I have been asked to reply on behalf of the Ministry of Defence.

Primary and intermediate health care for serving members of the Army, wherever they are based in the world, is normally delivered via a combination of Army and Defence primary health care organisations. These provide military general practice, general dentistry, specialist occupational health services, rehabilitation and community mental health.

There may, however, be occasions when Army personnel access the NHS for some services such as out of hours treatment and NHS general practitioners as temporary patients. This generally arises when personnel are staying

at another location away from their unit. Within the UK, all secondary hospital based care is also accessed via the NHS.

Information relating to the number of Army personnel treated by the NHS over the last five years is not currently held by the Ministry of Defence (MOD). However, this should change from April 2013 when, under the NHS Commissioning Rules, the MOD will be provided with data about the services armed forces personnel have accessed.

I have been asked to reply on behalf of the Department of Health.

Data provided for the work reported in the National Radiological Protection Board (NRPB) reports have been collated in an epidemiological database. Data were collated from multiple sources by the researchers. Key data included:

radiation exposure data (from Ministry of Defence (MOD)/Atomic Weapons Establishment records);

identity, employment and demographic data (mostly MOD records, information for civilians was provided through their employer organisation); and

mortality and cancer incidence data (follow-up data from national registries; provided through the national health service central registries).

Additional data included identity and test participation information provided independently by nuclear test veterans or their relatives and used (as detailed in the NRPB reports) to test the coverage of the data provided through the MOD as well as additional vital status information, used to ensure the completeness of follow-up and obtained through the Department for Work and Pensions (formerly the Department for Health and Social Security).

I have been asked to reply on behalf of the Department of Health.

To date, three analyses of the United Kingdom Participants in the UK Atmospheric Nuclear Weapon Tests and Experimental programmes (1952-1967) have been undertaken and published. The most recent analyses considered follow-up through to 1999.

Three full analysis reports as well as peer-reviewed scientific papers have been published and are available. These include details of the scope of the study and the work that was undertaken to collate and assess information.

The 2004 summary paper¹ and the 1988 National Radiological Protection Board (NRPB) report² provide the most useful access points.

The Health Protection Agency website also provides information relating to these studies in the form of Frequently Asked Questions³ and includes a list of references to NRPB reports and papers.

Data used for the work reported in the NRPB reports have been collated in an epidemiological database. Data were collated—by the researchers—from multiple sources including the Ministry of Defence (and Atomic Weapons Establishment), national registries and individuals.

In addition to the three reported epidemiological analyses, a small extract of database information, including some that would have been extracted from the source data, was also used in the study of Cataract and Stable Chromosome Aberrations in Participants in the UK Nuclear Weapons Testing Programme⁴.

Most source data were provided to NRPB during the period of the first analysis project, 1983-88. Small amounts of additional information were obtained from similar sources during the periods of subsequent analysis projects. Each analysis report provides information about the work undertaken.¹ Epidemiological studies of UK test veterans: I General Description. Journal of Radiological Protection 24 199-217; Kendall G M, Muirhead C R, Darby S C, Doll R, Arnold L, O'Hagan J A. Abstract available at:

http://stacks.iop.org/0952-4746/24/199² Mortality and cancer incidence in UK participants in UK atmospheric nuclear weapon tests and experimental programmes. Chilton, NRPB-R214 (London, HMSO). Darby S C, Kendall G M, Fell T P, O'Hagan J A, Muirhead C R, Ennis J R, Ball A M, Dennis J A and Doll R.³www.hpa.org.uk/Topics/Radiation/UnderstandingRadiation/UnderstandingRadiationTopics/RadiationEpidemiology/NuclearWeaponsTestParticipantsStudy/radnuclearweaponstestparticipantsstudyFAQ/⁴ Phelps-Brown N A, Natarajan A T, Darroudi F, Cox R, Little M P and Edwards A A. Cataract and Stable Chromosome Aberrations in Participants in the UK Nuclear Weapons Testing Programme. March 1997. NRPB Biomedical Effects Department Technical Memorandum 1(97).

I have been asked to reply on behalf of the Department of Health.

Source data made available to the National Radiological Protection Board (NRPB) for the purposes of the long-term follow-up epidemiological research programme were used by scientists employed by the independent NRPB and collaborating scientists from the Imperial Cancer Research Fund. Data extracted from the source documents were collated with other information for the purpose of the long-term epidemiological follow-up study. That database was created by NRPB, in 1983, and continues to be maintained by the Health Protection Agency (the successor organisation to NRPB).

The Ministry of Defence may have further data on other independent scientists to which the original source data were referred.

I have been asked to reply on behalf of the Ministry of Defence.

The Defence Medical Services (DMS) mandate the use of evidence-based mental health treatments that have been rigorously reviewed and approved by the National Institute for Health and Clinical Excellence

(NICE), unless specifically authorised for reasons such as clinical research. NICE only approves treatments which have been subject to rigorous scientific investigation to ensure that they are effective and do not cause harm.

A recent enhancement to the electronic health records maintained by the Defence Medical Information Capability Programme (DMICP) enables clinicians to input data on patients being treated by our Departments of Community Mental Health at every clinical contact. In future, this will enable us to measure much more accurately the clinical outcomes for each patient, including the treatment they received, when they are returned to full fitness, and whether they subsequently require further treatment.