WEDNESDAY 9 MAY 2001
  
                               _________
  
                           Members present:
              Mr Bruce George, in the Chair
              Mr Julian Brazier
              Mr Jamie Cann
              Mr Mike Gapes
              Dr Julian Lewis
              Mr Peter Viggers
  
                               _________
  
            MEMORANDUM SUBMITTED BY THE MINISTRY OF DEFENCE
                       EXAMINATION OF WITNESSES
  
                 DR LEWIS MOONIE, a Member of the House, (Parliamentary Under Secretary
           of State for Defence), MR CHRIS BAKER OBE, Head, Gulf Veterans'
           Illnesses Unit, Ministry of Defence, examined.
  
                               Chairman
        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 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 can all 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 advisor 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 papulation (?), 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.
  
                               Chairman
        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 biological 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 former 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 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 is in job. 
  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.
        20.      Thank you.  Obviously, there is no treatment for this.  We
  understand why the tests are being done and welcome the tests.  What
  counselling and support will be available to those who show a positive result?
        (Dr Moonie) First of all, I think we have to recognise that, certainly
  in the Gulf veterans, after ten years the levels are going to be very small,
  unless somebody, unknown to us, has ingested particles of DU.  So the chances
  of picking up high results are relatively slim, and that is why we really have
  to go for this very sophisticated test in order to establish what the levels
  are.  Another problem is, of course, that we have absolutely no knowledge of
  what the background level of DU is in the general population.  These isotopes
  are generally in tiny quantities but, of course, they are present in all of
  us.  So we are really breaking new ground here.
        21.      You are going to be counselling people who do turn out to have
  unexpectedly high levels?
        (Dr Moonie) If they did, yes, we would be more than counselling them;
  we would be looking at them very closely to see what happens.  If anybody
  turned out at higher than expected levels, what they would be offered is long-
  term monitoring to ensure that no adverse related effects occur.  With regards
  to the general point, anybody who raises concerns - because they are going to
  professionals to be tested - will have those concerns directly dealt with. 
  The GVIU has developed a considerable expertise in providing assurance for
  people.  That is one of their main, underlying functions and something which
  they do very well indeed and is most appreciated by the veterans who go there.
        22.      Final question: when we took evidence in December 1999 there was
  a considerable dispute between yourself and the veterans about testing for the
  presence of DU - about how it is actually conducted.  Has the consultation
  process which you have undertaken in the last few months persuaded the Gulf
  veterans that the way you are carrying out these tests is, in fact, the
  correct one?
        (Dr Moonie) We have indirect evidence from the first consultation that
  there was very little disquiet expressed by the 37 respondents that we had. 
  I think they were made on an individual basis, but the general consensus was
  that we had got it right in the area we are moving in.  I do not have direct
  evidence; people have not actually come to us and said "Yes, we are happy with
  this", but they have not come to us particularly to say "We are unhappy"
  either, and I think that they would have done if they were.  I think that we
  have moved to meet the concerns which they showed.  The degree of detail that
  we are bringing into it in order to ensure that this system is very thorough
  and very accurate will reassure people that when they go to the theatre they
  are active on, the supervision and Oversight Board, including veterans
  representatives, will provide much greater security and peace of mind to
  people that they are going to get a proper test.
        Mr Viggers: May I follow the statistical point?  You mention that NATO
  allies are pooling their information.  How can you account for the
  extraordinary disparity in public attitude and politicians' attitudes here and
  in Italy, for instance, where, from conversations with Italians, from reading
  Italian newspapers and watching Italian television, there is a widespread
  feeling that this is a subject of enormous importance and concern, and
  politicians respond accordingly?
  
                               Chairman
        23.      Please remember we are being televised.
        (Dr Moonie) I think what I should say is that we looked at this very
  carefully after all the furore over the Christmas period.  I passionately
  believe that what we have done is absolutely correct.  I cannot speak for
  other people; people respond to media-induced crises in different ways.  There
  is a great deal of ignorance about the epidemiology of the disease and the
  frequency with which in a young-to-middle-aged population certain conditions
  like cancer naturally occur.  That has been fed on by the media, not just in
  this country but in others.  People responded to it in the way they thought
  fit at the time.  As you know, politicians do not always respond rationally
  when they are riding on the line and the press is clamouring for something to
  be done.
        24.      What became of the soldiers, whether they were Portuguese or
  Spanish, who developed cancer, allegedly, as a result of exposure?  Was that
  investigated by our NATO allies?
        (Dr Moonie) I think they are investigating that themselves.  I think
  what we have to be very clear about is that all the scientific evidence on DU
  is that were it to produce any cancers at all - and that would only be because
  of massive exposure, because, remember, it is much less radioactive than
  ordinary uranium - it would take years, decades before these cancers would
  appear.  Speaking as an epidemiologist myself in the past, the chances of any
  of these cancers coming from DU exposure are infinitesimal.
  
                                Mr Cann
        25.      Could I ask a couple of questions about the proposed Oversight
  Board, which I understand will include veterans' representatives?  How many
  members will the Board have, how many of them will be veterans and,
  importantly, have representatives of Gulf veterans indicated that they are
  willing to participate?
        (Dr Moonie) I have not, as yet, seen the full responses.  I am unaware
  yet of who has actually requested specifically to go on the Board, as opposed
  to just approving the setting-up of the Board.  It has got to be large enough
  to have confidence in what it does and small enough for it not to degenerate
  into, as you know very large committees can do, something which will not be
  productive.  I would envisage it will have a considerable majority of people
  from outside our own area; so there will be experts on it, there will be
  representatives of Gulf veterans and one or two of our own people who have
  specific knowledge and expertise in the subject.  I think you are asking me
  to guess what size it is likely to be.  I think my own view would be round
  about 12 people.  It might be slightly larger.
        26.      Thank you.  Do you believe that their participation in the
  Oversight Board is likely to overcome the "many reservations" veterans have
  about MoD involvement in the screening programme?
        (Dr Moonie) We have been very specific that it is going to have a
  majority of people from outside the MoD.  The last thing I would want people
  to believe is that we were just packing a Committee in order to get the
  responses that we want.  We shall ensure that there is a fair representation
  of the spectrum of veterans' representatives and scientific experts so that
  any concerns that they have can be allayed by people who are not seen to be
  directly responsible to us.
  
                               Mr Gapes
        27.      You have already touched on this indirectly, but we seem to have
  - despite various assurances, statements and publications in the British
  Medical Journal, Lancet reports and other scientific evidence - a very wide
  public concern about possible adverse health effects of exposure to depleted
  uranium.  This seems to be prevalent, despite all the evidence and all the
  scientific studies saying, as you just did, that there is no evidence of the
  risk, or that the risk is lower than with naturally occurring uranium, and
  that there is no risk particularly quickly after exposure - it takes decades,
  as you said.  Why is this?
        (Dr Moonie) It is very easy for somebody like me who, before I spent
  half a lifetime in politics, spent half a lifetime in medicine, to talk with
  confidence about something that I know quite a bit about.  It is much more
  difficult for the general population, who, frankly, do not have an enormous
  scientific knowledge, for whom radioactivity is something frankly mysterious
  and dangerous.  You are almost talking about collective unconsciousness (?)
  of the way in which we respond to things that we perceive as potential
  threats.  It is very difficult to allay fears of that type.  You can talk to
  the press, but they will not necessarily report you in the way that you hoped
  they would and they will give equal weight to non-scientifically validated
  views, which take the opposite point of view to your own, in order to provide
  balance.  All you can do is continually repeat what we know to be true, and
  where there are residual concerns that you cannot completely dispel just by
  giving that reassurance, then I think - as we have done with the retrospective
  exposure assessments we are ready to do - you have to respond to people's
  continuing concerns and given them further reassurance.
        28.      Is there not a danger that your decision, for the best of
  motives, to embark on this testing programme will, in fact, rather than
  helping to allay these concerns actually feed this media frenzy, if you like,
  and that misguided perceptions about potential contact with any depleted
  uranium will still be, in a sense, seen to be more of a problem than it is,
  because you are carrying out this testing programme?
        (Dr Moonie) There is, at least in theory, a danger that that will
  happen.  You are doing something, therefore there must be a core reason for
  it.  There is a simple reason for it: people were concerned and continued to
  be concerned after assurance.  I think that we owe these people a bit of extra
  effort.  In view of the long history of the way in which successive
  governments have handled Gulf veterans' illnesses, in particular, I think it
  is incumbent on us to go that extra mile and to provide that extra assurance,
  whatever the cost in terms of public perception may be.  I have to say I
  believe that what I have seen in the press since we have made that decision
  is a general acceptance that what we are doing is right.  So we have actually
  responded to the concerns and, paradoxically, we have reduced anxiety about
  it if we are seen to be doing something about it.
        Chairman:   We are now moving on to the military use of depleted uranium.
  
                              Mr Viggers
        29.      Just to get a sense of perspective, there have been some 10,000
  depleted uranium shells fired in a range in Scotland.  We used 100 depleted
  uranium shells in the Gulf War and none in the Balkans, whereas the Americans
  used about 900,000 in the Gulf War, I understand.  We currently use depleted
  uranium in Phalanx anti-aircraft, anti-missile guns in the Royal Navy and with
  the 120mm Challenger tank rounds.  We are phasing them out in Phalanx because
  tungsten is found to be more effective.
        (Dr Moonie) We have now seen that a tungsten alloy in that particular
  situation provides a longer reach and therefore destroys a missile further
  away from the target.
        30.      Depleted uranium is currently used and projected for the future
  in the Challenger round and it is your intention to continue with that?
        (Dr Moonie) It is, yes.
        31.      Have there been any changes in safety procedures since the
  beginning of this year?
        (Dr Moonie) As you know from previous information we have given you,
  we have developed protocols and information to give to people on how to handle
  depleted uranium.  We insist, if people go into a confined environment where
  it has been fired and is likely to be left around, that people wear full
  biological protection.  If people are on the outside of a tank that has been
  hit, say, they must wear appropriate gloves if they are going to be handling
  material and wear a face mask.  These were developed as an advice.  They have
  now been implemented as an advice and they have been given to all our troops
  as they are sent to Kosovo.  They are given a further briefing once they get
  there on the danger of the environment that they are going to because DU is
  not by any means the only hazard that they are going to be finding in that
  area.  We have put into practice what we were saying we were going to do at
  an earlier date.  I do not know if that answers the concerns that you have.
        32.      Are you continuing to investigate further safety and health
  improvement measures?
        (Dr Moonie) Yes.  That is a continuous process now.  It is something
  which has developed over the years.  We are not going to claim credit for this
  but we are much more aware now of potential hazards and much better equipped
  to deal with them and to produce proper guidance for people.  That is
  something which will apply in the future as well.  I have to stress that,
  while there is no better alternative available, we intend to continue using
  the DU round in tanks.
        33.      Have you stepped up research to find viable alternatives to DU?
        (Dr Moonie) Research is going on in a wide variety of areas.  At
  present, it is not terribly promising.  DU is a remarkably effective penetrant
  and so far nothing has been developed in the way of armour that would leave
  the vehicle capable of moving.  There are areas of research that we are
  looking at.  We have looked at other materials.  Nothing has yet proved to
  give anything like the rate of penetration that DU does.  We can look at novel
  ideas.  We are looking at them all the time obviously, but I would not say we
  were stepping up.  There is a strong programme of research ongoing, both here
  and in the United States, looking for alternatives.  In fact, that is the way
  in which the new tungsten alloys were found to be better than DU for the much
  lighter rounds that the Phalanx fires.
        34.      Are other countries also setting up research or have any moved
  to a different form of alternative to DU?
        (Dr Moonie) Not to my knowledge, no.
        35.      Other than for reasons that tungsten ----?
        (Dr Moonie) I can assure you that if we find a better material which,
  biologically and practically, is easier to use and is as effective or more
  effective, then we will use it.
        36.      We mentioned earlier countries where concern appears to be more
  widespread, albeit in your submission without justification.  Has any country
  changed its policy on the use of DU as a result of public concern?
        (Dr Moonie) Not as far as I know.
  
                               Chairman
        37.      We will now move on to Gulf veterans' illnesses.  Are you
  satisfied that the current War Pensions Scheme is adequately meeting the needs
  of Gulf veterans?  
        (Dr Moonie) If we look at the two schemes which are currently
  administered, I think that they do, yes, in the round.  Obviously, there may
  be exceptions.  There may be people who feel that they have been unfairly
  treated.  I think that is always the case with a pension scheme but, by and
  large, I think people have been fairly treated and seem to be well satisfied.
        38.      Will this fall within your remit of Minister for Veterans'
  Affairs?
        (Dr Moonie) I believe it will, yes, assuming I am retained in that
  role after the election and assuming we are in a position to do that.
        39.      If anyone has any complaints about the War Pensions Scheme,
  address them to you over the next few weeks, or at least to your office?
        (Dr Moonie) I think it is currently Mr Bailey's concern in the DSS.
        40.      What assessment have you made of veterans' level of satisfaction
  with the services and provision they receive from the War Pensions Agency?
        (Dr Moonie) It would be fair to say that there are longstanding
  dissatisfactions with the way in which the system occurs.  Anybody who does
  not get what they think they deserve is obviously going to be dissatisfied,
  but the scheme at present bends over backwards to ensure that people are
  included.  There is dissatisfaction with the length of time it takes to
  process claims.  Claims are very complex and the system itself is a bit
  creaky.  We have to remember it was set up in 1917 and there cannot be many
  of our institutions still around that have not been properly revised since
  then.
        41.      Except the House of Commons, of course.
        (Dr Moonie) Except the House of Commons, indeed.  Foolish of me to
  forget that.  I think it is time now to have a very thorough review of what
  is going on to try to meet some of these concerns.  The delays are annoying. 
  I would like to see that certainly speeded up, particularly for the people who
  are very severely disabled and who require quick help.
  
                               Mr Gapes
        42.      Minister, in March you published the long awaited consultation
  document on compensation arrangements following a review with the Department
  of Social Security.  It could be argued that this change owes a lot to the
  lessons learned from the way in which Gulf veterans have been dealt with.  A
  lot of the new proposals were based upon experience from the past but, as you
  are aware, the proposals you have come forward with do not have any
  retrospective element to them.  Although lessons have been learned, the new
  proposals will do nothing to improve compensation for Gulf veterans and those
  who have been injured in the past.  Why has the Ministry of Defence decided
  that the current compensation arrangements will continue to be acceptable for
  Gulf veterans but not for existing personnel?
        (Dr Moonie) I am hiding behind the standard government response here:
  new schemes are never made retrospective.  Whatever scheme is extant at the
  time at which you become entitled to benefits under it, for example, that is
  the scheme which will be applied to you.  I do not think there is any great
  level of dissatisfaction with the outcomes of what happens at present -- more
  so with the process and the time it takes.  This scheme was set up in 1917. 
  We have two schemes which people have to apply for.  They apply different
  criteria and therefore they can, on occasion, heighten the sense of injustice
  that people feel.  I think it is high time that the system was reviewed and
  we brought in a better one to replace it, but it cannot be made retrospective. 
  We cannot clear up the regulations under which somebody was first seen and see
  them again at a much later date under the new scheme.  After all, you could
  not just restrict it to Gulf veterans; in these cases if you were going to be
  fair, you would have to make it applicable to anybody in the past and that is
  why schemes are not made retrospective.  We just could not do it.  It is not
  practical.
        43.      When will the new arrangements come in?
        (Dr Moonie) On the overall scheme, we are still out for consultation
  and it is going to take us a considerable time to take in the responses we
  receive, to decide how we are going to do it and to proceed, for example,
  merging the two schemes, deciding which roof it is going to sit under.  I
  would think to be able to do it over the next year would be setting a
  challenging timetable.  It might take longer than that; it might not.  I do
  not actually know how difficult it would be to bring in the new arrangements
  and put them into place.  It will be done as quickly as practicable.
        44.      There will not be any retrospective arrangements?
        (Dr Moonie) There will not be retrospective arrangements, no.
  
                               Chairman
        45.      The Committee said in previous reports that with public/private
  partnerships and with PFI the private sector is getting closer and closer to
  the front line.  If we want to encourage this process of civilians engaging
  in what could be very hazardous activities in peace time and in war, are you
  absolutely satisfied that arrangements for compensation and insurance would
  give some encouragement to add to a sense of patriotism for those who will not
  receive the benefit of being a member of the armed forces but who might be
  injured or killed?
        (Dr Moonie) You are quite right.  We have to ensure that people in
  future have adequate cover for what may happen to them.  It is possible that
  this could be based on some form of insurance.  It might be that insurance
  companies might prove a little difficult to convince of the benefits of
  offering that type of scheme to people.  I think we would therefore have to
  look at some form of indemnity.  We are actively considering that and it is
  something which I think we will probably have to do.
        46.      Through what vehicle will that be administered?
        (Dr Moonie) That I have not decided.  I honestly cannot say what the
  most appropriate method would be.  I presume it would have to be done within
  the Ministry of Defence.
        Chairman:   Perhaps they should redesignate your role Minister for
  Veterans and Civilians Working Alongside Veterans' Affairs during a time of
  conflict, rather an unpalatable set of acronyms.
  
                                Mr Cann
        47.      When we reported last year, we suggested that you might consider
  compensation for those who were injured civilians in the Gulf and basically
  you said then what you have just said now which is that you are discussing
  possible future arrangements.  Has the MoD's position on compensation for
  civilian contractors who served alongside Service personnel in the Gulf
  changed in any way since our report last year?
        (Dr Moonie) No.  We are looking to the future when we are making
  proposals for civilian contractors.  If we clearly had liability, we would pay
  compensation.  If we do not, we do not.  The future arrangements will provide
  a much better safety net than exists at present.
  
                              Mr Viggers
        48.      Regular forces are of course eligible under the Armed Forces
  Pension Scheme and reservists are eligible under the Attributable Benefits for
  Reservists Scheme, ABRS, which has recently been extended to include
  eligibility for reservists who are medically downgraded after mobilisation. 
  A response to a parliamentary question indicated that that change would take
  effect from April, so presumably it is running now?
        (Dr Moonie) Yes, it is.  I am not sure how long it is going to take
  to deal with the cases that are extant but again they will be dealt with as
  quickly as possible.
        49.      How many individuals will receive such payments?
        (Dr Moonie) It is a very small number.  I think it is round about ten
  under the scheme itself and fewer than that under the ex gratia payment that
  we are offering for the very few people who are left uncovered by either
  scheme.
        50.      For the record, perhaps you could say who that very small number
  who may receive ex gratia payments are, what categories they are and how many
  you anticipate they will be in the coming years.
        (Dr Moonie) I always find this horrendously difficult to get my head
  round.  These are the handful of people from the long term reserves who went
  back to being civilians after they left the theatre in which they were
  engaged.  There are very, very few of them within that category who have
  missed out on the provisions that we have.  In these cases we think it correct
  to make an ex gratia payment to them which will be the equivalent of what they
  would have received had they been in the scheme, but it is a very small
  number.
        51.      Are you aware of any other groupings on behalf of whom
  representations have been made that in equity they should also be eligible?
        (Dr Moonie) I do not think so.
        52.      No doubt they would come forward if they felt themselves
  aggrieved?
        (Dr Moonie) Were they brought to my attention, I would certainly have
  to deal with them.  I think we have had long enough now for any such groups
  to have made themselves clear to us.
        Chairman:   I would like to come to the question of negligence claims and
  mediation.  As at 1 April 2001, the MoD had received 1,866 active notices of
  intention to claim from veterans and members of their families in respect of
  illnesses from the Gulf conflict.  However, no writs or detailed claims have
  yet been received.  The Committee has received a memorandum from a firm of
  solicitors, Hodge Jones & Allen, which represents over 600 veterans in respect
  of such claims.  I met them last week.  The solicitors claim that despite the
  government's declared policy of using mediation wherever possible the MoD have
  informed them that they are not prepared to engage in mediation as they do not
  see the evidence as likely to succeed in court.  The Joint Compensation Review
  Consultation Document concedes that, "Concern is frequently expressed that
  civil negligence cases against MoD can be confrontational and protracted,
  cause distress to claimants and result in disparate awards for the same
  disablement" and it expresses the hope that the new compensation arrangements
  will enable more claims to be settled without referral to the courts.  I will
  ask my colleague, Mr Cann, to ask the specific question.
  
                                Mr Cann
        53.      Why has the MoD so far refused to enter into mediation
  discussions with the reps of Gulf veterans who have given notice of negligence
  claims?  Would you accept that mediation seems the most logical and cost
  effective way of going forward?
        (Dr Moonie) No, at present I would not.  We have been very clear. 
  Where it is appropriate, we will use mediation but in these circumstances
  there would have to be a recognition on our part that we had in some way been
  negligent.  We do not accept that in any way at present and I see therefore
  no point in going to mediation where we are absolute in our defence of our
  position.
        54.      You are defending your position; presumably the veterans are
  defending theirs.  Is not that a case where mediation can judge properly
  between the two conflicting views?
        (Dr Moonie) No.  I believe in this case the only way in which it can
  be resolved is by people who feel they have views taking them to court and
  testing them.  I am absolutely convinced -- I have looked at the evidence in
  detail -- that there is no point at present in going to mediation.  We would
  not accept a compromise position.
        55.      You are going to need a lot of court space, are you not?
        (Dr Moonie) That is possible, yes, but so far no court action has been
  raised against us.  We are not just going to pay compensation for an easy
  life.  I do believe that what we have done and the stance we have taken is
  correct and I therefore feel that we should defend it.
  
                               Chairman
        56.      A large sum of money has been paid out of the legal aid fund to
  lawyers to represent them and, if it is pushed to court, even one court case
  can be very protracted and costly.  The record of the MoD in court is about
  the equivalent of the DA in Perry Mason.  Would it be wiser perhaps to test
  it out by way of mediation in a couple of cases?  Are you absolutely
  irrevocable in this decision to avoid mediation?
        (Dr Moonie) I would never say I was absolutely irrevocable about
  something.  If the position changed and if new evidence was presented to us
  which showed things in a different light, clearly I would review it again, but
  at present I see no justification for altering our position.  What I have said
  to representatives of Hodge Jones & Allen when I met them a few weeks ago is
  that we are trying to be inclusive.  We are trying to keep in discussions. 
  One of the things I see as Veterans Minister is not just sitting on
  committees, making decisions, but making direct contact with people who have
  concerns and trying to work our way through it.  The important thing for the
  veterans after all is to try to alleviate in some way the suffering which they
  are undergoing.  I think that is where our main efforts should be targeted,
  but as a department, where we feel we have nothing to be ashamed of and we
  have done nothing that we consider to be wrong, certainly not negligence, I
  think it is our duty to defend our position properly.
  
                              Mr Viggers
        57.      There have been several statistical studies comparing groups of
  Gulf War veterans with groups of people who have not been to the Gulf.  The
  statistical conclusion seems to be that there is little to show between the
  two groups, I understand.  I remember in the States we were briefed and told
  that the only statistically significant figure was that reservists were far
  more likely to claim to suffer from Gulf War Syndrome than regular forces,
  perhaps indicating that the strain and physical stress of reservists going
  into battle was greater than that of the regulars.  Are there further
  statistical studies planned in this country of Gulf War veterans compared with
  comparative groups perhaps, focusing on people of the same age?
        (Dr Moonie) It is difficult to get morbidity data on illness.  If we
  are talking purely about mortality here, that is a very straightforward thing
  to do.  For any population, we can construct standardised mortality ratios for
  the normal population and compare the group to see whether it is different. 
  In fact, for both the group who served in the Gulf and for the non-Gulf
  soldiers, servicemen and women, who were used as a comparator, both are very
  considerably below the expected level of the general population for mortality. 
  The general figure is 660; whereas they are both hovering at round about 493
  Gulf veterans, which you would expect.  Servicemen and women are fit people. 
  You would not expect so many of them to die as in the general population. 
  There is adequate standardised epidemiological data available for mortality. 
  It is very much more difficult however when you come on to symptomatology of
  illness, which is much less clearly defined.
        58.      There is a study of 109 Gulf veterans who have died in road
  accidents which is being investigated.  Can you tell me what form that study
  is taking?
        (Dr Moonie) First of all, I think we are going to try and find out
  details of what the accidents involved -- were they pedestrians?  Were they
  drivers?  Were they passengers? -- to see whether there is any obvious linking
  factor within them.  We will compare that obviously with the group who were
  not serving.  We do intend to follow this up.  It is an interesting and
  slightly disturbing finding to me that there should be this disparity.  We are
  talking about relatively small numbers in statistical terms and although there
  is a statistically significant difference between the two that does not rule
  out the possibility that there is still a chance.  If you conduct enough
  investigations, look at enough constructions, some of them will show up by
  chance as statistically significant.  It does not necessarily mean that they
  are.  It could still be a random factor.  It is just that over the years it
  will balance out.  It is worth looking at -- and we are going to spend some
  time on this -- initially identifying the causes of the accident, what was
  involved and then seeing if there is any further work that can be done.
        59.      Are there any other statistically surprising results which have
  come out of the studies so far?
        (Dr Moonie) Not to my knowledge, other than that there is an excess
  of deaths from accidental causes in the Gulf veterans' group which is matched
  by a relative reduction in the number of non-accidental deaths due to illness,
  cancer and a wide variety of things.  By and large, no, there is nothing
  particularly surprising.  There are fewer cancer deaths within them but that
  is again I think a random factor.
  
                               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 GBIEU, the road traffic accident deaths studies in 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.  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.
  
                               Chairman
        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 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 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 effectively 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.