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Disqualifications Bill

Brought from the Commons; read a first time, and to be printed.

Gulf War Veterans: Illnesses

8.6 p.m.

Lord Morris of Manchester rose to ask Her Majesty's Government what further consideration they have given to setting up a public inquiry into the undiagnosed illnesses of Gulf War veterans, as called for by the Royal British Legion.

The noble Lord said: My Lords, I have an interest to declare, but not a financial one, having been honorary Parliamentary Adviser to the Royal British Legion for many years; nor does my membership of the Inter-Parliamentary Gulf War Group, which has a keen interest in the outcome of this debate, have any financial implications. Other members of the group, ably chaired by Colonel Terry English of the Legion, include the noble Countess, Lady Mar, and the noble Lord, Lord Burnham, Michael Mates MP and Paul Tyler MP; representatives of the ex-service charities; Major Ian Hill and Flight Lieutenant John Nichol from the veterans' associations; and senior doctors and nurses. Inevitably my approach to this debate is influenced also by my upbringing as the son of a war widow and by active service in the Middle East during my own years in the forces.

This evening's "cast"--as it were--has changed since the previous debates I initiated on Gulf War illnesses; but the purpose of this further debate is the same as before. It is to seek due priority for the claims of men and women who were prepared to lay down their lives in the service of this country in the Gulf War and the dependants of those who did so.

The noble Earl, Lord Effingham, who, with his customary quiet authority, spoke with such distinction in the debate I opened on 24th March 1999, is sadly no longer in the House. Many of us hope to see him return to the Cross Benches, informing our debates on the problems and needs of the ex-service community as he did so often and so effectively over recent years. The noble Lord, Lord Burnham, who is abroad, was kindly in touch before he went to let me know how sorry he was not to be able to join us again this evening; and no

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doubt my noble friend Lord Gilbert, whose concern and courtesy in replying for the Government to so many previous exchanges on the problems and needs of Gulf War veterans were much appreciated, will be looking with some nostalgia on our proceedings this evening.

Meanwhile, I welcome his successor as Minister of State, my noble friend Lady Symons, who I know will want to respond as helpfully as she can to the debate; and I am grateful to her for sending me the three MoD papers published on 20th January. One reviews the available evidence on the suggested exposure of UK forces to chemical warfare agents in Al Jubayl on 19th January 1991; the second is a report on the implementation of the anti-biological warfare immunisation programme during the Gulf conflict; and the third is the MoD's response to the audit of the Gulf Veterans' Medical Assessment Programme. The Legion, having also received the three papers, states:

    "They are, of course, welcome and helpful, up to a point. But they add little to what is already known. Their contents would form a valuable source of evidence for the public inquiry".

My Lords, I agree.

I appreciate of course that my noble friend the Minister, like her ministerial predecessors who spoke for the Government in earlier debates, has the difficulty, when she comes to reply, that the Ministry of Defence is not the only department with an interest in Gulf War illnesses. Among other departments, the DSS and DoH also have an interest, as does the Treasury, which is why the Legion pressed for an inquiry at a level which would call for appointment by the Prime Minister and not by any departmental Minister.

In seeking the inquiry, as Brigadier Ian Townsend, the secretary-general made plain, the Legion was,

    "very conscious that in the United States a Presidential Commission was established very soon after the conclusion of the war",

and that a public inquiry of comparable standing here,

    "would be providing our veterans and service people with no more than parity of treatment".

This year marks the 10th anniversary of the Iraqi invasion of Kuwait that triggered the Gulf War. Thousands of the men and women we deployed, then fit and well, now have to live with debilitating illnesses, some very severely disabling. Of the 413 veterans who have already died, 67 took their own lives, with devastating consequences for their families.

Thus no one can argue that the Legion acted precipitately in calling for a public inquiry into all aspects of the handling of the Gulf War illnesses. It did so in May 1998, in a motion that was unanimously approved by its annual conference, to which the Prime Minister was asked to give urgent effect. It took over 16 months for a response to come, in a letter rejecting the call for an inquiry from my honourable friend John Spellar MP, the Minister of State for the Armed Forces, to whose predecessor at the Ministry of Defence the Legion's representations to the Prime Minister had been referred.

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Reacting to this in a letter to me dated 11th November 1999, Ian Townsend said the rejection of the motion had caused,

    "considerable bitterness among Gulf War veterans".

He added:

    "Indeed the Legion membership, as a whole, will be angered by it".

He went on to ask me to appeal to the Prime Minister to reverse the decision; and I did so in a letter to my right honourable friend dated 16th November. My letter emphasised the strength of feeling in the ex-service community, made it clear that the Legion wanted an inquiry that would go wider than the responsibilities of any one department and pressed for reconsideration of the decision conveyed in John Spellar's letter. To date there has been no reply.

For the Secretary-General of the Legion to write in terms of "bitterness" and "anger" is not only unusual. In my experience, it is unprecedented; but Ian Townsend's letter to me of 11th November in no way overstated the strength of feeling among Gulf War veterans--many of whom talk of being treated by Whitehall as "yesterday's people"--or that of the Legion membership more generally.

They argue that an urgent, independent and wide-ranging inquiry is imperative not only in fairness to those afflicted, but to restore public confidence and demonstrate to our armed forces that they will be thoroughly prepared and protected in future deployments. The Legion membership wants past mistakes in the handling of post-Gulf War treatment of veterans to be investigated by the inquiry:

    "working concurrently with the scientific and medical studies to minimise further delay".

The inquiry they seek would be empowered also to look into complaints about the setting up, funding and progress of these studies; to compare them with the much more urgent and comprehensive studies prompted by the Presidential Commission in the United States; and to examine the extent to which failures in the MoD's Medical Assessment Programme, MAP--which I know the noble Countess, Lady Mar wishes to address--have alienated and demoralised many veterans.

The inquiry could examine as well questions raised in parliamentary debates that still remain unanswered. For example, I asked in previous debates how many of the Gulf War veterans who had committed suicide since the conflict were service men and women with post-traumatic stress disorder and how many, successfully or otherwise, had applied for a war pension for the disorder. That question remains unanswered, as does the point I made in the debate on 24th March 1999 about the failure of MoD's report on the use of depleted uranium to attempt any estimate of the combined and interactive effects of exposure to depleted uranium and of all the inoculations and injections that were administered to those who served in the Gulf.

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Other important questions raised in parliamentary debate that remain unanswered include one put to me in a helpful note from the noble and gallant Lord, Field Marshal Lord Bramall, before the debate on 24th March 1999--namely,

    "Why tests were not done as soon as possible after the conflict into the effect of the cocktail of inoculations and injections given to our service men and women who went to the Gulf, all administered at the same time, on the human immune system. Or why if tests were done the results have never been published?"

No less disturbing are the long delays in replying to representations about the cases of Gulf War veterans made by letter. My noble friend wrote to me on 6th December 1999 about the case of Justin Harvey, who lives in Stoke-on-Trent. Her letter was in a reply to representations I made on 8th June. The delay of six months in replying was not the fault of my noble friend; nor I suspect was it that of her immediate predecessor. In fact long delays in dealing with representations for Gulf War veterans were common before the present government took office. The fault seems deeply rooted in flawed administrative arrangements for dealing with veterans' complaints. Nevertheless, the average time taken to deal with them by the MoD and DSS alike alone warrants an inquiry.

Again, the inquiry The Royal British Legion is seeking could establish why service men and women have not been given copies of their medical records on discharge to assist their GPs in the early diagnosis of illness that could be attributable to their service. It could address also serious questions about the consequences for individuals of lost or incomplete records, could identify culpability in past cases and could consider changes in current procedures for keeping records.

I have had assistance in preparing for this debate from Dr Peter Heaf, the Legion's highly respected medical adviser. His first concern is that we must learn from experience in the Gulf War if our forces are to be made safer in future deployments. He asks whether Ministers are aware of developments in the US in relation to their Centres of War Related Illness, which concentrate on exposure information, on clinical examination, on education and, perhaps most important of all, on the assessment of risk factors prior to deployment.

Dr Heaf is concerned also about failure to publish the report of the fact-finding team set up in September 1997 to look at the implementation in theatre of the 1991 programme of immunisation; the absence so far of any report of the evidence taken from representatives of Gulf War veterans by the Defence Select Committee; and failure to make clear whether any research has been undertaken to investigate the extent to which the effects of vaccines, pyridostigmine bromide--NAPS--and OP pesticides can change when they are administered to service personnel under stress.

Among the most memorable personal recollections of the Gulf conflict I have read is one on the effects of setting Kuwait's oil fields on fire. The recollection is that of Squadron Leader Philip Congdon of the RAF, as he then was, who led the training team sponsored by

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the British Government that went to Saudi Arabia after the invasion of Kuwait to train expatriate Saudi Arabian military and civil defence personnel in chemical and biological warfare defence. He writes:

    "Everybody who was present in the Gulf will remember the smoke cloud generated after the oil fields were set on fire. The result was not a fog but rather the pollutants, held by ugly thick smoke, which rose into the atmosphere producing a dirty sable black dome that extended from horizon to horizon over Kuwait and often drifted well into Saudi Arabia. Within this dome a mist of oil particles would occasionally precipitate. We now know that the atmosphere was saturated with pollutants of the most profoundly life-destroying type".

But what research has been done on the health effects on British servicemen and women of releasing into the atmosphere--which is what the burning of six hundred oil wells achieved--of 50,000 tons of sulphur-dioxide, 100,000 tons of soot and 85,000 tons of carbon-dioxide every 24 hours? Air samples detected the presence of carbon monoxide, nitrogen oxide and polycyclic aromatic hydrocarbons, together with benzine, cadmium copper, molybdenum, nickel, lead, vanadium and zinc in "above average" concentrations? Squadron Leader Congdon describes what happened as,

    "passive smoking of the most deadly type",

and it was shared with the Kuwaitis and Saudis by British personnel. Anyone who thinks exposure to pollution on that scale was but a passing inconvenience for those affected by it ought to speak, as I have done, to public health officials in Kuwait. After visiting Kuwait and talking at length with Ministers there, including the Minister of Health, I was left in no doubt that much could have been gained from increasing our knowledge of the effects of the Gulf conflict on public health in Kuwait. I hope my noble friend will comment on this when she comes to reply.

My noble friend Lord Gilbert was always most helpful after previous debates in pursuing with the DSS cases that were raised from both sides of the House of Gulf War veterans with undiagnosed illnesses who were in dispute with the War Pensions Agency. I shall be grateful for any help my noble friend Lady Symons can give in having urgently resolved some especially disturbing cases of which I shall let her have details. Taken together, they are described by the RBL as,

    "nothing short of shocking".

There is time for me to cite but one case tonight--that of a man from Leigh in Greater Manchester, who served in the Gulf with 2 Field Regiment RA. Such has been the deterioration in his health since the conflict that he is now subject to severe depression, panic attacks and acute breathing difficulties. On two desperate occasions he has tried to end his own life. His wife has to remain at home to care for him and they now rely totally on state benefits, including both the care and mobility elements of Disability Living Allowance.

Four independent psychiatric and medical assessments have been sent to the War Pensions Agency, confirming post-traumatic stress disorder in

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this case, including two from Dr Nick Cooling, of the Combat Stress Centre at Audley Court, and Dr Malik of Leigh Infirmary. Where a Gulf War victim is already in such poor health--with job prospects described as between "minimal and non-existent"--surely it is right that an appropriate award should be made without further delay.

None of us here, wherever we sit in this House, wants to see those afflicted in the Gulf made to suffer the added strain and hurtful indignities that long delay in dealing with their rightful claims can impose. There was no delay in their response to the call to duty. Nor can there be any excuse for preventable delay now in meeting in full our debt of honour to them. That is what the Royal British Legion's work for them is all about and it is much the best way of showing our regard and admiration for those who served us with such gallantry in the Gulf War 10 years ago.

8.22 p.m.

Baroness Park of Monmouth: My Lords, we all owe a great debt to the noble Lord, Lord Morris of Manchester, for enabling us to talk yet once more about this immensely important subject.

The noble Lord, Lord Robertson, when Secretary of State, wrote in his preface to the MoD paper, published in July 1999, Defending against the Threat of Biological and Chemical Weapons, that to know what the biological and chemical weapons threat is, how to reduce it and how to protect against it, is

    "a constantly developing process to which we are firmly committed".

He added that he regarded it as one of his highest priorities. That the MoD accepts that the continuing, and as yet unresolved, problems of the Gulf War veterans form part of this process is confirmed by the inclusion of the MoD Gulf War Veterans Illness Unit Internet site among the major source references quoted in the paper. It is indeed vital for the MoD to learn from its failure to talk to the veterans at a far earlier stage. They, after all, were there.

Why then, nearly 10 years after they were exposed to biological and chemical attack, are the Gulf War veterans still denied recognition of their illness and still denied in many cases the pension and benefits to which they are entitled? Successive governments have, under pressure from the noble Lord, Lord Morris of Manchester, the redoubtable noble Countess, Lady Mar, and indeed the Royal British Legion, produced papers such as Gulf War Veterans Illnesses: A New Beginning in 1998. That was indeed a significant paper and a milestone on the way. Unfortunately, not very much happened after that.

Under pressure governments have instituted research, but, again, only after a long delay. We have had the MoD's Medical Assessment Programme--MAP--launched with grossly inadequate resources--Group Captain Coker and one other, and eventually Group Captain Coker on his own--in 1996, then resumed in 1997 and 1998. We had the King's Fund Survey which did a management audit of MAP, and

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we had research by the Medical Research Council, both begun under the previous government. There followed MoD funded epidemiological studies into the health of Gulf War veterans in general. One at Manchester University was due to report in mid-1999. Can the Minister say whether it has been published. Another was by the London School of Tropical Medicine.

In March last year we were told that by then about £2 million had been spent in research into Gulf War illness, and the Government expected the research programme to cost a total of £5.9 million. Yet all this time after the Gulf War, the veterans are still waiting for what I can only call the barest basic justice. By March last year 381 were already dead--I was shocked to hear how many had committed suicide--and those alive are still struggling just for recognition that they are ill. Those illnesses, in their various painful and debilitating manifestations, arose from their service. Still after all this time they are struggling for pensions and benefits.

The Minister told us in March last year that the Government had appointed two new doctors to the Medical Assessment Programme, presumably as a result of the management audit. In view of the appalling state of the grossly underfunded, undermanned Defence Medical Services in general, we should be grateful for that if these had been consultants, or even partly conversant with the medical and other conditions from which the veterans suffer. However, the accounts we had in debates both in 1998 and 1999 of the treatment meted out to some of the veterans by these two MAP doctors, who were said to have dealt with some of them as if they were malingering wimps and to have refused to look at their records, suggests that these may have been doctors with no specialised knowledge whatever. At least one was said to be under instruction not to offer the veterans treatment as that would create a precedent. How does that square, I wonder, with the MoD commitment, set out in the paper on Gulf War illnesses, that MAP would work with the Department of Health on this very thing? We were told, incidentally, that MAP costs £750,000 a year to run. Has that been cut?

Those men and women and their families have a right to be treated honourably and fairly. Long overdue and protracted research has demonstrated that they have real and serious health problems attributable to their service, which are exacerbated by the stress of needing to fight to be believed. They are dying off year by year and must by now have lost hope of decent treatment. As the noble Lord, Lord Morris of Manchester, said, there have been suicides in that small group. They must look with envy at the US Government's very different record. I hope that the Minister will tell us whether our continuing exchange of information with the Americans has had any useful practical results.

The main issue now is how to get the War Pensions Agency, the Department of Health and the DSS to do what is needed and to do it quickly; and how to secure treatment when the need for that is demonstrated. The

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veterans have always said that they do not want to litigate but simply to be able to have their claims recognised and to receive the benefits to which they are entitled. That must happen and be seen to happen without delay. I shall turn later to possible action to achieve this.

There is, however, an important issue of justice and good governance which calls for a thorough and immediate public inquiry into the performance of the War Pensions Agency, the DSS and the MoD, an inquiry which we were told last year would be considered. Since I wrote my speech, I have heard from the noble Lord, Lord Morris of Manchester, that that has been turned down. I had not realised that. We know, alas, from the Organophosphate Pesticide Investigation Team's report of 6th December 1996--OPIT--that there has been over years serious incompetence, muddle and bureaucratic delay in various places, and that standards of professional competence have been low. Evidence to the Defence Committee confirmed that as far as concerns the MoD. I do not know whether the other two departments have been called to account.

It would be reassuring to know whether, after the formal reprimands were administered, action was taken to ensure against any repetition of such incompetence as the "failure in medical record keeping" which led to the loss of over 15,000 medical events. These, as the MoD admitted to the Defence Committee, included data relevant to some of the Gulf War veterans. Because the events could no longer be attributed to the individuals concerned, this may well have deprived them of important evidence needed for the preparation of their case.

But is the real problem a subliminal but nevertheless well-understood policy of delay dictated by the termites in the Treasury, designed to delay payments as long as possible? Time is passing; some claimants are dead, others may weary of the battle. Can we allow that to happen? We have to consider how the veterans perceive the matter.

The Government should understand clearly that there is a major issue of confidence here. Morale in the Armed Forces, thanks to a combination of overstretch and under-manning and of covert financial cuts, is at an all-time low. Men and women of the forces will be watching to see what treatment the veterans receive. They have seen the Defence Medical Services cut to the bone. Now they see how they can expect to be treated in the aftermath of war. This is the kind of issue which could constitute in their eyes one more reason for them to leave the services--and they are not short of reasons at the moment. They can scarcely be encouraged by what they see in this case.

What we need to do is look at the delivery of pensions, benefits and treatment. As long ago as March 1998 we heard of long waits for pensions and were told that although, allegedly, 219 pensions had been granted out of 425 claims, in fact, according to the solicitors working for the veterans no case had (at that time) yet been settled. The Minister undertook in

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our last debate to look at the interface between the MoD and the War Pensions Agency. The difficulties and delays have continued.

I said on a previous occasion that I hoped there were no more unexploded time bombs of unrevealed mistakes, and I hope that the OPIT report did find all there was to be found. I am the first to understand the importance of "need to know", but it should never be used to protect incompetence at the expense of the victims of that incompetence--in this case, people who have fought for their country. I understand the pressures on many public servants, but I am concerned at the way, often insensitive, in which the veterans are sometimes treated, and the time that it took to act. Why were they not consulted long ago, when they first began to say that they had problems?

Research is necessary, of course, and it takes time. I recognise that public money cannot be spent without good foundation. But that has been amply proved and re-proved. It should have been undertaken much earlier. Now, we have to get on with it. I recognise that the Government have tried to repair the fault. Nevertheless, there is much to do.

A public inquiry may be the only way in which justice can be seen to be done. But I hope that its chief task would be to establish effective machinery immediately to secure action in the field of pensions, benefits and treatment. I should not like to see a long drawn out inquiry which succeeded only in kicking action into the long grass and finding scapegoats. That was done by OPIT to some extent.

There is now a Gulf War unit in the MoD. I suggest that similar units should be set up in the War Pensions Agency, the Department of Health and the DSS respectively, to which all Gulf veterans' cases could be directed for action in conjunction with the MoD as necessary. Incidentally, this issue has arisen in previous debates in which the noble Countess has spoken where there has been an overlap on organophosphate issues between the Department of Health and other departments. So there is a precedent. Those appointed should have proper powers to act within their ministries along agreed guidelines, and there should also be an independent ombudsman to whom veterans could appeal if they still encounter obstruction and delay. After 10 years of waiting, and of research and consultation, there should be no need for any further bureaucratic delay and it should not be tolerated. I am not talking about a consultative machinery, but about powers of execution. A point of appeal will also be necessary, with sufficient power to secure speedy action.

I hope that in this case, since it was the Prime Minister to whom the appeal for an inquiry was made in 1998, he might be asked to think again, and to make it absolutely clear to the relevant ministries that, in the old and honoured phrase, action this day is required of them, and that joined up writing, to use the present phrase, is the order of the day. Action is required of them, and on this occasion at least the Prime Minister must make sure that the Treasury does not have the first, last and only word, or at any rate the wish to save

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the public purse above all else. Men and women are valuable resources too. We cannot afford to under-value them. Nor can we afford to lose their trust in us.

8.34 p.m.

The Countess of Mar: My Lords, I am grateful to the noble Lord, Lord Morris of Manchester, for his timely tabling of this Question. I am also delighted to follow the noble Baroness, Lady Park, who has such wide experience of the internal workings of Whitehall and government and speaks with such knowledge.

I declare an interest in that I am patron of the Gulf Veterans Association. Noble Lords may not be aware that I became interested in the plight of Gulf veterans when in 1993 they began to report their symptoms. I was struck by the remarkable similarity between their illnesses and those of sheep farmers who had become ill after exposure to organophosphate sheep dips. I still believe that there is a connection between the illnesses of the veterans, anticholinesterase pesticides and medication, although I do not believe that they are the only cause.

Not only is there a similarity between Gulf veterans and sheep farmers: no one who has been associated with either or both of these groups for any length of time can have failed to notice that the two government departments responsible for commissioning research into the causes of the illnesses have mirrored each other in their dilatory management of the problems. At first the sufferers were all wimps. Then there was no evidence that any of the factors to which either group attributed their symptoms was unsafe. I found myself repeatedly reminding those who looked only at current evidence of Toyber's Dictum:

    "Absence of evidence is not evidence of absence".

Those men and women, many of whom were reservists or members of the Territorial Army, responded to the call to arms in the belief that their country would care for them if their health should be harmed as a result of their service. Instead, they have found that, following the Gulf conflict, they have had to fight inch by inch to convince the Ministry of Defence that their illnesses are real, that they are not the result of post-traumatic stress disorder or of psychological origins and that they do have an organic cause.

As the noble Lord, Lord Morris, said, the Royal British Legion originally wrote to the Prime Minister to ask for a public inquiry into Gulf War illnesses on 11th June 1998. Despite a number of reminders, it was not until 26th October 1999 that a reply was produced. I was astonished to find that the decision not to hold a public inquiry had been delegated to the Minister for the Armed Forces. It may help if I read the first sentence of the letter from the British Legion. It states:

    "At the Royal British Legion Conference in Blackpool on 24th May, delegates unanimously passed a motion calling on you, as Prime Minister, to commission a public inquiry into the way in which the aftermath of the Gulf War has been handled".

Brigadier Townsend went on to detail the reasons for the request.

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In his response to the letter, the Minister for the Armed Forces, Mr Spellar, begins:

    "In June 1998 you wrote to the Prime Minister requesting a public enquiry into aspects of Gulf veterans' illnesses".

My Lords, he did not. That statement was disingenuous, to say the least. In his penultimate paragraph, Mr Spellar states that he has,

    "considered very carefully this issue and concluded that a public enquiry will simply not be able to answer the question of why the Gulf Veterans are ill".

He made no attempt to address the questions posed by Brigadier Townsend.

Surely, in view of the fact that the Prime Minister and the Secretary of State for Defence could have been in no doubt as to the scepticism with which the Gulf veterans viewed the actions of the Ministry of Defence, an independent person should have been brought in to make the decision. I ask the Minister: why was that not done, and was it even considered?

This week sees the ninth anniversary of the end of the air war and the start of the land war in the Gulf. It is at least eight years since veterans started to complain of unusual illnesses. Some 428 (here I correct the figure given by the noble Lord, Lord Morris) young men have died from diseases associated with their service in the Gulf or have committed suicide. In all that time only one research programme has been completed. That was an epidemiological study funded by the American Department of Defense which found that Gulf veterans did have a higher level of reported symptoms than the control groups but carried with it the inference that they were more likely to be of psychological than organic origin. Subsequently, the same research group has been funded to conduct neurological studies on the veterans. The group would appear to be in some difficulty, as I understand Professor Wessley has recently informed the US Department of Defense that few subjects have come forward for further examination and, as a result, he believes that the British Gulf veterans must have got better. I wonder whether he has considered alternative reasons for their lack of response.

I am sure we all acknowledge that trust is an essential ingredient in any doctor/patient relationship. When the Medical Assessment Programme was set up in 1993 under the leadership of Group Captain Coker the veterans trusted him implicitly. When he was succeeded by a string of seemingly unsympathetic and in some cases incompetent doctors, the veterans lost their trust in the programme. The MoD appears to rely entirely upon the MAP for its evidence on veterans' illnesses, yet Professor Harry Lee, who is currently head of the Medical Assessment Programme, personally stated to the independent panel on 29th March 1999 that the MAP was not there to treat Gulf illness. He gave the impression that there was little, if any, communication between MAP doctors and veterans' GPs, despite the fact that MAP doctors arranged for clinical tests to be conducted and presumably it was they who got the results. Professor Lee seemed to have very little concept of the extent to which veterans were exposed to toxins or the manner in

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which medication was administered to them. The MAP is not now involved with research. Can the Minister say, first, exactly what is the purpose of the MAP and, secondly, when is the promised clinical audit to be carried out?

I move on to research. The letter of the Minister for the Armed Forces to Brigadier Townsend made much of the research currently being conducted. There is only one clinical study which, as I explained earlier, seems to be in trouble. There are two epidemiological studies, one at the University of Manchester and the other at the London School of Hygiene and Tropical Medicine. All that these studies tell one is whether there is a higher incidence of mortality, morbidity or birth defects in the children of the Gulf community. They will not tell one which veterans are suffering from what illnesses or how they should be treated.

I recall the noble Earl, Lord Howe, advising me that the Medical Research Council had informed him that no causal research was necessary. I do not know what it said about clinical research, but it is clear that no proposals for clinical research to the Gulf War Illness Panel of the MRC, apart from the King's College study, have been funded. In paragraph 42 of its July 1997 statement Gulf Veterans' Illnesses: A New Beginning one sees the following statement:

    "New and potentially important ideas in the field of Gulf health research are being suggested by the scientific community all the time. Accordingly the Government encourages those with interest in this subject to submit proposals for further work to the MRC for consideration".

I ask the Minister just how many new research proposals have been received and accepted since the Gulf War Illness Panel of the MRC was set up, particularly since July 1997. How many of those whose applications were rejected were given reasons for the rejection? I also understand that neither the Interactions research at CBD Porton Down nor the anthrax and pertussis vaccine research to be undertaken by the National Institute for Biological Standards and Control has begun.

In 1997 the Burton Committee in the USA reported:

    "After 19 months of investigation and hearings, the subcommittee find the status of efforts on the Gulf War issues by the DOD, VA, CIA, and FDA to be irreparably flawed. We find these efforts hobbled by institutional inertia that mistakes motion for progress. We find these efforts plagued by arrogant incuriosity and a pervasive myopia that sees lack of evidence as proof. As a result, we find current approaches to research, diagnosis and treatment unlikely to yield answers to veterans' life-or-death questions in the foreseeable, or even far distant, future".

That could have been written about our institutions and, sadly, it still appears to apply here. Since that committee reported the culture of denial has changed in the USA. We should compare the miserable outlay by this and previous governments on Gulf-related issues with the enormous expenditure of the United States Government in this field. We should compare the number of research projects that receive funding in the United Kingdom with those in the USA. Men and women from both countries fought side by side, received similar medication and were exposed to the same toxins.

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The United States Government have accepted that their veterans are ill from Gulf service. Of the nearly 700,000 US troops who served in the Gulf, 83 per cent are eligible for benefits through their Veterans Agency and 45 per cent have sought medical care at the VA. The US Government have accepted that 100,000 US troops were exposed to repeated low levels of chemical warfare agents; that more than 250,000 received pyridostigmine bromide, which the Pentagon cannot rule out as being linked to Gulf illnesses; that 150,000 received the hotly-debated anthrax vaccine; that more than half their force entered or lived for months in areas contaminated by more than 315 tonnes of depleted uranium and radioactive toxic waste; and that thousands of them lived outdoors for months near 700 burning oil wells that belched fumes and toxic particles day and night. If the US Government accept these facts, why do ours continue to deny them?

Only last week I received a copy of two internal MoD reports, to which the noble Lord, Lord Morris, referred: one on the immunisation programme and the other on chemical weapons. I read them very carefully. I ask the Minister whether, in view of the time which has elapsed since the Gulf conflict and the clear gaps in factual information highlighted in both these and previous reports, Her Majesty's Government will immediately acknowledge the probability that our Gulf veterans are ill as a result of their service and that, as the US Government have done, they will immediately implement measures to ensure that all our sick veterans receive proper clinical assessments and treatment on the basis of their known exposures. The veterans know to what they were exposed.

I pay tribute to all those Gulf veterans who have worked so hard over many years to establish the facts. Far too often a brick wall has faced them, but they have never lost their courage or determination. They have established contacts with Gulf veterans from other countries, scientists from many specialties and politicians. Despite the failure of the MoD to grasp the nettle, these veterans have continued to meet and co-operate with officials and Ministers and offer them information. These men and women are ill and are tiring. I do not believe that that is what Ministers have been waiting for, hoping that they will go away. They deserve better.

I wholeheartedly support the repeated call by the Royal British Legion for a public inquiry which would allow for a full investigation of the failure of the MoD to act promptly when the alarm bells began to ring in 1993. That inquiry would examine the management of the MAP, the research programme, war pensions and other social security benefits in the period since the conflict; it would bring facts that have hitherto been concealed into the open; it would give Gulf veterans an opportunity to be heard and to regain their confidence in the authorities; and, above all, it should prevent similar mistakes in the future.

8.47 p.m.

Lord Clement-Jones: My Lords, it is difficult to add to the very powerful speeches that we have heard this evening. I start by paying tribute to the noble

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Lord, Lord Morris, and the all-party group for their tireless efforts on behalf of Gulf War veterans. On 24th March of last year we had a debate on this subject. Although I prepared for it I did not take part in the debate. I was unable to attend and my noble friend Lord Avebury spoke from these Benches. It is extraordinary how little progress has been made. I have looked carefully to see what has happened since then. I suspect that the Ministry of Defence takes the same approach. My noble friend received a letter from the Minister on 6th December purporting to answer questions raised in the debate on 24th March. That had a distinct lack of urgency about it. One wonders what resources are being devoted to attending to the issues and concerns of Gulf War veterans if even parliamentarians cannot receive replies to questions within what should be a few weeks rather than several months. I accept that, through the website, the Government have attempted to put more information into the public domain; indeed, in 1997 they adopted a more proactive stance. Yet I fear that their credit in this respect is rapidly running out.

We need to keep reminding ourselves that behind the basic fears personal tragedies are being masked. As the noble Baroness, Lady Park, said, we are talking of 67 suicides. Some 5,000 of the 53,000 servicemen and women who served in the Gulf are reckoned to have been affected. Therefore, it is hardly surprising that there is such frustration among the veteran organisations. I understand that contact between them and the MoD has been broken off. I do not know whether it is temporary or is likely to last a long time, but it is unfortunate and must be the result of the handling of these issues by the MoD.

The MoD claims that £2 million has been spent on research, yet the fruits of that research are limited. In addition to concern about the effects of the cocktail of vaccines mixed with the use of the organophosphates there is now concern that servicemen could have been exposed to depleted uranium. Again, there has been no real change since last year, except that protocols on the testing of urine sampled in Canada have been agreed.

I looked at the research that is under way and it is very much the same as last year. There are few new avenues. We have seen research into low level exposure to organophosphates at the Institute of Public Health in Edinburgh and at Porton Down into the effect of vaccines on guinea pigs. Professor Nichola Cherry of Manchester University has carried out a study, the results of which are soon to be published. However, they have been due soon to be published for some time. Dr Hoyle of the London School of Hygiene and Tropical Medicine is carrying out research and Professor Glyn Lewis of the University of Wales is conducting a literature review. Neuromuscular research is being carried out by Drs Sharief and Rosa at King's College Medical School.

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However, should not the MoD be commissioning research which also includes the impact of stress? Has there been adequate research into biochemical causes in terms of the immune system? Why does not the MoD sponsor directly, or via the MRD, research into the way the human immune system is affected by vaccines and organophosphates? I see no willingness to undertake such research.

Apart from the research there are other key questions. The Royal British Legion wants an independent public inquiry into Gulf War illnesses. But as the noble Countess, Lady Mar, in her powerful contribution said, the Government's response came after a long delay. Was that response adequate? Did the veterans receive a full response to their request for a public inquiry? They certainly did not. What compensation has been paid to date, other than through service pensions?

A number of noble Lords raised the issue of medical records. I recognise that the MoD has attempted to give more information about them, but what resource is being applied to help the ex-servicemen find their records? It is not enough to say that there was some confusion, that some may have been lost and certain departments should be asked for the records. What resources are being devoted to that within those departments? Indeed, what lessons are being learnt for the future? I hope that this whole sorry episode, which has taken 10 years, will help the MoD to learn some lessons.

I have a particular concern. Although there was little progress last year, one piece of maligned legislation was passed; that is, the Access to Justice Act. As legal aid has effectively been abolished for personal injury cases, it is unlikely that these claimants will receive legal aid. It is interesting that the latest MoD paper states that 1,817 claims have been notified to the department. These cases will not be suitable for legal aid, nor will they be suitable for conditional fee agreements because of the huge investigative cost involved. What assurance is there that in future claimants will be able to take action to obtain compensation? They seem to be caught in a catch-22 situation and under the funding code of the Legal Aid Board will not be eligible to take action.

Therefore, the onus rests entirely with the claimants to establish legal liability. Despite what one might have thought were reasonably hopeful interim conclusions in the King's College study, there is no admission of legal liability showing that these ex-servicemen are more likely to become ill. These ex-servicemen are no ordinary litigants; they have given considerable service to their country. It is an outrage.

The noble Lord, Lord Hoyle, who replied to the debate on 24th March, said that he believed that we were making real progress. I beg to differ. I ask the Minister, who is fresh to the issue, to take a new look at it. Perhaps with the Department of Health she will examine the whole issue to see whether other solutions are available. Will she recognise that in this respect we compare unfavourably with the United States and cede to the request of the Royal British Legion for an inquiry? I look forward to hearing her reply.

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8.56 p.m.

Earl Attlee: My Lords, I, too, am grateful to the noble Lord, Lord Morris of Manchester, for raising this important and sensitive issue once again. He is right to do so. I am a newcomer to the topic, but my noble friend Lord Burnham is an expert and I know that he works closely with the noble Lord, Lord Morris. Unfortunately, my noble friend cannot be here tonight. I remind the House that I have a potential interest in compensation and war pension issues.

Servicemen engaging in operations are apprehensive on several counts. That which predominates will depend on the individual and the circumstances. Naturally, they will be concerned that they will meet the demands of the operation and perform to the utmost limits of their capability and not let down their comrades. There is hardly ever a problem here, which is why our country holds Her Majesty's Armed Forces in such high esteem.

Then there are the perils of war: being killed, captured or physically or mentally injured by the enemy or by the environment of active service. However, the possibility of returning from an operation injured and permanently disabled must be at least as daunting as the other perils. We have heard tonight about fit servicemen going on operations and returning unfit and unable to look after their families as well as they would like or being unable to support themselves at all.

Of course, we have war pension and compensation arrangements in place, but it is doubtful that any arrangements can put a disabled serviceman in as favourable a position as before he came to grief, not least, I suspect, because the Treasury would be reluctant to approve anything that was more than adequate.

Another problem is that not all service careers progress at the same rate; hence the standard of living enjoyed and pensions earned will vary at the end of a full and successful career. It is extremely difficult to forecast how a career would have progressed. However, if we want our servicemen to prosecute an action to their maximum capability, they must be confident that they will be properly looked after if the worst happens. They should not have to fight for it post-conflict. At the very least, Gulf War illnesses are undermining that confidence and therefore, indirectly, to some extent our military capability.

Noble Lords will therefore not be surprised that I have a great deal of sympathy for the Gulf War veterans. I believe that no stone must be left unturned in the search for the cause or causes of the illnesses. I am sure that the Minister will tell us what the MoD is doing about this.

The noble Lord, Lord Morris, referred to the inquiries in the United States. I take it that the Minister will pay special attention to any conclusions from those inquiries. There is also the need to avoid duplication of research. There does not appear to be much risk of that as so few new studies are being funded by ourselves, as pointed out by many noble Lords.

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My noble friend Lady Park of Monmouth referred to the audit of MAP by the King's Fund. When I read the audit I thought that it was reporting on a large organisation. I then discovered the reality. Can the Minister confirm, as requested by my noble friend, that MAP funding at £750,000 has not been cut? Can she also say how many people work at MAP? Following on from the noble Countess, Lady Mar, is it true that technical reasons are not given by the MRC when it rejects a research proposal?

The few noble Lords who have spoken tonight made excellent and well-informed speeches, but it is a pity that the debate has not been better attended. There has been much hysterical comment in the media about depleted uranium tank ammunition. They have been portrayed as almost mini-nuclear tipped weapons. The fact is that the extremely high density of the DU is used in order to increase the kinetic energy of the anti-tank round known as the armour piercing fin stabilised discarding sabot. Its long rod penetrator is only about one inch in diameter in order to reduce its wind resistance, which increases rapidly with its diameter. The increased weight due to the DU enables the round to penetrate the toughest armoured vehicles. It is therefore essential that this round is available in order to be able successfully to engage enemy vehicles. Can the Minister confirm that there is no consideration of withdrawing DU ammunition in the absence of a more effective alternative or firm evidence that it is not harmless to friendly troops?

However, we do not know what is causing the Gulf War illnesses. Many hold that the DU is the cause, or part of it, either on its own or in combination with other factors. Over the past few days I have read much on the subject of testing for DU. Ministers have made it clear that DU testing is available if clinically indicated--in other words, if the doctors detect symptoms associated with DU or uranium poisoning. However, I have read the paper published in March last year entitled Testing for the Presence of Depleted Uranium in UK Veterans of the Gulf Conflict: The Current Position. From reading the paper it seems to me unlikely that any veterans will be displaying symptoms of DU or uranium poisoning and therefore no tests will be indicated. As the noble Countess, Lady Mar, put it, the absence of evidence is not evidence of absence.

It is simply unsatisfactory to have a few individuals undertake tests privately in a non-structured way. When results which are not scientifically robust are submitted to the MoD, further controversy is created. However, I am not a scientist. I do not know how large samples and controls should be; neither do I know what the costs would be. However, I believe that it is essential that DU should be positively eliminated for individual veterans by an appropriate study, even if it is not clinically indicated.

As regards the substantive Question tabled by the noble Lord, Lord Morris, regrettably I do not believe that the situation has changed since he asked a similar Unstarred Question last year. I do not think that a public inquiry would benefit anyone other than the lawyers and the printing and paper industry. The need

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is to identify the causes of the problem and not to find a scapegoat. I believe that it is far more important that the Minister leaves no stone unturned in the search for the cause or causes of Gulf War illnesses and also that she does everything in her power to ensure that servicemen adversely affected by operations are properly provided for.

The noble Lord, Lord Clement-Jones, spoke about the lack of progress since our last debate. I hope that the Minister can explain what she and her colleagues are doing to achieve progress.

9.4 p.m.

Baroness Symons of Vernham Dean: My Lords, I, too, am very grateful to my noble friend Lord Morris of Manchester for providing the opportunity to debate the Government's policy on Gulf veterans' illnesses and in particular to explain the Government's position on a public inquiry. I hope to respond to as many of the points raised this evening as I can, but I shall write if I am unable to cover in detail all the very many and important points that have been raised. The Government's approach to Gulf veterans' illnesses was set out in July 1997. Since then we have made considerable progress in delivering on the commitments we made. Perhaps I may assure all noble Lords who have participated in the debate, and others who I know are very interested in it, that responding to the concerns of those who participated in the Gulf conflict continues to be a very high priority for this Government.

The present Minister of State for the Armed Forces, my honourable friend John Spellar, met representatives of the Gulf veterans soon after taking up his appointment. He has since visited the United States to discuss Gulf veterans issues with senior officials there. As the noble Countess, Lady Mar, remarked, that is a very important point given the number of American personnel who were involved.

Under my honourable friend's direction the Gulf Veterans Illnesses Unit of the Ministry of Defence--the only central Ministry of Defence unit established to assist a discrete group of veterans--continues to oversee important research in this country and monitor that elsewhere, as the noble Baroness, Lady Park of Monmouth, said.

In October last year the Government announced that it had decided that a public inquiry into Gulf veterans' issues at this time was not appropriate. That decision followed requests from the Royal British Legion and several other interested groups, including veterans' associations and parliamentarians. The noble Countess, Lady Mar, has certainly left us in no doubt about her disquiet concerning that decision. Therefore, I should like to explain the background to that decision.

As the noble Lord, Lord Morris, said, there has been considerable scientific research on this issue, most notably in the United States, and there is a great deal of important research still under way. Despite that, an accepted cause for Gulf veterans' illnesses has not been

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found. As research results come through, we hope to rule out certain factors and so narrow down the scope for subsequent research. It is regrettable that much of that research is taking longer than we and the veterans themselves would like, but we cannot avoid the fact that robust scientific research is a time-consuming process. However, it is an essential process.

The noble Lord, Lord Clement-Jones, dedicated much of his contribution to the issue of the research under way. Perhaps I may explain. The Government are funding two major epidemiological studies, one at Manchester University, to which a number of noble Lords have referred, and another at the London School of Hygiene and Tropical Medicine. I can assure the noble Baroness, Lady Park, that we expect the results from the Manchester research very soon. The Government are also funding research at King's College into the neuromuscular symptoms that some veterans have reported. Another study is being carried out into the interactions between the vaccines that were given prior to deployment to the Gulf. Those two studies are still ongoing. Altogether, we are investing £6 million in our portfolio of four substantial research projects.

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