HC Deb 28 March 1955 vol 539 cc165-74

Motion made, and Question proposed, That this House do now adjourn.—[Mr. Studholme.]

10.7 p.m.

Mr. F. H. Hayman (Falmouth and Camborne)

The case which I wish to raise this evening is that of Mr. Thomas Henry Marks, of Redruth, an ex-soldier now aged 59. He was wounded by enemy shell fire on the night of 3rd November, 1917, during a heavy bombardment of our lines as our troops were preparing to attack Gaza for the third time. The Ministry of Pensions and National Insurance admit that he then received multiple gunshot wounds. An old colleague of mine at County Hall, Truro, was alongside Mr. Marks when he fell.

I think we might for a moment consider the pattern of events at that time. In October, 1917, there was the great battle of Passchendaele, in which there were 400,000 casualties. The Italian Army collapsed at Caporetto with a loss to the Allied Armed Forces of 800,000 soldiers. It was also the time of the great October Revolution of Russia, which took Russia out of the war. Field Marshal Allenby was conducting his great movement in Palestine partly, presumably, as a diversion and partly to accomplish what had been the dream of the Christian world, to end the Turkish domination of Palestine. On 6th November Gaza fell and on 8th December the Turks abandoned Jerusalem after 400 years' occupation.

Mr. Marks as one of the private soldiers in that war and in that battle had gunshot wounds in both legs—multiple wounds involving the bones and tissues of each leg. He was awarded a 30 per cent. disability pension. This was thought by him to be not altogether unsatisfactory as, until 1952, he was able to work fairly regularly. He then had pains in his legs. He was treated for arterio-sclerosis. Eventually, the legs became gangrenous. He was admitted to hospital on 26th October, 1953. He had one leg removed. Then, a month or so later, the second leg had to be amputated. Both amputations were above the knee.

I should like to know whether the Joint Parliamentary-Secretary to the Ministry of Pensions and National Insurance is satisfied that the causes of arterio-sclerosis are sufficiently known for anyone to be quite satisfied that this condition was not ultimately traceable to the multiple gunshot wounds in this man's legs in 1917. The doctor who has been attending him through the years is Dr. O'Donnell. of Redruth. a man who is very highly respected in that town, which happens to be the one in which I have lived for over thirty years. He says that the amputations could well have been due, in the first instance, to the man's injuries. He tells me that the bilateral amputation is practically unknown.

It seems to an ordinary layman fairly obvious that there must have been some other aggravating condition. An aggravating condition could well have been the scarred tissues of the leg preventing the setting up of new blood circulation. The scarred tissues were pressing on the blood vessels already there. These two conditions, taken together, could have prevented a proper circulation. Another factor is that the second amputation followed so quickly on the first.

Mr. Marks claimed full disability pension. Who would have thought that a man wounded, as he was wounded, in battle would have been denied that full disability pension even though these severe amputations of the legs took place so many years afterwards? The Ministry's senior doctors, however, are unable to connect leg trouble with war wounds or war service. What an extraordinary statement—unable to connect these amputations with the war wounds of thirty years ago.

Later, an independent medical expert said that the wounds of both legs played no part in causing gangrene. All I can say is that these experts fail to convince me and millions of other ordinary people who think along common sense lines. Will the Parliamentary Secretary tell us whether he is sure what causes arteriosclerosis? If the answer is in the negative, how can he be sure that the war wounds were not a contributory cause? If there is any medical doubt at all, surely the man is entitled to the full benefit of it. I should like a categorical answer to that question.

I should like to know whether this man has been seen by a medical man other than his own doctor or case reports, and if he has, how often. To the layman, the relationship between these war wounds and the culminating double operation seems clear and logical. I submit that medical opinion must be tempered by common sense. Doctors have a history of disagreement on medical issues just as great as the differences on political issues between politicians. I understand that not long ago cortisone was regarded as the great new remedy for rheumatism. It was then rare and expensive, just the qualities for all the newspapers to expound and make a lot of. Now I believe that the idea has been exploded and that the simple aspirin is probably equal or better than cortisone for rheumatism.

If some of us retain a healthy scepticism about the profundities of some medical experts, surely we are justified. In 1954, the Ministry rejected the claim of a man discharged from the forces in 1942 because of ill-health. He developed severe pulmonory tuberculosis. Although, during his service, the man was subjected to living in the open air under severe conditions. the Ministry held that this had nothing to do with his subsequent tuberculosis. That seems to me an extraordinary viewpoint. It so happens that that man lives within a quarter of a mile of Mr. Marks, in Redruth. I quote this example to show how much many of us are becoming doubtful about the decisions of medical experts.

My hon. Friend the Member for Chorley (Mr. Kenyon) brought to the notice of the Minister the case of a man who had died, and where, eight or nine months afterwards, the Ministry experts rejected the death certificate, even though the cause of death had been ascertained by a post-mortem examination. We wonder whether the chief function of the medical experts is to reject these claims. But surely all hon. Members of this House wish to give justice, and more than justice to ex-soldiers and other ex-members of the Forces, either men or women, who have suffered injury or illness as a result of their war services.

I should like to say something about the financial condition of Mr. Marks. I will read extracts from a letter I received from the area officer of the National Assistance Board. He wrote: Mr. Marks' disability pension was increased to 15s. 6d. a week from 2nd February, 1955, and this amount is disregarded in our assessment. Part of this disregarded resource must be treated as available to meet the special expenses to which you refer, and it is for this reason that I am unable to make a discretionary addition to his weekly allowance in this respect. However, there are some shortages of bed-linen, and in the exceptional circumstances of this case I am making a grant of £5 so that these can be made good. I wrote to the area officer to ask him whether he would tell me what is the man's income and the National Assistance allowance. I was told, The current allowance is calculated as follows. Scale rate for applicant and wife, 63s.; rent (in full), 10s.; total, 73s. Resources: sickness benefit (in full). 52s.; disability pension, 15s. 6d. a week, wholly disregarded: nil; total, 21s."— the net amount of the National Assistance allowance. The following is significant: From 19th May, 1955. Mr. Marks' Sickness Benefit will be increased and the Board's allowance will be correspondingly reduced from week commencing 23rd May. The Government are responsible for the hardship to this man and to hundreds of thousands of other people who are in receipt of National Assistance. I wish to emphasise that part of this miserable disability pension of 15s. 6d. a week must be available to meet special expenses of the heavy wear and tear on bed clothes, towels, etc., which are the ordinary concomitants of a disabled man like Mr. Marks.

This hero's total income for himself and his devoted wife is £4 8s. 6d. a week, and, when his sickness benefit is increased in May, his National Assistance allowance will be correspondingly reduced. Surely that is the meanest cut of all. Mr. Marks lost both legs and he receives 15s. 6d. a week as a war pensioner. Surely he is entitled to the full disability allowance with all the trimmings, including the constant attendance allowance. According to the booklet issued by the Minister in February, Mr. Marks ought to get £9 6s. 4d. instead of only 15s. 6d.

Is it not possible for there to be a reappraisal of the Ministry's attitude towards men who were injured in the First World War, who are now so much older, and who, because of their wounds, are subjected to increased severity of the disabilities which come with old age? I hope that the Minister will tell me tonight and Mr. Marks and all his friends, that he is able to grant the full disability pension in this case.

10.22 p.m.

The Joint Parliamentary Secretary to the Ministry of Pensions and National Insurance (Brigadier J. G. Smyth)

Any case of severe disability or of severe mis- fortune always excites the very deepest sympathy in this House, and I am sure that will always be so. That is certainly the case in the tragic misfortune which has overtaken Mr. Marks, whose case has been put so movingly by the hon. Member for Falmouth and Camborne (Mr. Hayman).

I cannot for one moment agree with the hon. Gentleman when he says that many people in this House are becoming doubtful about the humanity and the fairness of the Ministry of Pensions and National Insurance. I would not admit that for one moment, because I am quite certain that the present Ministry and the old Ministry of Pensions have a very high reputation indeed in this House for their fair and sympathetic handling of personal cases under the war pensions scheme. That is borne out by the fact that in the more than three and a half years that I have been Parliamentary Secretary in the two Ministries, this is only the fourth personal case that has been raised on an Adjournment Motion. The last one was over a year ago. I am quite certain that if there were any truth in what the hon. Gentleman has said about the Ministry's lack of sympathy, or doubts on the part of the House as to the fairness of the Ministry's dealings with pensioners, that would certainly not have been the case.

This is a war pension scheme. It is a scheme for war disabilities, and a pension can be awarded only in a case like this if it is medically certified to be causally related to war service. Otherwise, the man comes under the ordinary social security schemes, just like any other citizen. In this case, Mr. Marks has been in receipt of a 20 per cent. war pension —not 30 per cent. as the hon. Member said—which is the lowest one we can award, since 1919, for shrapnel wounds of the left arm and both legs. That was made permanent in 1924.

The hon. Member would appreciate that I must be entirely objective in arguing a case like this. Mr. Marks had been in regular work for a number of years. Then, 36 years after his wound, at the age of 58, he was admitted to hospital suffering from thrombo-angiitis obliterans, with cardiac enlargement, resulting in gangrene of both his legs. It was as a result of that condition that in October and November, 1953 he had both legs amputated above the knee. The Ministry's doctors were in no doubt whatsoever that Mr. Marks was suffering from a generalised form of cardio-vascular disorder, and that neither his war disability nor his war service of 36 years before had played any part in his then existing condition.

Dr. Barnett Stross (Stoke-on-Trent, Central)

Does that mean that the hon. and gallant Gentleman's advisers, having given full consideration to the question of the aggravation and acceleration of a condition which affects people who do not have these wounds, had taken into account the fact that the man had had wounds of both his lower limbs, both of which later suffered from this occlusive artero-sclerotic condition?

Brigadier Smyth

They took into account every shred of evidence in the case.

The British Legion took up this case in the first place—and we always advise anyone bringing a case against us to consult the British Legion, because it is of the very greatest help to the pensioner in making a claim of this sort—and the hon. Member later lent his weighty support to the British Legion claim. As he explained, it was upon the opinion put forward by Dr. O'Donnell, a local doctor, that they based their opposition to the Ministry ruling. Dr. O'Donnell put forward two points. He maintained that cases of comparatively young people seldom developed gangrene requiring amputation, and also that the condition was due to the pressure of scar tissue upon the blood vessels.

The Ministry doctors were in entire disagreement with Dr. O'Donnell, largely because the condition of the pensioner was a general one. It showed itself in the blood vessels of the retina, and all over the body. Nevertheless, before I had recommended it to them—as I should undoubtedly have done—they recommended to me, in order to give every chance to the pensioner, that we should ask for the opinion of an independent medical expert appointed by the Royal College of Physicians. That is generally considered to be a fair way of resolving any medical difference of this sort, and it is generally so regarded by all ex-Service associations.

An independent medical expert was appointed and both sides of the case were submitted to him, including every possible detail that could be provided. In September of last year the independent medical expert gave us his report, and it was definite indeed. It was not in the least doubtful in any particular. He said he could not accept the opinion of Dr. O'Donnell, and he could not believe his opinion would gain credence from any independent body of medical opinion. The independent medical expert maintained that the amputations for gangrene would have occurred at the same time and at the same age if he had never suffered from any wounds at all.

I would mention just four points in the medical expert's report. He said, quite clearly, that Dr. O'Donnell's opinion was unsupported by clinical experience nor was such attribution recognised in any textbook of medicine. Secondly, he said that the condition of the arteries, the enlarged heart and auricular fibrillation had one common cause, and that was degenerative cardio-vascular disease. He disagreed with Dr. O'Donnell when he said that gangrene at the age of 59 was not a remarkably young age for this condition to lead to amputation of a leg or both legs. Fourthly, he said that bilateral amputation was to be expected sooner or later whenever gangrene had been caused by thrombo-angiitis obliterans.

In accordance with the terms of the Royal Warrant, the Minister, having referred the matter to an independent medical expert, was of course bound to accept his advice, particularly as it was so completely definite in every single particular.

In conclusion, I would say that at least the hon. Member can be satisfied that he has explored every possible avenue to support the case of his constituent, and all I can say is that if I had been in his place I would have done exactly the same as he has done tonight. I think he has put his case in as moving and as convincing a way as he possibly could, and I know he will realise that, although I am in the very deepest sympathy with Mr. Marks in his very grave misfortune, I have to argue a case like this entirely objectively and in accordance with the medical evidence, which is very convincing indeed.

I can only say I regret very much that, although I sympathise deeply with Mr. Marks, I am unable to attribute the mis- fortune which has overtaken him, 36 years after he suffered these wounds in the First World War, either to his war disabilities or to his war service, and I am sure that I could come to no other conclusion.

10.34 p.m.

Dr. Barnett Stross (Stoke-on-Trent, Central)

I am sorry that the Parliamentary Secretary has not found it possible to give way to the request of my hon. Friend the Member for Falmouth and Camborne (Mr. Hayman). I speak not as a layman but as a former chairman of a tribunal for the Ministry of Pensions, and as one who served it for many years.

We do not fully understand the causes of this condition. I am not blaming the Parliamentary Secretary for a moment; he must take the advice of his experts, but I have always felt that because there is doubt about these causes we should give the man the benefit of that doubt. When a man has been wounded in both legs, even though a long time has elapsed since the injury, if there is even the slightest doubt I think the Ministry should consider the matter very carefully and should not hesitate to give the benefit of the doubt to the injured man.

It is unusual to see such a close coincidence as this—both legs having to be amputated above the knee within three months in a case of thromboangiitis obliterans. Although we have speculated on many causes, we do not fully know what may be the primary cause. But if, as in this case, there might be the possibility of acceleration or aggravation because of injury to both lower limbs, even 36 or 38 years later, I feel that the Ministry might have stretched a point and given the man the benefit of the doubt.

Brigadier Smyth

The hon. Member has great experience of these matters and of the Ministry. It is precisely because we wanted a second opinion and because we took notice of what the local doctor said that we referred the matter to an independent medical expert of the highest repute. I am sure that in his heart of hearts the hon. Member agrees that the Ministry acted very properly in taking that step. I am sure he would have done the same.

Dr. Stross

I do not blame the Ministry.

Adjourned accordingly at twenty-three minutes to Eleven o'clock.