Select Committee on Defence Minutes of Evidence

Examination of Witnesses (Questions 1 - 19)




  1. Dr Moonie and Mr Baker. Welcome, Dr Moonie, on your first appearance before the Committee as a witness—ironically coinciding with the last meeting of our Committee. This will be the Defence Committee's last evidence session in this Parliament. Our first evidence session in this Parliament, in July 1997, was also on Gulf veterans' illnesses. That we should begin and end on the subject of Gulf veterans' illnesses creates a fitting symmetry and demonstrates our continuing interest in this very important area. It is a year since we published our report on Gulf veterans' illnesses. That report continued the work begun by our predecessors in the previous Parliament, who reported twice on the subject. In our report last year we welcomed the progress made by the present Government in addressing some of the problems faced by Gulf veterans, but, equally, we highlighted areas where we believed more should be done and made recommendations accordingly. Today we will begin questioning you about developments over the last 12 months. One of the most important developments, which received wide coverage in the media in January, was the increased public concern about possible adverse health effects for military personnel arising from the use of depleted uranium munitions in the Balkans. In response, the UK Government announced that a screening programme for exposure to depleted uranium would be set up, which would also be available to Gulf veterans, and two consultation documents have since been issued. Our evidence today will examine the progress made so far towards establishing the screening programme and some of the wider issues concerned with the use of DU. Perhaps you may like to kick off, Dr Moonie, with an opening statement.

  (Dr Moonie) Chairman, thank you very much. I welcome the opportunity to give evidence before the Defence Committee on Gulf veterans' illnesses and on depleted uranium. In April I provided the Committee with a memorandum setting out the current position on the various activities which the Ministry of Defence is undertaking in respect of Gulf veterans' illnesses. With the permission of the Committee, on 8 May I made the text of that memorandum public so that the Gulf veterans, and others with an interest in this important subject, can see in detail what is being done. Since the then Minister for the Armed Forces last gave evidence before this Committee in April 1999, considerable work has been completed. For example, we have published seven major papers as well as other information ourselves and seen the completion of several MoD-funded studies, such as the University of Manchester mortality and morbidity studies. Also, the Medical Assessment Programme passed the 3,000 patient mark, and a new information pack has been published and sent out to every GP in the country. I do not propose to recapitulate in detail the information in the latest memorandum, as I expect that the Committee will want to discuss particular aspects in detail in due course. Instead, I would like to make some remarks on two recent developments. First, my recent appointment as Minister for Veterans' Affairs and, second, to outline what the Ministry of Defence is doing to address concerns raised earlier this year about the use of depleted uranium-based ammunition in the Balkans. My appointment as Minister for Veterans' Affairs was announced by the Prime Minister on 14 March this year. This will be the first time that veterans have had a single Ministerial focal point for any queries or problems that may have arisen as a result of their service. We will be consulting representatives of the ex-Service community about how the detail of this initiative should be taken forward, including seeking their views on arrangements for the Veterans Task Force and Forum. The Task Force will include Ministers from the Department of Health, the Department of Social Security, the Department of the Environment, Transport and the Regions, and the Department for Education and Employment as well as the relevant Scottish and Welsh Departments, the Northern Ireland Office, the Foreign and Commonwealth Office and the Lord Chancellor's Department. The Task Force is intended, among other things, to ensure greater coherence between what is done by Government and the tremendous work done on behalf of veterans by their associations. The Veterans Forum will include representatives of the veterans' groups and will enable them to articulate to us their principal concerns. Although we cannot at this stage predict what new measures might come out of the work of these new groups, the appointment of a Veterans' Minister will provide a focal point across Government departments. It also reflects the Government's determination that veterans' issues should be handled in a co-ordinated way to ensure a properly integrated approach to veterans and their concerns. I look forward to using and developing this mechanism to address the concerns of all veterans, including of course Gulf veterans. If I could now make some remarks about depleted uranium-based ammunition. Depleted uranium is not a new issue: DU ammunition has been around in the UK since the early 1980s and the risks have been acknowledged and handled throughout that period. We are clear about the potential health risks of DU and have been for a very long time. There have also been a number of reports on the potential risks from DU munitions published recently. Increasing amounts of environmental monitoring data from the Balkans is becoming available and these assessments continue to support the Ministry of Defence's views on the potential risks from DU. In essence, the risks from DU are minimal compared to the other risks faced by troops during combat or peacekeeping operations. On 9 January this year, in recognition of concerns amongst Service personnel caused by media coverage on DU, John Spellar announced that the Department will identify an appropriate voluntary screening programme for UK Service personnel and civilians who have served in the Balkans. We have made it clear that this programme will also be applicable to Gulf veterans. A second consultative document on proposals for this screening programme was published on 11 April. The proposals that it contains were developed in the light of the 37 responses, mainly from the medical and scientific communities, that we received to the first consultative document, published in February. The latest document, available on our website, emphasises the need to put in place arrangements that are technically well founded and scientifically validated and reiterates the Department's commitment to using the best science, consulting widely to achieve this. The Oversight Board that we propose to put in place with largely external membership, including veterans representation, is intended to ensure that the process of putting in place arrangements to measure historical exposure remains open and transparent to all concerned. The issue of the second consultative document, and our proposals for oversight, demonstrate our intention to be open and inclusive in developing plans for a testing or screening programme. The closing date for responses to the second phase of consultation is 4 July. We recognise the need for a speedy resolution of veterans' concerns, but this is the minimum consultation period required by Government guidelines. We welcome responses from anyone. We expect the greatest interest will come from the academic and scientific communities, and from veterans and their representatives. As the document indicates, consultation will be followed by the establishment of oversight arrangements, which give veterans a real stake in the process, and we will then have a competition to ensure that we have an effective and validated test. There is a choice to be made between the precise methods to measure the isotopic ratios of uranium in urine, and which organisations might best provide the testing, so a competition is, in our view, appropriate. I appreciate that some may consider this to be an overly long process. We believe, however, that it is better to take time and put in place an effective and validated test in which we all can be confident rather than to improvise a regime that might risk scientific criticism and invite controversy from veterans. In the meantime, we are continuing to liaise with allies about their data on the risks to health in the Balkans, the actual health of the peacekeepers there, the responses our allies plan, and to ensure that all data available across NATO is pooled as a basis for subsequent decisions. Senior NATO medical staffs ("COMEDS") met on 15 January 2001, and an ad hoc committee was established. This committee is keeping the situation under review and acts as a clearing-house for information, providing a mechanism for Alliance data to be shared with non-NATO troop-contribution nations and other international organisations in the Balkans. So far, no information reported to this group has altered the original assessment of the NATO nations that they cannot identify any increase in disease or mortality in soldiers who have deployed to the Balkans. Also, on the evidence available, a causal link cannot be identified between DU and the complaints or pathologies of some peacekeepers, specifically those few who do have cancer, including leukaemia. John Spellar also announced on 9 January that the Department will enhance its existing environmental surveillance programme in the Balkans to ensure that no health threats to our forces, and indeed to the local civilian population, are overlooked. A reconnaissance team visited Kosovo in January to plan the necessary work for the enhanced environmental monitoring programme. They visited seven of eight sites in the UK sector where DU was fired. At one site, three largely intact penetrators were found. No penetrators were found at any of the other sites, and no significant levels of DU contamination were identified other than in the immediate vicinity of the penetrators. The results of these field measurements are now being checked by more sophisticated laboratory analysis of soil samples collected during the visit. Even at the one location where DU was found, significant contamination could only be detected within a few centimetres of the recovered penetrators and radiation levels were indistinguishable from naturally occurring background at all other locations surveyed. It is anticipated that the preliminary results of this reconnaissance mission will be published soon. We intend that the full monitoring mission will begin in July, using a protocol prepared with independent, external input. Thank you.

  Chairman: Thank you very much. May we say how delighted we are that you have this new role. As an adviser to the Royal British Legion and other people who have been arguing for a Minister for Veterans' Affairs I suspect it will be a very full job if it is going to be taken seriously, and I am sure it will be taken very, very seriously, otherwise people will, perhaps, see it as a public relations exercise, which I know it is not going to be. I am glad it has happened now. In my own area, the Airborne Force, South Staffordshire Regiment, who were at Arnhem and Sicily, have now disbanded themselves because there are too few of them and they are getting a little too old for it. So the number of veterans who fought in the Second World War are, regrettably, fading away. So congratulations on your new appointment. You probably will not be in it for a great period of time unless reincarnated in five weeks, but whoever is the incumbent of that role we hope to work very closely with. Just one question from Julian Brazier.

Mr Brazier

  2. While welcoming the focus the new role provides, Minister, could I just ask, is the Government still firmly committed to keeping the War Pensions Agency in the Department of Social Security? There are several very good reasons for why there would be an outcry if there was an attempt to move that across to the MoD.
  (Dr Moonie) That matter is under review at present. It will be a matter for the next government, whoever it may be, to decide what the future of the War Pensions Agency is.

  3. So there is a possibility that we could end up with a situation where the war pensions fund, which is, I think, £1.25 billion, was transferred across en bloc to the MoD vote, and we had the future aircraft carrier programme—to choose one subject at random—competing with the particular arguments about, for example, compensation payments to war veterans within the same vote?
  (Dr Moonie) I am not absolutely certain of what the procedure is for deciding votes. I can assure you that whatever was to happen to the War Pensions Agency its funding would not be available to be poached for any other purpose.

Mr Viggers

  4. Can I also welcome the new responsibility you have, Minister. Most of the people who serve within the armed forces thoroughly enjoy the experience and feel it is the most enriching career to follow, and many of your comrades have many happy memories. However, there are some who do fall through the cracks partly because of the enormous strains and stresses that service personnel are put under. It is disturbing that a considerable number of those who are sleeping rough, for instance, have been previously in the armed forces. So that is just one symptom, perhaps the most extreme. I hope you will be able to co-ordinate the work of helping those who, perhaps, cannot help themselves. As my colleague Julian Brazier has pointed out, sometimes in trying to help a constituent's case we find it is not the MoD but the DSS which is responsible.
  (Dr Moonie) I must say you have hit on a very good point there. It is all too easy, often, to pass responsibility from one department to another. Having a really well-focused centre to deal with problems like that should improve services in future. Certainly I am very well aware of the problem with rough sleepers, and is a subject in which I will take a very active interest.


  5. You may have pre-empted the first question but you can elaborate slightly, Minister. What are the main issues which still need to be resolved before the appropriate DU testing of personnel can begin? Are you confident that the second consultative document will answer the questions you have asked in a way which will enable you to proceed without further delay?
  (Dr Moonie) We have to ensure that the test which we use is sensitive and specific; in other words, that it picks up depleted uranium if it is there—does not miss it—and that it actually is capable of detecting what are bound to be very low concentrations. There are tests available at present for using mass spectrometry of various kinds which are sensitive enough to look at levels like this. They have not formerly been used, to my knowledge, on the study of a biological material like urine. So one of the things which we will have to do is ensure that the tests can be transposed to the type of testing environment that we are going to be using. We are confident that that is achievable, probably using Thermal Ionisation mass spectrometry. I do not propose to go into the gory details—I am sure you are glad about that, and I can barely understand them myself. I have worked with them in the past but that was a very long time ago. There are a range of techniques available. They are different to the ones that have been used by other NATO countries to look at the potential levels in their own forces. We think that we need to, if you like, take it a stage further and go for a test which is really capable of doing the work. We are confident that we will be able to have this up and running by the end of the year.

  6. Will it require the purchase of any special equipment?
  (Dr Moonie) The equipment is available in research centres, and one of the reasons why we are conducting a competition, inviting people to do the work for us, is to ensure it is done in the most appropriate location. The equipment is there.

  7. At how many locations will this equipment be located?
  (Mr Baker) Possibly several. I think that would depend on the nature of the test we eventually chose. There are different types of equipment in different laboratories in different academic institutions, and the choice of type of equipment—whether it was Thermal Ionisation mass spectrometry or whether it was Multi-collector Inductively Coupled mass spectrometry—would dictate—

  8. We, of course, understand these terms, but it will take a little time. Would you go over those awkward words again?
  (Mr Baker) Thermal Ionisation Mass Spectrometry or Multi-collector Inductively Coupled Plasma Mass Spectrometry—to name but two of a family of mass spectrometry techniques which we might choose from. Different institutions have different machines and the precise number that was available would depend on the choice we made. One of the factors we have to bear in mind in making the choice is the need to ensure that we can achieve a sufficient throughput of samples to meet the demand of the testing programme.

  9. Thank you. If the proposals in the second consultative document are agreed, how will it be decided which groups of Service personnel should undergo biological monitoring?
  (Dr Moonie) Biological monitoring is looking to future situations where danger may occur. What we will be doing in any future operation is deciding whether there is a depleted uranium hazard present and, then, which of our troops are likely to be exposed to it. You could envisage a situation where only a handful of people were likely to come into contact with it and they would be monitored. Equally, you could envisage a situation where there was general contamination in an area, where you might have to do a much larger exercise. It really has to be tailored to the situation you are going to be facing.

  10. Are you confident that a test for historic exposure to DU, which is sufficiently accurate, quick and cheap, will be available by the end of this year? Will the test be available to anyone who requests it?
  (Dr Moonie) Cheap I am not confident about. Mass spectrometry has always been a very expensive tool, although it is much cheaper than it used to be. They even make them off-the-shelf in my own constituency and export them—smaller versions. So it is much cheaper than it used to be, but the potential could be for quite a substantial cost. Hopefully, the numbers that we are likely to look at will bring the cost down. The main people likely to be involved are the two groups of Balkans and Gulf veterans. If other veterans thought and could show that there was a chance they had been exposed, then we would not exclude them. We would not be looking to include people, for example, who had worked at our test establishment—so Eskmeals or Kirkcudbright—who are already very closely monitored under Health & Safety legislation.

Mr Viggers

  11. You are considering permanent mass testing of armed forces personnel for depleted uranium and other issues. Can you explain how permanent mass testing for depleted uranium would fit into permanent mass testing for all other biological hazards?
  (Dr Moonie) It is a very specific test. Unfortunately, it is not the sort of thing that could be readily adapted for anything else. It will be conducted in parallel. I do not honestly think that mass testing in future is likely to be necessary. We are now much more aware of the effects of DU on the battlefield, and after we have done some of the studies that we are doing over the next year we will be much more so. That will inform the process by which we decide on the risk assessment of conflicts as they arise. What we will probably do is be much more pro-active in future and prevent problems like this arising. So I do not envisage a need for huge levels of mass testing, I must say. If there were, then we would do it.

  12. When do you envisage it would be possible to make a further decision as to whether permanent mass testing would be necessary?
  (Dr Moonie) I think, in the light of the retrospective assessments which we are going to be doing and the biological monitoring which we are extending in the Balkans, that will give us enough information—plus whatever information comes out of the Gulf—to decide on what the normal parameters are. The behaviour of uranium is fairly well understood. There are very strong theoretical predictions of how it will behave, and so far these have been absolutely borne out in practice. So I am confident that the need for generalised testing is not going to arise; it is much more likely to be specific groups of people who are actually exposed directly to the hazard.

  13. The consultative document asks for views on the use of a possible Veterans' Assessment Centre. What role do you envisage for it?
  (Dr Moonie) The GVIU (Gulf Veterans' Illnesses Unit) has developed over a period, and what we are looking at now is how we develop in future. It is very much a concept just now; we have not much in the way of hard data to give you on it. It is something we are, really, only beginning to discuss. Some of my own ideas, for example (which will not necessarily be dear to your own heart), might be that a suitable site for it might be at the new Centre for Defence Medicine in Birmingham. It would build on the work that the GVIU has done and is doing, and extend it into other spheres.

  14. Since you have trailed your coat in that manner, Dr Moonie, I have to point out that the Haslar Hospital, obviously, would be very suitable as a site as well.
  (Dr Moonie) I shall certainly keep that in mind.

  15. How would the Veterans' Assessment Centre compare with the Gulf Veterans' Medical Assessment Programme at St Thomas's Hospital? Would there be comparisons?
  (Dr Moonie) It is a specifically targeted programme. I think that, again, it is very much a conceptual thing. I would see it as providing an expert focus to answer the individual concerns as they arise, with the medical back-up available to do whatever examination or testing would be needed. What we are trying to do, again, is to put into place a system which will allow people easy access to information. If they are worried about an issue they can pick up a 'phone and talk to someone about it to have their concerns allayed immediately and not have it just pushed off or postponed until a massive problem arises.

Mr Brazier

  16. Could I, first of all, ask you—to bring a particular name into it—whether you have taken evidence from Dr Doug Rokke, who has figured in the UK media and also addressed a couple of private meetings here? He commanded the American reserve army unit which cleared up the mess after the Gulf War and has himself been treated for cancer several times. A number of people in his unit have died of cancer. Have you received any testimony from him or not?
  (Dr Moonie) Indirectly I am familiar with some of the statements he has made and the claims he has made. I have not directly met him.

  17. One of the central points he made in an informal presentation here was that the people who are most at risk are not the people who participate in the battlefield, and that studies done across very large numbers of people are not necessarily going to produce an interesting result. It is the people involved specifically in handling the aftermath who are most at risk because of the very short distances which you alluded to in your testimony. Are you doing any kind of testing that focuses specifically on the relatively small category of people who were handling the debris of war afterwards in either of the theatres you are looking at?
  (Dr Moonie) The retrospective assessment which we are carrying out would, certainly, I think, pick up anybody who had been directly exposed. That is part of the general history taking of good medical practice. If any sub-group arises which shows higher levels than one would expect or levels which give rise to any concern they will be investigated in detail. I can guarantee that if that proved to be the case and people had been involved in going in the tanks, on the battlefield or in cleaning things up, they would be picked up.

  18. Forgive me, you are a qualified medical doctor. I, for my sins, was once a professional statistician and Doug Rokke is a scientist. We all know that it is how you categorise the sub-groups in advance, when you look for tests; you cannot pick them up afterwards as a result of the tests. If you have got, in among a very large sample, a small group among whom there is a higher incidence, if you are sampling across the group as a whole you are not going to pick them up unless you have identified that group first and sampled them secondly. Are you?
  (Dr Moonie) I think you are talking about aggregating data. That is not what is proposed here. We are testing, so every individual result will count as an individual result. It is perfectly recognisable that if certain people within a population who you are testing show up with higher than expected results you then look at all the individual data and see what factors—

  19. Cross-correlate.
  (Dr Moonie) —if any, these people have in common. Cross-correlate. So it is perfectly possible to pick out the at-risk groups. That will certainly be a factor. I can guarantee that is one of the factors we will be looking at.

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