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Lord Donoughue: The system of national quotas under the common fisheries policy applies without discrimination to all member states. It derogates without time limit from the principle of equal access.
Lord Donoughue: All of the surveillance vessels operated by the Royal Navy's Fisheries Protection Squadron and the Scottish Fisheries Protection Agency, which were listed in my Written Answer of 12 January (WA 187), currently have an expected lifespan of 30 years, measured from the date of commissioning.
Lord Donoughue: This information is provided in the new European Community technical conservation regulation that will come into force on 1 January 2000. The regulation has not yet been published in the Official Journal of the European Communities but I have arranged for a copy of the text as agreed by the Council of Ministers on 30 October 1997 (SN 4282/1/97 rev-1) to be placed in the Library of the House. Annexes I to V, in particular, provide details of the mesh sizes agreed including exceptions.
Lord Donoughue: The main species of fish with no swimbladder discarded from demersal trawl fisheries are flatfish and rays. The majority of discards are below the minimum landing size. Studies on discarding of under-size fish from large commercial beam trawlers in the North Sea indicate that survival varies from 0 to
Studies on discarding of plaice by inshore trawlers in the English Channel found survival rates between 65 and 95 per cent. The higher survival compared with large beam trawlers is thought to be caused by slower trawling speeds and smaller catches.
Large numbers of small flatfish are also discarded in small-meshed shrimp fisheries. A number of studies have found survival rates for plaice and sole of more than 50 per cent., with generally lower rates for dabs.
Lord Donoughue: The preamble to Council Regulation (EEC) No. 3760/92 refers to the restrictions on access within 12-mile limits expiring on 31 December 2002. The regulation does not expire in its entirety on 31 December 2002.
"On 16 December you tabled a Written Question which asked what tests and medical examinations have been conducted by the Ministry of Defence's Medical Assessment Programme, MAP, on Gulf veterans since its inception, on what dates any changes were made, whether the Ministry of Defence intended to incorporate any new tests into the programme and, if so, which.
The medical programme which became the MAP was set up in July 1993 in order to examine veterans who were unwell and who believed that their illness was related to their service in the Gulf. The intention was to provide a diagnosis wherever possible and to document all illnesses in veterans who were referred to the programme. Any veteran who was referred to the programme was examined by a Consultant Physician and a number of tests and examinations were carried out. This essentially remains the case today. The MAP was originally located at the Princess Alexandra's
When the programme was first established, Wg Cdr, now Gp Capt Coker, who ran it until December 1996, initially carried out those tests that he felt were necessary on clinical grounds to establish a diagnosis. When the number of patients referred to the MAP increased, he carried out a number of screening tests, similar to those used by the US Department of Defense's Comprehensive Clinical Evaluation Programme, the US DoD's equivalent to the MAP. Any other tests considered clinically necessary would also be performed, these additional tests varying from patient to patient. This system of investigation was in place at the time of the clinical audit which was carried out by the Royal College of Physicians, RCP, in 1995.
The RCP's subsequent report, published in July 1995, endorsed the MAP's professional independence and integrity, and put forward recommendations concerning the future direction of investigation into Gulf veterans' illnesses. These recommendations ultimately led to the Medical Research Council commissioning the two epidemiological research studies currently being carried out by teams led by Professor Nicola Cherry and Dr. Patricia Doyle. The Report also made specific comments on how the Programme could be improved. However, with the exception of their recommendation concerning psychiatric assessments, on which I comment below, the RCP did not recommend any changes to the tests and examinations carried out by the MAP. A copy of the RCP's report and its appendix, which lists the tests being carried out by the MAP at the time of the audit, are attached. Psychiatric assessments
The RCP did comment unfavourably on the prior discontinuance of psychiatric testing for non-serving veterans and suggested that there was a need for all MAP patients to have a psychiatric assessment. This comment and recommendation were carefully considered by the Ministry of Defence at the time, but, ultimately, were not accepted for a number of reasons. First, a psychiatric testing programme was available at RAF Wroughton for Gulf veterans who were still serving. However, this programme required two or more visits to Wroughton and, for those who had left the Services, it was considered more appropriate for any assessment to be undertaken locally by the National Health Service, which would also be responsible for any follow-up treatment. Gp Capt Coker had recommended such an assessment to veteran GPs when he believed it to be clinically appropriate.
Secondly, you will be aware that the provision of health care and treatment for veterans who have left the Services is the responsibility of the Department of Health and not of the MoD. At the time of the RCP audit, MoD had been assured on several occasions by both the Department of Health and the President of the Royal College of Psychiatrists of the competence of
At an early stage of the MAP consideration was given to undertaking psychiatric assessment on a wider scale, but it soon became clear that the numbers involved, the need to couple assessment with treatment, and the fact that the few ex-Service cases, which had already been assessed, had psychiatric conditions which were well recognised in the NHS, did not make this a feasible proposition. These arguments were reconsidered in the light of the RCP's report and found to remain valid.
A list detailing the baseline tests currently carried out on MAP patients, by St. Thomas' Hospital on the MAP's behalf, is attached. I should stress that these are only baseline investigations. They will be added to, or modified, depending on a patient's clinical history and examination findings. As you will see, the current list is similar to that from 1995.
Additional investigations and/or referrals to other consultants/specialists are sometimes required, and further tests and examinations may, therefore, be carried out if appropriate. For example, some patients have been, and continue to be, referred to Dr. Kocen, a consultant neurologist at the National Hospital for Neurology and Neurosurgery in Queen's Square, London. You may recall that, when new information about the use of OP pesticides in the Gulf came to light in October 1996, a number of Gulf veterans, whose symptoms could be consistent with exposure to OPs or where there was evidence that they had been exposed to pesticides, were invited to re-attend the MAP and, where considered medically appropriate, were referred to Dr. Kocen. The results of the tests which any particular patient has been given are recorded on his or her case file and remain available to the doctors responsible for that patient's treatment.
No specific changes to the baseline tests listed on the attachment are envisaged for the immediate future. However, as you are probably aware, the Ministry of Defence plans to conduct a thorough audit of the MAP during the course of the year, focusing on all aspects of patient care and on the service provided by the MAP, including the range of tests and examinations currently undertaken.
Doctors at the MAP have now examined over 2,000 patients and there is naturally considerable interest amongst veterans and the public at large as to what the MAP has been finding. You will be aware that the Government has undertaken to publish detailed diagnostic results from the MAP. A paper is currently in the final stages of preparation and will shortly be submitted to a medical journal for peer-review and possible publication.
A copy of this letter, and its attachments, has been placed in the Library of the House. I assume that, like me, you will wish the text of this letter also to appear in the Official Report. I understand that the only way in
"Introduction: The Gulf War Medical Assessment Programme has been the main focus of the Ministry of Defence's investigations into the alleged Gulf War syndrome and any UK Gulf veterans, whether or not presently serving, who are concerned about their health have been invited to receive a full medical evaluation by military medical specialists. The Royal College of Physicians was asked to carry out an independent clinical audit of the assessment programme (Ministry of Defence News release 8/2/95).
Background: About 51,000 UK service personnel served in the Gulf War conflict in 1990-91. Although not all of them saw active service, they were nonetheless involved through, for instance, vaccination programmes or taking medication for the prevention of damage from nerve gas (NAPS).
In the last two or three years attention has been increasingly focused on a wide variety of illnesses reported by veterans of the Gulf War. These reports led to the suggestion that a specific Gulf War Syndrome existed, which was attributable to some aspect of serving in this conflict. Factors that have been suggested as agents in the causation of theses illnesses include exposure to chemical or biological weapons, the vaccination programmes used and medication taken for the prevention of damage caused by nerve gas (NAPS). In addition to these agents are the stress and possible psychological trauma associated with involvement in all conflicts. Reports of illness by Gulf War veterans have appeared chiefly in the USA and UK, but also in Canada and Norway.
In response to these reports in the autumn of 1993 the Defence Medical Services started referring veterans to the hospital at RAF Wroughton, where a special clinic was established. We are informed that the aims of this programme were to ensure full clinical examination of veterans coming forward to facilitate any necessary treatment and to give an early indication whether the Gulf operations of 1990-91 have led to (a) the emergence of a new syndrome, or (b) a higher than expected incidence of known diseases. Assessment protocols were established in the first half of 1994. Veterans have not been contacted individually with offers of this service but it is well-known to veteran associations and to the Gulf War Solicitors' Action Group. Its existence has also been reported in the press. Veterans who have left the armed services who enquire about this service are asked to seek referral from their General Practitioner. To date some 260 individuals have come forward and over 200 of these have already been assessed. At first the waiting time for assessment was up to 12 weeks. Wing Commander Coker, who had been assigned to this work, was then seconded to it full-time and, for a while, had the assistance of another physician,
Assessment: The assessment commences with a medical interview and physical examination lasting about one hour. Routine investigations are then performed and include blood and urine analysis. Other specialist investigations performed where indicated are shown in Appendix 1. At first all veterans were also assessed by a psychologist-administered questionnaire and approximately two-thirds were then interviewed by a consultant psychiatrist with special experience of people who have endured very stressful experiences. This psychological and psychiatric assessment is now available only for personnel who are still serving. Any relevant medical records are requested from the individual's own doctor. For personnel who are no longer serving, recommendations for any further specialist investigations are made to the general practitioner involved.
Findings to date: The results obtained by assessment of the first 200 veterans are at present being entered by Wing Commander Coker into a computerised database. Preliminary analysis suggests that major organic illness, e.g. tumours or heart disease, was present in about 14 per cent. Forty per cent. suffered from a wide variety of less serious illnesses, e.g. skin disorders. Psychiatric disorders were present in some 36 per cent., especially the post-traumatic stress disorder. A diagnosis of Chronic Fatigue Syndrome, using the CDC Atlanta diagnostic criteria, was made in 8 per cent. Complex and multiple epidemiological studies would be required to establish whether any single disease encountered in this group occurred with greater frequency than would be expected randomly. Nevertheless the incidence of psychiatric disease, at least, is noteworthy and requires further attention. Provided consent is obtained from the patient, the results of the assessment can be made available at the War Pensions Agency in support of a disability claim.
(a) We had an in-depth briefing with Wing Commander Coker, the consultant at RAF Wroughton who runs the veterans' assessment programme.
(b) We have reviewed background literature supplied by the Surgeon-General, including extensive documentation about the work that has been performed in the USA.
(c) We have visited RAF Wroughton, where we attended a morning assessment clinic, interviewed personnel involved in the assessment and reviewed the diagnostic facilities available.
(d) We had a detailed presentation by Wing Commander Read and Squadron Leader Neal, consultant psychiatrists, of the protocol used in psychological screening, together with the results obtained to date.
Preliminary Findings of RCP Audit:
1. Wing Commander Coker is well placed to conduct the assessments. He is a well trained consultant physician who has an honorary degree in chemistry and a toxicology background. He spent three years at Porton Down running clinical trials of nerve gas prophylaxis. He was also part of the United Nations Special Chemical Destruction Group that spent several months in Iraq in 1992.
2. Although there was initially a delay in seeing veterans, the assessment programme is now working well with acceptable waiting times.
3. The history, examination and baseline investigations are appropriate. However, limited use has to date been made of sophisticated tests of immunological function, but the precise place of such investigations is not yet established. Also, the psychological and psychiatric assessment that was instituted in spring 1994 was later limited to veterans still serving. This is unfortunate because of (a) the frequency of psychological abnormalities and (b) the great expertise available at RAF Wroughton for post-traumatic stress disorder.
4. The initial assessment is thorough but follow-up for personnel no longer serving is uncertain. Communication by Wing Commander Coker to the veteran's general practitioner is satisfactory, but there is no certainty that his request to be kept informed of subsequent developments will be met. Consideration should be given to the establishment of a mechanism for the collation of follow-up information.
5. Referral of veterans to RAF Wroughton at present depends on an unstructured "grapevine". This may well be efficient but it is not known at present how far news of this service has spread amongst the 51,000 Gulf War veterans.
Conclusions and Recommendations: The findings at present are hard to assess in the context of the possible existence of a specific "Gulf War Syndrome". This is partly due to the fact that the population studied is self-selected by coming forward for assessment. The plurality of diseases encountered in this group makes it difficult to conceive of a single aetiological agent. It is notworthy that, after extensive study, it has been stated to Congress by the US assistant secretary of defence for health affairs that no evidence has been found to implicate chemical or biological weapons as causes of illness in Gulf War veterans. Nevertheless doubts persist, for instance concerning the significance of high blood levels of lead found in a small number of deceased veterans.
We note particularly the high incidence of psychiatric illness revealed in veterans by the Wroughton programme. There is a need for further assessment, with subsequent treatment where needed, of veterans in this particular respect.
In addition we believe that greater expertise in tropical disease should be available to the assessment programme, especially given the concern expressed in the USA about the occurrence of visceral leishmaniasis in veterans.
The frequency amongst veterans of short-term malaise following vaccination against biological warfare agents is noteworthy but not surprising. We are not aware at present of reasons to believe long-term damage to the immune system following such vaccination but we advise the involvement of expert immunologists in assessment of this possibility. Study of the vaccination issue will not be facilitated by the poor vaccination records we encountered in the medical documents of veterans. We do not underestimate the difficulty of maintaining such records in wartime circumstances but the patchiness of such documentation remains regrettable.
Thorough epidemiological assessment of the findings to date would involve very large and expensive studies. Even with unlimited resources the difficulties to be overcome in this area are enormous. The US Institute of Medicine Committee asked by Congress to report on Defence Department studies made of illness in Gulf War veterans has advised large scale epidemiological studies with particular reference to toxicological aspects of the problem. US investment in this area is already large and continuing. With the limited resources available in the UK it would seem prudent to take full advantage of the US studies. We are therefore pleased to learn that a MoD team, including Wing Commander Coker, has recently visited the US Defence Department. The Surgeon-General had already visited the USA to discuss these issues.
We are not at present in a position to comment on a recent report from Glasgow of unexplained damage to the nervous system detected in some veterans. To the best of our knowledge the findings are not yet published and will require scrutiny and confirmation as with any research findings. We are also not able yet to comment on claims made by the group in Duke University, North Carolina, in support of the hypothesis that a combination of the anti-nerve gas agent with an insecticide used by the US forces in the Gulf War can cause damage to the nervous system.
Summary: The Gulf War assessment programme addresses appropriately the medical needs of those veterans reporting illness and attending the clinic at RAF Wroughton. It demonstrates commitment to them and provides advice to their general practitioners and service doctors. With the exception of the psychological assessment programme, the resources at present provided are adequate for these purposes. The clinical aim of this programme, namely to examine veterans and facilitate treatment, is being achieved (See page 1).
The complexities of the issues raised by illness occurring in veterans need further specialist advice, notably requiring immunological, toxicological and tropical disease expertise. The epidemiological issues raised are complex and require very large scale studies for their solutions. Further progress in these areas will require the deployment of far greater resources than have yet been made available.
We note the publication by the American Institute of Medicine entitled Health Consequences of Service during the Persian Gulf War. It is clearly desirable that the UK keeps abreast of the findings of the extensive research programme in this area that is continuing in the USA." Appendix 1 Clinical Assessment Programme
Initial questionnaire detailing Service record and Gulf War experience, including geographical details, whether exposed to oil well fires etc. History and Clinical Examination Urinalysis Screening Blood Tests:
Psychological Assessment Psychological Assessment Computer Clinician Administered PTSD Scale Becks Depression Inventory General Health Questionnaire Psychophysiological Testing Patients identified as positive for psychiatric disorder will be offered diagnostic interview with a Consultant Psychiatrist. Appendix 1 Specialist Investigations Diarrhoea