Select Committee on Defence Minutes of Evidence

Examination of Witnesses (Questions 60 - 69)



Dr Lewis

  60. Given the findings of the University of Manchester study that Gulf veterans do suffer more ill health than service personnel who did not go to the Gulf and the accumulated findings of research already published, on what issues will the MoD now focus in seeking to understand the health problems of Gulf veterans and in trying to help sufferers to deal with their symptoms?
  (Dr Moonie) There are two points there. One is on what we are actually doing in the way of investigating illness. For my own convenience, I jotted down from the vast array of notes I have a list of the research projects which are taking place, because I can never keep more than half a dozen things in my head on the subject at any one time. There are 12 studies ongoing just now. I may have missed one or so but there are a dozen studies which will report over the next year. They will provide us with a huge array of data. A bow wave of knowledge, if you like, about this is about to produce results. For example, the follow-ups to the original King's study, looking at medical and clinical investigations of the group and the longitudinal study on health experience of veterans which we are doing ourselves and which will provide us with information. You might be familiar with all the studies but it is quite an interesting list and a huge range: neuromuscular function, reproductive history, studies on pesticides, on organophosphates, vaccine interactions in animals, looking at the evaluation of outcome of studies like the PTSD group, case study reports which are ongoing from all the people that we see at GVIU, the road traffic accident deaths and studies on DU. At our next meeting, should I be on the other side of the table or should any of us for that matter, we will have some very interesting findings to look at. There is a huge volume of research taking place at present which, over the next nine months or so, will provide us with a great deal of further information. Sadly, it may all be negative. We are left then again with the situation where we have many people who are suffering as a result of the symptoms they have and for whom we can produce no convincing aetiology and who therefore we have to look to treat, largely in a sympathetic and symptomatic manner. Symptomatic treatment where there is no identifiable cause is all that is available to us. I do not like that as a doctor but I have to accept it.

  61. I am glad you referred to your medical background because, drawing on your own professional expertise, would you agree that one of the problems when somebody is suffering from a perceived malady is the feeling that they are not getting the chance to put their case properly and their case is not being taken seriously enough? Are you satisfied—you used the word "sympathetic" in your answer, I think—that the manner of the approach which the MoD is taking towards these people, who clearly genuinely feel that there is something seriously wrong with them, is sufficiently sympathetic, that at least they feel they are getting the opportunity to present their case in full and that it is not that their case is going to be heard by default, because that is terribly important from a therapeutic point of view.
  (Dr Moonie) I think the assessment unit at St Thomas's has shown that, as it has developed. We have done studies of people's attitudes to it and well over 90 per cent of people express satisfaction. It is somewhat anecdotal, with individual cases where people phone and say they have been reassured by what they were told.[3] A sympathetic ear, even if you cannot immediately alleviate the illness, is vitally important, in the same way as they are entitled to a sympathetic ear from ministers as well. It does not always mean that we will be able to agree on everything we are doing but they should certainly be listened to where people have serious concerns and we are unable, despite the enormous amount of time, effort and money we are spending now on research, at present to give them a reason for what they have. That uncertainty I think as much as anything is one of the things which really upsets people. They want to be convinced; they want to know what it is. Nobody likes having unexplained symptoms. We cannot at present give them an answer but we will try.

Mr Brazier

  62. What evidence do you have to show that Gulf veterans suffering from Post Traumatic Stress Disorder are being successfully treated under the arrangements you have put in place? To what extent are veterans' organisations consulted about the arrangements and to what extent are they happy? You say that 90 per cent of the people were happy as individuals. Have the organisations expressed satisfaction with the shape of the treatment?
  (Dr Moonie) The PTSD group is a sub-group obviously for the people that we are looking at. We were not satisfied after a review a couple of years ago with the speed at which they were accessing treatment. We therefore brought in a method whereby they would be referred to experts in the field. That is happening now. They are being seen within the time that we are suggesting. As regards whether the treatment is successful, at present we do not know and we are going to conduct another study to look at the first 80 or so people who have been referred for specialist treatment to find out from them what the outcome has been and whether they are satisfied with it. PTSD is a very difficult condition, as you know, to manage effectively. There is a huge debate within the medical profession as to whether it should be treated by specialists or treated within the general psychiatric population. Some psychiatrists believe in the one and some in the other.

  63. I thought the balance from the Falklands was very strongly that it should be treated within a military context rather than as part of something wider. There is quite a lot of evidence from the Falklands of people recovering from both physical and stress ailments if they were treated in a military context rather than being dispersed into a wider civilian population, for rather obvious reasons.
  (Dr Moonie) I think it is fair to say that our management of people within the military context is very much better than it was, both from the point of view of informing people before campaigns of what they are likely to meet and debriefing them within the theatre and their management afterwards. Some will still slip through the net of course and these are largely the people we are looking at just now.

  64. Netley went several years ago now, I suspect under our government. Is there a specific military focus now for treating mental health in a military context or not?
  (Dr Moonie) Yes. We have a system in place now to conduct a proactive look at this, to try to prevent it arising. We do not really have enough information at present to be able to say how successful that is but every campaign that we deal with will produce further results and further validation. We have enhanced our psychiatric capability within the armed forces. We do recognise that it probably is better to treat it as quickly as possible and within a military context where we can.

Dr Lewis

  65. You have already partly touched on this. Are you getting more positive feedback now from Gulf veterans on the Medical Assessment Programme and other MoD provision for them than when this Committee took evidence from their representative organisations in December 1999?
  (Dr Moonie) The hardest evidence we have is from the Medical Assessment Programme itself, where we have conducted a survey and shown that in general there is a high level of satisfaction with it. If any specific problems are seen to arise, we can deal with them. We have provided an alternative assessment centre in Northallerton for people who cannot get to St Thomas's. That was in response to concerns. We are being responsive. I do not go out to see how we are doing on a regular basis. Perhaps that is something which will develop as the role of the Veterans' Minister develops. I genuinely believe that much closer contact, involvement and inclusion of veterans in decisions that are made on their behalf will aid this process in the future. Generally speaking, while I am quite sure that there are still individual dissatisfactions, overall the level of satisfaction is reasonable in the circumstances.

Mr Cann

  66. Has the MoD's change of policy on DU testing had a beneficial effect on relations with Gulf veterans?
  (Dr Moonie) It is very hard to say, as I think I said at the start. We have had no great body of negative responses to the consultation documents. By and large, the responses were favourable. I do not yet have the responses to the second consultation to hand. This is perhaps an assumption I am not entitled to make but I think it is reasonable to believe that in the absence of protest there is at least no dissatisfaction. "Satisfaction" is maybe too strong a word to use without having asked them.


  67. There was a paper published by Guy's, King's and St Thomas's Hospital School of Medicine to coincide with the tenth anniversary of the end of the Gulf conflict. They found that the balance of evidence is against there being a Gulf War Syndrome but that "Gulf service has affected the symptomatic health of large numbers who took part in the campaign." Do you have any observations on that statement?
  (Dr Moonie) I would generally have to agree with it. At present, we have not identified a single syndrome despite all our efforts. That is why our research is proceeding in so many branches, to try to find if there are any sub-groups within it, where we can find a direct cause for it. In terms of the volume and depth of research that has been carried out, not just here but in the United States as well, we have to assume that there is no single syndrome.

  68. In addition to seeking to address the existing health and welfare problems of Gulf veterans, we would hope that all the research which the MoD has carried out would lead to better preventive measures being put in place to minimise health problems arising from future conflicts, not least because of the willingness of some servicemen to go to lawyers. Can you give us some examples of changes in practice which have already been adopted as a result of lessons learned from the problems faced by Gulf veterans?
  (Dr Moonie) Yes. We have learned lessons from the past. We continue to learn them. We will certainly apply them in the future and to a very large extent we are applying them just now. First of all, on medical record keeping, we have brought in a new medical record which will provide much more comprehensive data on health experience and history of soldiers and other servicemen in conflict. We have introduced a much more open policy about involving people in the decisions that are made on their behalf. For example, we are reintroducing the anthrax vaccine. That has been extensively discussed with those who would wish it adopted, very openly telling them what it involves, the reasons why they are being given it and all the rest of it. There is a general presumption that we will be open and discuss things with our men and women, not just all the time tell them what is good for them. It is far better to be inclusive and bring them along with us. We are at present and will certainly in the future be much more comprehensive in the operational records that we keep in theatre, details of potential hazards which may occur and which other armed forces were involved with them. Again, that will produce benefits in future conflicts. I have already referred to the fact that in Kosovo we give very detailed briefings on DU and other health hazards. This again is a feature of the information which we give people. The new Muster Centre at Chilwell for reservists[4] being sent to join our forces will provide a very good focus for both military and medical and general information acquisition so that people are much more aware of what they are going into and what they can expect. We are now conducting much more intensive debriefing of potentially serious incidents, of what people think has happened—for example, if they think that they have been subjected to a biological or chemical hazard. These complaints would be taken seriously and would be properly dealt with. More importantly, the awareness of the long term hazards of deployment and the way in which we are trying to prepare people better for what they are likely to experience. It is slightly conjectural at present because we do not know how effective it is likely to be. It is only in the future, looking back over what we are doing now, when we will be able to tell whether it is effective or not. We believe that being more open with people, telling them the type of things which they are going to experience, perhaps in future trying to identify the subset of people who are likely to suffer stress reactions to deployment and trying to deal with that in different ways. There is a wide variety of things which we are doing at present. We would look to expand on them in future as well.

  Chairman: This has nothing to do with the subject at hand but, as you are the last Minister who is going to talk to us, Mr Brazier would like to dump on you a problem to pass on to your colleagues. It is something we have already raised within the Defence Committee.

Mr Brazier

  69. The Chairman has on earlier occasions raised the issue of postal votes for servicemen. I apologise that I only had notice of this this morning. I have the Royal Irish Rangers in my constituency but oddly enough the report came directly from the Province and I have not had time to check with them how widespread the problem is. The report told me that postal vote forms which are out of date have been issued to a large number of Irish servicemen. The chief electoral registration officer in Belfast has moved only to just round the corner but the effect of this has been that allegedly hundreds of postal vote forms have been opened and, in the course of opening, of course the address has been revealed of the soldier sending it and sent back to them with "Not known at this address". As a result, they are both losing their vote and having their private addresses revealed. I do not have any vested interest in this. By definition, a postal voter in my constituency is not someone with the option of voting for me or not, as he chooses, but could I possibly ask you to investigate this because I think the closing date for postal votes is only just over a week away?
  (Dr Moonie) I shall certainly do that today.

  Chairman: Thank you. The evidence, Minister, that you have given today will be on the House of Commons Defence Committee website tomorrow. We will be producing a hard copy next week. May I say, without seeking to be patronising and not suggesting in any way that any Gulf veterans here would agree with everything you have said and without wishing to provide you with a paragraph in your election address, I have been very impressed by your command of your brief. I can see why you were appointed to this role. Perhaps you run the danger of staying in the Ministry of Defence which would in no way be a bad thing. I am sorry but because of your command of your brief Mr Baker's role has been almost superfluous. I can assure you in future that you will have ample scope, whatever advice you are giving, to join in very frequently. With those final remarks of this Committee, thank you, Minister, and we hope you can come to our beano this evening.

3   Note by Witness: 275 individuals have completed detailed user satisfaction questionnaires. 95 per cent of these indicate they are satisfied with the MAP service. Back

4   Note by Witness: The Reserve Training and Mobilisation Centre, Chilwell Station, Chetwynd Barracks, Nottinghamshire. Back

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