§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. E. Wakefield.]
§ 9.59 p.m.
§ Miss Margaret Herbison (Lanarkshire, North)
I wish to raise tonight a problem which affects not only many of my constituents but miners all over Britain. I have dealt many times in this House with various aspects of this problem. In my constituency there is the greatest incidence of pneumoconiosis anywhere in Scotland. The Parliamentary Secretary must be aware from the many letters which she receives from me that at present there is a definite feeling of frustration amongst many of these men.
§ 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. Barber.]
§ Miss Herbison
Not only is there frustration but also great dissatisfaction, and I sometimes find the miners in my constituency very angry indeed about what is happening.
I wish to raise tonight two cases in particular—two men who are in receipt of disability pensions as persons suffering from pneumoconiosis. The first case is of a man who was first examined in November, 1954. He was assessed at 40 per cent. and was paid a disability pension at that rate. The following year he was again examined by the pneumoconiosis medical board and was again assessed as suffering to the extent of 40 per cent. In November, 1956, he was again examined by the 'pneumoconiosis board and was again assessed at 40 per cent.
This third examination had been suggested by the man's own doctor. The man felt that the pneumoconiosis had worsened since the previous examination the year before. The doctor examined the man and sent him to hospital, where he was examined by a consultant physician. His lungs were X-rayed. The consultant physician said that there was certainly an aggravation since the previous year. I have here the certificate 938 which was give by the man's doctor. She said:The above-named attended Law Hospital in September, 1956. He was seen by the consultant physician who considered that his disability is greater than 40 per cent. and who recommended that his position be reviewed by the Pneumoconiosis Board.There we have a consultant physician, a specialist in lung diseases, saying quite clearly after a very careful examination that this man's disability is greater than 40 per cent. The man goes before the board, but the board does not accept that and again assesses his disability at only 40 per cent. It says that this man is also suffering from hypertensive cardiovascular condition—in other words, high blood pressure.
In the second case, the first assessment was 20 per cent. When he was examined a second time by the pneumoconiosis medical board he was again assessed at 20 per cent. On my advice he appealed, and the figure was raised to 30 per cent. Two years later, he was again examined by the board and the figure was set at 30 per cent. He appealed against this decision and appeared before the medical appeal tribunal. He has complained very bitterly to me about what happened when he appeared before the medical appeal tribunal. Under section 38 of the Industrial Injuries Act, the medical appeal tribunals are set up and the Minister appoints three men—a chairman and two medical practitioners. I looked up the Regulations and I found these words in Regulation 12 (4):Where the Tribunal are unable to reach a unanimous decision on any case referred to them, the decision of the majority of the members thereof shall be the decision of the Tribunal.The majority is two out of three. In other words, in such a serious case, if there is a difference of opinion, two out of three can say that the man has or has not to get additional compensation.
The complaint of my constituent, however, is this. He appeared before this tribunal, with at least two medical practitioners on it. He tells me that he had no examination whatever. They asked him a few questions: did he sleep well at night? Did he need pills? That was the sort of question. The tribunal decided that he could have only 30 per cent. assessment. One can understand how unsatisfactory that must appear to these 939 men. I expect that they examine the X-ray plates, and also have the report of the pneumoconiosis medical board.
In other words, they have in front of them only the information that they get from the pneumoconiosis medical board with, possibly, some information from the consultant physician. If these medical appeal tribunals are really to give any sense of satisfaction to the men who go before them, they ought at least to give the men a medical examination, and it is because I feel so strongly about that that I want to stress it in the House tonight.
I want to deal next with this subject of cardio-vascular hypertension—blood pressure. Are we certain, are the members of the medical appeal tribunal, and the members of the pneumoconiosis medical board certain, quite certain, that this disease could not be caused by pneumoconiosis? Have we done sufficient research into that disease to know the answer to that question? I know that we are doing rather more research now than we did, but I do not think that nearly sufficient research has yet been made. Unless I am absolutely convinced by the Minister's reply that there can be no connection between pneumoconiosis and high blood pressure, I will not be satisfied, nor will hundreds, perhaps thousands, of miners in Great Britain.
There is another question which ought to be answered by the medical people, through the Minister. If there were no pneumoconiosis, would this condition of high blood pressure be as disabling as it is when pneumoconiosis is present? If the answer is that it would not be so disabling, I would suggest that it just cannot be discarded by the pneumoconiosis medical board or by the medical appeal tribunal. In other words, if pneumoconiosis either causes or aggravates in any way this other disease it ought to be taken as a factor in assessing the amount of disability pension that ought to be given.
I know these men very well. Sometimes they are almost coughing their lungs out. Will anybody suggest that that does not aggravate high blood pressure? This disease causes great distress. It causes nervousness in many of these men. I have always understood that if somebody is told by a doctor that he has 940 high blood pressure he is always advised to "take things very quietly. Do not do anything that will excite you. Do not do anything at all that will put up your blood pressure."
If one has pneumoconiosis, a disease that causes so much coughing, a disease that causes so much distress, and a disease that causes a high degree of nervousness at times, I suggest, although I am not a doctor and have not any great medical knowledge, that it must, indeed, make the other disease more disabling. It is for these reasons that I ask the Minister and her right hon. Friend to have this whole question examined to see if these men are getting the justice that I think everybody in this House would like to see them get
§ 10.10 p.m.
§ Mr. Harold Finch (Bedwellty)
My hon. Friend the Member for Lanarkshire, North (Miss Herbison) has rendered a service by drawing the attention of the House to the decisions so frequently made made by the medical appeal tribunal.
My hon. Friend has cited two cases, but I say without any exaggeration that there are hundreds of such cases in the mining industry, where there is a strong feeling among the miners about the injustice which is regarded as being done by the decisions that are made. This arises particularly in questions of aggravation or acceleration as the result of an accident. The medical man, on behalf of the claimant before the tribunal, very often gives very powerful evidence about the extent to which the accident had aggravated or accelerated a pre-existing weakness or complaint.
Under the old Workmen's Compensation Acts—and I want to say at once that in many respects the Industrial Injuries Act is far better than the old workmen's compensation system—in dealing with the medical evidence before the tribunal on this point of aggravation and acceleration, the county court took a far broader view than the medical appeal tribunal had done, and where there was any doubt the benefit of that doubt was invariably given to the applicant. I submit that in these cases that come before the medical appeal tribunal the benefit of the doubt is not, in so many cases, given to the 941 applicant. I fully appreciate that in many cases the medical evidence may be conflicting, but let me cite a case from South Wales which will illustrate the point.
A miner who was a well known athlete, and who was regarded as being in the pink of condition for years, sustained an accident to the spine while working underground. He received his injuries benefit, and subsequently his disablement benefit. At a later date, the case came before the medical appeal tribunal. He had had his provisional assessment for a few years, and later the tribunal had to decide the final assessment, and they came to the conclusion that he was suffering from arthritis, which could not in any way have contributed to the accident. The medical evidence on behalf of the applicant was that he was suffering from arthritis, but that the accident was the lighting up of his arthritic condition, and his medical man gave very strong evidence that the arthritis was aggravated by the accident which he had sustained.
I venture to say that, in a court of law, in a case where a man had led a normal life before, where there was no evidence that he had been incapacitated before the accident—this man worked at the coalface, was a runner and was prominent in athletics, and then sustained an accident—it was found that he was suffering from arthritis which could not be attributed to the injury.
My hon. Friend referred to cases of pneumonociosis, in which we have had a similar dispute. We have had cases in South Wales, in which pathologists—I quite agree that the fact that a man has pneumoconiosis does not mean that he will die from it—after the post-mortem examination came to the conclusion that death was accelerated by pneumoconiosis. Surely, where we have prominent and well-known pathologists who disagree with the pneumoconiosis medical board, there should be some means of an appeal to some higher authority by which these cases can be decided? In these cases, in a court of law, reliance has often been placed more on legal points that may be put to a medical man, but they are not put today. Under the old county court system, I remember a case which illustrates what happened under the old compensation law. The case went to the Court of Appeal. The doctors admitted that this man could have died from heart 942 trouble walking upstairs. In fact, he was found underground, lying by a tram. Although he was suffering from a heart complaint due to natural causes, that final act of filling a tram was the climax in his condition. Therefore, in the case of that man it was ruled that death was attributable to the injury which he sustained in the course of his employment.
This medical appeal tribunal does not give the benefit of the doubt in these cases. I support my hon. Friend in this matter, and I ask the Joint Parliamentary Secretary to ascertain whether there is some means of increasing the numbers on the medical appeal tribunal or whether it is possible when there is powerful evidence of aggravation for applicants to go to a higher authority where these cases can be dealt with in a better way than they are dealt with now. I impress upon the Joint Parliamentary Secretary that there is growing discontent, particularly in the mining communities, about these decisions.
§ 10.16 p.m.
§ The Joint Parliamentary Secretary to the Ministry of Pensions and National Insurance (Miss Edith Pitt)
The hon. Lady the Member for Lanarkshire, North (Miss Herbison) has mentioned two cases, but I think she will realise that it would not be proper for me to comment on those cases, although she was kind enough to send me a note in advance of the names, because they have already been the subject of decisions by independent authorities and, therefore, it is outside my jurisdiction to comment on them. If I tried to do so, I think you, Mr. Speaker, would rule me out of order.
I will deal with the hon. Lady's main point, which is the general one, reinforced by the hon. Member for Bedwellty (Mr. Finch), that men who appeal to the tribunal against the assessment of disablement, especially pneumoconiosis, sometimes feel that adequate consideration has not been given if they do not have a further physical examination by the members of the tribunal. The other main point which both hon. Members have in mind relates to when the disabling accident or disease is complicated by other issues. I will do my best to answer those two main points.
I sympathise with the point of view of the man who goes before a tribunal and 943 feels that he has not had adequate consideration if the members of the tribunal do not give him a further physical examination. I think it is perfectly natural for a layman to feel that the medical man has not understood his case unless he has made a personal examination.
The functions of the tribunal are perhaps better understood when they are considered in relation to the procedure for dealing with claims for disablement benefit. For certain specific injuries—and those hon. Members who are interested in this debate know this as well as I do, and perhaps even better—for the loss of a leg, arm or eye, standard assessments are laid down in Regulations. For other injuries or prescribed diseases the amount of disablement pension or gratuity depends on the assessment of disablement. Disablement is assessed in the first place by a medical board, and these boards are constituted generally of doctors in active practice—general practitioners. They examine the claimant and they record their findings. They may have a specialist report provided, or they may ask for one. If the claimant has been in hospital, the doctors usually have a report from the hospital. After considering this evidence and their own clinical findings, the board makes its assessment.
Pneumoconiosis, of course, is a special problem, and here special arrangements apply. Because of the difficulty in diagnosing this disease and assessing its effects, medical boards for pneumoconiosis cases are constituted from separate panels of specially qualified doctors. They are the pneumoconiosis medical panels to which the hon. Lady has referred. Most of the members of these panels are engaged full-time on this work. I think it is fair to claim that as a body these panels have a unique experience in the diagnosis of pneumoconiosis which is a particularly difficult disease.
In the same way as the ordinary medical boards, the pneumoconiosis medical board examines the claimant and record their clinical findings in detail, including the results of tests to measure breathlessness. They have X-ray photographs as a matter of routine; they also have access to hospital reports and X-rays.
If the claimant is dissatisfied with the assessment given by a medical board, 944 including the pneumoconiosis medical board, there are rights of appeal to the medical appeal tribunal, the next level. The Minister also may refer cases to the tribunal if there is room for doubt, either on behalf of the Ministry or on behalf of the claimant. I do want to emphasise that the tribunal is the final authority established under the Industrial Injuries Act for the assessment of disablement. The Minister has the right to make submissions to the tribunal and to be represented at a hearing, but the tribunal is quite independent of the Minister and its decisions are binding on him. The Minister, of course, has no right to issue directions to the tribunal about its conduct or procedure.
I am sure that both hon. Members will agree that the tribunal is a body of the highest standing. It consists, as the hon. Lady said, of a chairman who is an experienced lawyer, plus two medical members of consultant status, usually the most eminent men in their professions, nominated by the universities. If she does not know it already, I am sure the hon. Lady will be particularly interested to learn that in Scotland the chairman may be one of five Queen's Counsel nominated by the Lord Advocate, and the consultants are drawn from a panel of consultants recommended by the universities of Edinburgh and Glasgow. There is no need for me, I think, to dwell on the high standard of the medical schools in those two universities.
The function of the tribunal is to weigh the medical evidence before it and to decide whether the medical board's assessment was right. The evidence which was before the medical board is available to the tribunal. In addition, the records of what the members of the medical board themselves found on examination, plus any specialist reports and X-rays, are made available to the tribunal. In pneumoconiosis cases, the tribunal has before it the X-rays and records of detailed medical findings of the medical board or, more usually, of successive medical boards which have examined the claimant, because in these difficult cases a claimant has often gone before a succession of boards. It may have reports from hospitals or chest clinics also.
The claimant himself has the right to appear before a tribunal and to be represented, either legally or by his trade union 945 representative. If he wishes to produce medical evidence or witnesses, again he can do so. If the members of the tribunal themselves feel that the evidence on any point is not satisfactory, they have full power to ask for further examination by a specialist. They do so on occasion, and they adjourn the case until they have this further report.
The hon. Lady mentioned the other illnesses and diseases which sometimes appear to cloud the issue, and she referred in particular to cases where blood pressure had been diagnosed. The hon. Gentleman the Member for Bedwellty also referred to cases where there is some other disease or disability. I should like to say that the Pneumoconiosis Research Unit and other researchers are closely studying the relationship between pneumoconiosis and other diseases. It is for the medical board or tribunal to decide whether pneumoconiosis is making the other condition worse or more disabling. If it is, the board or tribunal takes that into account it discounts only the disablement which the claimant would have had anyway through any cause which is not affected by the pneumoconiosis.
The function of the tribunal is not to provide more specialised examination of the claimant, because the tribunal is not well constituted for that purpose. There is no requirement that the members of a tribunal shall carry out any examination of a claimant, although they may find it helpful on occasions to look for themselves at the injury or disease. The tribunal is essentially a court whose function is to evaluate the medical evidence before it and decide whether the assessment of the medical board was right and in accordance with the general standards of the scheme. The members are eminent in their own profession, as I have emphasised, and they acquire specialised knowledge on methods of assessing disablement.
The hon. Lady referred to instances where they may have to take a majority decision—two out of three members. When we remember, however, that the tribunal is a court, I think she will agree with me that, as theirs has to be the final legal decision, they are bound to reach a decision provided they feel they have obtained all the evidence which will 946 assist them in arriving at a decision. They really are well qualified to judge the evidence and to judge whether the case has been properly assessed.
As I have said already, the evidence will usually contain specialist opinion, either as a specialist report obtained for the medical board or, in the pneumoconiosis case, the record of findings of the pneumoconiosis medical board. The tribunal is well able and fitted to judge whether this evidence is sufficient or whether, and on what points, a further report should be called for.
§ Mr. Finch
With great respect to the Parliamentary Secretary, she has gone over the procedure under the Industrial Injuries Act, but my hon. Friend and I are concerned about the problem of aggravation and acceleration. Medical men differ on this point. I could quote case after case of prominent medical men differing. The hon. Lady has referred to the courts. Yes, under the court system we had a right of further appeal which we have not got under the Act.
§ Miss Pitt
The hon. Gentleman and I had a discussion on this matter last September when he asked to see me on a case which was giving him concern. If my recollection serves me right, he then agreed that this is the final court of appeal and that their decision is binding on the Minister under the Industrial Injuries Act.
It is clear from what I have said that it is completely within the discretion of the tribunal whether to call for further reports or to examine the claimant if they think that would be useful. Evidently in those two cases which the hon. Lady has in mind the tribunal did not think it would be helpful to make further physical examination.
The Act provides that there shall be these independent tribunals and I think we would all agree, having had experience now for nine years of the Industrial Injuries Act, that it is better to leave these decisions to the unfettered judgment of the independent tribunal. The point has been made by both hon. Members that some of their constituents feel that justice is not being done, and that there is a sense of frustration and great dissatisfaction, to use the hon. Lady's own words. 947 I agree it is very important, to use the old maxim, that justice must not only be done, but it must be seen to be done. I am confident, however, that the medical appeal tribunals keep this point constantly in mind. They are the independent statutory authority constituted under the Act. Their decision is binding on the Minister, and I hope that the fact of the hon. Lady having raised this point on the Adjournment tonight will go some way towards satisfying her own constituents that they receive a fair hearing and justice in their respective cases.
§ Miss Herbison
Before the hon. Lady sits down, we know the procedure that has been outlined, and it is because we feel so strongly, and because I am sure that what has been said will not satisfy our people, that I ask the hon. Lady and 948 her right hon. Friend the Minister to give some serious thought to this matter, and not just say that this is the procedure and that there is not much else we can do. I ask her sincerely to do that.
§ Miss Pitt
I will certainly give the hon. Lady an assurance that I will bring this matter to the notice of my right hon. Friend. Indeed, he will be interested to read our debate. It would be wrong for me to attempt to suggest that the procedure is likely to be altered, nor indeed can we raise that matter in the course of an Adjournment debate. I assure both the hon. Lady and her hon. Friend that their points have been noted.
§ Question put and agreed to.
§ Adjourned accordingly at twenty-nine minutes past Ten o'clock.