§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Godber.]
§ 9.13 p.m.
§ Dr. Edith Summerskill (Warrington)
This is the first occasion for a very long time on which I have drawn the attention of the House to a case which a Minister has refused to reconsider. I do so because there are elements in it which call for attention and which might apply to other cases.
I think the Parliamentary Secretary would agree with me that, in a large Department such as his own, concerned with the welfare of more than 50 million people directly and indirectly, it is necessary to exercise the greatest vigilance lest the needs of a few people are overlooked and the people concerned are afraid to press their claims. I have in mind particularly the sick, the aged and the disabled. These people are reluctant to enter upon what might be considered a controversial issue. Although they might write a letter to the Parliamentary Secretary's Department or make some appeal through an organisation to which they are attached, they are very reluctant, if they have received a refusal, to continue to appeal through their Members of Parliament, although they feel justified in so doing.
In raising this one case tonight, I am doing it on behalf of others who are not less deserving of attention but who have not had their cases brought before the House. I want to impress upon the Parliamentary Secretary a certain principle which is involved in this case. May I refresh his memory? Permission has been given to me by this man to raise his case in this House. Otherwise, in no circumstances would I ventilate the details.
The name of the man is Mr. Jonathan Bacon, and he is a constituent of mine. 1221 He is an ex-Service man of the First World War. He had an amputation of the left leg in 1918, and he has worn an artificial limb from 1919 to 1955. In 1955, his right leg developed a certain vascular disease and the patient suffered from a condition known as intermittent claudication. Subsequently, in March, 1955, he had a right lumbar sympathectomy, which was performed in Warrington General Hospital.
Later, a new growth appeared in the stump of the left leg and, on 6th January, 1956, a re-amputation was performed. I want the Minister to bear in mind what this man had suffered in the preceding few months from his sound leg. On 26th January, 20 days after the re-amputation, the Minister of Pensions reduced the man's treatment allowance from 100 per cent. to 80 per cent. because, in his opinion, it was not caused through war service or the wearing of an artificial limb. Furthermore, it was decided to transfer this man from the medical field in which he has been treated hitherto as a war pensioner to that of a civilian patient under the National Health Service. Apparently, whatever stump trouble appears in future will mean that he has to be treated as a private patient and as a civilian for a new artificial limb. The latter is usual, and I recognise it.
Since 26th January, this man has been receiving only an 80 per cent. disability pension. He is still unable to return to work. Here is a man of 60 who has had a double amputation and whose remaining leg, which he thought was sound, is affected. The Parliamentary Secretary may be surprised to hear that this man is even considering returning to work. I would point out that this is not a man pretending to want to return in order to evoke the sympathy of anybody. He is a man who throughout his disability has worked and is lost without work. I shall read an extract from a letter in a moment to prove that this is so. Why has the Parliamentary Secretary's Department adopted this niggardly attitude towards a man, a patient, who should be deserving of the utmost sympathy and extended the maximum help? It is because the Minister's senior doctors were of the opinion that it was not possible to associate the new growth which appeared 1222 in the stump at the end of the femur with the original amputation of 1918.
I want to make it clear that I have every respect for their opinion, which is an opinion. I know the doctors who serve the Parliamentary Secretary's Department, and I have always had the highest respect for them. He has had some of the finest advisers. Nevertheless, there are views expressed by other surgeons, equally eminent, which do not accord with those of the Minister's advisers.
This is an element in this case which I say surely can be related to other cases. The condition of the bone of this man before amputation was explored by a distinguished surgeon at Mossley Hill Hospital, Liverpool, in November, 1955. That was the surgeon who was on the spot. It was the surgeon in the operating theatre who actually explored the condition. In a long report he said:I feel that it would be impossible to dissociate the amputation as a factor in its initiation.He meant the amputation of 1918 as a factor in the initiation of the new growth. He later amplified this opinion and said, referring to the query regarding the association of the new growth with the original amputation:With reference to the query raised that the lesion did not arise at the site of pressure, to this I naturally agree. However, the lesion in question appeared at a site subjected to the trauma of traction and not to the opposing type of trauma, that is pressure.He is referring to the artificial limb.In a B.K. amputation the adductor muscles are put to greater stress than normal and in my opinion this lesion developed at the site of a chronic traction strain where the adductor magnus is attached to the bone.That is what the surgeon said who examined this man and operated on him.
The Ministry then referred the case to another surgeon whom the Minister called, in his letter to me, "an independent medical expert." The other surgeon wrote this:I have read the papers examined the X-rays.May I stress that point to the Parliamentary Secretary. Whereas the first surgeon was one who examined the man and operated on him, the independent medical expert—I am using the Minister's phrase—was obviously in a position only 1223 to read the papers and examine the X-rays. He said:I have paid particular attention to the opinion expressed by Mr. —"—that is, the surgeon of the hospital—but am entirely unconvinced by the theory as to causation of the tumour that he puts forward.The Parliamentary Secretary knows that this is a very long report, but I think I have been right in taking parts from it. The Minister wrote as a result of this:In the light of this knowledge and with the opinion of the independent medical expert before me, I find it impossible, after the most careful and sympathetic consideration, to increase Mr. Bacons assessment to 100 per cent. as you suggest.First of all, I want to query the validity of this expression "independent medical expert." Here we have a Liverpool surgeon who saw the man in question. As the Parliamentary Secretary knows, Liverpool has some of the finest physicians and surgeons in the country. It is a place to which people go from North Wales, and often people from all parts of the North of England. I agree that Leeds is an excellent centre, as is Manchester, but Liverpool has a high reputation in the medical world in the North.
Here was a Liverpool surgeon treating a poor man in hospital. He had no monetary interest whatsoever. Why is he not regarded as "independent"? Surely he is as completely independent in his approach to this subject as is any surgeon whose advice might be invited by the Ministry. On behalf of the first surgeon, whom I have never seen in my life, I slightly resent the fact that another surgeon, looking at the papers and examining the X-rays, is quoted as being "an independent medical expert," as though he were in a much better position to judge of this man's condition because, for some curious reason, he had no bias—because, surely, that is what can be inferred from "independent."
In no circumstances would I exaggerate in a case of this kind, but I would say that it is possible to go to surgeons throughout Britain—indeed, throughout the world—and find in a case of this kind that they expressed different opinions. In such a case as this nobody yet can be dogmatic, because, unfortunately, medical 1224 science has still not discovered just why this kind of lesion should occur.
The other point relates to this man being treated under the National Health Service. The Joint Parliamentary Secretary may be able to comfort him by telling him that there will be absolutely no difference in any respect here. I know that the limb-fitting centres have now been merged. The limb-fitting centre under the old scheme, of course, was conducted by a different Department from that which looks after the National Health Service. I know that the centres have been merged, but I want the Parliamentary Secretary to assure me that this man will not experience any other differentiation for this reason, and I am quite sure that I have not to ask for his sympathy in this matter.
I always feel that these very fine men, who have been deprived of a normal life in consequence of their injury, have one compensation. They are always found with their friends and their "buddies"; these disabled men are often in chairs, and often frequent those places where other disabled men play, and live and work. Here a man finds that he is suddenly deprived of a service which emphasises the fact that he is an ex-Service man who has served his country. This must have sonic psychological effect on him, and any comfort he might derive from being part of a service which is catering for the needs of fellow disabled ex-Service men should be afforded him.
I believe that, in the Army, a man who complains of his lot is called a "bellyacher". I should like to assure the Parliamentary Secretary that I have not, and would not, come to this House and quote the case of what is known as a "bellyacher". This man wrote to me on 20th November. At that time he had no idea that I was to raise this on the Adjournment. I asked his permission, and he was quite willing that I should do so. I am sure that he will not mind my quoting his letter to show what kind of man he is.
He writes:My disagreement is only concerned with the re-amputation case.He is not bringing into this the other leg—that he had to have this other condition seen to and so on:I only want 100 per cent. treatment allowance restoring from 26th January until I can 1225 resume work. I still wish to be treated as a war pensioner for future necessities such as artificial limbs, etc., and not treated as a National Health civilian, as I have been since 25th January, seeing that I lost my leg through war service in 1918. This has caused me great bitterness, through the action of the Minister of Pensions.Mr. Speaker, I only hope that this is an isolated case. If it is not an isolated one, I say that the Minister is open to a charge of bureaucracy.
I shall not tonight put the Parliamentary Secretary into the painful position of having to justify this publicly. I know he can, according to the letter of the law, justify it, but I do not believe that he can justify it according to the spirit of the law. The Minister should in this case have tempered justice with mercy.
If distinguished surgeons disagree on a matter about which nobody is in a position to dogmatise, then, taking all the other considerations into account—the man's age, his service, his injury, his expectation of life—the Minister should have exercised his discretion. As I know full well, there are hard and fast rules and they may apply to the great majority, but in a Department of this kind these rules must be administered with compassion in special cases. Otherwise, the Welfare State tends to become a bureaucratic machine. If some of us here do not see that Ministers and the whole Department are vigilant on behalf of a tiny minority, then we have indeed failed in our duty.
I believe these numbers may be small. Because of that, the Parliamentary Secretary cannot say that if he deals with this case in a more compassionate manner a precedent will be established forthwith which will make serious inroads on the funds. I know perfectly well what the arguments are, and many of them are valid. I have been on that side, and I have had to tell the House on many occasions that if a certain concession is granted a most important precedent will be established, in consequence of which there will be many anomalies and it would be impossible to administer a vast Department in a tidy manner. I fully realise that.
Here we have a man representing a very small minority of people, but they are people who may be suffering great hardship, not necessarily financial. They are in a state mentally and physically 1226 which tends to be aggravated if they feel they are suffering from some injustice.
After all, what does the Minister lose? They are a small minority, and he cannot therefore be afraid of establishing some precedent which will get out of hand. What does he stand to lose? If in the future there is some scientific proof forthcoming that this lesion was not associated with wearing an artificial limb for nearly forty years, then all that the Minister will be guilty of in granting this humane concession is charity in dealing with a fine old ex-Service man.
§ 9.34 p.m.
§ Mr. James Simmons (Brierley Hill)
In supporting my right hon. Friend the Member for Warrington (Dr. Summerskill), I want to remind the hon. Gentleman the Joint Parliamentary Secretary that this case is a kind of test case for the claims of the organisation representing the limbless of the country. We claim that the assessment of a man's pension should not be entirely tied to the tape measure—to the length of the stump. In reply to that claim that it is tied to the tape measure, the Ministry of Pensions of recent years has granted certain easements so far as the assessment of the limbless man is concerned.
There are, I think, eleven different cases in which a man suffering an amputation for which he has a fixed assessment can claim extra compensation because of added disabilities which can be slightly attributable to his amputation. For instance, hernia caused by strain, flat foot, and osteo-arthritis of the leg when the other leg has been amputated are now accepted grounds on which the fixed pension for amputation can be increased by the Ministry of Pensions.
After listening to my right hon. Friend it seems to me that the case which she has quoted has a far stronger claim than any of the eleven cases given in the Ministry's own publications in which the pension can be increased beyond the pension purely for amputation. This man has not only had a further amputation of his existing stump, but he has lost his other leg.
When we are told that the doctors disagree on this matter, I would remind the Parliamentary Secretary that in our long-standing fight for the ageing limbless we have been bandied to and fro by the 1227 medical profession for a long period of years. The Ministry has now come down on the side of the ageing limbless by accepting one set of medical or surgical opinions against another. The standard which ought to be taken in cases like this is the standard which is laid down, if not in actual words, in spirit in the Royal Warrant, that in all cases where there is doubt, the pensioner shall be given the benefit of all reasonable doubt. I suggest that as there is that element of doubt in the case which my right hon. Friend has brought before the House this evening, this pensioner should be given the benefit of that doubt.
I do not want to labour the point. My purpose in speaking is simply to reinforce—not that that is necessary—what my right hon. Friend has said in support of her case, and to remind the Parliamentary Secretary that his decision in this one case will have far-reaching repercussions among the limbless ex-Service men.
We are grateful for what the Ministry has done for the limbless in the past. We are grateful for its recent concession—although we do not think it went quite far enough—to the ageing limbless. While we are grateful on these issues embracing the whole of the limbless, we are still concerned with individual cases, on which there is an outstanding opportunity for the Ministry to show its humanity by giving the pensioner in all instances the benefit of the doubt.
§ 9.39 p.m.
§ Mr. F. H. Hayman (Falmouth and Camborne)
I had not intended to intervene in this debate, but my right hon. Friend the Member for Warrington (Dr. Summerskill) has drawn attention to a case which is not very dissimilar from one which I brought to the attention of the House about two years ago, and about which I saw the Parliamentary Secretary approximately twelve months ago. It is the case of Mr. Marks, of Redruth, a man who was wounded in Palestine in 1917. He had severe injuries to his legs and was given a pension of, I think, 20 per cent.
About two years ago he had one leg amputated, and less than twelve months later the second leg was amputated. The doctor who did the amputations came to see me about the case, and he said that in his opinion the amputations were due 1228 to the original leg wounds which the man had had. He was a decent man who had worked throughout until his limbs were amputated. Now he has no legs at all. Only ten days ago I went to the local hospital to see somebody else, and I was told that in another bed in the same ward was Mr. Marks. I went to see him, and I found that he had now developed diabetes.
It seemed to me that there was an element of doubt in his case whether the amputations were not due to the original wounds. Dr. O'Donnell who did the amputations, thought so, and he is an experienced surgeon. He appealed to the Minister to give this man the benefit of the doubt. I hope that it will be possible, even at this late hour, for the Minister to exercise discretion in favour of Mr. Marks and of my right hon. Friend's constituent, because I feel very strongly that here we are dealing with marginal cases, and that the country as a whole would want to give them the benefit of the doubt.
§ 9.43 p.m.
§ The Joint Parliamentary Secretary to the Ministry of Pensions and National Insurance (Mr. Richard Wood)
I feel rather diffident in getting up to answer the right hon. Lady the Member for Warrington (Dr. Summerskill) because, naturally, it is impossible for me to match my rather rudimentary medical knowledge against her very wide medical experience. Therefore, I find that I must rely on my own small, personal, practical experience, which alone enables me to reply to her case a little better than I should otherwise be able to do, and to understand some of the very great problems and difficulties which face her constituent, Mr. Bacon, about whom she has spoken this evening, and the constituent of the hon. Member for Falmouth and Camborne (Mr. Hayman), whom I remember discussing with him some time ago.
Naturally, we all have immense sympathy with the misfortunes of these two men. We all profoundly admire the courage of the right hon. Lady's constituent in wanting to return to work as soon as he possibly can. The right hon. Lady is, of course, perfectly correct in saying that we all should exercise the greatest vigilance in cases of this kind. As the hon. Member for Brierley Hill (Mr. 1229 Simmons) pointed out, these perhaps are the best opportunities we have for talking about the individual cases which happen to worry each one of us in our own constituencies.
The hon. Member for Brierley Hill said that we in the Ministry of Pensions and National Insurance should not be closely tied to the tape measure. I entirely agree with his observation. He pointed out that we had these eleven or so clauses by which a pension could be increased for consequential injuries or difficulties. He might have pointed out, if he had thought of it, that there is also the possibility, which bears very directly on the right hon. Lady's case, of increasing pensions under the paired organs formula. The hon. Member said something about giving the benefit of reasonable doubt. I should like to say a few words about that later.
I remember the case of the constituent of the hon. Member for Falmouth and Camborne. I am afraid that I cannot add to what he already knows about it, and what he was told in an Adjournment debate at the beginning of 1955 by my hon. and gallant Friend the Member for Norwood (Sir J. Smyth). I agree that these two cases, that of Mr. Marks and that of Mr. Bacon, raise some similar issues, and perhaps I shall be dealing partly with the case of Mr. Marks as I go on.
The right hon. Lady gave us Mr. Bacon's history though she did not say that in 1919 he was discharged with a 50 per cent. pension. She then told us the subsequent developments, namely, intermittent claudication in his right leg and the re-amputation of his left leg early this year. She then pointed out that in late January, after having been operated on at the beginning of that month, his treatment allowances had been reduced from 100 per cent. to 80 per cent. I think the right hon. Lady must have meant that his treatment allowances of 100 per cent. were removed and that he was then given a pension on an 80 per cent. assessment, which comes to much the same thing.
I do not understand Mr. Bacon's complaint about not being treated any longer as a war pensioner. As both the right hon. Lady and the hon. Gentleman know, at the time of the merger what I might 1230 call the medical functions of the old Ministry of Pensions were given to the Ministry of Health, and the financial functions, the actual payment of the pensions, were transferred to the Ministry of Pensions and National Insurance.
Therefore, I cannot quite understand why Mr. Bacon now thinks he is being treated as a civilian patient. When any of us go to Roehampton we are treated with civilian patients and with ex-Service patients because we are all being treated under the Ministry of Health. However, if the right hon. Lady would like it, I will willingly ask one of our welfare officers to find out exactly what is in Mr. Bacon's mind, discuss it with him, and try to get the matter sorted out.
This new growth and the reamputation of his left leg affected the position that had existed up to the beginning of this year in two different ways. First, it gave rise to the question as to whether or not the reamputation was an indirect consequence of the war injury or of wearing the artificial limb for nearly forty years or whether it was a coincidence which was entirely unconnected with his injury. That was the question posed by those events at the beginning of the year.
The second way in which it affected the situation was that it made possible the increase of pension from 50 per cent. to 80 per cent. under the paired organs formula for the intermittent claudication in Mr. Bacon's right leg. I would like to consider as carefully as possible both those consequences. The first is the question as to whether the reamputation and the new growth had a connection with the war injury forty years before.
All the medical opinion which was consulted, with one important exception which the right hon. Lady mentioned, denied the possibility of a connection. The medical advisers of the Ministry of Pensions and National Insurance, about whom the right hon. Lady was very polite—I think justifiably so—and the limb-fitting surgeons at Roehampton all agree that there could be no connection. One of the limb-fitting surgeons at Roehampton wrote that he had never seen a new growth of this kind at the lower end of the femur developing in a below-knee amputee. He said that other surgeons agreed with him and that they were all agreed that the occurrence was a pure coincidence.
1231 Against this the right hon. Lady justifiably put the opinion of the surgeon who, she said, examined Mr. Bacon. I think she said, too, that he had performed sonic operation at the end of 1955 on Mr. Bacon but had not actually performed the reamputation at the beginning of 1956. He had examined Mr. Bacon not only, I think she said, in November or December, 1955, but I believe he had actually examined him two or three days before the reamputation took place; so, if anything, that is strengthening the right hon. Lady's case that his opinion should be taken extremely seriously. To that extent doubt existed. The Ministry of Pensions doctors said one thing, the Rochampton doctors said the same thing, and this surgeon, who had examined Mr. Bacon very shortly before his reamputation, said the opposite. He said in fact that connection did exist.
I should like to assure the right hon. Lady, as sincerely as I possibly can, that the opinion of this surgeon who thought that there was some connection was taken very seriously indeed. There was no suggestion that he was not an independent witness—indeed, he certainly was—but the fact remained that his opinion stood absolutely and completely alone. That opinon was given by him, and all the other doctors who had been consulted had given a contrary opinion. Therefore, as in a number of other cases where doubt exists, this case was referred to an independent medical expert. I do not think that the right hon. Lady would in any way quarrel with the independence of the independent medical expert because he is a nominee, either of the Royal College of Physicians or the Royal College of Surgeons. He is entirely independent and is asked for an opinion in order to resolve any doubt that there may be.
This practice of referring cases to an independent medical expert is a fairly long-standing one and, so far as I know it has always proved completely acceptable to the ex-Service men's organisations There is no doubt whatever that if the independent medical expert had found that there was a connection between the war injury and the later new growth that connection and the effect of it would certainly have been included in the new pension assessment; but, in fact, he 1232 emphatically found that there was no connection at all.
Again I should get on difficult ground if I began to go deeply into medical matters which the right hon. Lady would think that I ought to keep off; but the surgeon whom she quoted suggested that in a below-knee amputation of forty years' standing the adductor muscles, which, I think, are the muscles which bring one's legs from outside inwards are put to an abnormal strain. But apart from people with below-knee amputation, who do not seem to suffer to any greater extent from the danger of this new growth than the completely able bodied, there are many people who put an undue strain on their muscles without apparently suffering in that way. I suppose that anyone who constantly rides on a horse's back and tries to sit there by gripping and using these adductor muscles is constantly putting a strain on them. So far as I know there has never been any suggestion that those who ride horses are at all liable in any extra way to this trouble.
The right hon. Lady and the hon. Member for Brierley Hill talked a certain amount about doubts. It has certainly long been the practice of the Ministry of Pensions—in fact, it is statutorily required to do so—to give prospective pensioners the benefit of all reasonable doubt. The right hon. Lady, I am sure, will agree that doubt is a very relative term.
When one conies to think of it, I think that we are certain about extremely little in this world. We see certain effects apparently following certain causes, but we cannot be sure that they in fact follow those causes. They might cone from entirely different sources and, to that extent, doubt seems to exist about all propositions of which we can think. But most propositions about which we can think are at least free from reasonable doubt.
In this case where, on the one side, we have the opinion of the surgeon whom the right hon. Lady has quoted and, on the other, of the medical advice connected with the Ministry of Pensions and National Insurance plus the opinion of the independent medical expert. I find myself able to say that it is possible that there is some connection, but it is not in the slightest degree probable. I find that when I can say that I cannot agree that any reasonable doubt exists.
1233 The second development of the situation in early 1956 was that this reamputation made possible, as it had not been possible before, an increase in Mr. Bacon's pension from 50 per cent. to 80 per cent. Until the total assessment of his disability was 100 per cent., we were unable to take into account under the paired organs formula the intermittent claudication in Mr. Bacon's right leg. But now we can, and now we are paying Mr. Bacon not only the 50 per cent, for his war disability—the original amputation of his left leg—but we are also paying for more than half the disability which I think was once suggested might be due to strain on his other leg, but which has never been accepted as being due to war service.
We do not believe, as I have been trying to point out, that war service caused the trouble in his right leg or that it subsequently made necessary the reamputation of his left leg. For those reasons, therefore, we cannot pay the pension, as the right hon. Lady suggests we should, of 100 per cent. I suggest that it is not at all ungenerous for us to pay the 80 per cent. although the right hon. Lady knows how much I should like it if we were able to go further and pay the 100 per cent.
Three-eighths of the 80 per cent. pension is in respect of disabilities which are unconnected with Mr. Bacon's war service. The difficulty is that if we were to accede to the right hon. Lady's request and pay a pension of 100 per cent. in this case we should, by so doing, be making no distinction at all between a pensioner who is 50 per cent. disabled by his war service and a pensioner who is considered to be 100 per cent. disabled by his war service. In fact, Mr. Bacon has only been disabled 50 per cent. by his war service.
1234 The right hon. Lady was kind enough to say that she could be certain of my sympathy, and so she can. I should have loved to be able to give an affirmative answer to all the questions which she put to me tonight, but I feel that if I did so I should not be playing fair with those who have been most severely disabled by war service—the people who have been 100 per cent. Or, if one can calculate it in that way, more than 100 per cent., and are more disabled by war service than Mr. Bacon.
Secondly, I do not think that I should be playing fair with all those hundreds or thousands of people whose disabilities we have been unable to accept as being due to war service. There are lots of them.
§ It being Ten o'clock, the Motion for the Adjournment of the House lapsed, without Question put.
§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Godber.]
§ Mr. Wood
I suggest that, quite apart from those two considerations, if we stretched the matter too far and tried to pay a pension of 100 per cent. in this case we should be doing something entirely out of place in a scheme of war pensions.
Lastly, I suggest that if we did it, much as our sympathy would lead us to want to do it, we should be unjustified by the letter and the spirit of the Royal Warrant, which imposes upon us the duty to do this for people who have suffered war injury. We should be spreading the net much wider than would be justified.
§ Question put and agreed to.
§ Adjourned accordingly at two minutes past Ten o'clock.