§ Motion made, and Question proposed, "That this House do now adjourn."—[Captain Margesson.]
§ 11.8 p.m.
§ Mr. GUYI wish to raise a question in relation to the employment of independent medical specialists in cases 494 where the claimant is in Scotland. The point is a narrow and simple one, but is of considerable importance. I am not in any sense attacking the administration of the Ministry of Pensions, or criticising the use of independent medical specialists in appropriate cases. I am altogether opposed to criticism of the high qualifications, impartiality and skill of those independent medical specialists to whom cases have been remitted for consideration in the past.
The use of the independent medical specialist in pension cases was inaugurated in 1929 by the late Minister of Pensions, Mr. Roberts. He revised the existing system for dealing with late claims, and one item which was in the nature of an innovation was that, in certain late cases which raised difficult 495 medical questions, there was a remit to an independent medical specialist, who was nominated, not by the Minister, but by the President of the College of Physicians or of the College of Surgeons. It is important to keep in mind that these independent medical specialists are not Ministry officials. On the other hand, they are not so completely independent as in the case of the medical referee in workmen's compensation cases. But I understand that the Minister usually, if not invariably, accepts the advice of the independent medical specialist when it is tendered to him.
In many cases where there has been a remit to an independent medical specialist, an examination of the claimant by the specialist is necessary and advisable. In that case it is important that the examination should be conducted by the independent specialist himself. Where both the claimant and the specialist are in London, no difficulty arises, but where the claimant is in Scotland and the specialist is in London serious difficulties at once arise. There is the question of delay before the examination can take place; there is the question of inconvenience; and there is the question of the expense either of the specialist going to Scotland or of the claimant coming from Scotland to London. There is also the possible consideration of prejudice to the health of the claimant if he had to travel from Scotland for a medical examination. My request to the Minister is that in these cases—they are only a limited number of exceptional cases—where there has been a remit to an independent specialist and where an examination is necessary and the claimant is in Scotland, the specialist should be a Scottish specialist in Scotland who would be nominated not by the Minister but by the President of the Royal College of Physicians or the Royal College of Surgeons in Scotland.
The Minister may say that it might be considered advisable or necessary to have a consultation between the Minister and the specialist and that there would be difficulties if the specialist were in Scotland. But that would be treading on dangerous ground because, assuming that the specialist is independent of both the Minister and the claimant, it would be inadvisable to have any opportunities for persuasion, however peaceful, by the Min 496 istry, when there were no opportunities for consultation between the claimant and the specialist. The Minister might suggest that the examination might not be conducted by the specialist himself but by a deputy. There would be grave objection to that because where a difficult question arises as to the condition of the claimant, or the cause of his condition, it is important that the examination should be conducted by the specialist himself because if it were conducted by a deputy, the Minister would not have the best evidence available. The Minister might suggest that it is not advisable to have a Scottish specialist in Scottish cases. If that argument were put forward, the converse would apply, that all English cases should be examined by Scottish specialists. I submit that my suggestion would improve a very valuable piece of administrative machinery. The question is quite open as far as any statement has been made in Parliament. The question was raised in 1929, and the Minister of Pensions said:
It is not, in my judgment, practicable or desirable at this stage to define minutely the procedure on points which experience alone can properly determine."—[OFFICIAL REPORT, 25th November, 1929; col. 966, Vol. 232.]In the following column of the OFFICIAL REPORT it appears that my hon. and learned Friend the Treasurer of the Household asked whether any arrangements had been made as to how medical experts would be selected for Scotland. Mr. Roberts replied by asking for notice of the question. The question, I understand, as a result of my inquiries, was never repeated in this House. That was six years ago. I hope that now the question has been raised again, my right hon. and gallant Friend will be able to reply to it in the way I suggest. If he can see his way to do so, I am sure it will give considerable satisfaction to ex-service men in Scotland.
§ 11.16 p.m.
§ The MINISTER of PENSIONS (Major Tryon)I am very much obliged to my hon. Friend for raising this question, if only because it is really important that it should be cleared up and that there should be no misapprehension whatever about the position of these independent medical specialists. To clear the ground, perhaps, he will allow me to say that there need be no anxiety what 497 ever about the care or treatment of ex-service men in our hospitals in Scotland. I have often visited those hospitals, and I have found the hest relations there between patients, doctors and nurses, and the staffs of the hospitals are doing all they can for them. If there were the smallest doubt which we wish to resolve about the nature of an illness or the kind of treatment needed for a particular case, we should not hesitate to call in from Scotland specialists of the kind needed, so that the fullest possible treatment is given and specialists from Scotland are fully available already for the Scottish cases.
The point raised goes beyond that. It deals with the question of the independent medical specialist. In the great majority of these cases, there is no doubt whatever about the condition of the patient or the nature of the illness or wounds from which he may be suffering. The only point to be decided is whether the illness from which he is suffering to-day, the nature of which is fully known, can in any way be connected with his War service which ended, perhaps, 16 years ago or even longer. When Mr. Roberts regularised the arrangement which had been used occasionally he made an announcement in the House of Commons part of which my hon. Friend has quoted. Mr. Roberts, who was then Minister of Pensions, said on 18th November, 1929:
I intend, in addition, to secure the assistance of independent advice by the appointment of medical experts (to be nominated by the presidents of the Colleges of Physicians and Surgeons), who will be associated with the Department in advising on all cases on which there is material conflict of evidence on the claim."—[OFFICIAL REPORT, 18th November, 1929; col. 25, Vol. 232.]So far as any national question comes into this, we have about 11 of these experts. The number seems large, but the fact is there are so many difficult subjects which arise that we had a number of different experts to deal with the variety of illnesses and troubles from which the ex-service men are suffering in our hospitals or in other hospitals. Of the experts who have been nominated two of the 11 have Scottish qualifications which my hon. Friend recognises is more than a national claim. There is, in addition, another expert who holds the great distinction of being one of the examiners at Glasgow University, so that so far as 498 the Scottish outlook on these cases is concerned it is fully provided for, and we are very fortunate to have this Scottish assistance given to us in dealing with these Scottish cases.What my hon. Friend has not quite appreciated is that if the patient were seeking advice and he went to a doctor, and, not being satisfied, he saw an expert, the expert would be called in and would advise him on the spot, coming from one of these many sources which are available in Scotland; but in this case it is not a question of the patient seeking advice, it is the Ministry of Pensions seeking advice; and, as Mr. Roberts clearly indicated was done, and as we have invariably done, the expert actually comes to the Ministry of Pensions. My hon. Friend would not go so far as the suggestion that any pressure is put upon him, for of course we should not call him in if we did not want his advice. Could it be said that on a highly technical and difficult medical question he, a great expert, would be influenced in any way by what any officials or any one said?
The kind of thing that happens is that some case comes up and we are genuinely in doubt about it at the Ministry. We feel that there is an element of doubt and that there is not sufficient evidence to enable us to grant a case. We cannot on the available evidence grant a case for pension, and we must have proper authority behind the case before we can authorise the expenditure of public money upon it. Therefore, sometimes, on the initiative of the Ministry itself, we seek advice, and these men come to us at our headquarters in London, and, through them, we obtain advice. I am not prepared to define now or to illustrate the infinite variety of problems that arise, but anyone can imagine for himself the great difficulty of associating an illness now in existence with any past war record of any post-war record of a particular man. Whatever the poblem may be—the connection between one illness and another, or a present illness or a past illness—we seek the advice of a medical specialist in London, because it is in London that the headquarters of the Ministry are. The hon. Member raised the question of a medical examination. It is not in every case that the expert examines the man; but in every case the expert does come to 499 our centre in London and give us his valuable advice. The expert comes to give us his advice, but whether there is an examination or not depends on the independent judgment of the expert.
§ Major TRYONThat would not be nearly as satisfactory, although it would be possible for an expert in Scotland to send his opinion, in which case it would receive due consideration. What we want is a personal opportunity of putting our difficulty to the expert and getting his advice. The experts are perfectly free to examine a man, if they wish to do so; or, if they like, we are perfectly willing that the man should be examined by anyone whom the expert wishes should examine him; that is, a man of any position, and we would equally allow a man to be examined in Scotland or anywhere else by some recognised authority independent of us if so desired on the suggestion of the medical expert. The main point is that the experts come to help us in difficult cases. We want to see them and ask their advice on these cases and if we were not to have the advantage of experts 500 coming to us in London and advising us Scottish ex-Service men would be placed in a position where it would be more difficult to decide their case than under the present arrangement.
§ 11.25 p.m.
§ Mr. BRACKENThis is the first time for two years that we have had the advantage of listening to a speech from the Minister of Pensions. He is one of the least advertised Ministers and therefore one of the best. Anyone who has had anything to do with the Ministry of Pensions is grateful to him for the great work he is doing for those who were wounded in the War, the attention he gives to their case and the care he takes with those who are still suffering as the result of war wounds. I am sure that every hon. Member will regret that the right hon. and gallant Member should only make one speech in two years and sincerely hope that we shall have an opportunity of hearing him oftener, perhaps in a position of greater eminence in the Government.
§ Adjourned accordingly at Twenty-six Minutes after Eleven o'Clock.