ANNEX A
This memorandum constitutes the Government's response
to the House of Commons Defence Select Committee's (HCDC) Seventh
Report on Gulf Veterans' Illnesses. This is the third occasion
on which the Committee has reported on this issue and the Government
welcomes their continued interest in this important subject.
The report covers the period from July 1997 when
the Government's policy statement entitled "Gulf Veterans'
Illnesses—A New Beginning" was published. That statement
set out the way in which the Government would approach the subject
of Gulf Veterans' Illnesses. The Government undertook to deal
with veterans in an open and honest manner, to engage in dialogue
and to ensure that Gulf veterans would have prompt access to medical
advice via the Medical Assessment Programme (MAP), to undertake
appropriate research into Gulf veterans' illnesses and to make
all relevant information public.
The Government believes that the observations made
by the Committee are balanced and that they acknowledge the complexity
of the central scientific issues. In particular the Government
notes the Committee's acknowledgement of the efforts that have
been made over the past three years in addressing the concerns
of Gulf veterans. Continuing to deal with these issues will remain
a high priority for this Government.
Annex B is an update to the MOD's progress in implementing
the 20 Key Points set out in "Gulf Veterans' Illnesses—A
New Beginning". Detailed responses to the Committee's specific
comments and recommendations are as follows:
MOD WEBSITE ON GULF VETERANS' ILLNESSES
We recommend that the MOD look at ways in which it
could further enhance the information provided on its Gulf illnesses
website, including facilitating contact between veterans. (Paragraph
15)
The Gulf veterans' illnesses website contains all
the information and reports that have been published by the Gulf
Veterans' Illnesses Unit. It also contains information about MOD
funded research, and the MOD's Gulf Veterans Medical Assessment
Programme. The website links to a wide variety of other related
websites, including the War Pensions Agency, the MOD Veterans
Advice Unit, the US Department of Defense Office of the Special
Assistant for Gulf War Illnesses, the British Medical Journal,
the Lancet and the United States Persian Gulf Veterans Co-ordinating
Board—Research Working Group Annual Report to Congress.
A link to the official Royal British Legion Website has recently
been added. The Website has proved popular, scoring over 10,000
hits per month this year.
The website is being redeveloped as part of the general
redevelopment of the MOD's Internet presence. As part of the redevelopment
the website address has been changed to http://www.gulfwar.mod.uk.
Those using the old web address will be automatically re-directed
to the new site. Veterans will henceforth be able to receive news
and updates by e-mail subscription. We will continue to add new
information and to look at ways to enhance the website further
for the future.
THE MEDICAL ASSESSMENT PROGRAMME
We believe that the MOD has been remiss in not
using the data available to the MAP to better advantage. Research
should have been instituted before now, based on the MAP's findings,
to ascertain the prevalence of illness amongst all Gulf veterans
and to determine whether the symptoms demonstrated by patients
seen at the MAP are representative. This has been a wasted opportunity
and has contributed to the low opinion which users of the MAP
have of its services. (Paragraph 19)
As MAP patients are self selected and thus not a
random sample of Gulf veterans, the prevalence of illness amongst
Gulf veterans as a whole cannot be determined from the MAP data.
The prevalence of illness amongst Gulf veterans can only be determined
by epidemiological research, using random samples and comparing
Gulf veterans with a similar group which did not deploy to the
Gulf. This work is being undertaken separately at Kings College
Medical School, Manchester University and the London School of
Hygiene and Tropical Medicine. The primary purpose of the MAP
is to undertake medical assessments of individual veterans. Nevertheless,
the publication of MAP data has been a useful contribution to
the debate on Gulf veterans' illnesses.
Data from the MAP has been used to produce a paper
on the clinical findings from the first 1000 patients seen. A
second paper covering the second 1000 patients has been submitted
for peer-review publication. Work is in progress to produce two
further papers looking at the third 1000 patients and an overview
of all 3000 patients that have been to the MAP. MAP data is currently
being used in a UK/US collaborative research project investigating
"War Syndromes".
We were puzzled by the suggestion of a "low
opinion which users of the MAP have of its services". The
user questionnaire introduced as a result of the external audit
of the MAP showed that 92% of those who used the MAP and completed
a questionnaire were satisfied with their assessment and 27% added
further comments to express the extent of their satisfaction.
Management Audit of MAP
Although we welcome the progress made in implementing
the management audit recommendations, it remains to be seen whether
this will have a noticeable effect on the services veterans receive
from the MAP. We look forward to seeing evidence that the improvements
put in place are having a significant effect on the way the MAP
operates. We also hope that the results of the clinical audit
will be published in the very near future. (Paragraph 23)
The Government is pleased to note the Committee's
recognition of the work done in implementing the MAP management
audit recommendations. The Head of the MAP contacted the Royal
College of Pathologists last year and at present we are awaiting
final advice from the Royal College of Pathologists on the current
range of routine investigational tests. The results of the review
of the investigational tests undertaken at the MAP will be published
as soon as possible and appropriate adjustments made to the range
of tests routinely offered. Non-routine tests are available if
considered appropriate by the MAP physicians and this will remain
the case.
Veterans' view of MAP
We believe it is important to centralise the expertise
on Gulf illnesses in a single location and that London is the
most appropriate location. We hope the MOD will consider providing
additional assistance to Gulf veterans who have to travel long
distances to the MAP. (Paragraph 25)
We welcome the Committee's conclusion that expertise
on Gulf illnesses is best centralised in London. The MAP does
all it can to make travelling to London as easy as possible—providing
travel warrants and arranging and paying for accommodation near
to the MAP and St Thomas' Hospital for veterans and their carers
if appropriate. Arrangements are in place for veterans who cannot
travel to London to have medical assessments locally. Sometimes,
where it is impossible for veterans to travel to London, MAP physicians
have visited the patient; for example in prisons. In addition,
we are now exploring the feasibility of holding medical assessment
sessions outside London for Gulf veterans who cannot, or do not
wish to, travel to London.
PSYCHIATRIC ASSESSMENTS
We hope that this audit has been carried out and
look forward to seeing the results in the government's response
to this Report. (Paragraph 28)
Since July 1999 the MAP has been utilising a network
of psychiatric assessment centres with specialist knowledge of
Post Traumatic Stress Disorder (PTSD) to which veterans have been
referred as appropriate. In general we believe this system has
been working very well. The MOD undertook to review progress made
in this area once the system of referrals had been in place for
one year. This has just been done in conjunction with the consultant
psychiatrist who helped MAP to set up the PTSD network.
Although the assessment of Gulf veterans for PTSD
within this network has been very successful, it has become clear
that, once diagnosed as suffering from PTSD, Gulf veterans are
not always receiving the treatment they need. This is either because
of a lack of local provision or a lack of knowledge on the part
of their doctors as to what is available. We aim to reduce the
time taken for patients to be seen and for reports to be written,
and to ensure that patients are able to receive appropriate treatment
through the NHS by providing more information to GPs about PTSD
in general and the provision of treatment locally. We hope to
implement some changes to our procedures shortly, which should
result in speedier assessments and easier access to treatment.
We will also pursue discussions with the Department of Health
on the provision of treatment for PTSD.
RECENT DEVELOPMENTS
There have been serious inadequacies in the services
MOD has provided to sick Gulf veterans, through the Medical Assessment
Programme, over a number of years. It may now be time for the
MOD thoroughly to review the way it provides medical assistance
to Gulf veterans, taking full account of the views of veterans
themselves, so as to provide a service which meets their needs
and fulfils the MOD's obligations to them. (Paragraph 29)
We acknowledge that there have been past problems
in the running of the MAP. However, more recently the MAP has
been run efficiently and the vast majority of veterans have been
well satisfied with its services. This is borne out by the external
audit report published early in 1999 and the more recent responses
to the satisfaction questionnaire. Nevertheless we consider carefully
criticism of the MAP by any veterans. We continue to be responsive
and will continue to improve the service delivered. For example,
following feedback from satisfaction questionnaires we have made
it clearer to veterans attending the MAP that MAP consultants
automatically write to their GPs at the time of their visit and
again approximately six weeks later and that veterans have a right
of access to their MAP assessment report. If the Committee or
veterans provide specific examples of where the MAP is failing
to meet veterans' needs we will consider each very carefully,
and respond fully. We will also investigate any specific claims
that serving Gulf veterans cannot get referrals to the MAP.
ORGANOPHOSPHATES
In its report the Committee noted that the MOD would
continue to monitor the debate about organophosphate (OP) safety
and review scientific evidence in the light of future research.
(Paragraph 32)
In order to address the questions posed by the Committee
on Toxicity in its report of November 1999 and other questions
raised by scientists working in the area, the Government is developing
a targeted programme of research. This will look at the central
issue that remains; whether low level exposure to OPs is a causative
factor of the chronic symptoms reported by sheep farmers and others.
PROGRESS IN ASCERTAINING THE CAUSES OF GULF VETERANS'
ILLNESSES
Depleted Uranium
We hope that the MOD will learn from this and
approach veterans' concerns in a less defensive and more collaborative
way. What is of immediate importance now is that Gulf veterans
should be offered appropriate tests, based on the most up-to-date
scientific information available. The full scope of the tests,
and any limitations, should be clearly explained to those undergoing
them. (Paragraph 39)
Extensive data on the use of Depleted Uranium (DU)
in the Gulf, its hazards and potential exposures was first published
in 1993, and again in 1999. MOD remains open minded on the suggested
link between DU and veterans' illnesses and wishes to move forward
in the light of scientific evidence. The MOD has met some of the
scientists involved in DU testing for veterans to hear their views.
We have urged the scientists who say they have tested British
veterans as being "positive" for DU to publish and to
share their data with us, but no response has yet been received.
The MAP physicians will arrange for veterans to undergo
any tests that they consider to be clinically appropriate. This
includes testing for total urinary uranium if the examining physician
assesses a clinical need for it. A small number of veterans have
undergone this testing.
In addition to this, in September 1999 the MOD offered
to test veterans who had their urine tested for DU in Canada and
on whose behalf claims of high levels of DU in urine samples have
been made. The MOD received little positive response initially
to the proposed testing protocol that was sent to veterans for
comment on 1 November 1999. However, MOD has recently held discussions
with Gulf veterans' representatives about protocols for testing.
The MOD also wishes to ensure that appropriate scientific methods
and ethical standards are used and has therefore proposed that
both the MOD and veterans' representatives independently nominate
appropriate institutions that are able to carry out tests for
Depleted Uranium (i.e. to determine the isotopic ratios of U235
and U238 in urine samples), in accordance with an agreed protocol.
The MOD would also wish to ensure that veterans who accept the
DU testing offer are clear about what is intended and that the
results of any tests and the health consequences of the results
are properly communicated to them.
The use of depleted uranium is of wider relevance
than Gulf veterans' illnesses alone. The government have indicated
that, where necessary, DU will continue to be used in ammunition,
with the possible concomitant future implications for British
personnel. (Paragraph 40)
At present, no satisfactory alternative material
to DU exists to achieve the level of penetration necessary to
defeat Main Battle Tanks. The use of DU, therefore, remains an
important potential option for the Armed Forces of this country.
If the safety of British troops in any future operation were to
require such a capability against Main Battle Tank armour, DU
ammunition would be deployed and used. The radioactive and chemical
toxicity hazards of DU are recognised, but we believe the risks
to health which they pose are small. Nevertheless, we take appropriate
precautions and detailed safety instructions on the hazards of
DU are provided to all Service personnel during the course of
pre-deployment training and to all units serving in operational
theatres where there may be a risk of exposure.
We hope that the MOD will take on board the findings
of the Royal Society's study of depleted uranium when they are
available, even though it has not initiated the work. We expect
the MOD to demonstrate that it is driving research in this area
rather than, as has appeared to be the case so far, adopting a
reactive approach and responding to new developments only when
forced to by events. (Paragraph 40)
The Government welcomes and actively supports the
independent review of Depleted Uranium by the Royal Society Working
Group. MOD presented evidence to the Working Group on 19 January.
Arrangements are being made to provide the Working Group with
a sample DU tank round to assist in their investigation. MOD has
also made available relevant information it has received from
international sources.
In addition, a MOD Depleted Uranium Working Group
has been established which aims both to provide a better explanation
of the potential chemical and radiological hazards associated
with DU, and to examine the potential for additional research.
VACCINES—LESSONS LEARNED
We conclude that it is now unlikely to be possible
finally to prove or disprove, to the satisfaction of all parties,
whether vaccines precipitated some of the illnesses presented
by Gulf veterans. We are pleased that the MOD has acknowledged
the deficiencies in its immunisation procedures during the Gulf
Conflict and welcome the detailed research which has been undertaken
to discover what went wrong and why. The MOD has demonstrated
that lessons have been learned and improvements to procedures
have subsequently been achieved. Unfortunately, this does not
help those who may have suffered as a result of the initial deficiencies.
(Paragraph 48)
The Government welcomes the Committee's acknowledgement
of the information published by the MOD concerning vaccines. Since
the publication of the Committee's report, further independent
work has been published by King's College, London Gulf War Research
Unit in the British Medical Journal (May 2000). This research
was based on their initial hypothesis that multiple immunisations
may be associated with later self reported ill health in Gulf
veterans, first put forward in the Lancet in January 1999. The
researchers did not find an association between self reported
ill health (reported by questionnaire) and the individual vaccines
given in the 1990/91 Gulf immunisation programme. Nor did they
link self reported ill health to a particular combination of vaccines.
Multiple immunisations before deployment to the Gulf do not seem
to be associated with self reported ill health, whereas multiple
immunisations given during the deployment do seem to be associated
with self reported ill health. The paper suggests that this different
outcome is stress mediated, but the paper does not suggest any
mechanism which might explain this. The paper did not find an
association between immunisations and traditional military stress
(e.g. combat) or between immunisations and pesticide exposure.
MOD is continuing with the programme of research
at CBD Porton Down to investigate possible health effects of interactions
between all the vaccines used in the Gulf conflict and pyridostigmine
bromide, the Nerve Agent Pre-treatment. King's College are undertaking
further work on blood samples from UK Gulf veterans to investigate
the hypothesis that veterans' illnesses may be related to shifts
in the balance of chemicals in the immune system, possibly due
to stress.
MEDICAL RECORDS
We welcome the MOD's acceptance that there were problems
with medical record-keeping during the Gulf conflict, and the
improvements which it has already put in place to improve such
procedures. Recent experience has demonstrated that units may
frequently be deployed overseas. It is essential that full and
up to date medical records are maintained for all individuals
in the Armed Forces throughout their service careers and including
any medical treatment received during deployments. (Paragraph
50)
The Committee's comments on Medical Record Keeping
during deployments are endorsed. A new operational medical record
(called an F Med 965) has been introduced to overcome previous
shortcomings in this area. MOD has introduced a post deployment
screening procedure for troops returning from Sierra Leone, one
aim of which is to ensure that all deployment medical data is
recorded on an individual's permanent medical record.
We welcome the clarification of the MOD's position
on access to medical records, and trust that this will ensure
that in future former and current Service personnel and their
medical practitioners are able to obtain necessary information
without undue delays. (Paragraph 52)
We echo the Committee's wish that Service personnel
and their medical practitioners should be able to access the necessary
information without undue delay but would re-iterate that for
the reasons given in our evidence some delays are unavoidable.
Chemical and Biological Attack
It is regrettable that these studies took so long
to get off the ground as the time lapse can only have had an adverse
effect on the discoverable evidence. However, we are impressed
with the level of detail contained in the studies, and the clarity
with which they explain what occurred and the implications for
UK personnel. (Paragraph 64)
We welcome the Committee's comments on the level
of detail contained within these studies. Since the publication
of the Committee's report MOD has published a further paper entitled
"A Review of the Activities of the 1 Field Laboratory Unit
and Suggested Biological Warfare Agent Detections during Operation
Granby". A paper entitled "A Review of UK Forces Chemical
Warfare Agent Alerts during the 1990/1991 Gulf Conflict"
is due to be published shortly.
The MOD has made good progress, therefore, in
establishing what took place and addressing specific areas of
concern which have been highlighted by veterans. The findings
of this research are consistent with the view expressed to us
in the United States, that it is likely that there is no single
cause of Gulf veterans' illnesses. If further progress is to be
made in understanding the nature of Gulf veterans' illnesses,
detailed work will need to be carried out to ascertain whether
there are any links between possible exposures veterans might
have suffered and the symptoms which some are now exhibiting.
(Paragraph 65)
The MOD will continue to conduct research on exposures
and on symptoms. Examples are the vaccines interactions work,
work on NAPS and the immune system, the neuro-muscular symptoms
study at King's College, and the offer to test some veterans for
Depleted Uranium. We will also monitor closely other ongoing work
in the UK (e.g. King's College clinical investigations, their
immune systems research, and the Government funded research on
organophosphates.) A substantial number of ongoing US projects
are being closely monitored.
ASSESSING THE EXTENT OF THE PROBLEM
Epidemiological Studies - Future research
But we believe that further research is necessary,
and that it should be of the same high standard and detailed nature
which has characterised the research into possible causes of veterans'
illnesses discussed above. (Paragraph 71)
We recommend that the government take advice,
as a matter of urgency, from the Medical Research Council to enable
systematic and detailed research to be conducted into the number
of veterans with unexplained illnesses, the nature of the symptoms,
and the way the illnesses are progressing. It is not sufficient
for these studies to be based solely on questionnaires; a representative
proportion of veterans should be seen by clinicians. Veterans
and their associations should be asked for their views on the
form the studies should take and their co-operation with them
actively sought. The outcome of this research should enable us
to have well-founded evidence of the morbidity and mortality amongst
Gulf veterans to measure against comparable groups in the general
population. (Paragraph 72)
Research of the type suggested by the Committee is
already underway or has been completed. The King's College Phase
1 work published in the Lancet in January 1999 demonstrated the
nature and frequency of symptoms in British veterans of the Gulf,
Bosnia and those not deployed (who in epidemiological terms are
the group against whom health should be measured).
The MOD also commissioned the study being carried
out by Professors Cherry and Macfarlane at Manchester University
which is designed to ascertain the prevalence of illness. Work
on this study is complete and the data is being analysed and the
manuscript is being prepared for submission to a peer-reviewed
scientific journal. Publication is out of the Government's control
as the research team has proper editorial independence. Another
Manchester University study completed by Professors Cherry and
Macfarlane has looked specifically at the mortality of Gulf veterans
in relation to a comparable group of Servicemen. Their results
were published in the Lancet on 1 July 2000. This study
showed no statistically significant excess of deaths among UK
Gulf veterans. The MOD plan to update Gulf veteran and control
group mortality data on a regular basis. Similar work is planned
on the incidence of cancer in Gulf veterans.
In Phase 2 of their study, the team at King's College
has been conducting clinical examinations of 400 Gulf and other
veterans who took part in the questionnaire based Phase 1 of the
study. Ill Gulf veterans and three control groups of 'well Gulf'
'sick Bosnia' and 'sick era' have undergone two days of intensive
clinical testing.
The Government remains open to the possibilities
of further research. The MOD has stated that researchers may,
at any time, put their proposals to the Medical Research Council
(MRC) for peer review and that MOD will consider any proposal
that has been formally reviewed and approved by the MRC. However,
a general principle has been that research into specific causes
of Gulf veterans' illnesses should await the outcome of the epidemiological
studies currently underway which will define the nature and extent
of any unusual ill health in the population which deployed to
the Gulf.
In this context, the King's College proposals for
Phase 3 of their study have recently been approved by the MRC.
Phase 3 will involve a longitudinal follow up study of UK Gulf
veterans, to determine whether their overall health has improved
or not. They will also further analyse their existing data concerning
the health of the group of Bosnia peacekeepers that were originally
used as a control group for the Gulf group. MOD will fund this
new work, at an estimated cost of £150K.
The Government has also sought advice from the MRC
on current research into Gulf veterans' illnesses, and guidance
about the appropriate future direction of research based on what
has been achieved to date. The MRC will continue to give advice
to the MOD on potential research proposals.
We suggest that the new Chief Scientific Adviser
be encouraged to review the past scientific advice given to the
Ministry on Gulf War illnesses and to draw lessons from this for
the future. (Paragraph 73)
The Government accepts that the lessons of the Gulf
conflict need to be learnt and that the resources and mechanisms
required for future health surveillance of veterans needs to be
examined. The MOD is currently compiling a 'Lessons Identified'
paper that draws together various strands of the lessons of the
Gulf with a view to ensuring that they are incorporated in future
operational and deployment health policy. We will cover the provision
of scientific advice on Gulf veterans' illnesses.
FINANCIAL ASSISTANCE
War Pensions
Despite all the detailed research discussed above
and the genuine efforts being made by the MOD to put more information
into the public domain, it is possible we may never find the answer
to the causes of Gulf veterans' illnesses. What is important,
though, is that those who have served their country feel that
they are adequately compensated if they have suffered illness
as a result of their service. (Paragraph 74)
The Government welcomes the Committee's comments
on the efforts made to put information regarding Gulf veterans'
illnesses into the public domain. We accept that those who have
served their country should be adequately compensated for ill
health arising from their Service. This is currently provided
by War Pensions, the Armed Forces Pension Scheme attributable
benefits and preferential rates of pensions and supplementary
allowances compared with most Social Security equivalents.
However, we believe there is a case for waiving
the seven-year rule in relation to Gulf veterans because the nature
of their illnesses means that it may be some years before symptoms,
and their severity, are apparent. This waiver could be extended
to other groups if their circumstances were comparable. The MOD
should not use its overall review of pensions as a means of deferring
action to assist Gulf veterans, and we look forward to an early
announcement of the government's position. (Paragraph 77)
The Government believes that the legislation covering
claims made outside the seven year rule is sufficiently generous
to allow claims for war pensions to succeed. For deaths arising,
or disablement claims lodged within seven years of termination
of service, the onus lies with Secretary of State to show beyond
reasonable doubt that the disablement or death is not due to service.
There is no onus on the claimant to show any link between disablement
and service. These provisions are in Article 4 of the Naval, Military
and Air Forces (Disablement and Death) Service Pensions Order
1983, as amended. Even where a claim for disablement is made more
than seven years after termination of service, or where death
occurs more than seven years after service, the onus of proof
is still more generous than the burden of proof in civil tort
which rests on a balance of probabilities. Article 5 of the Naval,
Military and Air Forces (Disablement and Death Service Pensions
Order 1983, as amended provides that it is necessary for the claimant
only to raise reasonable doubt, based on reliable evidence, that
the death or disablement is due to service. The benefit of any
reasonable doubt is always given to the claimant.
As these provisions have applied to claims for war
pensions for half a century it would not be feasible to restrict
any concession on the seven year rule to Gulf veterans. Whilst
it is true that the rule switches the onus from the Secretary
of State to the claimant at the seven year point, for a claim
to succeed it requires only that the claimant produces reliable
evidence to raise a reasonable doubt. Therefore, were further
research to show any reliable evidence of there being a service-related
cause for an otherwise unexplained illness, claims for war pension
could succeed. This applies not only to Gulf conflict related
claims, but to any medical condition suffered by any participant
in any theatre. The seven year rule applies not from the end of
any given conflict but from the point the individual ends their
total service. Some Gulf veterans could still be benefiting from
its provisions for over 20 years to come.
We welcome the improvements which appear to have
been made in the way the War Pensions Agency deals with Gulf veterans
and, in the light of the recommendations made by the Social Security
Committee last Session, we hope to see further evidence that effective
claims and appeal procedures are in place.
(Paragraph 81)
The Government is pleased that the Committee has
recognised the positive steps taken by the War Pensions Agency
(WPA) to improve the handling of Gulf claims. The WPA has further
streamlined some of its processes in relation to Gulf claims,
and efforts to reduce the time it takes to deal with these cases
and to improve communications with Gulf veterans, continue. MOD
and the WPA have also improved their co-ordination on Gulf veterans'
matters.
ABRS
The Committee notes in its report that there has
been no outcome from the review of ABRS (Attributable Benefit
for Reservists Scheme). (Paragraph 82)
The Minister of State for the Armed Forces announced
on 18 May 2000 an extension of the benefits available to members
of the Reserve Forces who served in the Gulf. This announcement
was the result of the completion of a review into attributable
benefits, which began in the summer of 1998. It has taken some
time to complete the review as the rules and regulations applying
attributable benefits for Reservists are complex and required
MOD to seek advice from its legal adviser and Counsel about the
scope of the regulations. Up until now some Reservists have been
denied attributable benefits from the Armed Forces Pension Scheme
because MOD has awarded benefits only if an individual was medically
discharged when he was demobilised from active service. Following
the review MOD will now consider claims from Reservists who were
medically discharged from the Reserve Forces at other times. MOD
is reviewing a number of existing claims from Reservists, and
will also consider new claims from Reservists who did not submit
at the time of their discharge from the Reserve because of the
way that the policy on attributable benefits was applied at the
time. Some Reservists who were not formally members of a Reserve
Force would not, under the regulations, be eligible to make a
claim. MOD will, however, sympathetically examine claims from
such individuals, with a view to making payments where they would
otherwise be treated differently from other Reserves, solely because
of their status.
Other forms of financial assistance
COMPENSATION
We believe more should be done to assist veterans
and their representative organisations in this respect. If the
MOD is unable or unwilling to provide this assistance, veterans
should be assisted by more appropriate government departments
and agencies. The MOD should not use its position of strength
in this area to the detriment of ill veterans and their families.
(Paragraph 87)
The MOD position on compensation for negligence was
set out in the 'New Beginning' policy statement in July 1997 and
remains unchanged. Since the repeal of Section 10 of the Crown
Proceedings Act 1947 on 15 May 1987, British Service personnel
have had the same right to claim compensation from the MOD as
any other employee against his or her employer. No writs or claims
of sufficient detail have been received from Gulf veterans to
allow MOD to handle these cases. If such claims are received,
the MOD will try to resolve them as quickly as possible and will
pay compensation where a legal liability exists. It is likely
that each claim will have to be considered on its merits because
each individual's symptoms, degree of disability and personal
circumstances, which would determine the level of award, will
be different. However, it is possible that a pattern may emerge
in handling the first cases which would facilitate the handling
of the remainder. Where a legal liability is established the vast
majority of compensation payments made by the MOD are made without
proceeding to court.
Far from using its position of strength to the detriment
of ill veterans MOD has assisted veterans through its policy of
openness, making available the information it possesses which
is relevant to Gulf veterans' illnesses. MOD has also agreed not
to rely on the defence of limitations under the Limitation Act
1980 in respect of negligence claims concerning Gulf veterans'
illnesses. This means that such claims can in effect be launched
at any point of the veterans' choosing instead of before the normal
cut off point of 3 years, unless and until the Department gives
notice to Gulf veterans to issue and serve such proceedings and
they fail to do so within the notice period given. MOD has also
agreed to extend the standard provisions of the Access to Medical
Records Act of 1990 which normally entitles individuals only to
their medical records compiled after 1 November 1991. In the case
of Gulf veterans we have arranged access to records back to 1
August 1990 to ensure their whole period of Gulf service is covered.
In short MOD has done nothing to deprive Gulf veterans of their
right to take legal action against MOD in accordance with the
provisions of the Crown Proceedings (Armed Forces) Act 1987.
CIVILIANS
We believe the MOD should review and clarify its
contractual arrangements with civilian contractors and their employers
to ensure that they are adequately protected when deployed overseas
with the Armed Forces. (Paragraph 91)
We therefore recommend that the MOD consider ways
in which civilian contractors who served alongside Service personnel
during the Gulf conflict, and who had no other form of insurance
protection, can be adequately compensated for injuries and illnesses
they sustained as a result of their service. (Paragraph 92)
The MOD is currently reviewing and clarifying its
policy for contractual arrangements with Civilian contractors
through the joint MOD/Industry Contractors on Deployed Operations
(CONDO) Project Team. The Team has been established with the aim
of examining the scope for deployment of contractors in support
of the Armed Forces across the spectrum of operations. The project
will examine all constraints and risks before providing agreed
policy for the deployment of contractors on operations. It is
intended that consideration of these activities will result in
an outcome acceptable to all stakeholders.
The CONDO Project Team is looking at a wide range
of issues including the implications of contractors staff being
subject to military discipline and their being offered protection
under the Armed Forces welfare system. Further, it will be seeking
advice and making recommendations on insurance and indemnity issues.
The Team is due to report by the end of 2001.
CONCLUSION
In launching its new approach to dealing with
Gulf veterans' illnesses in 1997, the government said that it
has 'a debt of honour' to those who have served in the Armed Forces.
We agree. We believe that the government has gone a considerable
way towards meeting that debt in its efforts to research possible
exposures which may have led to veterans suffering ill health
and in putting the findings in the public domain. However, it
may be necessary now to accept that precise causes may never be
found and to focus attention instead on improving the current
circumstances of ill Gulf veterans. (Paragraph 98)
The government's record has been far less impressive
in respect of improving the quality of life of ill veterans. We
wish to see a great deal more progress in terms of ensuring Gulf
veterans have access to adequate financial provision and to appropriate
medical treatments and advice. Urgent action from the government
is required in both these areas if it is to fulfil the debt of
honour which it has acknowledged. (Paragraph 99)
Veterans have access to the full range of services
available via the NHS or, if still serving, the Defence Medical
Services. In addition to this the MAP has contributed to ameliorating
veterans' conditions in very practical ways. Firstly, a number
of veterans that attend the MAP come for reassurance about their
health which the MAP physicians are able to provide. Secondly,
the MAP has assisted particularly in the area of identifying Post
Traumatic Stress Disorder, by diagnosing over 200 veterans and
then helping to ensure they receive the appropriate treatment.
The Government believes that the current financial
provisions are the most appropriate way of compensating Gulf veterans;
they are able to apply for no fault compensation through the War
Pensions Agency, and for an Armed Forces Pension or an Attributable
Benefit for Reservists. (The scope of the latter scheme has just
been extended.)
Research must continue into possible causes of
Gulf veterans' illnesses. However nine years on from the Gulf
War, the highest priority now is to try to deal with the symptoms
of ill health which veterans suffer by providing care and treatment
which will improve their quality of life. It may not be possible
at present to cure such illnesses, but maximum efforts should
be made to identify treatments which will reduce their effects.
We recommend that the MOD follow the US example in this regard
and work with the Department of Health to establish trial treatments
which may be of benefit to veterans. The MOD should actively encourage
participation by veterans and their representative organisations
in such trials. (Paragraph 100)
We note the Committee's comments about putting more
emphasis on the treatment of Gulf veterans. This is of course
extremely difficult given that we are dealing with ill-defined,
multi-symptom illnesses. Research on UK Gulf veterans has found
no unique Gulf war related illness and, despite Gulf veterans
reporting more symptoms than control groups, disability was generally
not severe. These findings (from the King's College work) are
supported by data from the MAP.
Gulf veterans' illnesses share many characteristics
with other poorly understood multi-symptom illnesses such as Chronic
Fatigue Syndrome. These types of illnesses are an active area
of ongoing medical debate and no proven effective treatment for
these conditions has yet been established. Nevertheless, we recognise
that treatment trials involving cognitive and exercise behavioural
therapy are being conducted in the US based on therapies that
have been reported as being beneficial in the treatment of chronic
fatigue syndrome. There is however, no evidence yet that this
type of treatment would help ameliorate the symptoms of Gulf Veterans'
Illnesses. Initial data from the Special Care Program in the USA,
which uses similar techniques has recently been published and
the results appear so far to be very modest. An antibiotic trial
is also being conducted in the US. Given that the large scale
trials are under way in the US, it seems sensible to await those
results before recommending comparable treatment for UK veterans.
In the meantime, the MOD and the Department of Health
will keep the matter of possible treatments under review. In particular
we will follow carefully the progress of the Chief Medical Officer's
Working Group on Chronic Fatigue Syndrome/Myalgic Encephalomyelitis
which may provide guidance on possible treatments for Gulf veterans.
We will also liaise with US colleagues on the forthcoming systematic
review of treatments for ill defined chronic multi-symptom illnesses
which is being undertaken by the United States Institute of Medicine.
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