To ask Her Majesty’s Government what assessment they have now made of the findings, published on 17 November 2008, of the Congressionally-mandated United States Research Advisory Committee on Gulf War Illnesses.

My Lords, we are met to debate a report which, exhaustively researched and of excelling integrity, is one also of humane concern for the many thousands of men and women, now in broken health, who were prepared to give their lives in the service of this country in the most toxic war in western military history.

I will of course speak in detail about the report as I proceed, but I must first welcome my noble friend to the Dispatch Box. Before she became my noble friend here in 2005, I was for many years her right honourable friend in another place; but we were friends long before then, having first met when, in 1974, at the suggestion of a dear friend of ours, Lily Howe, I went as a Labour Front-Bencher to support her parliamentary candidature in Bolton. Yet, sadly, there is one irreconcilable difference between us: she is an ardent supporter of Bolton Wanderers and never more delighted than when they humble one or other of the Manchester teams.

I am grateful also to the other noble Lords who will follow me in the debate, and the House will understand why I am specially glad to see among them the noble and learned Lord, Lord Lloyd of Berwick, and the noble and gallant Lord, Lord Craig of Radley. Had the findings of the independent public inquiry into Gulf War illnesses, headed by the noble and learned Lord, Lord Lloyd, been acted upon, the controversy it addressed could have been settled years ago; while the abiding devotion of the noble and gallant Lord, Lord Craig, to helping those afflicted and bereaved by the Gulf War is held in high admiration in all parts of this House. All of us deeply regret that, for medical reasons, the noble Countess, Lady Mar, cannot be with us. She is warmly regarded by Gulf veterans and much missed here this afternoon.

I have a non-pecuniary interest to declare. In January 2002, the United States Congress co-opted me, uniquely for a non-American, to serve from the dais on its committee of inquiry into Gulf War illnesses, from whose deliberations federal funding of the Congressionally-mandated Research Advisory Committee ensued. That is why I was asked to speak at the launch of its historic report in Washington last November.

Appropriately, one of the first voices to be heard on the report in this country came from the medical community. The Lancet, in an editorial, called urgently for,

“expanded programmes of care, support and compensation”,

which it described as,

“the least that is now owed to those whose tenure of service to their country turned into lifelong disability”.

The editorial pointed to the RAC's repudiation of claims that what veterans and the media have called Gulf War syndrome—GWS—is a psychiatric disorder or stress-related whereas in truth, reported the Lancet, Gulf War veterans,

“actually have lower rates of post-traumatic stress disorder than veterans of other wars”.

Readers were also told of cognitive problems, complained of by British and American veterans, as well as,

“fatigue and chronic pain, and digestive, respiratory and skin disorders",

and of their having been found by successive scientific studies to have,

“significantly higher rates than other veterans of amyotrophic lateral sclerosis and brain cancer".

Readers were further informed that Gulf War illness, which for its greater precision the RAC prefers to Gulf War syndrome, had now been attributed to two neurotoxic exposures to which virtually all British veterans were subjected; namely, organophosphates and pyridostigmine bromide, a drug never tested on human beings and designed to protect against nerve agents.

The RAC's report has been backed by many distinguished doctors and scientists, including Dr Norman Jones, formerly emeritus consultant physician at St Thomas's Hospital, who sat with the noble and learned Lord, Lord Lloyd, as medical assessor throughout his inquiry; Dr Malcolm Hooper, an emeritus professor of medicinal chemistry, who presides over the National Gulf Veterans and Families Association; Professor Christopher Foster, professor of pathology at the University of Liverpool and author of a masterly assessment of the report; and crucially, Dr Jack Melling, formerly executive director at Porton Down. They point out that the RAC was,

“packed with eminent medical scientists, all leaders in their fields, and based on 1,840 scientific communications, the vast majority of which have appeared in peer-reviewed journals, most of the remainder having been included because of the repute of their authors”.

What emerges from all that has been said and written about the report both here and in the United States is a clear consensus now of informed opinion that Gulf War illness—GWI—is real, serious and potentially deadly; that at least two neurotoxic exposures were causal factors; that GWI relates only to Gulf War deployment and differs from illnesses experienced by veterans of other conflicts; that attempts to pass off GWI as primarily a psychiatric condition are not supported by the evidence; and that any delay now in addressing the implications for British veterans of the RAC’s findings would be inexcusable.

Two points sometimes made for the MoD are that it never doubted that some veterans were ill due to the conflict and that its spending of some £8.5 million—$12 million—on researching the scientific background to the illnesses was to be welcomed and by implication applauded. This is said despite US spending on research totalling $380 million.

The MoD’s spending did not impress Flight Lieutenant John Nichol, whose bravery under torture in Iraq in 1991 was seen on TV screens across the world. He told the Lloyd inquiry:

“The MoD says it has spent £8.5 million pounds on research in the years since the conflict. That compares with the nearly £8 million they spent in a single year on entertainment”.

He added:

“We weren’t the enemy, but that’s exactly how Gulf veterans have been made to feel by the MoD”.

Samantha Thompson, the widow of a Gulf veteran, was no less pointed in telling the inquiry that she and her seven year-old daughter would have been better treated if her husband had served in the armed forces of the United States. Yet in saying that she was literally correct because her husband Nigel, decorated by Tony Blair in Downing Street for “conspicuous gallantry”, died of motor neurone disease which in the United States, such is the prevalence of the disease among veterans there, is treated as a Gulf War-related affliction.

Research showed the statistics here make the case even more strongly, but the MoD’s response was to tell Samantha that:

“Research must be peer-reviewed”.

As of now, five years on, motor neurone disease is still not accepted as Gulf War-related in the UK.

Further to the reply of my noble friend Lord Drayson of 17 December at col. WA 43 of the Official Report on the Medical Research Council’s much criticised involvement, can my noble friend Lady Taylor say what peer review there has been of the MRC’s work for the MoD on Gulf War illnesses, and its findings, and also how the department reacts to Dr Norman Jones’s comment on my noble friend Lord Drayson’s reply that:

“The RAC’s report reviewed hundreds of studies published after the MRC’s report to the MoD of 2003 which must therefore now be regarded as left far behind”?

And why do we now need a peer review of an RAC report that is itself a peer review of already published scientific work that was peer reviewed before publication?

Before my noble friend replies, it might be helpful for me to give her my understanding of the constitutionalities vis-à-vis the peer reviewing of RAC reports, which is that Congress by law has designated the RAC itself as the body responsible for,

“reviewing the scientific evidence and Federal Programmes relating to the health consequences of 1991 Gulf War service”.

She might like to check this, and in doing so read what the RAC says on its legal status at page 20 and elsewhere in the report.

None of us here—and certainly not my noble friend—can want to see the afflicted and bereaved of the Gulf conflict made to suffer the strain and hurtful and demeaning indignities of still further delay in reaching closure on their anxious concerns. Yet they still see no end to their anguish.

Of all the duties that fall to parliamentarians to discharge, none is of more compelling priority than to act justly to those who, alone in this country, contract with the state to lay down their lives in its service and the dependants of those who do so. There was no delay in the response of our troops to the call of duty in 1990-91. Nor must there be still further delay now—more than 18 years on from the conflict—in discharging in full our debt of honour to them.

My Lords, I congratulate the noble Lord, Lord Morris of Manchester, on securing this important debate. No one has done more than he has over the years to obtain some satisfaction for the veterans of the first Gulf War who are now suffering from Gulf War syndrome, a label which, ultimately, the Ministry of Defence accepted as being a correct umbrella term. However, if we accept the findings of the massive new report which is now before us, we can instead refer simply to “Gulf War illness”. There is an interesting passage in the report at page 41, where the authors of the report discuss what we mean when we talk of Gulf War syndrome as being unique. They accept that the consistent pattern of symptoms from which veterans are now suffering would fall well within most definitions of what is meant by “syndrome”, but say it is easier and simpler to refer to Gulf War illness. I am certainly happy with that and I imagine that the veterans will be happy too.

However, I am not so happy with an Answer given by the noble Lord, Lord Tunnicliffe, on 9 December 2008, to a Question asked by the noble Lord, Lord Morris. He said at column 258 of Hansard that there is—and I paraphrase—no justification for treating Gulf War veterans differently from others from other operations who have the same conditions. I have difficulty with that Answer for this reason: the one thing on which everyone is agreed is that there has been no similar widespread and unexplained symptomatic illness identified in any other war zone, either before the Gulf War or since. That finding is made quite clearly on page 1 of the report. So, in that sense at any rate, Gulf War illness or syndrome—whatever you call it—is, indeed, unique. I hope that when the Minister comes to reply she will at least accept that.

I turn now to the more important issue of causation. When Dr Norman Jones, Sir Michael Davies and I wrote our report in November 2004, there were a number of different possible causes. A medical appendix, written by Dr Norman Jones, was attached to the report, and in part 2 of that appendix he listed no fewer than nine possible causes of the illness, either alone or in combination. But although there were nine possible causes in all, there were three front-runners to which I shall refer.

The first was the multiple vaccinations to which it was said by the Ministry of Defence that the men had given their informed consent, whatever that may have meant. So the first possible cause was what came to be known as the cocktail of injections which the men were given before going to Iraq. Secondly, there were the organophosphate pesticides used to spray the tents in which they were living when they got to Iraq. For many years the Ministry of Defence denied that OP sprays had been used at all, except in the case of one single tent. But eventually, on 10 December 1996, Mr Soames admitted that Parliament had indeed been misled. Thirdly, there were the nerve agent pre-treatment sets, or NAPS tablets as they were known for short, which the men were required to take in the event of a threatened gas attack. They had never been used before by our forces or the American forces on anything like the same scale.

The medical appendix deals with each of these causes in some detail and we owe a great debt of gratitude to Dr Norman Jones, who wrote it. He also dealt with the other possible causes, such as depleted uranium shells which were used for knocking out the Iraqi tanks. In the body of our report we did not reach any conclusion as to which of these actually caused the illness. It would have been ridiculous for us to attempt to do so because there was still much research to be done. Causation was an issue, as we saw it, on which the jury was still out. Stephen Irwin QC took the same view when he advised in March 2003 that legal proceedings against the Ministry of Defence would be unlikely to succeed, for without reliable evidence as to cause of illness, it would be difficult to establish negligence as the basis of the cause of action.

We are now six years on and a prodigious amount of money has been spent—said to be $300 million in the United States on research and £9 million in this country. As a result of all that research, we now have a much clearer picture, and that is why this report which we now have is so important. It has provided us with the evidence which we have always needed. The committee which prepared the report under the chairmanship of Mr James Binns was appointed by Congress in 2002. It published an interim report in 2004 and the final report, which we now have before us, in November 2008. As the noble Lord, Lord Morris, said, the committee has reviewed 1,840 scientific papers listed alphabetically at the end of the report. I am told by Dr Norman Jones that the great majority of these papers have been published in peer-reviewed journals.

The committee has gone through all the possible causes in the greatest detail and concluded that only two remain which have been consistently identified by all the evidence—NAPS tablets and OP pesticides. Together, as they say, these causes make a compelling case as the causative factors involved. True, other factors cannot be absolutely ruled out, but there is little or no evidence to support them.

In his Answer on 9 December the noble Lord, Lord Tunnicliffe, said that the Government would need time to consider the report—no one would quarrel with that—but he went on to say that it would have to be peer-reviewed. Why? The report we now have is not a piece of original research; it purports to be a report of findings based on the research of others, and that it is indeed what it is. It is a report of findings by a committee of medical scientists, all of whom, according to Dr Norman Jones, are leaders in their fields. What more do we need?

In our report in 2004—modest when compared with the report we now have—we said that on causation the jury was still out. I suggest that the jury has now returned and that the verdict is to be found in the Binns report. If that report needs peer review, then peer review will never cease. After six years the Binns committee has brought its labours to an end; what conceivable purpose could be served by asking the MRC or indeed any other body to go through the evidence all over again—all 1,840 papers of it? It is surely not suggested that Gulf War illness on this side of the Atlantic is any different from Gulf War illness on the other side. I ask the Minister to accept on the basis of the Binns report that the probable causes of Gulf War illness are the two that have been identified by the committee. We cannot be certain, of course. Little in life is certain, and even less in litigation. But probability, the civil standard of proof, is enough now to enable us to deal justly—and, I hope, generously—with the veterans suffering from Gulf War illness.

Where, then, does that lead us? The Government have already apologised for the way the veterans suffering from Gulf War illness have been treated, but say that the veterans are now receiving pensions to which they are entitled and, so far as compensation is concerned, that is the end of the story. That is not an end to it, however. The war pension scheme entitles the veterans to a pension for injuries attributable to their service. But the peculiarity of the present case is that the injuries received by the veterans are not attributable to enemy fire, accident or anything of that kind; they are attributable to the NAPS tablets with which they were issued by the MoD and to the OP sprays, supplied by the MoD, with which their tents were sprayed.

No government department likes to create a precedent—

My Lords, we are limited to a 10-minute contribution in this debate, and the noble Lord has taken 12 minutes.

My Lords, I shall complete it in two sentences. I need only say that no department likes to set a precedent, but if I am right that Gulf War illness is unique then no precedent will be set. It is time for the department to act generously in response to the many requests that have been made.

My Lords, I congratulate the noble Lord, Lord Morris of Manchester, on obtaining this debate. It gives Her Majesty’s Government an early opportunity to comment on the scientific findings and recommendations of the US congressionally mandated examination of all evidence on Gulf War illness. It is a most impressive document and I hope that we can be assured that the Government are treating its findings and recommendations seriously. I remind the House that I was the Chief of the Defence Staff throughout the first Gulf War.

All those who have suffered from illness following their operational involvement in that war, their families and close friends, many others in the service charities, especially those in the National Gulf War Veterans and Families Association and in Parliament who have taken an active interest in this issue, anxiously wait for the Government’s response. The hope for us this evening is to be told that Her Majesty’s Government accept these findings and that they will act on them and make clear to all in the British Armed Forces that they intend to do so.

As I have pointed out in a number of debates on this issue in your Lordships’ House, it is not only those who served in the Gulf in 1990-91 who are concerned; so, too, are many others now serving. They need to be reassured that any Government of the day will act promptly and fairly in their dealings with them and their dependants if they were to become ill as a result of their service. This undertaking to deal fairly was explicitly promised by the Prime Minister in the foreword to the recent Command Paper 7424, The Nation’s Commitment.

It cannot be said that many of those who became ill following the 1991 conflict have had a fair deal at any time in the past 18 years. For far too long, lasting health consequences were denied, trivialised or regarded merely as a stress-induced psychiatric condition. While claims have been accepted when the claimant has a recognised clinical condition, it has been very much harder—and not always with a satisfactory outcome—for a veteran to gain an award if their illness is not listed by the World Health Organisation. This has been a Catch-22 situation for Gulf veterans. While obviously far from well, without a condition that is listed their claim for adequate compensation may be turned down.

Is it satisfactory to assume, however, that the World Health Organisation list is a complete and unchangeable lexicon of clinical conditions? Medical advances alone can lead to the discovery and recognition of new conditions. I believe, following this US report, that Gulf War illness should be added to the list of conditions acknowledged by the WHO. Then the way ahead for a claimant would be much more straightforward. Is there enough in the US report to merit this addition by the WHO?

Rightly, the US report emphasises the need to help those who are sick. Research into some form of cure or alleviation of the worst effects of the illness is important. I hope the Government will also agree on that and underwrite their support with further funds for research.

The medical director of Breakspear Hospital, in Hemel Hempstead, wrote to me recently to say that they had been working in this field of environmental medicine. They had experience in dealing with people who had been exposed to pyridostigimine and other neurotoxins. I hope this will also be looked into by the Ministry of Defence.

I would like to touch on another issue. The Command Paper set out some good intentions for looking after veterans when they have left their service. I am far from clear, however, how the Government intend to monitor progress and introduce any necessary changes to the new supporting arrangements. Gulf War illness veterans will be most interested in this. The Command Paper mentions an external reference group which is to report annually to the Prime Minister and the Defence Secretary. Has this group yet met? When will it be making its first report?

The group itself, which includes government departments, devolved Administrations, defence academia, service families’ federations and key service charities, sounds unwieldy and perhaps not so well equipped to deliver on these new initiatives. Will the National Gulf War Veterans and Families Association be invited to attend? I would like to see an independent chair for this external reference group.

It is alarming to read that a considerable number of veterans have criminal convictions and that some are now in prison. Whether their misbehaviour is a symptom of clinical depression or not, it is worrying that we do not yet seem to have enough interest or understanding of the reasons why previously well disciplined individuals now misbehave. I welcome the new prison in-reach initiative, which reflects a greater commitment to veterans in trouble with the law who have left the service. But pre-offence support is far less evident.

The service charities do an excellent job, but it should not all be left to them alone to assist veterans in difficulty. The introduction of a part-time junior Minister for veterans within the Ministry of Defence is a start, but is it enough? Regrettably, this Minister and his supporting staff have, from time to time, been seen to act in defence of the MoD’s interests rather than in the interests of the veteran.

In the United States there is both a Department of Defense and a wholly separate Department of Veterans’ Affairs. The US forces and their veterans are, of course, very much larger in number than ours and the supporting services for US veterans are structured differently from those here in the UK. But we have a large number of veterans, stretching back over many decades, many of them in need of advice or help. They do not have a single-service point of contact to support them or to point them in the right direction. Should there not be within each service, perhaps at the command headquarters, a well publicised and active veteran support cell? Veterans of all ages could be made aware of this cell, knowing that it is there to help with any issue that arises in their civilian life after they have left the service and to point them in the right direction. That would be much less impersonal than contacting the Veterans Agency. Not many are comfortable with the agency concept, and some do not even have a clue what it does. While the service charities provide much valuable support, some veterans and dependants may feel embarrassed or reluctant to have to turn first to charity.

It is time that the Ministry of Defence was no longer seen in any way as the uncaring face of bureaucracy but was structured to provide proactive support for veterans—ongoing, whole-of-life support. We must turn the fine words of giving veterans a fair deal into practical and reliable help for all of their lives. They have served their country well; they deserve the unashamedly special treatment that the Minister has said is their due. It is still due to veterans with Gulf War illness.

I acknowledge that the present Minister for veterans has embarked upon a range of initiatives and set himself the challenge to do better by our veterans. In that, I wish him well.

My Lords, I crave your indulgence to speak in the gap. My noble friend Lord Morris of Manchester acquits me of any discourtesy; in fact, he rather wants to see me on my feet.

I speak on this subject with very little knowledge except that for a couple of years I had to field a stream of questions on it from the noble Countess, Lady Mar, and my noble friend. I cannot speak too highly of my noble friend’s dedication to this cause and the time he has put into it, as the noble and learned Lord, Lord Lloyd of Berwick, has said.

I want merely to say today how much I endorse everything that I have so far heard in this debate. I ask the Minister to try to get the Ministry of Defence to move as quickly as possible to closure on this matter. I know perfectly well that she will be sympathetic. The veterans have waited far too long and have often been libelled in the press, which is most unfortunate, as I am sure my noble friend will agree. Anything that the Minister can say that will encourage us to believe that the veterans’ years of agony are quickly coming to an end will be welcome in all quarters of your Lordships’ House.

My Lords, I also congratulate the noble Lord, Lord Morris, on bringing this debate forward, and recognise the considerable campaign that he has carried out over many years. Since 1997, when I think he asked his first parliamentary Question on this matter in another place, he has been consistent in his endeavours to obtain justice for those who suffer from Gulf War illness.

The US report, which was published last November, concluded that Gulf War illness is a serious condition. It affects one-quarter of US veterans who served in the 1990-91 war. That is a very high proportion. It is described as a,

“complex of multiple concurrent symptoms [that] typically includes persistent memory and concentration problems, chronic headaches, widespread pain, gastrointestinal problems and other chronic abnormalities not explained by well-established diagnoses”.

It also says that no effective treatments have been identified for Gulf War illness, and studies indicate that few veterans have recovered over time. It is an extremely serious condition that all these servicemen have suffered from over the years.

As the noble and learned Lord, Lord Lloyd, has pointed out, the US report is not simply a one-off report by one scientist, but a combination of conclusions from extensive research carried out by many people, both in this country and the United States. I hope that its conclusions put an end to the suggestion that Gulf War illness is nothing more than a psychiatric condition. At one time, during discussions about Gulf War syndrome, one particular medical professional voiced the opinion that 90 per cent of those who said that they were suffering from it were malingerers. This report has finally and conclusively put an end to that.

I share the concern of the noble and learned Lord, Lord Lloyd, over the reply of the noble Lord, Lord Tunnicliffe, on 9 December, when he said:

“There is no justification for treating Gulf veterans differently from others from other operations who have the same conditions”.—[Official Report, 9/12/08; col. 258.]

I have considered that as a serious question. Many veterans have been injured and suffered illness and the consequences of being involved in military operations. Why should the Gulf War veterans be singled out for ex gratia payments or something above the war pensions or lump-sum payments that are customarily awarded? There are a number of important distinctions. First, as has been said, this is a unique condition that has arisen from this conflict. Secondly, it is a condition that does not come from any enemy action. The US report now shows conclusively that it is derived from treatments and applications that were imposed on our soldiers in the course of their service. The PB tablets, which were anti-nerve gas agents, were given to them because there was a risk of injury in chemical warfare. The organophosphates were employed to fumigate the tents to prevent illnesses derived from pests. That is rather different from the kind of illnesses and injuries that soldiers might expect in conflict with the other side.

The Government have failed to recognise this as something for which special treatment should be given. It reminds me that the same approach is used in relation to those servicemen who were exposed to nuclear testing in Australia in the 1950s. I know that a case is going on at the present time and that I should not say too much about it, but it was interesting to see the Government’s response to the bringing of those proceedings. A Ministry of Defence spokesman said:

“The UK government recognises the vital contribution service personnel played in the UK's nuclear tests during the 1950s and understands its obligation to veterans. When compensation claims are received they are considered on the basis of whether or not the Ministry of Defence has a legal liability to pay compensation. Where there is a proven legal liability, compensation is paid”.

That is the attitude of the Ministry of Defence towards servicemen who were injured in the 1950s and have suffered ever since as a result of being exposed to radiation. When Gulf War syndrome was put forward as a basis for compensation, the Government again said, “Well, you can’t prove it. We need causation to be established before we are prepared to pay anything other than the ordinary war pensions or lump-sum payments”.

If these conclusions are accepted, it gives rise to the possibility of the resurrection of those actions which were stayed in 2003. The Government have sought in the case of the atomic tests to say that the actions are out of time and cannot be brought now, but it is possible that those limitations can under the Limitation Act be overcome by the provision of new scientific evidence. The Government should be aware that if they are not generous in their approach and do not accept the conclusions that the report puts forward, they may face the kind of claims that are being made by those who are claiming for exposure to radiation through atomic tests.

My noble friend Lord Tyler asked Her Majesty's Government in November what their reaction was to the report. The answer given by the Minister was that it was being carefully assessed. She noted that the US Department of Veterans Affairs had sent the report to the Institute of Medicine for review and said that she would await the outcome of that process before making any comments on it. As the noble and learned Lord, Lord Lloyd, has said, peer review is quite inappropriate to a report of this kind. It is comprehensive. It has brought in all the experts in this field, and their wisdom has been fully investigated and used for the purposes of coming to its conclusions. So what are we waiting for? What can the Institute of Medicine in the United States add to all the expertise that has already been brought forward? I urge the Minister today to accept the conclusions, to accept that the causes found in the report are established and to accept that special circumstances take the case of the Gulf War veterans outside the normal—and, in those circumstances, to bring forward proposals for properly compensating by way of ex gratia payments, or whatever, as the inquiry from the noble and learned Lord, Lord Lloyd, suggested in 2004, those who have had a sense of grievance over the past 18 years, ensuring that they can feel that their problems have been properly addressed and that they have received that which they are due.

My Lords, the House will be enormously grateful to the noble Lord, Lord Morris of Manchester, for introducing this important debate. I, too, pay tribute to him, the noble and learned Lord, Lord Lloyd of Berwick, and the noble and gallant Lord, Lord Craig of Radley, for all the work that they have done over a long period on behalf of those affected by Gulf War illnesses. I am also grateful to the National Gulf Veterans and Families Association for making its position clear to me.

Gulf War I was unique. It was the most toxic war in western military history, and exposures suffered have now been shown to be associated with a pattern of symptoms and physical signs that were previously unknown. The report produced by the congressionally mandated Research Advisory Committee on Gulf War Veterans’ Illnesses has gone a long way towards answering some of the questions surrounding the term “Gulf War syndrome” and what it represents. I take this opportunity to thank the committee for its extensive and scientifically based research into a condition that has been little understood, often trivialised and treated as a stress-related condition. This report shows not only that Gulf War illness is not stress-related, as the noble Lord, Lord Morris of Manchester, said, but that it can no longer be marginalised or dismissed.

As we are all aware, Gulf War illness displays many different symptoms. Some of these are,

“persistent memory and concentration problems, chronic headaches, widespread pain, gastrointestinal problems, and other chronic abnormalities”.

Previous studies have shown that higher rates of amyotrophic lateral sclerosis and brain cancer have been found than among other veterans. Moreover, according to the Lancet, these symptoms were suffered by 174,000 US veterans and somewhere between 6,000 to 12,000 British soldiers.

As the report states, it is now clear that,

“the extensive body of scientific research now available consistently indicates that Gulf War illness is real, that it is the result of neurotoxic exposures during Gulf War deployment, and that few veterans have recovered or substantially improved with time”.

It specifies that PB pills used to combat nerve agents and pesticides during deployment are “causally associated” with Gulf War illness. We can now see that for these soldiers their,

“short tenure of service to their country turned into a lifelong disability”.

The Ministry of Defence has on its website a clear statement of its position on Gulf War illness. It says:

“Gulf Veterans’ illnesses issues remain a priority for the Government”.

However, it goes on to say that,

“patterns of symptoms are similar to those experienced by personnel who did not deploy, and overall severity of the symptoms is not high”.

Will the Minister tell the House whether the Government intend to revise their line to include the more up-to-date information from the report? Will she also say why it has not been updated given that the report was published on 17 November last year? The Ministry of Defence website also states:

“We are committed to research aimed at improving the long term health of those veterans with persistent symptoms”.

This is highly relevant, because the report makes it clear that its findings should be seen as a basis for further investigation—primarily, of course, to research ways of helping those suffering from Gulf War illness, but also with regard to other related issues. It flags up the concerns about Gulf War veterans suffering from other diseases such as ALS, a progressive neurodegenerative disease that attacks nerve cells in the brain and spinal cord, and brain cancer. It suggests that these should be monitored for the foreseeable future. There are important questions about how to help to improve the health of Gulf War veterans, and further analysis is needed regarding the health of their children.

Will the Minister assure the House that the Government are committed to this new research? The noble and gallant Lord, Lord Craig of Radley, who was, as he said, Chief of the Defence Staff during the first Gulf War, has said that medical treatments for these conditions are needed to protect current and future military personnel at similar risk. Will the Minister tell the House what action will be taken to help to reduce the threat of this kind of illness in the future? In the US, especially in the light of the recent research, it is now a “national obligation” to make sure that the health of Gulf War victims improves and that nothing like this ever occurs again. This is made especially urgent by the many years during which Gulf War veterans have waited for answers and assistance. Will the Minister assure the House that plans are in place to make sure that the UK will also play its part in this national obligation? The noble Lord, Lord Gilbert, pointed out that our veterans have waited a long time. They and their families deserve our help.

My Lords, we have had an interesting, if brief, debate. The one point that unites everyone in this House is the congratulations expressed to my noble friend Lord Morris on obtaining the debate but also in his sheer dogged persistence over many years in pursuing this campaign and starting it when, as noble Lords have mentioned, it was not a popular or fashionable campaign. As has been said, in those early days many people trivialised the issue and assumed that this was a stress-related illness. I was alarmed by the figure that was quoted by the noble Lord, Lord Thomas, from the press, in the context of their derogatory remarks about people who suffer from it.

Having praised my noble friend Lord Morris, perhaps I can say that I was not too delighted that he reminded people how long ago it was that I first fought an election. We will leave that matter to one side. I would like to clarify and explain the Government’s position on Gulf veterans’ illnesses. It is, as other noble Lords have pointed out, a sad truth that some service personnel have been affected by ill health due to their time in the Armed Forces. I am sure that I speak for everyone in this House as well as everyone in Government in saying that we must make it clear that we are not only aware of the sacrifices they have made but that we also accept a duty of care to them. That is important and something I want to emphasise, because the Government take that duty of care very seriously. It is manifested in various forms, from research to better understand some of the conditions that our veterans suffer from, to medical assessments and NHS treatment for those who need it. I will later touch on another aspect, financial support, which is provided through MoD war pensions and Armed Forces occupational pension schemes.

We recognise that veterans may have particular needs. That is why in the Service Personnel Command Paper—which, it was mentioned earlier, was the first of its kind—we have committed ourselves to raising awareness among healthcare professionals in particular so that the needs of those who have served in the Armed Forces are met.

The noble and gallant Lord, Lord Craig of Radley, mentioned veterans’ organisations. There has been a breakthrough, which I know that he welcomes. I hope that he will have confidence in that because there is now a separate single point of contact for veterans. The committee that he asked about has met on two occasions already and is due to meet again soon. That will certainly lift the whole profile of the help that is available for veterans and I hope it will be constructive to all veterans.

In this debate, however, we are talking about a specific group of veterans—those who served in the Gulf in the 1990s—who have particular concerns about their health. We heard graphic descriptions about that this afternoon. I would like to take a moment to remind your Lordships that one of the first things that the Labour Government did after taking office in 1997 was to commission new research in this area. That was a mark of the serious intention on the part of Ministers from that date to take this issue seriously and try to find out what we could. That is why we have spent around £9 million funding expert medical research in this area.

That research has come to the same conclusion as the independent Medical Research Council report from 2003, which looked at all the UK and international research into these issues. The conclusion was that,

“there is no evidence from the UK or international research of a single syndrome related specifically to service in the Gulf”.

Of course, research work continues. Mention has been made today of the United States Institute of Medicine, which is currently considering the report published by the US Research Advisory Committee on Gulf War Veterans’ Illnesses. We look forward to seeing the outcome of that review. It is reasonable to have a review of the evidence that is presented by a set of experts. I congratulate my noble friend Lord Morris on having such a direct input into that committee, which shows the respect in which he is held on an international basis.

We have a copy of that report in the MoD, and people are looking through it. I read the executive summary because I did not feel competent to read all the technical, scientific and medical expertise in the main body of the document. It is important that we wait until we have time to examine it fully. The noble and gallant Lord, Lord Craig, said that it was reasonable to assess that report properly. It is a review of much of the evidence that has been put forward. However, it is important to bear in mind a couple of basic facts, not least that this report does not in itself identify a discrete pathological entity that is Gulf War syndrome. In some respects, therefore, we have not drawn the line in terms of definitions and in terms of causation. Obviously, we have to be willing to consider any credible new evidence, but the overwhelming consensus at the moment is that there are still too many symptoms and variations to have a syndrome according to the strict medical definition. Other noble Lords mentioned that as well.

As the noble and learned Lord, Lord Lloyd, said, the MoD changed its approach and acknowledged that the phrase “Gulf War syndrome” had become widespread, and we therefore reviewed our position in terms of the use of it and accepted it as an umbrella term to address the concerns of veterans who felt that there was a direct link between their service and their illness, and that that had not previously been recognised.

My Lords, would the noble Baroness not accept, even on the basis of the executive summary, that this committee, after six years has identified two specific causes as being the most likely causes of Gulf War syndrome? I identified those in my speech.

My Lords, the noble and learned Lord did identify those causes, but the report also states that Gulf War illness does not fit neatly into well established categories of disease. One of the important points that I want to make is about what the report says about future work and where the emphasis of that should be. While I recognise that the stance of the MoD does not go far enough for some people, it is important that we retain our evidence-based approach and that we follow the evidence that can be made available to us. We are always willing to look at new evidence when it is made available.

My Lords, in assessing the evidence, what standard of proof does the ministry demand? Is it proof beyond reasonable doubt or proof that it is more likely than not that the causes identified in the US report are the actual causes? If the Government were facing a case in court, the standard would be “more likely than not”. Surely this report has reached that standard for all time.

My Lords, one of the problems is that there is a lot of contradictory evidence and a lot of ifs, buts, maybes and combinations. Indeed, some years ago it was suggested that the real issue was that there had been a cocktail effect whereby there was a combination of causes, as has been mentioned. While this report states that although there is a persuasive theoretical case, and although the case is compelling, little evidence is available to indicate whether or not Gulf War illness is associated with combinations of these exposures.

If one looks at this report and the various issues that are very serious for many people—I do not underestimate how serious issues of brain cancer or a whole range of disabilities are—trying to collect those all together and establish a single causation needs a great deal of study. It is right that Ministers do not jump to conclusions and we go to the people who have the best information. I would not in any way minimise the impact of illness on any veteran, but we should bear in mind that there are some puzzling statistics in all of this, not least if we look at mortality statistics. The figures that I have state that there were 980 deaths of those who had served in the first Gulf War, but if one does an age-adjusted comparison, one would have expected more deaths by a considerable factor. We must be careful about making simplistic conclusions. This report states that it is difficult to make simplistic conclusions about cause and result, and that is important.

My Lords, I draw attention to the phraseology on page 10 under the heading “What the Weight of Evidence Tells Us About the Causes of Gulf War Illness”. The report states:

“An extensive amount of available information now permits an evidence-based assessment of the relationship of Gulf War illness to the many experiences and exposures encountered”.

Is the noble Baroness saying that the report does not give her and the Ministry of Defence the right weight of evidence to meet the type of challenge that would be required in a court of law?

My Lords, I am not trying to make judgments about what would happen in a court of law; I am trying to explain the complexities of the evidence, the fact that it is therefore right that experts in this field should be looking at this, and why peer review is important.

I am urged to look at the time, but perhaps I may deal with one other extremely important issue—I hope we can all agree that it is one of the important things to come out of the report. It concerns the approach that we should all take to veterans with this kind of illness. The section entitled “Research Priorities and Recommendations” says that the primary goal should be,

“improving the health of Gulf War veterans”.

The committee recommends that the,

“highest priority be given to research directed at identifying beneficial treatments for Gulf War illness”.

That is one of the things on which we must concentrate attention.

We are working to ensure that the right medical services are available for veterans and that general practitioners know that they have very serious responsibilities. Those should be among our primary goals. Although it is difficult to be absolutely precise about causation, and people will disagree on the weight of the evidence, there are things that we can do. One is to ensure that the war pensions and benefits to which veterans are entitled are paid. I wish to defend the statement of my noble friend Lord Tunnicliffe. He said that payments should be made in accordance with disability or injury and not on the basis of causation or, indeed, on the basis of the label put on any illness. Instead, payments should be made on the basis of need and the level of disability. It is also important that, looking forward, we concentrate our efforts on ensuring that the treatment and support available are as good as possible.

My honourable friend in another place, the Parliamentary Under-Secretary with responsibility for veterans, recently met the organisation responsible. He is hoping to build on that meeting and to work through one or two of the problems, such as the funding of specific types of research, and I hope that something positive can come out of that. However, I assure my noble friend and all Members of your Lordships’ House that the Government will look at the evidence very carefully and that we will ensure that it is considered by the right people. I am very pleased that we have been able to have this debate and I know that everyone in this House will take this issue seriously.