HC Deb 30 July 1958 vol 592 cc1531-43

12.6 a.m.

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

I do not apologise for keeping the House so late at night, because the subject I am going to raise with the Joint Parliamentary Secretary to the Ministry of Pensions and National Insurance is a very important one and is one which affects at least 2 million men and women in industry who are subjected to the inhalation of irritating dust and may at some time sustain damage to their lungs and bronchial tubes.

I shall raise the matter so that it falls into two parts. In the first place, I wish to raise what I think is a true grievance, namely, that the method in use at present by the pneumoconiosis panels for the diagnosis of the disease of pneumoconiosis has inherent defects. In the second place, I shall refer to the incidence of pneumoconiosis in the locality where my own constituency lies, in North Staffordshire, and among the 20,000 miners who work there.

First, I want to raise a grievance. I think something is going wrong and that our modern knowledge enables us to say what should be done to put right that which has gone wrong. In the second part of my speech, I want advice and the latest information which it is possible to obtain from the Joint Parliamentary Secretary and his colleague, who is very kindly sitting with him to listen to this debate. In North Staffordshire men at work, miners in particular, do think that they are suffering rather more than most miners in other parts of the country.

The Parliamentary Secretary is, of course, fully aware that quite large numbers of people apply each year to the pneumoconiosis panels claiming that they are disabled as a result of pneumoconiosis. Figures were given me on 10th March this year by the Minister in a Written Answer for the year ended 30th June. He said that 13,597 people had been examined by the panels. That examination was by X-ray. Moreover, 6,500-odd, that is about half, were rejected on this X-ray examination alone without being clinically examined.

Those who were accepted as a result of X-ray examination had a clinical examination for purposes of assessment. Of those 6,500 who were rejected, 372, or only about 5 per cent., used their right of appeal. It was only then that this small percentage of those who were rejected by X-ray received a clinical examination by the medical board on pneumoconiosis. Of the 372, it is interesting to note that only 39, or about 10 per cent., were successful on appeal, and it is also interesting to trace what happened throughout the country to make up the figure of 39 successful cases.

There were 43 appeals in Cardiff, and not one was successful; 21 in Swansea, and not one successful; six in the Bristol area, not one successful; 32 in the Manchester area, not one successful; 15 in the Newcastle area, and that too showed no success for a single worker. Six appeal cases were heard in London, and one succeeded; 126 appealed in the Sheffield area, and seven were successful; 123 in Stoke-on-Trent, of which 31 succeeded. So out of 39, 31 came from Stoke-on-Trent.

It is a matter of interest, when one looks at these figures, to find some explanation for the disparity in the different districts. I suggest that it seems impossible for the workers to understand why there should be this apparent disparity. I am not criticising the pneumoconiosis panels or their staffs. My criticism is directed against the Ministry, for they are essentially responsible. The medical men have understood for years that they must use a specific technique for diagnosis. This is imposed on them by and large, and if there is to be any blame attached I am as much to blame personally as anyone, for in 1928, before the first legislation which allowed silicosis to be made an industrial disease for compensation, I was on the committee that divided silicosis into these different categories on an X-ray basis. I plead, in extenuation for my part of the blame, that we know much more about these conditions today than we did then, and that is why I am asking the Ministry to progress as fast and as far as I have done.

I want to suggest that too much emphasis is being placed in all cases and in all areas on pure X-ray examination alone. It is wiser to say that all dust is dangerous. Our lungs and bronchial tubes were never made to bear easily, lightly or gladly with any kind of dust inhalation. Some we manage and cope with very easily. We will never get away from meteoric dust, there is always some household dust, and there is the dust in the streets—sometimes too much.

The kind of dust to which I refer is that inhaled by workers who get much more of it than we who are not so exposed would like to bear. It is quite wrong to assume that the inhalation of noxious dust cannot cause loss of faculty without specific fibrotic changes in the lungs, whether by nodular formations or other forms of fibrosis. The damage done by its inhalation can bring about other types of clinical change. It is essential to remember that the inhalation of dust causes us to cough, and if we cough for years violently and repeatedly we damage the bronchial tubes and our lungs lose their elasticity. Some people tend more than others to get chronic bronchitis, dilation of the bronchial tubes and loss of their lung elasticity, emphysema, or what we call miners' emphysema, with spasms of the bronchial tubes, shortness of breath and attacks of asthma. These are the results of prolonged, violent coughing over the years. Many of these cases spend a long time in a dusty atmosphere, due to their occupation, and yet an X-ray examination shows apparently nothing. Indeed, it is not expected to do so.

There are three reasons why the Joint Parliamentary Secretary to the Ministry of Pensions and National Insurance should accept what I am saying and why the Department should think again about this matter very carefully. First, why should it be that in Lancashire, where workers in the cotton industry sustain byssinosis or cardroom workers' asthma—although the X-ray findings are negative—if they have been in the industry ten years, inhaling these fragments of vegetable matter which causes an allergic type of asthma, the fact is accepted and they are paid industrial benefit, whereas those who inhale coal dust or stone dust and other types of dust in other industries are rejected for benefit although certain classical signs show that they have developed emphysema asthma or bronchiectasis? If it is right to diagnose byssinosis in the cotton industry, although the X-ray examination in these cases is always negative and is not relied upon, why should it not be right in these other scheduled industries?

The second argument is that since 1954 in South Africa compensation has been paid to the workers in the gold-mining industry, though unfortunately only to the white European workers, even though the X-ray findings are negative, if a worker has the signs which I have described, that is to say if on clinical examination he is found to be short of breath due to asthma or bronchitis, or if he has bronchiectasis or emphysema with dilation of the right side of the heart. They have accepted it there since 1954. They have had great experience—they were paying compensation for silicosis before we were—and they have had longer experience than we have had. I put it as evidence that if it is good enough for them to accept it we, too, should do so. It is not difficult on clinical examination to assess pulmonary disability. We can do it, easily, and it is done every day.

The third argument is a rather wider one. I vow that there is not a chest physician or a general physician in the world who would disagree with me when I say that in dusty occupations it is possible in some cases to get loss of faculty, damage or general inability to work and shortening of life without any X-ray findings whatever.

In Stoke-on-Trent, we have a long tradition both in suffering and knowledge of this disease, because it is a great centre of pottery as well as mining. We have had the good fortune from 1931 to have a very experienced worker as head of our pneumoconiosis panel, Dr. Meiklejohn, who holds the Chair for Social Medicine at Glasgow University. He goes so far as to talk in a somewhat derisory fashion about these "mystic nodules" without which a worker cannot get justice. It is true to say that when the fibrotic nodules are very small and there is a good deal of emphysema in the lung, the lung being damaged, the fibrotic nodules keep well hidden and are not seen in an X-ray even though, if the man dies, they can be felt with the fingers. We should be careful not to place too much reliance on X-rays alone.

I have two requests to make on this first part of my speech in which I have raised a grievance. It is that the Joint Parliamentary Secretary should ensure that every applicant who goes before a pneumoconiosis panel should be clinically examined as well as X-rayed. That means doubling the number holding clinical examinations, for at present half the applicants are clinically examined and half are not, except the few who appeal.

I appreciate all the difficulties associated with this. We will have to have more staff, and it is not easy to dilute pneumoconiosis panels, although we have done so in the past, and done it very successfully, by bringing in part-time people and getting the assistance of men who are trained chest physicians to work on a sessional basis to assist the permanent full-time staff. Even if further dilution were required, I believe that this could be done and that it should be done.

The second thing, and it is more important than the first, which is only a piece of machinery, is that it should be accepted by the Ministry, which should issue instructions accordingly, that, irrespective of X-ray findings, every worker who has been employed for ten years or more in any of the scheduled industries or processes should be assessed as we now assess byssinosis. That is a simple request, and there is a precedent for it.

If that were done, the whole picture would change. I know that a tiny fraction of people could have bronchial spasms, emphysema, chronic bronchitis, pulmonary disability generally, without having worked in a dusty occupation. They might have been smoking too many cigarettes or have the misfortune to live in Warrington or Salford where the atmospheric pollution is such that the polluted air which people have to breathe can cause spasms or bronchitis after a cold. There are too many industrial areas of this type. The majority of cases which come forward are where damage has resulted from inhalation of dust. As I am speaking only of the scheduled industries, the Ministry would be completely protected, because those who had suffered damage through atmospheric pollution, would not be able to come forward and claim benefit if they were not also employed in a dusty industry. The extra cost of doing this would not be significant when viewed in the light of the payments made by this great Ministry. But the injustice remedied would be very real.

May I turn briefly to the problem of pneumoconiosis among North Staffordshire miners. I hope that the Parlia- mentary Secretary will be able to give me information more up to date than I have myself. It is important that this should be discussed, for more medical attention has been applied to the problem of the miners of North Staffs than anywhere else in the country. We have more evidence of what is happening there than we have for a group of miners elsewhere in the country, except South Wales.

The men in North Staffs are disturbed. They feel that they are a greater risk than most of the miners in this country. They wonder whether it is because the dust is more dangerous, that there is more dust in their pits than elsewhere, or that their pits, because they are hot and deep, contribute to the fact that so many of them suffer in this way.

We have two sources of information. We have the Digest of Pneumoconiosis Statistics, which I know the Parliamentary Secretary has studied, probably more carefully than I have. But, better than that, we have a magnificent amount of new information, because permission was given two years ago, following an Adjournment debate in which I had the honour to speak, that all miners in North Staffs should be mass X-rayed at pitheads.

Some 15,000 out of 20,000 volunteered to expose themselves to this examination—in other words, over 76 per cent. When I think of the sort of objections that used to be heard in the olden days—that miners did not want this, were afraid of it, would not turn up, or would create industrial trouble if asked—what nonsense it appears now with this example set by North Staffs miners. This was a tremendously good percentage. I only wish that the remainder had undergone the examination, and I will show why when I give some facts and figures.

On 10th March the Minister of Health told me that of the 20,000 miners 15,000 had attended. As a result of that examination, we found 59 cases of active tuberculosis among the men and 200 cases of men who showed signs suggesting progressive massive fibrosis. Progressive massive fibrosis of the lungs is a very serious condition. Even with absolutely minimal pneumoconiosis, the addition of infection, which in most cases, we believe, is tubercular infection, causes rapid and dramatic deterioration dangerous to life. And we believe that some of those cases, perhaps all, are so infected. Certainly they have become infected, and most of them, I think, by their colleagues in whom we found 59 cases of open active tuberculosis. This survey was therefore essential.

On 7th July, the Minister told me that for the year 1956 out of 8,500 who were examined by mass X-ray 399 new cases of pneumoconiosis were found. This, in part, obviously explains why the figures have tended to be high in these last two years. If we were to take the whole of the 15,000 cases, it is fair to assume that about 700 new cases alone were discovered by this technique of mass miniature radiography during the period of two years.

I suggest that certain deductions may reasonably be drawn. First, the 59 cases of active tuberculosis damaged a large number of their fellow workers, and that damage can no longer arise from those 59 cases. They are removed from the industry. The chance of infection in future for other men must be greatly diminished.

There are further reassuring facts which I want to put to the Parliamentary Secretary, and I should like to know whether he agrees with me. In the Digest for 1956, it is shown that although in that year 405 men were judged by the panel to be suffering from pneumoconiosis and were so assessed, only 36 of them were under 40 years of age. That is about 9 per cent. But in Swansea in the same year the figure was 30 per cent., in the Rhondda 26 per cent. and in Aberdare 33 per cent. That is to say that in South Wales there are many more cases of men suffering from pneumoconiosis at a fairly young age as compared with North Staffordshire. I say this to bring comfort to my constituents. I was their medical adviser for 25 years, and they should take comfort from this figure, although I am the last person to deny that it is an unpleasant coalfield in which to work, and I am sure that the Parliamentary Secretary will agree that it is not one of the best from the health point of view.

Another reassuring fact is this. We find that in 255 out of the 405 cases there were assessments of 10 per cent. or less. It is my view that whereas conditions in North Staffordshire are probably as bad as any in the country, except South Wales, from the point of view of health, we should now expect a real fall in the numbers of cases, and the fall should be noted particularly in the dangerous cases of progressive massive fibrosis.

Moreover—and I ask the Parliamentary Secretary to say whether he agrees with me—is it not fair to say that in these low assessments where there is very little pneumononiosis—less than 10 per cent.—if we prevent tuberculosis infection amongst these men, they have a reasonable expectation of life—virtually a normal expectation of life; they should be able to work all their life, and if they had not been told they would not know that there was anything the matter with them?

This problem can be grappled with and is being grappled with. There will never be a moment when we can stop struggling against it, but with the full co-operation of medical science and engineering science we should be able to overcome the worst of it. Indeed, I think that we have now turned the corner.

If the Minister has any figures which can show us what is happening and that a fall in the number of cases is beginning, I shall be very glad if he will give them to us. If he agrees with what I have said, will he bear in mind—and have a word about it with the Paymaster-General, who, of course, represents Fuel and Power—the point which we in North Staffordshire have learned so much from the methods we use, particularly mass X-rays, and urge that men suffering from tubercular disease are in danger of their lives and are a danger to their families and certainly to their comrades? We ask that mass X-ray at the pit-heads should be extended into every area of the country.

This is a very wide problem. Many of us in the House are very deeply interested in it, and I have raised the subject because I believe, whether it be North Staffordshire or anywhere else, that the fortitude and courage of the men concerned will be best supported if they are assured that we shall leave no stone unturned to find a remedy for their grievances.

12.36 a.m.

The Joint Parliamentary Secretary to the Ministry of Pensions and National Insurance (Mr. W. M. F. Vane)

The hon. Member for Stoke-on-Trent, Central (Dr. Stross) has again raised the question of pneumoconiosis in the House, a most important subject, which has justifiably attracted a great deal of public attention recently. It is a good thing that he should have done so, because he is an hon. Member who has probably had more experience on the practical side of dealing with this illness than any other hon. Member.

I have seen X-ray films and lung sections, but I do not want to set myself up as a rival medical school to the hon. Gentleman this evening. I hope he will appreciate that what I have to say can only be a layman's reply to a speech which contained a great deal of technical matter.

The hon. Gentleman divided his speech into two parts. The first part, as he put it, was a criticism of my Department, and I am going to sub-divide that first part again into two parts. The first part I accept as a criticism of my right hon. Friend's administration. The second part is much more a comment on the wording of the Industrial Injuries Act.

The first suggestion made by the hon. Gentleman was that too great importance is laid on the value of radiography in this question of diagnosis. As he said, he was one of the pioneers who, in fact, developed this system in its early stages. My right hon. Friend does not consider that radiography is a short cut to deciding whether a man either has or has not the early stages of the infection. Nor does he consider that the methods now followed are in any way rule of thumb, and he would not like it to be thought that that was so.

My right hon. Friend considers that X-rays are used in the most discerning way, and after the X-ray, as the hon. Gentleman has said, every possible trace of pneumoconiosis shown on the film is followed up by a clinical examination. Where a man's case is rejected he has a right of appeal, and the appeal carries with it a clinical examination. Therefore, no man who may think that he carries the infection on him is denied a clinical examination.

Different doctors than those of the regions concerned examine these films. There is, therefore, no possible chance of the same man carrying out the clinical examination as has examined the film. That, of course, also helps uniformity of practice, but where the human element enters into any method such as this one can never guarantee absolute uniformity, nor, I think, would it be right to aim at absolute uniformity. One wants fairness and justice. Where a man whose claim has been rejected thinks that his case has deteriorated in any way, he has the right to start the whole investigation afresh.

Technical arguments have been produced as to the possible shortcomings of this system. My right hon. Friend is always ready to accept changes and to adopt improvements when he and his advisers think that it is in the public interest to do so, but I dare say now that there is some difference of opinion in this field, even among doctors, and my right hon. Friend is not conscious of any departure from sound medicine in the processes now current.

On the wider question of chest diseases, the hon. Gentleman has suggested that bronchitis and emphysema—which one agrees can be exacerbated by dust—ought, in certain circumstances, to be added to the list of prescribed diseases. That is not a new suggestion. It is a very big question, but it would require legislation. More than that, it would require a fundamental change in the principles underlying the Industrial Injuries Scheme.

As the hon. Gentleman knows, this matter was investigated at great length two or three years ago by the Beney Committee, and the majority decision was that it was not practicable for that to be done. We must remember that under the Industrial Injuries Scheme, the rules are very much more precise than they are under the National Health Service. We have to consider the risk of the occupation, and I will quote these words from the Act: A disease or injury may be prescribed for the purposes of this part of this Act in relation to any insured persons if the Minister is satisfied that:—it ought to be treated, having regard to its causes and incidence and any other relevant considerations as a risk of their occupations and not as risk common to all persons; and it is such that in the absence of any special circumstances the attribution of particular cases to the nature of the employment can be established or presumed with reasonable certainty. That shows the difficulty of the question that the hon. Gentleman has put forward. Bronchitis, in one form or another, is nearly a national complaint in this island, and it is very difficult to tie it to any particular occupation. In addition, there are, of course, separate problems of diagnosis—separate, again, from pneumoconiosis, which, in the main, we are considering.

The hon. Gentleman mentioned byssinosis, the rules governing diagnosis of it, and its presence as a reason for pension. Some form of bronchitis is found among workers in the cotton industry which, I am told, can be more precisely diagnosed. He mentioned South Africa, where a similar rule is now current. I hope that he will agree that the conditions in South Africa are so different from those in this country that they do not offer a fair basis of comparison.

The climate is different. There is not this universal bronchitis, I understand, that we have in almost every county in this country. In addition, I believe it is true that workers inspection takes place on entry into the industry, and a medical history is kept which is much more like a man's army medical history. That is quite different from what we have here. I would not, therefore, like to accept the fact that the conditions in South Africa should be taken as too closely comparable to our own. Nevertheless—

Dr. Stross

With respect, all new entrants to the coal mining industry now are carefully examined and X-rayed. I am thinking of from now onwards and saying that we should make a change. The only differences left, therefore, are differences of climate and the greater atmospheric pollution here, which is due, incidentally, to industry, than in South Africa. Does not the hon. Gentleman agree that his case is made a little weak in this context?

Mr. Vane

No, I do not consider that my case is a little weak. It is true that conditions are changing in that particular case, and that, after a number of years a larger proportion of men in the industry will have been examined on entry, so that the situation will be different in that respect. But I do not consider that my case is at all weak at the present moment.

The hon. Gentleman quoted statistics for 1956 and pointed to North Staffordshire saying that the first diagnoses of cases were large in number when compared with the figure for the rest of England. He asked whether I could read anything into those figures. In general, I think it is fair to say that it would be a mistake to try to read too much into these statistics when one has only the figures for one year, because circumstances differ between coalfields. There is also the important factor of awareness of the disease in the different districts and the fact that willingness to undergo X-ray and so forth varies from district to district. I do not believe that professional statisticians would be very happy to try to deduce too definite conclusions from those figures.

At the same time, I am sure that we can be very satisfied that, in North Staffordshire or in any other district, one will find that the great majority of cases first diagnosed should be only slight. That is surely a step towards eradicating the disease; it means that men are coming forward in the early stages. It can be discovered when the infection is slight, and I understand that, if that be so, it is possible for them, with due care, to lead what is often a normal life hardly distinguishable from that of other men who may be entirely free from it.

It is satisfactory to note also that in a number of districts the higher assessments are very small and that even many of the older men have, in fact, a low assessment after many years in the industry. Where the real danger lies is in the imprecise field where tuberculosis infection also is present. That is the danger point. It can be detected by X-ray. This matter is largely beyond the full responsibility of any one Department. I recall the Adjournment debate the hon. Gentleman mentioned, because on that evening I happened to be the Parliamentary Private Secretary of the Parliamentary Secretary to the Ministry of Health who replied, so that there is continuity in a sense. I assure the hon. Gentleman that some progress is being made, and I agree that this is a combined operation. It is not something which one Department can do on its own, nor is it something which, in the industry, either employees or employers can do on their own. Everyone must co-operate.

The deduction surely is that, with modern techniques, there is really no need to let the disease lie undetected for years until, perhaps, heavy infection has taken place. On the contrary, it is our duty to do all that we can to ensure that infection by pneumoconiosis, particularly accompanied by tuberculosis, is not allowed to infect others.

As a layman, I would think that one could reasonably suppose that the future will show a much more effective control than we have experienced in our lifetime. If we can achieve that effective control, we shall remove a haunting fear from many mining districts.

As for the effort that is being made generally, there is a great deal of research being carried on, mainly through the Pneumoconiosis Research Unit, which works under the Medical Research Council. There is other research by the universities and by the National Coal Board. My Department is in close touch, and there is a constant interchange of information and experience. In the wider field of chest diseases generally, the research is beyond my Department's responsibility, but I think everyone in the country has become more conscious of the loss of faculty and waste of effort among the population resulting from these chest infections.

The work now going on is not only on the fundamentality but also on causation. In the course of time, we may come a little nearer to some of the steps which the hon. Gentleman has said it ought to be practicable to take. In all this field, so far as it is the Minister's responsibility, it is his intention not only to help present sufferers but to assist in the control of the disease today and to add to the health and happiness of future generations.

Question put and agreed to.

Bill accordingly read a Second time, and committed to a Committee of the whole House.

Committee this day.