ANNEX B
GULF VETERANS' ILLNESSES: PROGRESS IN
IMPLEMENTING THE TWENTY KEY POINTS (JUNE 2000)
OPENNESS AND DIALOGUE
Point 1. The new Government pledges that its dealings
with Gulf veterans will be open and honest. We will listen carefully
to what they have to say and engage in a dialogue.
Ministers of State for the Armed Forces have held
eight meetings with Gulf veterans' representatives and also met
a number of veterans individually accompanied by their MPs. Regular
meetings have also been held between Gulf veterans' representatives
and officials from the Gulf Veterans' Illnesses Unit (GVIU). All
veterans' letters and phone calls receive comprehensive replies.
Point 2. The Gulf Veterans' Illnesses Unit (GVIU)
has been established as the focal point for this issue.
GVIU has continued as the focus for the Government's
response to Gulf Veterans' Illnesses. The two Helplines were made
Freephone numbers in February 2000.
MEDICAL HELP
Point 3. New guidance will be issued to Service units
and to doctors to ensure that veterans are able to take advantage
of the MOD's Medical Assessment Programme (MAP).
Guidance on the MAP was issued to civilian doctors
in November 1997 via the Department of Health's Chief Medical
Officer's Update and to Service units by MOD signal in December
1997. In October 1998, the GVIU produced the first edition of
an information pack, aimed at providing General Practitioners
(GPs) and other health professionals with information which they
may find useful in dealing with Gulf veterans' health concerns.
GPs were formally notified of the pack's existence in the Chief
Medical Officer's Update published in May 1999. The pack is now
sent to all doctors referring veterans to the MAP and anyone else
who requests one. It is available on the MOD Website. As at 2
May 2000, 2,243 packs have been distributed. The pack is updated
periodically as required. The Surgeon General has also recently
re-issued specific advice to all Service medical organisations
regarding Gulf veterans' illnesses.
Point 4. We have established new targets for the
handling of all new patients referred to the MAP. They will be
sent an appointment letter within 5 working days; and as far as
possible the date of the appointment offered shall be within 6
weeks of the patient's referral.
These targets are being met.
Point 5. Additional resources are being provided
for the MAP to assist with the coding and updating of the programme's
database, with a view to publishing detailed results in late 1997.
A paper on the clinical findings from the first
1,000 patients seen at the MAP was published in the British Medical
Journal (BMJ) on 30 January 1999. This was the first time that
the results of clinical examinations of a large number of UK Gulf
veterans had been published. A paper covering the results of the
second 1,000 cases seen at the MAP has been submitted for peer-reviewed
publication. Further analysis of the database will be undertaken
and published.
Point 6. We will undertake a full audit in the coming
year, focusing on all aspects of patient care and on the service
provided, to ensure that the MAP continues to adhere to best practice.
In late 1998, a management audit of the MAP was
undertaken by the King's Fund Health Quality Service looking at
all aspects of patient care and the service provided by the Programme.
The management audit report was published on 26 April 1999. Actions
to implement the recommendations of the management audit are almost
complete and are detailed in a report published by the MOD on
20 January 2000. A review of clinical procedures is being undertaken
by the Royal College of Pathologists. We will announce the outcome
of this review.
Point 7. We will work with the Department of Health
to look into the practical problems which some ill veterans face
in obtaining appropriate support or treatment after they have
left the Services.
GVIU has established a dialogue with the Department
of Health (DH) and others to raise awareness of the health problems
of Gulf veterans. The GPs information pack was produced following
discussions between MOD and officials from the National Health
Service (NHS) about how those working within the NHS might be
made more aware of the problems of Gulf veterans.
RESEARCH
Epidemiological
Point 8. We will continue to fund the two epidemiological
studies which are intended to establish whether Gulf veterans
are suffering unusual ill-health.
The studies are being carried out by teams led
by Professor Cherry of Manchester University and Dr Doyle of the
London School of Hygiene and Tropical Medicine. Professor Cherry
has completed the first phase of her research and has submitted
papers to a leading medical journal for publication. One of these
has been accepted by the Lancet and will be published on 1 July
2000. The results from Dr Doyle's study, which is by far the largest
of the epidemiological studies, are not expected until 2001 at
the earliest.
This research is also being coordinated with a
US funded study, led by Professors Wessely and David of King's
College School of Medicine and Dentistry in London. Initial results
from this study were published in the Lancet in January 1999 and
a further paper on multiple vaccinations was published on 19 May
2000. Other papers are in the process of being submitted for publication.
Further proposals for studies have been made.
The MRC has recommended a 3rd phase of research
by King's College which will consist of a longitudinal study of
the changing health of Gulf veterans over time, and a further
analysis of the health of the Bosnia cohort examined in the earlier
study. MOD will fund this research at a cost of about £150,000.
New MOD research into medical countermeasures
Point 9. The new Government will fund a research
programme into 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
total estimated cost of this new research programme is some £2.25
million.
and
Point 10. The new research into medical countermeasures
will include tests specifically aimed at assessing the short and
long term effects of the simultaneous use of pertussis and anthrax
vaccines.
An initial dose ranging study to inform future
work has been conducted at CBD Porton Down and results from this
have been considered by the Independent Panel which oversees the
research. This data has been submitted for publication in a peer
reviewed journal. The full interactions programme, which comprises
three major elements, is expected to be completed in 2003.
Point 11. An independent panel of scientific experts
will be appointed to oversee this new research and it will include
a member nominated by the Gulf veterans.
The Independent Panel, composed of distinguished
members of the medical and scientific communities and chaired
by Professor Donald Davies, Director of Clinical Pharmacology
at the Imperial College School of Medicine, continues to oversee
the research mentioned at points 9 and 10 above. The Panel includes
two members who have been nominated to represent
Gulf veterans.
Other research
Point 12. The Government encourages those with interest
in this subject to submit proposals for further research work
to the MRC for consideration.
Proposals for new research received by MOD are
passed either to the MRC or to the Independent Panel for consideration.
So far only a small number of new proposals have been received.
On 16 March 1998, the then Minister of State for the Armed Forces,
Dr John Reid, announced that MOD had decided to fund a proposal
for a programme of clinical tests to be carried out at King's
College, London on randomly selected Gulf
veterans identified through Professors Wessely and David's epidemiological
study. This clinical research, expected to be completed by the
end of 2000, will help describe any neurophysiological symptoms
or abnormalities which may be present in UK Service personnel
who served in the Gulf. The MOD has also accepted the MRC's recommendation
to fund Professor Glyn Lewis of the University of Wales to review
systematically the world wide literature relating to Gulf veterans'
illnesses and also to fund the collection and storage of blood
samples from UK Gulf veterans involved in Professor Wessely's
study. These samples will be used for future research.
Point 13. We are cooperating closely with the US
authorities to ensure that the UK has full visibility of US research
into Gulf health issues. [Paragraph 44]
Cooperation with the US is close and continuous.
Following the practice of previous Ministers of State for the
Armed Forces, Mr Spellar visited the US in October 1999 and June
2000 to see at first hand how the US is responding to Gulf veterans'
illnesses. On 13-14 April 2000, members of the Office of the Special
Assistant for Gulf War Illnesses (OSAGWI) visited the UK and held
meetings with Mr Spellar and officials from GVIU. GVIU also has
a full time Gulf Health Liaison officer based in the US, who sits
on the US Persian Gulf Veterans' Coordinating Board's Research
Working Group.
Organophosphate pesticides
Point 14. Research is already underway to try to
determine the effects of low level exposure to organophosphate
(OP) pesticides in the context of ill-health claimed by some farm
workers. This will be an important step towards understanding
the possible effects of potential exposures during the Gulf War.
Work at the Institute of Occupational Medicine,
which is sponsored jointly by the Ministry of Agriculture, Fisheries
and Food (MAFF), the Department of Health (DoH) and the Health
and Safety Executive (HSE), was published in July 1999. The Committee
on Toxicity (COT) also published a report on OPs on 26 November
1999. The MOD announced its analysis of this report on 20 January
1999. It remains the case that there is no firm evidence to link
low level exposure to OPs with ill health. Further research proposals
are under consideration by the MAFF, DoH and HSE.
Point 15. The Scout tents about which health concerns
were raised last month are being tested and the results will be
made public as soon as these are available. [Paragraph 25]
The results of the analysis by the Laboratory
of the Government Chemist and advice from the Pesticides Safety
Directorate were published on 10 October 1997.The results of these
tests established that, although a small trace of one OP pesticide—fenitrothion—was
found on one section of tent, this did not pose a health risk.
PROVISION OF INFORMATION
Point 16. The Government intends that veterans should
have access to whatever information the MOD possesses which might
be relevant to their illnesses and is determined that what can
be found will be made public.
A great deal of information has been made public
and the Government will make more available as work in progress
is completed. In March 1998, a joint UK/US case narrative entitled
'Kuwaiti Girls' School' was published concerning a tank of
liquid found at the Girls' School in Kuwait City after the Gulf
War which was initially suspected to contain chemical warfare
agent. In April 1998 a paper was published which investigated
concerns that dead animals that were reported in theatre had been
exposed to biological warfare agent.
In March 1999, a paper was published, entitled
'Testing for the presence of depleted uranium in UK veterans of
the Gulf conflict: The current position,' explaining the background
to the use of depleted uranium (DU) in the Gulf and the MOD's
policy on testing veterans for the presence uranium. In April
1999 a paper was published explaining the way in which medical
records were dealt with in the Gulf. In December 1999, a paper
was published providing background information about the defensive
system that was put in place to protect UK troops from the threat
of chemical warfare. At the same time information was published
about the release of nerve agent at the Iraqi munitions depot
at Khamisiyah in March 1991.
In January 2000 papers were published detailing
the way in which the anti-biological warfare agent immunisation
programme was implemented in-theatre and also reviewing the suggested
exposure of UK forces to chemical warfare agents in Al Jubayl
on 19 January 1991. A review of the activities of 1 Field Laboratory
Unit and suggested biological warfare agent detections was published
on 19 May 2000. Another report concerning the incidence of chemical
warfare agent alarms is now well under way and is expected to
be published in July.
The internet page, set up to help Gulf veterans
and others to find out what the MOD is doing to address the concerns
of Gulf veterans has proved very successful and was accessed nearly
13, 000 times in February 2000. The address of the page has changed,
and is now http://www.gulfwar.mod.uk.
Point 17. We have already started work to prepare
a full explanation of the scientific basis on which the various
medical countermeasures were used. It will include any reservations
expressed at the time and will be published as soon as it has
been completed.
The paper entitled "Background to use of
Medical Countermeasures to protect British Forces during the Gulf
War (Operation Granby)" was published on 28 October 1997.
Point 18. We are also establishing a fact finding
team to look into the implementation of the anti-BW vaccination
programme during the Gulf War.
The Fact Finding Team was established in September
1997. The report, 'Implementation of the Immunisation Programme
Against Biological Warfare Agents for UK Forces During the Gulf
Conflict 1990/1991' was published on 20 January 2000.
Point 19. We are also in the final stages of research
into reports of dead animals during the Gulf War. This work will
be published when it is complete.
The paper entitled "Dead animals during the
Gulf conflict : Review of the circumstances in which UK forces
reported the presence of groups of dead animals during Operation
GRANBY in 1990/91" was published on 6 April 1998.
FINANCIAL PROVISION
Point 20. The Government believes that no-fault compensation
for service personnel disabled as a result of their service must
continue to be provided under the War Pensions Scheme (WPS), under
which payments with a considerable capitalised value may be made.
In addition, Service personnel have the same right to claim legal
compensation from MOD as any other employee has against his or
her civilian employer. All such claims will be dealt with on the
basis of legal liability. If such liability is established by
future research or investigation, the MOD will of course pay compensation.
As at 31 March 2000, 1,460 British Gulf veterans
were in receipt of a War Pension of at least 20% from the War
Pensions Agency (part of the DSS) and further applications are
under consideration. As at 3 May 2000, the MOD had received over
1,835 notices of intention to claim from veterans and members
of their families in respect of illness allegedly arising from
the Gulf conflict, although no writs or properly formulated claims
have so far been received. In addition, a small number of specific
claims have been received in respect of recognised medical conditions,
alleged to have arisen as a result of Gulf service and these are
being taken forward under normal claims procedures.
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 the Ministry of Defence 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.
Ministry of Defence
6 July 2000
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