§ Order for Second Reading read.
§ Mr. SHORT
I beg to move, "That the Bill be now read a Second time."
This Bill was recently introduced in another place, and, after some discussion, passed through its various stages without meeting with any serious opposition, and I hope that that also will be the case in this House. The object of the Bill is to amend the provisions of Section 47 of the Workmen's Compensation Act, 1925, which gives power to the Secretary of State to make schemes enabling employers to pay compensation to work-people who contract the disease of silicosis caused by silica dust. The Bill provides for the introduction of improved medical arrangements for the diagnosis and certification of cases of silicosis, and extends the provisions of Section 47 of the Act of 1925 to fibrosis of the lungs caused by asbestos dust, which is now known as asbestosis.
The diagnosis of silicosis has been found to be a very difficult matter, requiring special skill and the latest scientific knowledge and appliances in connection with radiography and so forth. In order to meet this difficulty, Section 47 of the Act of 1925 makes provision for schemes for the appointment of medical boards consisting of whole-time medical officers, but it makes no provision for the setting up of any special fund out of which these whole-time medical officers can be paid, and it is only in the case of the refractories and sandstone industries that a general trade compensation fund has been created, to which salaries may be charged, and such a medical board has been instituted. In 1928, my right hon. Friend's predecessor, now Lord Brentford, launched what is known as the Various Industries Silicosis Scheme, but no compensation fund has been created by any of the industries covered by the scheme. The medical examination certification in the case of silicosis depends entirely upon what I may term the ordinary medical machinery; in other words, the certifying factory surgeon is the responsible person, and there is a right of appeal to the medical referees under the Workmen's Compensation Act. This system has been found to be totally inadequate as regards the diagnosis of silicosis.
751 I am sure that no hon. Member will think that I would say one word in depreciation of the capacity or the interest of the certifying factory surgeons, but it must be admitted on all hands that the certifying factory surgeon is not an expert. He has seldom, if ever, at his disposal radiographic and other facilities and, indeed, at the time this scheme was originally introduced it was fully understood that it would be of a very temporary character. Considerable hardships have arisen out of these very unsatisfactory medical arrangements and it has been found necessary, in consequence, to limit the operation of the scheme to death and total disablement, excluding partial incapacity due to silicosis—a strange anomaly having regard to our existing law of workmen's compensation. It is really impossible to defend a position under which a workman partially incapacitated by silicosis in the refractories and sandstone industries is entitled to compensation on the scale laid down by the Act while a workman partially disabled by the same disease contracted in another industry is not entitled to any compensation at all.
Therefore, when the Bill is passed, and when the medical organisation has been established, it is my right hon. Friend's intention to proceed with an amending Order under Section 47 to remove the anomalies to which I have called attention. The first object, then, of the Bill is to secure uniform and effective medical arrangements for the diagnosis and certification of the disease of silicosis in all cases; and, secondly, to provide for the payment of compensation in all the industries concerned, and not only in respect of death and total disablement but also in respect of partial incapacity.
Having made those general observations, I will deal with the particular Clauses and indicate my right hon. Friend's intentions so far as these medical arrangements are concerned. Clause 2 gives the Secretary of State power to make a general scheme applicable to all the industries to which the liability to pay compensation has been extended for the purpose of co-ordinating the medical arrangements. It is proposed that the medical arrangements to be embodied in the general scheme should be based on the recommendations of the Silicosis 752 Medical Arrangements Committee. This Committee, appointed by Lord Brentford, consisted of Dr. Bridge the senior medical inspector of factories, Professor Arthur Hall of Sheffield and Dr. Coutts of the Ministry of Health. Their report was presented to Parliament on September 17th, 1929, and it pointed out that the diagnosis of silicosis involves both clinical and radiological examination by competent medical men of wide and practical experience of the disease, and they recommended that medical boards appointed by the Secretary of State, consisting of at least two specially qualified whole-time officers, should form the basis of the medical arrangements, that there should be a medical board with panels set up at different centres, and that the work should be co-ordinated by a chief medical officer with a central bureau at Sheffield to maintain, as far as possible, uniformity in administration and, indeed, a uniform standard in so far as this matter is concerned.
I have indicated that, under the refractory and sandstone scheme, something has been done in the way of a compensation fund, and we have already established three separate panels, one at Sheffield, one at Newcastle and one at Bristol, with a chief medical officer at Sheffield. The arrangement is satisfactory and works well, and my right hon. Friend proposes, with the consent of the parties interested in the refractory and sandstone industries scheme, to convert the existing medical board into a national board. That will obviously involve a great deal more work and it will, no doubt, be necessary to arrange for the appointment of additional panels upon which they can draw.
§ Mr. SHORT
As far as I understand, under the Home Office. If I have made a mistake, I shall be happy to correct it. If I understand it aright, there will be no difference except that it will be national rather than confined to a particular industry. As regards finance, the proposal is to set up a medical expenses fund, which will be maintained by fees payable by employers and workers in respect of examinations, and additional grants from the Treasury. My right hon. Friend will appoint trustees, who will be responsible for the collection of the fees 753 and for the payments in accordance with the scheme.
Under Clause 2 (1, b) the fees to be paid in respect of examinations and certificates will be fixed by regulations which will be made by the Secretary of State and approved by the Treasury. He will naturally consult the employers and work-people concerned in these industries in relation to these fees and he will not be averse from the appointment of a small Advisory Committee or Council. Paragraphs (d) and (e) give powers for the enforcement of periodical medical examinations which the Secretary of State already has power under Section 47 of the Act of 1925 to require in case of particular industries or processes. Sufficient powers exist in relation to enforcement respecting workmen, for if a workman refuses examination he obviously forfeits the right to any compensation. The position is not quite the same in relation to employers. There are no means at present of enforcing such provisions except in the case of an industry where a trade compensation fund exists, and where that exists, of course, an employer can be called upon to pay a contribution.
May I say a word or two in reference to medical examinations. It is desirable that they should take place at once and periodically, if necessary, and those making the medical examinations and called upon to make a certification should be most competent and have at their disposal all that is necessary and desirable in the way of machinery and so forth. The Departmental Committee stressed the value of the initial and periodic medical examinations. They said:These examinations provide an opportunity for the diagnosis of silicosis in the earliest detectable stage and enable Suspension from the risk to be effected before the disease has made serious progress. This point was emphasised by witnesses who have appeared before us, in particular by Dr. Wickins-Pitchford, the late Chairman of the Medical Bureau in South Africa. The accumulated evidence of previous records is also of the greatest assistance when the question of certification arises.That was the very valuable opinion of the Departmental committee. I am pleased to say that in that connection their opinion was reinforced by the Potteries Workmen's Compensation Committee. They arrived at a similar conclusion. They said in effect—and I am summarising their conclusions 754 —that such medical examinations tended to the elimination of pulmonary tuberculosis, to the detection of early silicosis, and that they afforded evidence of the conditions producing the disease which once obtained could be supervised and possibly eliminated. There was also valuable assistance given in connection with the diagnosis; and, further, the suspension from employment in silica processes at the earliest stage of the disease tended to arrest the development of the disease. I do not wish to delay the House by quoting from the very striking evidence of Dr. Sutherland, chief medical officer of the medical board at Sheffield, but the facts stated by him justify the proposals embodied is this Bill.
I wish to make it clear that, in connection with these medical examinations—I do not want any misunderstanding to arise regarding the nature of the examinations or who has to be examined, it is not intended that all workers covered by the schemes should be required to be medically examined. I think that there are possibly some 60,000 or 70,000 workers, and it is not proposed to call upon them all to be medically examined, but periodical examinations will be made only as and when prescribed under the scheme and only in cases of processes where they are really necessary. Home Office experience justifies the scheme which is embodied in this Bill. I am pleased to say that the employers in the industries affected believe that this scheme is on right lines and the Trades Union Congress General Council representing the workers in the industries concerned also approve of them. I am hopeful that the proposals which I am now submitting will be acceptable to all parties of the House.
There is only one other matter to which I need refer, and that is in connection with Clause 1, which deals with the second object of the Bill, namely "asbestosis." The Clause proposes to extend the powers of making compensation schemes in Section 47 to industries and processes involving exposure to asbestos dust on the lungs. The effects of asbestos dust was recently the subject of a very wide and comprehensive inquiry by Dr. Merewether and Mr. C. W. Price, His Majesty's Inspectors of Factories. Their report was presented to Parliament in March, 1930. The inquiry covered not merely processes involving manipula- 755 tion of asbestos as such, but the working of asbestos cloth into all kinds of articles, and they came to the conclusion that the risk of an asbestos worker contracting fibrosis of the lungs, involving in some cases serious disability and in others death, was very great indeed. No one who reads the evidence submitted to that Committee can help being impressed by it and believing that there is a real justification for the extension of this Clause to asbestos workers.
Some interesting figures were set out in the report. I need only say that, in so far as the general incidence rate is concerned, it indicated that the proportion of those at work in the sections of the industry considered who were found to be affected by this disease was nearly one in eight. There are only some 2,000 workers involved, but the evidence proved that there is great risk indeed, and that it is desirable and essential that something should be done on the lines which this Bill indicates. The same medical arrangements to which I have referred in relation to silicosis are desirable and essential in this case. Periodical examinations are desirable. Consequently, I hope the House will give this Bill a unanimous Second Reading It may well be that there are some points which will need consideration on the Committee stage, but I cannot think that there can be great opposition to the fundamental principles of the Bill, and in that case I venture to beseech the House to give it a Second Reading.
§ Mr. DOUGLAS HACKING
I do not rise to oppose the Second Reading of this Bill. It would be very ungracious to do so after the interesting and illuminating speech which has just been delivered by the Under-Secretary of State for Home Affairs. I have very few observations to make at this particular moment, but there is one thing about which I should like to make complaint at the outset. I believe that the title of the Bill is somewhat misleading. It is known as the Workmen's Compensation (Silicosis) Bill. The hon. Member told us that only one of the two operative Clauses deals with silicosis and that the first Clause deals solely with this new disease, as far as workmen's compensation, at any rate, is concerned, which, for want of a better name, he describes 756 as "asbestosis." If this Clause referred to silicosis, it would, I believe, have been unnecessary to introduce this Bill, because silicosis is dealt with under the old Act. As a proof that the disease is not silicosis, we find in the Schedule of the Bill that the name given to it is "fibrosis of the lungs, due to asbestos dust." I suggest that it would have been a good thing—and in fact it may be desirable at a later stage in Committee—to have amended the title of the Bill to "Workmen's Compensation (Silicosis and Asbestosis) Bill," in order that the country and everybody concerned in the industries should realise the problem which is dealt with by the Measure.
When I was at the Home Office occupying the position which is now occupied by the hon. Member who has just spoken, I had, as one of my duties, to preside over a committee on this disease of silicosis, and it was my duty to travel about the country and visit several of the works where silicosis was a prevalent disease. I remember going to Sheffield, and there seeing some of the steel-grinding works, and being very impressed with the terror of this particular complaint. I remember visiting the pottery industry at Stoke, where, again, there was a great deal of this disease prevalent. One could see it in the faces of the people who were working in those industries, and, therefore, one could not help being sympathetic towards those poor people working, in some cases, under very deplorable conditions. But I am bound to say that in some of the well-managed factories, every precaution was taken so that the silicosis dust could not get into the lungs of the workmen. They had all sorts of devices which sucked the dust away from the man's mouth, and in Sheffield they had new wheels known as abrasive wheels, which did not contain silica, and thus the dust which came from them could not affect the lungs in the same way as the dust from the old-fashioned silica wheels.
I mention these two facts only in order to lead up to this: In my belief a great deal can still be done towards the prevention of this disease, and I believe that we should, in the main, concentrate on that side of the case, for, after all, prevention of disease is better than permitting the disease anti allowing compensation to follow. Therefore, I do beg of the 757 Government to concentrate on prevention, and even if it is at some expense to the general taxpayer, I ask them to consider whether or not they can do more than they have done in the past to press upon certain employers the desirability of having some of these new safety devices installed in their factories, in order that this disease may be prevented. As I have said, this would be a good deal better than having the disease and then allowing compensation to follow.
The hon. Member made no mention of the cost of this Measure to the industry. He has told us that there are about 70,000 persons engaged in the industry affected—that is, silica alone. I believe that that is true. We have 2,200 more now included on account of asbestosis. But he said that of these 70,000 persons, it would not be necessary to have an examination carried out in connection with them all. I am not sure that that is true. I, myself, believe that if you are really going to conquer this disease, you must have a very full examination of every individual connected with the industry, and, if so, it means that there will have to be an examination carried out by 100 doctors. I am open to correction by my hon. Friend behind me, but I believe that it is a fact that a doctor cannot make more than about 800 satisfactory examinations in a year, especially in connection with a very complicated disease such as this. If that be so, it will need about 100 doctors to carry through 70,000 examinations in a year, and it must be remembered that these doctors must not be ordinary doctors but specialists in this disease, because it is so difficult to diagnose. It gives one the impression that there will be a very heavy cost, and if that cost is in the main laid upon the industry, it may be a very serious thing to the employers and employés of the industry. Therefore, I beg that we may have some estimate of the cost which the hon. Gentleman anticipates will have to be borne by the industry, and, if it is a very heavy cost, I suggest that the Treasury should come to the assistance and should give a substantial grant to the industry to prevent the industry having to bear such a very large expense.
I have nothing more to say. In the report, which the hon. Member has 758 quoted, I believe it is a fact that doctors agree that preventive measures should be considered, and I do hope that those measures, a few only of which I have mentioned, will not be overlooked. I agree that this Bill should have a Second Reading. I am doubtful that it will be necessary to amend it very much even in Committee, but I do ask that we should have very careful consideration given to several of the points contained in the Bill. I believe that it is a very important, a very desirable Measure, and if we can amend it in Committee, not with any desire of wrecking the Measure, but of improving it, then, I believe, we shall have done a service not only to those industries, but to the two terrible complaints of silicosis and asbestosis which are covered by the Clauses in the Bill. I offer, as I said, no opposition to the Second Reading of the Bill, and I hope, as the hon. Member hopes, that the Bill will receive its Second Reading by the unanimous decision of the House.
Mr. H. W. SAMUEL
I rather gather from what has been said by the right hon. Gentleman opposite, and by the Under-Secretary, that this Bill applies only to those engaged in one trade, but, after reading Clause 2, I would like an assurance from the Under-Secretary that it extends even to miners who are engaged in processes which expose them to silica dust. I am sure that other Members as well as myself would like to get that assurance. I am in hearty sympathy with Clause 2 for this reason. It has been said by the Under-Secretary, and, indeed, by the right hon. Member opposite, that diagnosis is particularly difficult when you have to ascertain whether a man has died from silicosis or not. In this respect, I think medical referees have been pressing for such an Amendment as that in Clause 2. An instance has been brought to my knowledge by a referee. This referee reminded me that all he had by way of remuneration for diagnosis was three guinees, and we all know that for purposes of a claim for compensation you have to get a certificate from the medical referee to the effect that death was due to silicosis.
This particular referee, who has had considerable experience, told me that diagnosis was very difficult, and, having 759 regard to the fact that he was conscious of his own limitations, he got into touch with a leading provincial pathologist, who, at his request, went with the referee to make a post-mortem examination. On a visual examination, the pathologist who conducted the post-mortem examination came to the conclusion that the deceased did not die from silicosis. He, was satisfied from the colour of the lungs that there was not silicosis, but he had the lungs sent for examination to the School of Mines, and the report came back to the effect that the man did die of silicosis. There was silica in the lungs to bring about the man's death. There we have the extraordinary circumstance that the medical referee, who was deputed under the Act to make the postmortem examination, with the assistance of one of the leading provincial pathologists, came to the conclusion that the man was not suffering from silicosis at the time he died, but, upon incineration of the lungs, it was found that the lungs themselves contained silicosis sufficient to bring about the man's death.
So far as Clause 2 is calculated to bring about a better condition of things, obviously it is in the interests of those engaged in the particular industries which are exposed to silicosis dust, and if we can have an assurance from the Under Secretary that the scheme will apply to miners I am sure that the miners' representatives in this House will give their heartiest welcome to this particular Clause.
I also welcome the appearance of this Bill and I cordially support the Second Reading, but I would like the House thoroughly to understand what it means. This Bill is purely a skeleton by which we bring into Section 47 the power to grant compensation to cases of silicosis and asbestosis. The whole success or failure of the Bill will depend on the scheme which the Home Secretary will adumbrate, which will be issued by Order and laid on the Table of the House. If the regulations or the instructions which the Home Secretary makes are sufficient, then the procedure will do good, but if they are not, it may do harm. I congratulate the Under Secretary on the lucidity with which he dealt with a medical subject, and I was pleased to hear from him that the panel of doctors who are going to deal with 760 the matter will probably be under the Home Office.
Hon. Members who take a great interest in these industrial diseases must be aware that there are great dangers in this legislation and also great disappointments. These diseases are not incurable in the early stages, when they have not a very bad effect upon health. The health is slightly deteriorated, but if the patient is removed from the industry in time there is practically no detrimental effect upon the health. The difficulty that is going to happen under the scheme to be elaborated by the Home Office is the same trouble that we have at the present time over pension cases. There may be a man who may have worked in a mine or a sandstone quarry for a year or two, and a few years afterwards, having left the industry, he may develop a little chronic bronchitis and a cough, whereupon he will say: "I must have contracted silicosis," and he goes to be examined. Unless the medical men who make the examination in these cases have the absolute confidence of the people of this country it will be difficult to satisfy a man who is of the opinion that he has got his disease through working in a mine or in a sandstone quarry or in an asbestos works, when the medical man decides that that is not the case. Therefore, legislation of this character although very necessary has danger attached to it.
Take a case of asbestosis. A man does not develop that disease until he has worked five or ten years in that particular industry. Long before that time that disease will have been diagnosed. What will happen then? The employers in the industry will naturally be anxious that the disease should not progress and will have their workmen examined periodically. Upon the first sign of any weakness in the lungs, the man will be dismissed. The employers will say I hat they are not going to run any risk. Therefore, in the course of time, and particularly in some of the worst industries, a boy or a young man will be examined before he is allowed to work in the industry, and the result will be that only first class lives will be admitted. That will increase unemployment and there will be a section of men who will not be allowed to work in certain industries. I want hon. Members to understand what is 761 going to be in front of them in this respect. A man who works as a collier or in a sandstone quarry may have a boy who desires to follow in his footsteps. The boy may be examined by a doctor who says that his lungs are not very strong and that he is not suitable for this particular occupation. That may be the only occupation in the district. What is that boy to do. He may have to leave home to go into some other industry.
These are some of the troubles which will have to be faced in the future. Therefore, it is essential for the success of the Bill and the success of the scheme that the medical men should be absolutely above suspicion. For that reason, I am strongly of opinion that the medical boards should be absolutely under the department of the Home Secretary, that there should be a Government medical service for these industrial diseases which should have the confidence of the employers, of the workmen, and of this House. That would mean that the verdict of these medical men would be decisive. If any medical board decided that a man has a slight degree of silicosis but not sufficient for compensation that verdict would have to be accepted straight away. That is one reason why this should be an independent medical service. The diagnosis of silicosis is expert work by men who have been trained for it. I would like to assure the right hon. Member for Chorley (Mr. Hacking) that it will not require 100 doctors, because it will not be necessary to examine all the 70,000 men in the industry in the first year. It will be possible to take the serious cases first and the cases where the risk is greatest, and in the course of time work through. Six or seven medical boards and perhaps more will be required. These men, trained in the diagnosis of silicosis and asbestosis would be able, first of all, to deal with the bad cases and gradually work down until they had dealt with all the cases in the industry, and in any case where there was the slightest suspicion of silicosis a warning would be given advising the person concerned to find another job, if possible.
I know how anxious certain hon. Members are about silicosis and how anxious the miners are that they should be included in the scheme, but they must bear 762 in mind that at the present time it has been regarded as essential that there should be a certain percentage of silica in the dust. If the scheme provides that there must be 20, 30, 40, or 50 per cent. of silica in coal and then it turns out that that particular coal is below that content, it will mean that the miners in that colliery will not come under the scheme, and there may be trouble there. I am anxious that hon. Members opposite should not think that to-day we are passing legislation which is going to get rid of all their troubles and make them perfectly happy, and that in the future any man with a cough will get compensation if he has worked in silica. That will not happen. There will be a very large number of cases that will not come under the scheme. It is well that hon. Members should thoroughly understand that now, in order that they may not raise hopes among the miners and other workers that once this Bill is passed any man who has a trace of silica or asbestos in his lungs will be scheduled for compensation. That will not happen. Otherwise, I heartily support the Bill and I hope the Home Secretary will do all that he can to see that it is quickly put upon the Statute Book.
§ Mr. HARDIE
I only want to raise the point that the dust from these workings is not allowed to come into contact with people living near, because otherwise they become subject to the same disease. You have only to visit works in Staffordshire to see the effect on the women and children, and I hope the Home Office will devise some method which will provide that the dust can be taken away and shall not be allowed to dry in the open air.
§ Question put, and agreed to.
§ Bill read a Second time, and committed to a Standing Committee.