§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Wills.]
§ 11.38 p.m.
§ Miss Alice Bacon (Leeds, South-East)
Although tonight I wish to draw attention to an individual case, it involves two important points of principle, one of which is the concern of the Ministry of Pensions and National Insurance and the other the concern of the Ministry of Health.
Mr. T. W. Barr, of Leeds, some time ago had an industrial accident for which he receives a disability pension of 40 per cent. As a result of the accident he had an operation. Part of the roof of his mouth and part of his gums had to be removed. In order to speak at all and to carryon a normal life he has to wear an appliance, attached to which is a lower denture. One would have thought that that would have been provided free of charge, but he is being treated as an ordinary dental patient, and he pays as though he were a patient merely requiring dental treatment and dentures.
I believe that two points of principle arise. The first, as I have said, is the concern of the Ministry of Pensions and National Insurance. Section 75 of the National Insurance (Industrial Injuries) Act, 1946, gives the Minister the power tomake arrangements to secure the provision and maintenance, free of charge or at a reduced charge, of equipment or appliances for any person …What I wish to emphasise is that Section 75, although in the 1946 Act, was never put into operation, and that was solely because there was put into operation at the same time the National Health Service Act, which provided these appliances free of charge for everybody in the country.
I know that the Government will say—I have had this reply from both the Ministry of Health and the Ministry of Pensions and National Insurance—that we ought not to differentiate between those who suffer an accident in the course of everyday life and those who suffer an accident by way of an industrial injury. But we already accept differentiation. We 657 accept differentiation in regard to the Ministry of Pensions and National Insurance. War pensioners are treated differently from civilian sick. The industrially injured are treated differently. I would emphasise that those who are insured under the National Insurance (Industrial Injuries) Act pay an extra contribution each week to be so insured.
I have a letter from the Minister of Pensions and National Insurance, in which he says:If the introduction of the Health Service had come after the coming into force of the Industrial Injuries Act, Section 75 would have been there to anticipate the introduction of the Health Service in the field of the industrially disabled; but, in fact, as you know, this situation never arose, as the Acts came into force simultaneously.That shows that, but for the fact that we had a National Health Service Act that covered the whole population, special treatment would have been allowed to those who had industrial injuries. Surely now that there are charges for certain appliances under the National Health Service Act it is reasonable to expect that there should be some special provision for those who are injured at work. For the first time for many years workers are today having to pay for some of these appliances although they have been injured in the course of their employment.
It seems that there is a certain element of chance whether or not one gets a free appliance according to one's injury. If Mr. Barr had lost an arm or leg he would have been provided with a free appliance without question, but because it happens to be an appliance to which teeth are attached it comes within the provisions for National Health Service charges.
There is another point which was raised by the Minister in the letter that he wrote to me on 16th June. He said:… in a case where some form of appliance has been found to be necessary, the extent of the disabilities caused by the loss of faculty may well depend on whether a suitable appliance has been fitted and, if so, whether it can be worn comfortably and used effectively.If that means anything at all, surely it means that if Mr. Barr had not a satisfactory appliance, his disability pension would be greater than it is. Yet he is having to pay for the appliance.
The Government ought to consider putting Section 75 of the National Insurance (Industrial Injuries) Act into operation. It is only fair to the great body of 658 workers who are paying their industrial injury contributions that they should be covered for appliances of this kind. If the Government refuse to do this, and if the Ministry of Pensions and National Insurance finds that it cannot do it, it is the responsibility of the Ministry of Health. I know that the Joint Parliamentary Secretary is in a little difficulty because two Ministries are involved. I believe the case might have been dealt with a little differently by the Ministry of Health.
I do not want to debate whether it is right or wrong that we should have charges for various appliances, but even if we accept that there should be a charge for dentures I believe that such charge was never intended in a case of this kind. The fact that Mr. Barr has an injury to the roof of his mouth, that 1½ inches of his gums are missing, and that he cannot speak without the appliances, surely puts him in an entirely different category from someone who merely has dentures.
I have here a letter from the Parliamentary Secretary to the Ministry of Health in which she says:We appreciate that patients may suffer inconvenience while their dentures are under repair and that this will be greater in some cases than in others. There are unfortunately a large number of people who would not be able to attend properly to their duties if their dentures were broken—telephonists, shop assistants, 'bus conductors …and so on. Surely, we are not going to put Mr. Barr in the same category as somebody who happens to be without dentures for a few days. It is not merely a question of experiencing difficulty in speaking: he cannot speak at all. Further, he finds it extremely difficult to get a dentist who will supply the kind of appliance which he needs. It constantly needs repairing, and when it needs repairing he just cannot speak and so cannot follow his occupation. Indeed, I believe that he really ought to be allowed two appliances, because he finds it very difficult to carry on his normal life when anything goes wrong with the appliance which he has.
Up to now I have received very little satisfaction in this matter. I have asked Questions about the matter. I have had correspondence with the Ministry of National Insurance and the Ministry of Health, but neither Department seems to accept responsibility. This means that 659 a man who has been unfortunate enough to sustain an industrial injury suffers this great disability, and yet he is regarded as a normal dental patient. I know that a big principle is involved, but I believe that the time has come when Section 75 of the National Insurance (Industrial Injuries) Act should be put into operation. In the meantime, I suggest that the Ministry of Health should have dealt differently with the matter.
§ 11.48 p.m.
§ The Joint Parliamentary Secretary to the Ministry of Pensions and National Insurance (Miss Edith Pitt)
As the hon. Lady the Member for Leeds, South-East (Miss Bacon) said, this debate is about her constituent Mr. Barr, and since the wording she chose for the subject of her debate was "The provision of mouth appliance for Mr. T. W. Barr", I will deal with the particular case before I come to the general principle she raised.
Mr. Barr was involved in an industrial accident in June, 1949. He sustained an injury to the nose. The wound did not heal and an operation became necessary in February, 1952. The operation took place at Leeds General Infirmary, and part of his palate was removed. Consequently, Mr. Barr now has to wear a full set of dentures, the upper denture also serving as an obturator, which is an appliance specially made to fill a hole in the roof of the patient's mouth.
The first point I should like to make is that Mr. Barr is still an out-patient of Leeds General Infirmary and is being seen regularly by the ear, nose and throat specialist who performed the operation on him. He is also referred to the Dental Hospital at Leeds, as necessary. It is true that he receives a disability pension administered by my own Ministry under the National Insurance (Industrial Injuries) Act, on an assessment of 40 per cent.
Mr. Barr's first set of dentures was supplied by the hospital in June, 1952. In July, 1954, it was found that Mr. Barr needed a new upper plate, and that also was supplied by the hospital. I want to emphasise that no charge was made in either case, as the United Leeds Hospitals, which include the Dental Hospital at Leeds, are empowered, under an Order made under Section 4 of the National 660 Health Service Act, 1952, to remit charges for dentures where the dental services are provided as part of clinical teaching.
In June last year, Mr. Barr went to a dental practitioner in Leeds and that practitioner applied to the Dental Estimates Board for approval for a new set of dentures. That approval was given, and the dentures were supplied; and it is here, I think, that the hon. Lady comes into the picture, if I may put it in that way, because it was subsequent to this that Mr. Barr approached her on the question of the cost. In October, 1955, his case was taken up by the British Legion, who stated that he had to be fitted every year with new dentures; and, furthermore, that he really needed a reserve set. In the special circumstances, they asked that these should be provided by the State.
The Board, however, was unaware when this approach was made that Mr. Barr was still an out-patient at the hospital; and they said that if further dentures were clinically necessary, the Board would be prepared to consider estimates from his dentist. They could not, however, approve the provision of spare or duplicate dentures. They also stated that he would be liable for the statutory charge under the 1951 Act which the Board could not excuse, although he could seek help from the National Assistance Board.
In March this year, the hon. Lady wrote to my right hon. Friend the Minister of Health and referred to the fact that Mr. Barr was in receipt of a disability pension, and suggesting, therefore, that in those circumstances dentures should be supplied without charge. The Minister replied that appliances of which artificial teeth were a part were regarded as dentures for the purposes of the charges payable under the Act of 1951; and, I would point out that that was an Act passed by her own party when in power.
The Minister of Health also made the point which I have referred to earlier, that some teaching hospitals, including the United Leeds Hospitals, are empowered to remit charges under that Act where dental services are provided; and it was suggested that when Mr. Barr needed new dentures he should apply to the hospital he had been attending as 661 an out-patient. Mr. Barr is still an out-patient, and had an appointment on 31st May last. He was then due to see the professor of dental surgery and did attend on that date; but he did not, in fact, wait to see the professor.
I should make it clear that duplicate sets of dentures cannot be supplied under the National Health Service. That is due, in part, to the limitations of finance, but also to the shortage of dental man-power; and while that is the position, it is thought to be unwise to divert the limited resources of the Service to providing duplicate dentures.
There are, in fact, certain disadvantages in duplication unless the individual who has two sets of dentures wears both of them regularly. A person ought really to wear one set by day and the other by night. The tendency is for people to wear the set which is easier to wear, and as a result, when they use their reserve set some day, they probably find that it does not fit the mouth. That is one practical example of the disadvantages of having duplicate sets of dentures.
If Mr. Barr needs to have repairs to his dentures frequently, as the hon. Lady suggested tonight, I am advised that that can be effected usually in a matter of hours. If he went to hospital the work would be put in hand at once, or if he went to a dental practitioner, it could be done under the emergency service.
I would confirm, what I believe the hon. Lady already knows, that once artificial teeth are added to an appliance it becomes a denture, and a charge is payable. Mr. Barr's appliance is essentially a denture, carrying an extension to act as an obturator. Mr. Barr, from the information available to the Ministry of Health, has not lost or broken his dentures in the four years during which he has been wearing them. They may have needed repairs, but according to the records Mr. Barr has not needed a replacement because of any damage which has caused breakage. No charge was made for the previous two sets provided through the dental hospital, and I think that is important and links with the earlier point that it is most probable that, had the hon. Lady's constituent gone back to the hospital in 1955 when he ordered the last set, there would have been no 662 charge had there been need of replacement. If any further alteration occurs to his mouth, it is open to Mr. Barr to seek new dentures from the hospital at which he is still an out-patient, in which case he would not be liable to any charge.
On the general principle of the power under Section 75 of the National Insurance (Industrial Injuries) Act, I would say that power has never been used to date. I understand that that Clause was written into the 1946 Bill, which became operative in 1948, as a stopgap measure in case there was any delay in bringing in the National Health Service. The hon. Lady confirmed my understanding in her speech. That contingency did not arise because the National Health Service, the Industrial Injuries Scheme and the main National Insurance Scheme, came into operation on an identical date, 5th July, 1948. Under the social insurance schemes, there has never been any differentiation in the matter of payment for treatment and appliances between those whose injuries entitled them to compensation under the Workmen's Compensation Acts or Industrial Injuries Acts and other sick and injured workmen.
§ Mr. James Griffiths (Llanelly)
I want to raise a very important point. I think there is a deep fallacy here, contained in the Minister's letter. When the Joint Parliamentary Secretary says, as she has done, that there has been in our social insurance schemes no differentiation in treatment between people whose disabilities arise from injury or accident and others, that is quite true, if what the hon. Lady means by the social insurance schemes is the general schemes. But she has to remember that the National Insurance (Industrial Injuries) Act was to replace the old Workmen's Compensation Acts. Under the latter Acts it had become the practice of good employers everywhere to make a contribution, over and above the monetary payment, for appliances and limbs of all kinds. The reason why Section 75 was introduced into the Act was to enable the Ministry of National Insurance to maintain that good practice.
If employers did that when workmen did not contribute towards their disablement benefit under the Workmen's Compensation Acts, surely there is the strongest possible reason for making that provision when, for the first time and in the 663 only country in the world this applies, the workmen are paying for it. If what the hon. Lady has said is made the general rule, the trade union movement will be asking the Government to reconsider the matter, because it means that the Industrial Injuries Scheme, for which half of the money comes from the workmen, will be less generous than the workmen's compensation schemes. It was never intended that that should be the case.
§ Miss Pitt
I am glad that the right hon. Gentleman has paid a tribute—perhaps unconsciously—to employers in saying that it was the practice of good employers to supply such appliances where necessary over and above what workmen had under workmen's compensation. I shall elaborate on that issue a little later. I imagine that the right hon. Gentleman would agree with my interpretation of the reasons for Section 75 in the National Insurance (Industrial Injuries) Act—that it was intended to bridge a gap.
§ Mr. Griffiths
The reason for Section 75 was that it was the practice under the old Workmen's Compensation Acts to do that. It never came into operation, because the National Health Service provided this kind of service free for everybody, but when we began to make charges for it good employers would have made an extra payment in cases of this kind. Is the Industrial Injuries Act to be less generous than the good employer?
§ Miss Pitt
I willingly accept that the right hon. Gentleman, in his personal experience, knew of many good employers, but it is surely not correct to say that that service was available to every workman under the old Workmen's Compensation Acts. It was not part of the social services, which is the point I am trying to make. Under the social insurance scheme there had never been any difference—
§ Mr. Griffiths
There was no social insurance or Industrial Injuries Scheme until the Industrial Injuries Act. The Industrial Injuries Act is a separate Act, and the State makes only a small contribution. It is not the State which provides benefits to workmen.
§ Miss Pitt
Nevertheless, the old workmen's compensation scheme was part of 664 the social insurance in this country, before the considerable change made by the Acts to which I have referred. I am trying to emphasise that there was no difference in this matter of payment for treatment and appliances between those whose injuries entitled them to compensation under the Workmen's Compensation Acts, or the Industrial Injuries Act and all other sick and injured workmen.
In the old National Health Insurance Scheme, which was repealed by the 1946 Act, appliances were available to members of certain approved societies. That was the established position before 1948. Such benefits varied enormously between different societies, as I know from my own experience. They took the form of some kind of grant towards the appliance that was necessary. That provision was in no way tied to receipt of workmen's compensation. It applied to anybody who belonged to the old National Health Insurance Scheme, provided he was a member of an approved society though not all societies gave those additional benefits.
When the National Health Service was introduced in 1948, the supply of appliances was put on the same basis for the whole of the population. Successive Governments have maintained that basis. The National Health Service Act, 1951, passed in May of that year by the Socialist Government and, of course, including a charge for dentures, which is the subject of the case tonight, still made no change and still provided that there should be no difference in the treatment for industrial injuries cases. So again no use was made of the provision of Section 75.
A suggestion for the use of the power given by that Section was put forward during the Committee stage of the National Health Service Act, 1952. The Government's view then was that there was no good ground for introducing differentiation. That view still holds. Those who qualify under the National Insurance (Industrial Injuries) Act for injury at work draw a higher rate of benefit. They pay extra contributions, but they draw higher rates of benefit. There may be other cases equally disabling which are not caused by injury at work, in which those concerned experience the same difficulties and disabilities, but only draw sickness benefit 665 while away from work. They have no disability pension, even if they are able to work. To increase differentiation by giving industrial injury cases free appliances is not justified. The Minister said in his letter to the hon. Lady on 16th June that the reasons given in 1952 apply as forcibly now as then.
Just as there was no difference between industrial injury and other cases in 1948, and that position was maintained in 1951 and in 1952, so I think it ought to be maintained now.
§ 12.7 a.m.
§ Mr. J. Griffiths
I must say to the Joint Parliamentary Secretary that we shall feel obliged to return to this matter. She is laying down a doctrine which is untenable. It is one which we never contemplated would be accepted under the National Insurance (Industrial Injuries) Act, under which for the first time in history workmen are contributing to cover the risk of accidents in industry. That is operating for the first time in this country. It is not operating in any other country. We do not call this a denture case; it is a case of serious disability. I am certain, from many years of wide experience of workmen's compensation 666 cases, that good employers—and there were many, although there were some of the other sort—and that good insurance companies, would not have hesitated in this case. We cannot leave this matter where it is. It appears that under this Industrial Injuries Act, under which men contribute out of their wages to make provision, and are doing so for the first time in history, we are less generous than good employers were. That is not living up to the intentions of the Act. Section 75 was never brought into operation because in 1948 the National Health Service provided all these benefits for the whole population. If, under the Health Service, charges are to be made, we ought to invoke Section 75.
§ Mr. Griffiths
The case, according to the Minister's letter, was based on the fact that there has been no differentiation in the social services. That is untenable.
§ Adjourned accordingly at ten minutes past Twelve o'clock.