Examination of Witnesses (Questions 60
WEDNESDAY 9 MAY 2001
MOONIE, MP AND
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
(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 satisfiedyou used the word
"sympathetic" in your answer, I thinkthat 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
(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.
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.
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.
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.
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
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 happenedfor 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
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.
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
Note by Witness: The Reserve Training and Mobilisation
Centre, Chilwell Station, Chetwynd Barracks, Nottinghamshire. Back