Oral Answers to Questions

Madeleine Moon Excerpts

Monday 27th November 2017 Commons Chamber

[Gavin Williamson]

When I had the good fortune to sit down with Secretary Mattis to discuss our partnership, what struck me was the value that the United States puts on everything that Britain does, and the contribution our men and equipment make. He was left in no doubt that that commitment—that resolute support that we have always provided to the United States—will always be there.

[Mrs Madeleine Moon (Bridgend) (Lab)]

Despite what the Secretary of State says, Lieutenant General Hodges and James Mattis have both said that we will lose our clout in NATO and our place at the top table if the cuts continue. Will the new Secretary of State commit to stopping the cuts to our capability, and will he make sure that Britain stays at the top table and that we have the capability to defend ourselves and our allies?

[Gavin Williamson]

The Government’s commitment to making sure that we have the very best for our armed forces has always been clear. The rising defence budget, which is going from £36 billion to £40 billion, is evidence of that commitment. [Interruption.] The United States knows quite clearly that we will always be there in support of them, regardless of what the hon. Lady’s leader may wish. [Interruption.]

UK Amphibious Capability

Madeleine Moon Excerpts

Tuesday 21st November 2017 Westminster Hall

[Kevin Foster]

It is a pleasure to follow the hon. Member for Plymouth, Sutton and Devonport (Luke Pollard). He will know that that was my birthplace and my father spent 37 and a half years in Devonport dockyard in his constituency, with his last job being on HMS Albion before he retired in 2010.

It is particularly apt that we are having this debate on the 99th anniversary of the German high seas fleet entering Scapa for the internment, following the armistice of that year. Edward Grey famously commented at the start of the first world war on the lamps going out, but he made another famous comment:

“The British Army should be a projectile to be fired by the British Navy.”

That reflects how important amphibious capability was. Yet today is not about history. Wars are not won by emotion and we do not deliver aid by reminiscing about the times of the fleet defending the empire.

[Mrs Madeleine Moon (Bridgend) (Lab)]

I disagree with the hon. Gentleman. I think today is about history. If we do not learn our lessons from history, we will keep repeating our mistakes, and our mistake has always been to cut at exactly the wrong time, when the risks are high, and we are about to do it again.

[Kevin Foster]

I partly agree with the hon. Lady. If we went back to history, we would still have cavalry, because it was decisive at Waterloo, but this is about why amphibious capability makes sense today, in the 21st century. It is not just about reminiscing, although it is still worth while looking at the history of why this capability was developed and, of course, looking back to the Gallipoli landings, where we did not have a proper amphibious capability and the results were disastrous for those first world war soldiers.

Today’s amphibious capability is about giving the choice to deploy troops in either a war-fighting or humanitarian role anywhere in the world, going on the global commons. It is vital that it can operate as a stand-alone force. That means having the ability of the docks that are provided just offshore by HMS Albion and HMS Bulwark when deployed. Some argue that the Queen Elizabeth-class aircraft carrier can provide this type of support. The reality is that a large aircraft carrier is a vital asset that is defended in depth and would never be taken close to the shore, or to any place where it could be at threat, to provide landing support. While it may go close to the shore in a completely non-threat environment to provide humanitarian aid, it would never do that for an amphibious landing because it is a very high-value asset.

While special forces can be deployed via submarine, that is clearly not a practical option for larger scale amphibious forces and also ties up a vital asset that can be used for so much more than providing what Albion and Bulwark can currently provide to forces. If we were without this capability, we would be an island nation unable to deploy our forces independently and stealthily on to another island. Looking at the growth of population by the coast across the world, which the MOD’s own analysis points to, it is clear we need to keep this capability. Therefore it is vital that we retain a corps dedicated to delivering this capability, not one we could rebuild from reserve.

When the new Defence Secretary was appointed, some people asked me what my views were. I said that the key battle for the MOD at the moment is with the Treasury. I hope the new commander at the MOD will be just the person to win that battle. It is vital that the Prime Minister and the Chancellor listen to his advice.

Today marks 99 years since one battle for the fleet ended, and hopefully tomorrow another battle will be won by our fleet—this time to maintain a capability that is as relevant in the 21st century as it was when Edward Grey made that comment so long ago.

--- Later in debate ---

[Mrs Madeleine Moon (Bridgend) (Lab)]

Like everyone else, I want to start by thanking my colleague and friend, my hon. Friend the Member for Stoke-on-Trent North (Ruth Smeeth), for securing this debate. It is important that there is absolutely cross-party consensus in this Chamber that we are about to do something extremely dangerous. The debate today is entitled “UK Amphibious Capability”, but it really should be, “Who are we? What role do we want to play in the world? Has the decline of the Royal Navy damaged our reputation and our capability as a naval power and an ally? And will the cutting of our amphibious capability and our Royal Marines finally sink our reputation as a naval power?”

We have been a naval power for centuries. A major part of that has been our ability to project force anywhere in the world, coupled with the ability to land personnel and equipment, using our amphibious forces quickly and effectively. Equally important around the world has been our ability to send humanitarian aid quickly and effectively everywhere. We have provided food and equipment and evacuated in humanitarian crises in a way that we should be deeply proud of, but we are about to lose that capability. As an island nation, our ability to conduct a conventional war in an effective manner hinges on our ability to deploy troops from our island to the theatre of conflict. That requires us to retain an amphibious capability.

We need to ensure that we can hold our head up high among our allies. Britain has a reputation as a serious maritime player. After the United States, the UK was NATO’s pre-eminent naval power. That reputation was not come by lightly and gave the UK a distinct and advantaged position, not just in NATO, but on the global stage—as a trading entity as well as a military force. Our amphibious capability played a vital part in forming and maintaining that reputation, but our allies are reassessing it.

Let me quote from an article by an ally. It was by Jonathan Foreman and was published in the April-June edition of the Australian Navy news. It stated:

“The paper proposes in essence that the Royal Navy cannot be saved in its current form, that the problems…frequently noted in recent years by other, often non-British, publications…are likely to be terminal. Given that the RN is already little better than a token force…manifestly unable to carry out many of the missions expected of it in home waters as well as distant seas…and that UK decision makers are unwilling to face up to the decisions and obligations required of a major maritime power, the best that Great Britain can hope for may be to field a moderately capable North Sea flotilla as part of a combined UK Defence Force.”

That was from our allies. That is how we are beginning to be seen. Let us wake up and recognise that.

Recently, The Times carried an article in which James Mattis was highly critical of our decision to cut two of our four minehunters from the Gulf. We are beginning to hollow ourselves out, as has been said repeatedly, including at last week’s sitting of the Defence Committee by the former First Sea Lord, Admiral Zambellas, who described us as a third-world nation militarily. We have to wake up.

We in this Chamber totally support the Royal Navy and its personnel, and I think I speak for us all in saying that. [Hon. Members: “Hear, hear!”] We are all proud of its successes, its traditions, its long history of bravery and its capability to face down overwhelming force. We will not, and cannot, sit by and be silent while the Navy is hollowed out and while the Ministry of Defence spins stories of our retaining greatness, when even our allies are mocking our inability to project effective and enduring force in defensive and humanitarian actions.

The Navy must retain its amphibious capability and its Royal Marines. The spin and misrepresentation of the weakness of our Navy must be recognised. If we are to hold our role in the maritime world, which we once proudly ruled, it is time to tackle the weakness that we have all allowed to happen to the Royal Navy. Britain’s ability to deploy a full range of naval capability, including an amphibious option, plays a vital and central role in our security, capability and reputation. Without that, Britain’s Navy lacks the critical ability to project power and authority beyond the sea and, as such, limits the effectiveness of what a naval task force is capable of, as well as what this country is capable of doing in defending itself.

[James Gray (in the Chair)]

We have 15 minutes left for five speakers. I call Leo Docherty.

Armed Forces Pay

Madeleine Moon Excerpts

Wednesday 1st November 2017 Commons Chamber

[Mrs Madeleine Moon (Bridgend) (Lab)]

Perhaps it depends on where you come from, because certainly in Wales plenty of people are complaining to me about pay issues in the armed forces, and people are struggling to cope with their bills. People have rung me this morning concerned about press reports on the cutting of the £29-a-day allowance for service in Iraq, which they see as a further cut to their capacity to cope while remaining in the armed forces. I thank my hon. Friend for bringing this debate forward today. It is an issue and I am glad we are here to discuss it.

[Nia Griffith]

I thank my hon. Friend. She very much lives in the real world and is very aware of the cuts that have affected our armed forces, particularly the cuts to pay.

--- Later in debate ---

[Leo Docherty]

If the hon. Gentleman had been paying attention back in September, he would have noticed that the Government indicated that there will be a move away from a blanket 1% public sector pay cap. If the pay review board makes a recommendation to the Government about increasing pay, it is likely that the Government will accept it, so it is entirely erroneous to paint a picture of armed forces pay being cut.

We must recognise that, broadly, the offer to the armed forces is good. In addition to increases in basic salary, armed forces personnel enjoy subsidised housing and non-contributory pensions. That is important and we must recognise it. There are of course concerns, and we must be vigilant in safeguarding and improving the experiences of our armed forces personnel, but the offer is good. I hear from people in my constituency concerns that are more related to kit and equipment, and to opportunities for training and deployment.

The issue of pay should not be a political football to be kicked around by Opposition Members. There is a good story to tell and we should be positive about the broad offer that the armed forces present to people. Sadly, the Opposition are talking it down; to demonstrate how, I shall quote the Leader of the Opposition, the right hon. Member for Islington North (Jeremy Corbyn).

[Mrs Moon]

rose—

[Leo Docherty]

I shall make some progress before I give way.

A few years ago, the Leader of the Opposition said:

“I would like us to live in a world where we spend a lot less on defence.”

In 2015, he said:

“Why do we have to be able to have planes, transport aircraft, aircraft carriers and everything else to get anywhere in the world?”

Shortly after that, he said:

“Wouldn’t it be wonderful if every politician around the world, instead of taking pride in the size of their armed forces, did what the people of Costa Rica have done and abolished their army”.

What a disgraceful indictment of the Leader of the Opposition’s attitude.

Oral Answers to Questions

Madeleine Moon Excerpts

Monday 13th March 2017 Commons Chamber

[Harriett Baldwin]

Listing the 23 that do not spend 2% would take too long, but I reassure my hon. Friend that the five that do meet the target are the United States, the UK, Poland, Greece and Estonia. I am sure he can deduce from that the absentees.

[Mrs Madeleine Moon (Bridgend) (Lab)]

23. Germany currently spends 1.23% of GDP—€36 billion —on defence and to spend 2% it would need almost to double that, to €60 billion. Does the Minister appreciate that a rearmed Germany would give concern not only to some of its neighbours, but to Russia, thus potentially increasing the difficulties we face with tensions on the Russian border?

[Harriett Baldwin]

With the greatest respect, we think it is incredibly important that all NATO members, who share joint responsibility for the defence of the alliance, committed at the NATO conference in Wales in 2014 to spend 2% of GDP. We welcome the fact that eight further countries are now on a clear trajectory to meet that target, and Ministers from across all Departments continue to have discussions to encourage them to reach it.

Oral Answers to Questions

Madeleine Moon Excerpts

Monday 30th January 2017 Commons Chamber

[Sir Michael Fallon]

The expenditure that NATO classifies as meeting or not meeting the 2% is something for NATO to judge against its own guidelines. I note that our own Defence Committee commended the Government’s commitment to UK defence and found that our accounting criteria fell firmly within existing NATO guidelines, but ultimately, as I have said, this is a matter for NATO to judge.

[Mrs Madeleine Moon (Bridgend) (Lab)]

Since the Wales summit, 22 NATO countries have increased their defence spending in real terms, and 20 of them have increased it as a percentage of GDP. The number of allies spending 20% of their overall defence expenditure on equipment modernisation has also risen from eight to 10. Is the real risk to NATO not, in fact, defence spending, but a move away from transatlantic solidarity, which the present President is in danger of taking forward?

[Sir Michael Fallon]

Of course we welcome the increases in defence spending that have taken place—the baton is moving in the right direction—but I hope the hon. Lady agrees that a number of countries, including some that are quite wealthy, are still a long way from meeting the 2% target, and, in some cases, the 20% target as well. As for her latter point, I agree with her: this is a north Atlantic alliance, and it is extremely important for all of us to continue to assure the United States that that alliance is as much in the interests of the United States as it is in our interests here in Europe.

Oral Answers to Questions

Madeleine Moon Excerpts

Monday 12th December 2016 Commons Chamber

[Mrs Madeleine Moon (Bridgend) (Lab)]

The Israeli and US navies have recently been attacked with anti-ship missiles by Hezbollah and the Houthis. Is it not time to look again at the River-class offshore patrol vehicles and the Type 31 frigate to ensure that they have ASAM capability?

[Harriett Baldwin]

It is important that the Royal Navy continually assesses the capabilities with which ships are fitted. I cannot go into some sensitive details at the Dispatch Box owing to operational requirements.

Oral Answers to Questions

Madeleine Moon Excerpts

Monday 7th November 2016 Commons Chamber

[Sir Michael Fallon]

I am very happy to undertake to look into that particular matter, but our emphasis, as I am sure my hon. Friend would agree, must be on the 200 or 300 British citizens who have gone to Iraq and Syria to fight for Daesh and pose a potential threat to this country, and who may well have committed criminal acts in fighting alongside Daesh. They are the people who need to be investigated first.

[Mrs Madeleine Moon (Bridgend) (Lab)]

T3. The hon. Member for Gower (Byron Davies) and I have been campaigning to bring opportunities to air cadets in Wales to experience gliding in Wales. We were promised at a meeting in the Ministry of Defence last week that a decision was pending. Is it good news or bad news?

[The Parliamentary Under-Secretary of State for Defence (Mark Lancaster)]

It is good news. The hon. Lady and my hon. Friend the Member for Gower (Byron Davies) have been absolute champions when it comes to pursuing the opportunity for cadets in Wales to glide in Wales, so I am pleased to announce that I will facilitate summer gliding camps at St Athan on a trial basis next summer, with a view to continuing them in future.

Lariam

Madeleine Moon Excerpts

Thursday 27th October 2016 Westminster Hall

[Mrs Madeleine Moon (Bridgend) (Lab)]

I beg to move,

That this House has considered the Fourth Report from the Defence Committee of Session 2015-16, An acceptable risk? The use of Lariam for military personnel, HC 567, and the Government response, HC 648.

Before I turn to the overview of the report and the conclusions of the Select Committee on Defence, I want to put on record our thanks to those who gave us the impetus to investigate the issue and contributed their knowledge and their time. I apologise if I leave anyone out. Our thanks go to Trixie Foster and the retired Colonel Andrew Marriott for their persistence in raising the issue and co-ordinating a detailed submission; to defence correspondents who took the matter up; and to Forces TV whose work brought in more evidence. I thank the Library for its research and our Clerks, who do a magnificent job, as well as the witnesses who appeared at our three evidence sessions, including from the drug’s manufacturer, Roche.

I would also like to put on record my personal thanks to the Committee for agreeing to pursue the issue for the sake of the approximately 25% to 35% of personnel who have taken Lariam who have been directly affected. The Committee was determined to ensure that the Ministry of Defence would examine the damage to lives and the failure of the duty of care, and to make the necessary recommendations to protect our armed forces personnel in the future.

Lariam is one of several antimalarial drugs that the MOD uses to protect military personnel against malaria. None of the alternatives is without its problems, but Lariam has been the subject of concern for a long time. The inquiry set out to establish a clear picture of the impact of its use in the UK armed forces. I think it is fair to say that the Committee was shocked and surprised by what we found. I will leave others to go into details, as it is my role to give an overview of our principal conclusions and recommendations.

From the evidence we received from individuals and the statistics that the MOD provided, we were shocked that Lariam is still being used so often despite the well-known problems. We were told by the drug’s manufacturer that the MOD accounts for one fifth of all its UK sales. At a minimum, 17,368 personnel were prescribed the drug between 2007 and 2015. There may well be more, but one of our findings was the haphazard nature of MOD medical record keeping. Note to the Minister: it was particularly unhelpful when the MOD published its first 10-page statistical bulletin on Lariam on the day we took evidence from the Minister.

The MOD receives advice from the Advisory Committee on Malarial Prevention alongside the advice from the manufacturer. Roche is clear in its guidance that every individual who is prescribed Lariam should undergo an assessment with a medical professional to identify any contra-indications that might make them more susceptible to side effects. We questioned whether the ACMP’s advice was appropriate. It was clear to us that the general advice that it offered was not tailored to the specific needs and circumstances of the military. It fell short and put military personnel at risk. We concluded that the MOD should work with the ACMP to develop specific guidelines, similar to the US so-called “Yellow Book”.

[Douglas Chapman (Dunfermline and West Fife) (SNP)]

Is the hon. Lady now confident that the MOD will be able to deliver on the duty of care and the commitment to proper prescribing of Lariam, especially when a large number of troops are leaving at the same time?

[Mrs Moon]

If I am perfectly honest, no. I think that the medical care that is offered continues to fall short, but I hope that the Committee will be able to address the issue again in future and ask for further updates. Of course, we have the opportunity to hear from the Minister today what further progress has been made.

Alongside our findings about the ACMP, we looked at whether Lariam was appropriate to where personnel were sent and the work that they do. The Minister and the Surgeon General told us that geographical location was a consideration in prescribing Lariam. By contrast, other witnesses made it clear that there is nowhere where Lariam should be the preferred drug, particularly given that there is increasing resistance to it and there are alternatives available. Geography aside, and linked to our earlier concerns about the ACMP advice, we sought to clarify whether Lariam, given the known side effects, was appropriate at all in a military setting. A military deployment is a world away from a tourist sightseeing or sitting by a pool. The physical and mental strain of being deployed in stressful situations does not need to be exacerbated by the severe side effects that Lariam can induce.

Dr Nevin gave evidence of an alarming potential negative impact on military performance and operations. There were cases of service personnel experiencing

“episodes of panic resulting in abnormal behaviour”

and incidents of servicemen becoming confused and being found “wandering aimlessly”. There were incidents of tension and anger, episodes of severe mental and physical exhaustion and nausea, lapses of concentration and episodes of short-term memory loss, ill temper, dangerous driving, confusion and suicide ideation. That is a grim picture of medically induced problems for military personnel on deployment.

We explored whether other nations gave Lariam to their armed forces. Our research uncovered a mixed picture, but a tendency towards either no longer using Lariam at all or using it only as a drug of last resort. That all added weight to our recommendation that greater clarity is needed in determining when to use Lariam, and that attention should be paid to whether it is appropriate for military personnel.

At the heart of our inquiry was the question whether the MOD was fulfilling its duty of care by following the clear guidance on prescribing Lariam. Did every individual undergo the Roche-required individual medical assessment prior to deployment? Was it realistic to think that the MOD could ensure that that happened, particularly for a large-scale, short-notice deployment? Alarmingly, there was evidence that individual assessments were not happening. Lariam was included in pre-deployment kit; it was handed out on parade; or the MOD relied on an assessment of medical records only for prescription. We felt that that was a fundamental failure in duty of care. We concluded that, aside from the need to consider the practicalities of arranging assessments, prescribing Lariam should only ever be a last resort bounded by strict conditions. Linked to that, we uncovered concerns about non-reporting of contra-indications; military personnel appeared unwilling to admit to conditions such as a previous history of depression, because of fear of a negative impact on their career. That underlines even further the need for individual assessments.

Several witnesses reported that personnel were so concerned by the reputation of Lariam that they discarded their medication and were potentially left with no antimalarial protection at all. That came even from the very top. I believe Lord Dannatt has announced that he refused to take Lariam and would throw it away. We were deeply disturbed by that and recommended that the MOD should monitor compliance rates.

[Bob Stewart (Beckenham) (Con)]

I recall that evidence that came to us, as hearsay, from Lord Dannatt. It really shocks me that he was Chief of the General Staff and felt that way and did not take action. I think that the Committee felt that too.

[Mrs Moon]

We most certainly did; but that also shows the inertia in the Ministry of Defence. We heard from many personnel—either individually or as a Committee—at different ranks within the MOD. The matter was not something that was not known about, but it was not being tackled or recognised as a major problem for serving personnel.

Finally, and most tragically, we heard from many individuals who suffered severe long-term effects from taking Lariam. Long after leaving the military, they are still suffering such things as mental trauma, vivid dreams and suicide ideation. That is totally unacceptable. We sought to establish what support was on offer for them from the MOD as it became clear that arrangements were somewhat fragmented. We recommended the establishment of a single point of contact, which we felt was particularly important for veterans, some of whom have experienced mental health problems for years.

Having seen what happened in the previous debate, when the vice-chair of the Committee could not be called to speak owing to time restrictions, I shall now leave it to my colleagues to expand further on the report and evidence. We look forward to hearing from the Minister that further progress has been made.

--- Later in debate ---

[Johnny Mercer]

I thank my hon. Friend, loosely speaking, for raising that point. He gets to the crux of the problem. Essentially in the military, we go on medical advice. None of us are scientists or doctors. If we get into the real detail of the issue, it is on that point that we get to the nub of what has gone wrong.

[Mrs Moon]

Does the hon. Gentleman agree that the problem was that there was no medical advice? Often, a sergeant major would just walk down the ranks, saying, “Take these.” There was no assessment—nothing. It was just, “This is what we have in the stores. You take it.” There were no warnings about the side effects or about reporting them. That was, and remains, the failure.

[Johnny Mercer]

I absolutely agree that the single point of failure was that we had a drug that, like any drug—even paracetamol or Anadin—should be used within the guidelines set down by the manufacturer, but instead of people being given it carefully, in a medical fashion, with individual risk assessments as stipulated by Roche, Lariam was just handed out on parade. Clearly, that is not the way to do business. The hon. Lady is right. I am glad that we have identified that practice, and I believe that we have put a stop to it. That is a good thing to have come out of the report.

We now need to ensure that we look after those who come forward. There are conversations about compensation and things like that—I understand that that is the way of the world—but that is never the intent behind inquiries such as this. I am interested in looking after those who are going through the process. We must get those who come forward some sort of treatment. We must provide some point of contact that is not just known by me, other MPs and those within Main Building. Everybody should know where they can go to get help if they feel they have been affected, and we need to show them a clear pathway.

Ultimately, we need to pay people an interest and accept that something has gone wrong. There is a slight issue within the Department—I know that everybody, including the Minister, knows this—with accepting evidence of a problem. If I have seen that in my experience as a lowly Member of Parliament, I can only imagine what it is like for families who have an issue with the Ministry of Defence to come forward. I bring that point to people’s attention and ask that we never ignore evidence of problems. We all know what soldiers are like. They are fantastic people, although if they are not moaning, something is not right, but we need to be slightly smarter and understand what they are saying so that we can identify problems before they become as big a problem as Lariam.

--- Later in debate ---

[Fabian Hamilton]

My apologies for that. I obviously did not write my notes correctly. I am sorry if I misquoted the right hon. Gentleman.

As we discussed in the previous debate, we have a duty to ensure that people who put their lives on the line for the defence of this country, like hon. Members in this Chamber who have done so, do so in the knowledge that those who ask them to do it and who send them to dangerous places are looking after their interests.

We know that Lariam is the brand name of mefloquine and that it is used to treat malaria. It is most commonly administered as a prophylaxis, but the history of side effects, the evidence we have received and the evidence in the Defence Committee’s report make it clear that it is not necessarily the most appropriate prophylactic medication. I am glad we have made it clear that we do not blame the manufacturer, Roche, for the misuse of its drug. It is clearly an issue for the Army itself and we want the Army to get it right. That is why the Committee’s report was written in the first place. I myself have taken chloroquine and proguanil; I suffered some side effects, but nothing like those that have been recorded for Lariam.

We know that many countries’ military forces have used Lariam in the past, but that it is becoming increasingly uncommon because of its side effects. Some 17,000 British military personnel were prescribed Lariam between April 2007 and March 2015, and the reports of those side effects meant that many of them have discarded their Lariam tablets instead of using them. That makes them far more susceptible to malaria, which is extremely dangerous—as the hon. Member for Stafford said, it has killed 438,000 people in the last 12 months.

The summary of the Defence Committee report says:

“The evidence we received highlighted some severe examples of the possible side-effects of Lariam in a military setting. While they may be in the minority, we do not believe that the risk and severity of these side-effects are acceptable for our military personnel on operations overseas.”

When the Minister responds to the debate—I apologise that I will not be present to hear him—will he care to tell us about the handing out of Lariam to military personnel in future in the light of the report and the evidence contained within it?

In preparing for this debate, I sought the advice of a specialist—he has asked not to be named—who works at the London School of Hygiene & Tropical Medicine. His view was quite interesting. He made the point that Lariam is a cheaper medication than some antimalarials, and that it is very effective. That could be one reason why the MOD is maintaining its support for Lariam in the face of media controversy, the Defence Committee report and, of course, resistance from many military personnel. The specialist said that it is a good drug. He even gave it to his spouse when they went to west Africa a few years ago. He reported that she had had the most vivid and crazy dreams. Like most drugs, it is not good for some people, but it is good for others.

One thing in favour of Lariam is that it is administered once a week. Many other antimalarials are administered once a day. For someone in a military setting who is in a conflict situation, or who has been deployed in a remote area, it being a once-a-week drug will have a huge benefit for those administering it and those having to take it. A once-a-week dosage also increases the chances of compliance and of people actually taking the medication when they need to take it.

The specialist I mentioned noted that the number of tests on the effects of Lariam on Army personnel were small and were not done in an adequately controlled situation. I do not know whether my hon. Friend the Member for Bridgend would agree with that, given the evidence taken by the Select Committee, but there needs to be far more testing. There needs to be a much greater database of evidence to prove conclusively that so many people will not tolerate Lariam and that it should perhaps be replaced by other drugs, depending on geolocation and the individual assessment of military personnel.

[Mrs Moon]

Is my hon. Friend aware that there have been episodes in which serving personnel have murdered individuals, and in which they have deliberately carried out inappropriate acts, all because they were under the influence of Lariam? That is part of the record that the Committee looked at.

[Fabian Hamilton]

Yes, I was aware of that, but I am not aware of the details. I have heard anecdotal evidence, but it is important to hear about the actual cases and evidence.

I know that other Members wish to speak, and of course the Minister must respond, so I shall conclude. Paragraph 97 in the conclusion of the Defence Committee report states:

“The Ministry of Defence has a duty of care to protect military personnel on operations overseas. It includes ensuring that they are adequately inoculated against disease. This will never be without the risk of detrimental side-effects, and we understand that the MoD must balance those risks against the health of our Armed Forces. However, in the case of malaria, we conclude that the MoD’s current policy has got that balance wrong.”

I hope the Minister addresses that point in his response.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Defence (Mark Lancaster)]

It is a pleasure to serve under your chairmanship, Mr Rosindell.

We seem to have had something of a flurry of detailed questions towards the end of the debate, giving me little opportunity to address many of them in the nine minutes I have to respond to the debate. I will do my best, but at the start I simply commit to writing to any hon. Member whose question I do not manage to answer during that time.

Of course, I begin by taking this opportunity to thank the Defence Committee for its very thorough report on the use of mefloquine by service personnel, and I also thank the hon. Members who have spoken today, from the opening contribution by the hon. Member for Bridgend (Mrs Moon) onwards. I will address many of the points that were made as I go through, but on a specific point that she made, I absolutely regret the publication of the statistics on the day of the Committee hearing. However, she may not be aware that it is absolutely right that Ministers have no control over the collection or publication of statistics; it would be wrong if we did. So it was genuinely an unfortunate coincidence, and it would have been even worse if the statistics had been published the day afterwards.

I thank my hon. Friend the Member for Plymouth, Moor View (Johnny Mercer) for his passionate contribution, not least because every time he speaks in this House he seems to suggest that I should be promoted—so I thank him very much indeed. I also thank my hon. Friend the Member for Stafford (Jeremy Lefroy), who gave an incredibly incisive personal account; it really was very powerful. Of course, I also thank my right hon. Friend the Member for New Forest East (Dr Lewis), who asked a number of questions, which I will endeavour to answer during my response to the debate.

We had other good contributions from the hon. Members for Leeds North East (Fabian Hamilton), who has had to leave us, for Glasgow North (Patrick Grady), and for East Renfrewshire (Kirsten Oswald). I will endeavour to address all the points that they made in due course.

The Government have considered our conclusions carefully, and I will outline the positive steps that the Ministry of Defence is taking to address the Committee’s recommendations. Before I do so, I want to nail one issue that floated around towards the end of the debate—that Lariam is somehow the MOD’s drug of first choice, and that cost is a factor in its use. According to the “British National Formulary” of March 2015, Lariam, at £14.53 for an eight-week supply, is more expensive than Paludrine/Avloclor, less expensive than Malarone but more expensive than doxycycline. So cost is not a factor, and we would never prescribe on the basis of cost alone.

Equally, mefloquine currently constitutes only 1.2% of all the antimalarial tablets held by the MOD, and in terms of doses for a six-month deployment—of course, doses for different drugs are given at different rates—it accounts for just 14% of the stock. So 86% of our stock is not Lariam. That hardly represents a reliance on Lariam or evidence that it is being used as a drug of first choice.

[Mrs Moon]

I am delighted to hear about the low take-up of Lariam by the Ministry of Defence now. Does the Minister have the figures for what the take-up was in the past?

[Mark Lancaster]

Those figures give the current status, but I believe that the figures for the last eight years, which is as far as we go back, are similar. However, I am happy to write to the hon. Lady to give the exact figures. Of course, much of this debate is about how we move forward, as opposed to what we have done in the past, and I hope to demonstrate in my response over the next five and a half minutes that the steps we are taking are very positive.

It is important for me to state that we take the health and wellbeing of our personnel extremely seriously and acknowledge the duty of care to provide the best possible support to them. Malaria is a deadly disease, and we must protect our deployed personnel from it. The most effective way to do so is through the use of antimalarial drugs. However, as we have established, no antimalarial drug is 100% effective and risk-free. Indeed, all medications have the potential to cause side effects and adverse reactions in a small number of people. That is why the MOD needs to use a range of prevention drugs to protect our personnel and ensure that the treatment provided is the most effective for each individual. I should emphasise that despite tens of thousands of service personnel deploying to malaria-risk areas, no serviceman or woman has died from malaria resulting from an operational deployment since 1992, and cases of severe malaria are rare in the armed forces.

I turn to the two main recommendations of the Committee’s report. The first was that the MOD works with the Advisory Committee on Malaria Prevention to develop guidelines on mefloquine and other antimalarials, specifically regarding their use by military personnel. The MOD has always kept its malaria prevention policy under constant review, and I can confirm that a recently revised malaria prevention policy has been passed to the ACMP for its consideration.

The revised policy is based on three elements. In the first instance, at around the time when individuals complete initial training they will undergo a face-to-face consultation with a medical professional, to identify any adverse reactions to the five most commonly used antimalarial drugs. Secondly, after posting into a deployable role, armed forces personnel will undertake a generic face-to-face travel health risk assessment, again with a medical professional. Finally, once individuals are advised that they are likely to deploy, they will undertake a deployment-specific face-to-face travel health risk assessment.

The results of those assessments will be recorded in the patient’s electronic health record. Although the need for a risk assessment is not new—defence policy since 2004 has been clear on the requirement for such assessments—monitoring will now be better aided by an electronic records system. In answer to a question put by my right hon. Friend the Member for New Forest East, perhaps I can say that if the actions that he described need to be taken, in extremis, before an emergency deployment, they will be based on those three thorough, face-to-face, comprehensive interviews, as recorded in the electronic record.

On that point, I reiterate what I said when I gave evidence to the Committee. I recognise that anecdotal evidence submitted to the Committee suggests that, in a small number of cases, some people believe that their individual risk assessments did not take place in the past. I hope that the new system will prevent that situation from recurring. I encourage anyone who has concerns about the issue to come forward, in confidence, as there are established processes by which current and former members of the armed forces can be referred to medical staff to have such concerns investigated.

That leads me to the second main recommendation of the Committee’s report, namely that the MOD should establish a single point of contact for those who are worried about their experience of mefloquine. I am pleased to report that the mefloquine single point of contact has been set up and publicised widely through the chain of command, veterans’ organisations, military publications and GPs. As I sat here listening to the debate, I googled the advice about that single point of contact, and there it was on the gov.uk website. It was launched last month and is easily accessible. It is a confidential service for people to make contact by phone and email, and it is supported by other information on the Government website, as I have just said. Depending on their circumstances, individuals are directed to a range of information and services available to help them. That includes how service personnel and veterans can find out whether they have been prescribed mefloquine in the past. My right hon. Friend the Member for New Forest East has raised concerns about the quality of information being given on the helpline. I am more than happy to go and examine that, and I will write to the Committee with details as to exactly what advice is being given.

Again, I encourage anyone who is concerned about their experience of mefloquine and who has not yet gone to the single point of contact, including those who believe that their risk assessment did not take place, to contact the single point of contact or speak to their GP.

In addition to those two main recommendations, the MOD will conduct a prospective audit of returning travellers, to assess the impact of the new policy. That will be for any antimalarial drug that has been taken. The MOD will also continue to undertake post-deployment surveys, to enhance its understanding of compliance with the revised policy.

The Government informed the Committee that the MOD would undertake further research into the impact of the adverse effects of antimalarial drugs on the performance of military personnel. A research proposal is currently being considered by the MOD’s research ethics committee. The research will be in the form of a retrospective survey of soldiers deployed on exercise in Kenya who have been prescribed one of three antimalarial drugs. A questionnaire will seek information about risk assessments, individuals’ compliance with prescriptions, the incidence and prevalence of side effects of the drugs, and the impact of those side effects on functional effectiveness.

If there are any other questions, I will endeavour to write to hon. Members about them.

Question put and agreed to.

Resolved,

That this House has considered the Fourth Report from the Defence Committee of Session 2015-16, An acceptable risk? The use of Lariam for military personnel, HC 567, and the Government response, HC 648.

Defence Expenditure

Madeleine Moon Excerpts

Thursday 27th October 2016 Westminster Hall

[Mrs Madeleine Moon (Bridgend) (Lab)]

I will not delay everyone for long. Although the Committee found that the Government’s accounting criteria fell firmly within the NATO guidelines, we also found that those criteria had been amended to include several significant items that had not previously been included when the UK calculated its defence expenditure. That is the nub of the issue that we must address. The Committee is concerned that the inclusion of such items, which were critical in attaining the 2%, could undermine the promises in the SDSR of new money for defence.

During our inquiry, there was considerable discussion of the 2% as an indicator of Britain’s political willingness. Witnesses said that

“2% is good politically”

and not to meet the 2%

“would have been damaging to our reputation politically.”

The 2% was said to have

“a…powerful symbolic meaning”.

The UK has made great play of that 2% as demonstrating its commitment to collective defence in NATO, but the inclusion of items that had not previously been included, such as pensions, has not gone unnoticed—with considerable contempt—across the alliance. As well as being a member of the Defence Committee, I represent the UK on the NATO Parliamentary Assembly, and I have found that other countries, when talking about their expenditure and accepting that it does not reach 2%, take great delight in pointing out that their figures do not include pensions, as they have no wish to use creative accounting to bolster their spending. That is divisive within NATO and damages our credibility and capability to defend our shores and those of our allies.

Our report highlighted that 2% should be a minimum, not a target, and certainly should not be seen as an indicator of capability or capacity, or give a false glow of competency and readiness. The report also urged the Government to provide a calculation of what defence expenditure would be if we left out the new items such as pensions and used the same items as we had under the 2010 accounting rules. We still await those figures.

A perfect storm is building of cuts to personnel, cuts to training, problems in procurement and gaps in capability. With the 2%, there is a disparity between our procurement aspirations and their affordability—and our capacity to deal with major defence equipment deficiencies, such as the engines for the Type 45 destroyers and the delays in replacing the Type 23 frigates and logistics supply ships. I have a major concern in particular about the Royal Navy’s capacity and capability. If we went back to realistic accounting, perhaps we would be able to deal with those issues.

I do not want to take too much time, because I know that colleagues want to speak, but I must emphasise that in our report, the Committee expressed concern that the UK must not become a hollow force. Sadly, despite the great commitment and bravery of our personnel and their amazing “make do and mend” ingenuity, I fear that we are hiding our vulnerability behind the cardboard shield of 2%.

Ministry of Defence Future Accommodation Model

Madeleine Moon Excerpts

Wednesday 19th October 2016 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

Will the hon. Lady give way?

[Mrs Madeleine Moon (in the Chair)]

Order. The hon. Gentleman has not been present to hear the whole speech.

[Jim Shannon]

I was chairing another meeting. I have come straight from it, Madam Chair.

[Mrs Madeleine Moon (in the Chair)]

It is generally accepted that interventions should be from Members who are present for the whole speech. Is the hon. Lady happy to give way?

[Mrs Trevelyan]

I am going to run out of time, am I not?

[Mrs Madeleine Moon (in the Chair)]

It is up to the hon. Lady.

[Jim Shannon]

Just very quickly.