SERVICE RECRUITS (MEDICAL EXAMINATION) (Hansard, 16 December 1943)

§ Mr. Martin (Southwark, Central)

After the grave, complex Imperial questions we have been discussing I would like to recall to the House for a few moments a matter which is, I think, of some domestic significance. I think it is common ground that in the early stages of the war a very large number of men were drafted into the Army after insufficient medical examination. The consequences of that were that a large number of people returned to civil life in a state of invalidity. I first took up this matter in 1940, or at the beginning of 1941, with the then 1805 Financial Secretary to the War Office, who is now the Minister of State. My right hon. Friend showed me his usual courtesy and kindness, but he manifestly had some difficulty in dealing with his Department. There was a good deal of passing the buck between the War Office and the Ministry of Labour. The medical staff of the Ministry passed the men into the Army, which then became responsible for them. The present Financial Secretary to the War Office is rather apt—if my hon. and learned Friend will forgive me for the comparison—to remind me of these words: Oh! lover of my life, My soldier saint, Who thrust his breast, Between the spears and me. His position is always to stand between an angry and political world and the General Staff in all its forms.

Sometimes, perhaps, he does not receive all the gratitude from the General Staff that he should receive in such matters. At any rate the Minister of State found difficulty in overcoming the objections of his Department, and my suggestions were turned down. Perhaps I may mention what they were, because I think they are still valid. I said I thought it possible that men below the category of A.1 who were passed into the Army should be medically examined from time to time. Most units possess medical officers. Most units consist of reasonably healthy and strong young men, or men in the prime of life, who do not make great calls on the medical officer, and it was the experience of most people in the last war and the earlier part of this that the medical officer of the unit at home was not overworked. Most of the men spend a good part of some days in the week in physical exercises and so on, which offer an opportunity, with a certain amount of organisation, to see that medical examinations are carried out. However that may be, I suggested to the Financial Secretary that it was not an insuperable problem, but the Department put obstacles in the way of doing anything about it. After a time I wearied of well-doing. The blitz was on at the time, and the Luftwaffe succeeded in dropping an explosive missile on the War Office which, I hasten to say, in case I am suspected of divulging security secrets, had no effect whatever. At a Departmental conference a member of the staff of the Foreign Office said, 1806 "Will nothing move these people?" His colleague replied, "Only dynamite." Unfortunately even dynamite was insufficient. I felt that my dynamite ought to have been sufficient, and, as I say, I rather wearied of well-doing.

But I have repented of that, because I have found in the last year or so that the number of these people who come out of the Army has grown considerably. They go in for anything from six months to two years. Their career as a soldier is completely useless to the country, because before they are trained they have been found to be inefficient, for physical or mental reasons, and are marked for discharge. They are withdrawn from civil activities, often of a nature in which they could render very considerable service to the State at a very critical time. They are chargeable to the revenues of the State for an indefinite time afterwards by receiving pensions which, owing to the efforts of Members in all parts of the House, have now been put on a more satisfactory basis, but the fact remains that we are pensioning a great many people who ought never to have received pensions because they should never have been put into a position of having their health affected by military service. Most serious of all, these men have to look forward to a life of semi-invalidism in many cases. Practically any man who has his wits about him and two legs to stand on is able to get a job now, but their prospects, in spite of the efforts of the Ministry of Labour, of getting jobs after the war seem extraordinarily remote. They and their families are likely to suffer to the end of their lives in consequence of what has occurred, and all, I would suggest, with no profit to anybody concerned.

I would like to put it to my hon. Friend, who I know has very warm sympathy with this question, that something should be done now that we are tapping the older age groups and calling into the Army men who are round about middle age who have family responsibilities. Something should be done to keep a keen watch on these fellows and see that where they are unfitted for military life they are returned to civil life before their health is serious affected. I do not believe it is beyond the competence of the War Office and the wit of man to devise a system by which that can be accomplished. 1807 I should like to give two examples which came to me in the last few weeks and which rather perturbed me, for they showed that the matter was still not being satisfactorily dealt with. A woman came to see me and said that her husband was in seriously bad health. His own doctor had diagnosed him as an epileptic and had sent him to King's College Hospital. They declined to confirm the diagnosis and wished to keep him in for treatment, but as a soldier he could not remain. They wrote to the man's unit and when he returned to the unit, the medical officer said, "You are all right; this is a lot of fuss about nothing." The woman said to me, "Is my whole life to be ruined because these people will take no notice of this matter at all?" As a result of the representations I made to him, my hon. and learned Friend took the matter up, and I am satisfied with the consequences. This man has now been seen by a specialist and his grade has been reduced. Suppose that woman had not come to me and had known nothing about her Member of Parliament. Her husband would never have gone before the specialist or seen by the medical board, and his health might have deteriorated to a considerable extent, all to no purpose.

The other case was that of a boy of 18 who was only 15 or 16 at the time of the blitz. This lad was buried with his mother and younger brothers and sisters when his house was struck. His father, who had an injury to his back, could not get into the shelter and had to stay upstairs. When they were dug out he was found to be seriously injured. The father was taken to hospital, and five weeks later he returned. The night after he returned the mother and younger brothers were out and came home to find the house had been struck a second time. The father was killed, and the lad was dug out from the débris seriously injured. Three years later the lad, physically recovered but in a nervous state, was called up to the Army. His doctor expressed the view that if he went into the Army it might have serious consequences and he might become a psycho-neurotic, of whom there are unfortunately too many at the present time. I hope that the War Office will do something about this case that if the lad comes out he will be paid a proper pension, because a com- 1808 paratively young boy like that who has gone through experiences of that sort should be looked after properly by the State.

Those are two examples. I have no complaint against my hon. and learned Friend and only want to impress upon the House that this is a serious matter which I think needs looking into. We have been dealing in the last few weeks with very momentous questions and have heard one or two very moving appeals, one from my hon. Friend the Member for North Camberwell (Mr. Ammon) yesterday and one from another hon. Friend last week. If we are going to establish some kind of unity in this country to found a new world, I suggest that it will only be done if we understand, and master, the problem of reconciling the highest interests and welfare of the individual with the highest interests and welfare of the greater unity, whatever it may be, State or Commonwealth or international combination, and I suggest that we cannot do better than begin at once by showing that we are going to look after those people who will be the citizens of the new world and who must be made to enter it whole in body and in mind by every method we can devise.

§ The Financial Secretary to the War Office (Mr. Arthur Henderson)

I should like to assure my hon. Friend that whatever may have been the position in the early days of the war there has been no question of the War Office or the Ministry of Labour and National Service seeking to "pass the buck" from one to the other for the purpose of enabling me to deal with the matter which he has raised. I think it might be of interest, because it is obviously a very important consideration to most families in the country, if I were to give the House some idea of the system that has been and is in operation governing the medical examination of recruits into the Army. The medical examination of all Service recruits is carried out by medical boards set up by the Minister of Labour and National Service under the National Service Acts. The practice of the boards is governed by a code of instructions which was first issued in May, 1939. That code has from time to time been revised by a Committee under the chairmanship of Lord Horder, a very famous doctor. That Committee advises the Minister of Labour on all 1809 questions in connection with the medical examination of men for the Armed Forces and representatives of the three Service Departments are on the Committee.

In regard to the method of examination, every man is examined by a medical board and is seen by four doctors, that is, the chairman of the board and his three colleagues. The great majority of both the chairmen and members are general practitioners, a considerable number are retired officers of the Navy, Army and Indian Medical Services, and a few of the chairmen are consultants, either retired or still in practice. The duty of examiner No. 1, if I may call him that, is to investigate the mental condition, nervous stability and previous health of each man and to examine his nervous system. The duty of examiner No. 2 is to examine the eyes and test the voice, to examine the teeth, throat, nose and ears, to note the physical development, to test the movements of joints, and to inquire into the history of injuries and operations. The duty of examiner No. 3 is to take the pulse rate, examine the heart and, where necessary, test the blood pressure, and apply the exercise tolerance test, to take the measurements of the chest and to examine the lungs and abdomen, and to confirm any abnormalities noted by the previous examiners. The duty of the chairman is to review the case as a whole, and, after consulting three colleagues, to decide the grading. Perhaps the House would be interested to know that, on the average, the examination takes just under half-an-hour. Any man about whom the board has any doubt may be referred to a consultant or specialist. Since June, 1939, about five per cent. of the men examined have been referred to an opthalmologist and five per cent. to other specialists or consultants.

As regards classification, recruits are classified in one of five grades, I, IIA, II, III and IV. Only those men who are placed in Grades I, IIA, and II are accepted for service. Grade I men are those who are subject only to such minor disabilities as can be remedied or adequately compensated by artificial means such as spectacles, false teeth and so on, and attain the full normal standard of health and strength and are capable of enduring physical exertion suitable to their age. Grade II men are those who are suffering from disabilities disqualifying 1810 them for Grade I, do not suffer from progressive organic disease, have fair hearing and vision, are of moderate, muscular development and are also able to undergo a considerable amount of physical exercise not involving severe strain. Grade IIA indicates that a man has been placed in Grade II solely on account of defects either of visual equity or deformity of the lower extremities, or both.

This civilian medical board grade is subsequently translated into the corresponding Army categories A, A1, B, B1 and so on, and this is reviewed by the military medical officer when the man joins up for service. I want to be quite frank with the House; it is quite true to say that the Army medical officer does not undertake an exhaustive examination, although he does examine the man stripped; but he checks over the facts which have been ascertained by the Ministry of Labour medical board. It is sufficient for this lesser examination to take place when the man arrives at his unit, in view of the fact that the fuller examination has taken place by the Ministry of Labour medical board, and the facts contained in their report are with the military medical officer. Unless it is considered that there has been a definite error in grading, no category is changed by an Army medical officer until the man has been at least one month in the Army, except in the case of technical personnel. The interval between a man's medical examination under the National Service Acts and the date when he joins his unit does not normally exceed from six to eight weeks. The interval may be longer, it is true, in Some cases, for example where a man has secured postponement of his calling up on the grounds of exceptional hardship. In that case there may be a greater interval of time, but Regulations are about to be issued which will ensure that no man shall be called up for service who has not been medically examined or re-examined within the preceding six months.

Now the question may arise, What right of appeal, of protest, has a man if he disagrees with the findings of the Ministry of Labour medical board? A man who considers he has been wrongly graded by the Board can protest, and his protest will be considered by the Ministry of National Service. If there is any reason to think there has been a deterioration in his health since the first examination, 1811 or if any fresh medical evidence can be produced, a re-examination is arranged. In addition, I am told that since September, 1941, there has been a note placed on the grade card given to a man at the time of medical examination which asks him to notify the Minister of Labour and National Service if before he is called up for service he has a serious illness or accident or otherwise has reason to believe that his health has deteriorated.

It may interest the House to know that the number of men who have been invalided out of the Army within six months as a result of what, in the opinion of the Army medical authorities, was an error in grading during the period 1st July, 1941, to 31st August, 1943, represents seven in every 10,000 of the total intake during this period and three in every 1,000 of the total invalided out of the Army during the same period. The figures for the period before 1st July, 1941, are unfortunately not available. It 1812 appears therefore that the number of men who join the Army although they ought to have been rejected on medical grounds is very small indeed, and the figures quoted above, I suggest, can be regarded as satisfactory and are regarded as satisfactory by the Army medical authorities. I hope I have been able to give sufficient facts and sufficient explanation of the system that operates in regard to the intake of recruits from the point of view of their medical examination. I hope also that I have satisfied my hon. Friend that whatever does go wrong in individual cases, as I think is bound to be the case, and no doubt in spite of the arrangements that have been made will continue to be the case, the percentage is so small that the problem has been reduced to very minute dimensions, and the House and the country can take it that on the whole this problem has been very satisfactorily dealt with.