on Pest Control (JSP 371).

"We recommend that by 1 October 1997 the Department lays before the House or provides our successor Committee with a full account (except for the identity of individuals concerned) of why Parliament was misled about the use of organophosphates in the Gulf and what action has been taken as a result, including the outcome of disciplinary and court martial proceedings." (Paragraph 50).

  The Memorandum published on 26 February this year gave the conclusions of the further investigation into why proper and timely advice was not provided to MoD Ministers between July 1994 and September 1996 on the subject of organophosphate (OP) pesticide use during the Gulf War. Disciplinary proceedings are currently underway in respect of four civil servants. In parallel, the Service authorities are considering the report of a Service police investigation into these matters.

  The Government intends to publish an account of these matters by 1 October this year, as recommended by the Committee.

"We recommend that the Department should disclose as much as possible as soon as possible. The abandonment of disciplinary proceedings for anything less than serious misconduct might be justified if it would facilitate such disclosure." (Paragraph 53).

  The MoD believes that it was right to invoke its disciplinary processes in the light of the shortcomings revealed in the Memorandum published on 26 February. The disciplinary proceedings which are in progress concern the issue of why proper and timely advice was not provided to MoD Ministers between July 1994 and September 1996 and the material which has so far not been disclosed relates to that issue alone.

"It is not possible, in advance of the expected disciplinary hearings, to attribute responsibility for the failings within the Department with any degree of accuracy or fairness. We trust that these proceedings will investigate the role of individuals right the way up the chain of command. We can nonetheless express our deep concern that the true extent of OP use could remain undisclosed for so long both within MOD and to the House." (Paragraph 66).

  The further investigation, the conclusions of which were reported on 26 February 1997, considered the role of all members of the Department who had been involved in the matter. The Ministry of Defence accepts that answering Parliamentary questions incorrectly in 1994 and subsequently not realising that these errors had occurred until September 1996 constituted serious failures by the Department.

"For those Gulf veterans who can establish that they were exposed to OP pesticides and that there is no other explanation for current illnesses we believe that there is a strong case for ex gratia compensation payments. We recommend that the Government makes such payments." (Paragraph 77).

  No­fault compensation for service personnel disabled as a result of their service is already provided in the form of the War Pensions Scheme (WPS). The WPS applies to all those who have served in the UK forces and war pensions are currently being paid to some 325,000 people, some of whom are the spouses of deceased former service personnel. As regards Gulf veterans, some 1,285 have already applied for war pensions. Most of these applications are for ordinary conditions, such as hearing loss or knee injury. At present a total of 295 war pension applications relate to symptoms arising from undiagnosed illness or which the applicant identifies as a Gulf­related illness. Under the terms of the War Pensions Scheme 134 pensions have so far been awarded to these applicants, although none for a general Gulf War illness. 16 applications have been rejected.

  In addition, veterans may also be eligible for an Armed Forces Pension Scheme (AFPS) occupational pension and, if they have been medically discharged, this is supplemented by attributable benefits linked to the degree of disability, or non­attributable benefits linked to length of service, whichever is the greater.

  The new Government has considered in detail the provision of financial assistance to Gulf veterans. We have concluded that the two pension schemes described above, which apply to all veterans on a no­fault basis, are the appropriate methods of providing for disability amongst former service personnel. Having considered the matter very carefully, the Government is not persuaded that, on the basis of the information currently available to it, there is a case for paying additional no­fault compensation to Gulf veterans, separate from and above that which is already available to both Gulf and other veterans. However, this will be kept under review in the light of developments and, as we have made clear, if legal liability is established by future research or investigation, the MOD will of course pay compensation.

  As regards the Committee's suggestion in particular, the connection between low level exposure to organophosphate (OP) pesticides and subsequent illness is not a scientifically accepted fact. Research is currently underway - sponsored jointly by the Ministry of Agriculture, Fisheries and Food, the Department of Health, and the Health and Safety Executive - to try to determine the effects of low level exposure to organophosphate pesticides on human health in the context of ill­health claimed by some farm workers. This will be an important step towards understanding the possible effects of potential exposures during the Gulf War. However, pending the outcome of this and other work, there is no firm evidence to support a link between low level exposure to OPs and adverse health effects.

"In order to restore faith in the process we recommend that MOD, in conjunction with the War Pensions Agency, examines ways of expediting the process of claim examination and award." (Paragraph 80).

  The Government understands the frustration which some veterans have felt at the length of time taken for a war pension to be awarded. The MoD will work with the WPA to ensure that claims are handled as expeditiously as possible and this important aspect of Gulf veterans' concerns will be kept under review.

"We believe that the time is ripe for a thorough re­examination of the system of compensation for Service personnel injured while on duty for their country. We trust that our successor Committee will take up this issue in the new Parliament. We also believe that a good case has been made for some ministerial responsibility for veterans affairs, as exists in the United States and many other countries." (Paragraph 81).

  The Government notes the Committee's views and is aware of general concerns about the different arrangements for compensating Service personnel which apply according to the circumstances under which injuries were sustained. It is giving consideration to how these concerns might be addressed as part of longer term work.

  The issue of how veterans' matters should be handled in Government is currently under consideration.

14 July 1997