HC Deb 03 February 1961 vol 633 cc1393-420

2.37 p.m.

Mr. Leslie Spriggs (St. Helens)

I beg to move, That this House, whilst recognising the advantages gained from basing the diagnosis of pneumoconiosis on X-ray findings, accepts that loss of faculty can ensue from the inhalation of noxious dusts without appreciable radiological changes, and that pulmonary disability as shown in asthma, bronchial spasms, and emphysema results from occupational hazards in coal mining, pottery, and other occupations, and urges the Minister of Pensions and National Insurance to institute an examination of the procedure for the diagnosis of pneumoconiosis, and to accept that in all such occupations pulmonary disability without radiological signs should be accepted as an industrial disease after 10 years of work in the occupation. I have the honour to move this Motion, following my good fortune in the Ballot for the second time in a short period. I chose to raise this very serious problem concerning the procedure for the diagnosis of pneumoconiosis because of the serious social and economic problems which these diseases cause amongst industrial workers and their families.

I do not wish to give the impression that I am a medical expert. I am not. I intend to leave the technical and professional side of this matter to the doctors in the House. I believe that neither side of the House has a monopoly of sympathy for the people in those industries with which I am concerned this afternoon. I understand that doctors, technicians, engineers and the Ministry of Pensions and National Insurance have been grappling with this problem for many years, and I congratulate them.

While studying some of the relevant reports in the Library last night, I found a report of a committee which was set up in 1923. The chairman of that committee was Mr. G. Locker-Lampson, M.P. Then there is the report from the International Conference on Silicosis held at Johannesburg in August, 1930.

I now come to the basis of the problem which has been studied at great length by Dr. Ronald Howells, who went to a great deal of trouble to get details from pneumoconiosis medical panels in various parts of the country. To give some idea of how Dr. Howells carried out his terms of reference, I would point out that he interviewed pneumoconiosis medical panels in Cardiff on 30th January, 1958; in London, at the Ministry of Pensions meeting, on 13th February, 1958; the Stoke P.M.P. on 19th March, 1958; Newcastle P.M.P. on 14th April, 1958; Glasgow, including both the panels of Glasgow and Edinburgh, on 16th April, 1958; Manchester and Sheffield panels, at Manchester, on 22nd May, 1958; and Bristol pneumoconiosis medical panel on 18th June, 1958.

It would be as well if I referred to some of the discussions which took place between Dr. Howells and Dr. Egan, of the Newcastle Pneumoconiosis Medical Panel, at Newcastle, and then dealt with Dr. Egan's reply to questions which were raised for the purpose of obtaining expert information for the National Union of Mineworkers. I quote: Dr. Egan described the routine of the panel including clinical examination, length of occupation, work record, X-ray examination and the James Box Test, etc. He admitted that X-rays are not standardised because many are taken in different places where conditions are not entirely satisfactory. He admitted that some in categories 1 and 2 may be missed. In his panel category 1 pneumoconiosis is not accepted so Mr. Dale's contention contained in Mr. Horner's letter is therefore correct that some cases of early pneumoconiosis are not awarded an assessment. Dr. Howells then says: I read this letter out to Dr. Egan and he explained that the rejection was on the grounds that the pneumoconiosis was so slight that no clinical disability was caused. The earliest category that is accepted is category 2. When questioned about this he admitted that X-rays taken at different places may appear to be category I in one place and category 2 in another so it seems to me that a premium is placed upon the X-ray findings in this panel. I now proceed to the next point in reference to emphysema. The same doctor, in reply to some questions, said: The panel uses its discretion in individual cases, and when asked how the discretion worked he was rather evasive and I could not tie him down to anything definite. However, he did say in the case of simple pneumoconiosis category 2, 20 per cent. was often awarded out of a total disability of 80 per cent.; whereas in P.M.F. the full disability was awarded. He claimed that bronchitis and generalised emphysema are not caused by exposure to dust, but admitted that working underground does the bronchitis no good and had an aggravating effect upon chronic bronchitis and therefore on the disability. When asked specifically he agreed that he would accept aggravation by dust on existing bronchitis and emphysema. In this area simple pneumoconiosis is the most common but on the other hand P.M.F. is still occurring and is by no means an extinct disease. I will now deal with the next part of Dr. Howell's report. I may appear to be rather lengthy, but I think that, from the point of view of the House, this part of Dr. Howell's report is very important to those working in these industries from which we get these terrible diseases. The Minister will know well Dr. Watkins-Pitchford, to whom I am now referring, at the Ministry of Pensions and National Insurance. He said that he was prepared to agree that general emphysema and bronchitis should be included as industrial diseases provided they were listed separately and considered separately from pneumoconiosis. At London, when discussing the same subject, he referred to the difficulties of awarding an assessment to a particular miner because bronchitis and emphysema are quite common amongst the general population and it would be difficult to say that in a particular case of one miner the emphysema and bronchitis were due to occupation causes and not due to constitutional causes. Dr. McVittie, of London, said that he agreed that general emphysema and bronchitis are very common in miners and that they are twice as common amongst older miners compared with similar people in the rest of the population. In his view, mining perpetuates bronchitis and general emphysema although it does not actually cause them. Various factors responsible for this were mentioned—for example, lack of fresh air, high temperature, infection from other workers, overcrowding, etc. He seemed to agree that a case could be made out for making bronchitis and emphysema occupational diseases provided they are not called pneumoconiosis, and in this respect he was in accord with Dr. Watkins-Pitchford. Dr. Macnair, of Swansea, also agreed that conditions underground are not good for constitutional emphysema and bronchitis, owing to factors already mentioned by Dr. McVittie. He made the very significant statement that the presence of generalised emphysema will have an adverse effect upon pulmonary function and will worsen the pneumoconiosis. I promise my hon. Friends and hon. Members opposite, and the Minister who is to reply, that I shall not go any further, except to say this. I wish to restate that there is no contentious matter here. I believe that on both sides of the House we feel in the same way about this problem. I think that doctors and the trade union representatives can make a case in support of what I have said, and I beg the Minister to say how much of the Motion he is prepared to accept and how he is prepared to help us.

2.50 p.m.

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

I beg to second the Motion.

I congratulate my hon. Friend the Member for St. Helens (Mr. Spriggs) on both his good fortune and the modest and self-sacrificing way in which he has put the Motion before us. I shall try to follow him and, although this is a subject on which I could speak for some hours, I shall carefully try to limit myself to ten minutes in order that others of my hon. Friends and hon. Gentlemen opposite may have time to speak and the Parliamentary Secretary will have an opportunity to give a full reply so that we have a reasonably good debate.

The Motion is as modest as the modest way in which my hon. Friend spoke to it. It falls into two parts. In the first part a statement is made and in the second part there is a request for action. The statement or claim made in the first part has long been admitted by the present Minister himself. On 18th November, 1957, I asked the Minister: … whether it is now accepted that prolonged inhalation of noxious dusts can cause injury to lungs and bronchial tubes without any changes shown on X-ray; and whether he will instruct the pneumoconiosis panels to examine every worker clinically as well as radiologically when a claim is made. The Minister gave away the case stated in the first part of the Motion today. He was very frank about it. In his Answer to me, he said: As a general proposition, I have no reason to disagree with the first part of the hon. Member's Question."—[OFFICIAL REPORT, 18th November, 1957; Vol. 578, c. 10.11.] Therefore, I say that our statement of fact, as it were, in the first part of the Motion was accepted three or four years ago by the right hon. Gentleman himself.

Our request in the second part of the Motion is based on what is happening in the country today. The Parliamentary Secretary will be interested to hear the figures given by the Minister on the same day in answer to another Question which I asked. I wanted to know how many people were examined, how many people came forward to claim, how many were examined by X-ray, as they all are in the first place, and how many were rejected on X-ray examination without being seen physically or clinically examined. Further, I wanted to know how many of those rejected appealed and, of those who did appeal, how many were successful.

The figures are astonishing. I shall not give the exact figures, though I have them here. It is staggering to see what happens. In the year ending at June, 1957, 13,500 people put forward a claim in England and Wales. Roughly half of them, 6,500, were rejected on X-ray examination alone, with no other examination. Of the half rejected, only a tiny proportion appealed, that is to say, 5 per cent., and of those who did appeal only 10 per cent. were successful. This means that, in the end, out of the 6,500 who were rejected as a result of X-ray examination, only 39 got through the mesh, and of those over 20 were from Stoke-on-Trent. When I looked into the matter very carefully and when I put further questions, I found that there were areas where pneumoconiosis panels had not in that year allowed a single case on appeal.

I do not blame the doctors. I blame the Minister. The Parliamentary Secretary and the Minister must accept responsibility for pinning the whole of their faith on X-ray diagnosis alone. The Ministry cannot have it both ways. To say three or four years ago that they do not quarrel with what I said and they accept it as true, and then to refuse to do anything to give justice is really no good at all.

In the second part of the Motion where we ask for action, we use different words. We use the expression "pulmonary disability". We do this because, as my hon. Friend in adducing evidence from learned doctors in many parts of the country pointed out, the time has gone to talk about silicosis, pneumoconiosis, siderosis, asbestosis, byssinosis and anthra- cosis. Pulmonary disability is what matters—loss of faculty because a man cannot get oxygen to his tissues because the lungs are damaged.

Every time men cough as a result of breathing noxious dusts they are damaging their bronchial tubes and their lungs. The cough was given to us in the first place as a possible means of protecting ourselves, but prolonged constant coughing over many years damages more than the bronchial tubes. We do not need doctors to tell us this. It destroys the elasticity of the lungs and ultimately prevents the interchange of oxygen and carbon dioxide in the tissues. This is why men cannot breathe and why they cannot work. We are today demanding justice for these men because, in so many cases, the X-ray findings are minimal or even absent, although the grossest emphysema, bronchial spasm and bronchitis are present. In putting in the ten-year limitation to protect the Ministry, we are, I think, going as far as we ought to go. Some of my hon. Friends in the mining industry may well consider that we have gone further than we should. We put it down because that period is used in this way in respect of byssinosis. In the cotton industry, when a person inhales cotton dust and develops bronchitis and asthma, with loss of faculty, X-ray findings are not much use. It is on clinical diagnosis alone that he is given industrial payment to which he is entitled. A few years ago, the period was twenty years. We complained bitterly at the time and suggested that it should be ten, and now it is ten years.

Men enter industry in first-class health. No one is allowed to go into mining, for example, if he is not first very carefully examined and X-rayed. Surely, if after ten years he has pulmonary disability, leading to loss of faculty, he is entitled to have compensation for it. That is what we ask.

I do not ask the Parliamentary Secretary to accept every word of the Motion. We shall not force the matter to a Division today, but we feel very deeply about the matter on this side of the House and I am sure that we shall hear that his hon. Friends behind him feel much the same. I am sure, too, that the Department, if asked, will support our argument. We are merely asking the Parliamentary Secretary to promise that, without further delay, there will be reconsideration of the principle, that we shall not have so many of the best medical brains arguing whether a man should have 5s. more or 5s. less, and that if there is a suspicion that pulmonary disability has an industrial origin then compensation will be paid for it.

2.59 p.m.

Mr. Harold Finch (Bedwellty)

I join with my hon. Friend the Member for Stoke-on-Trent, Central (Dr. Stross) in congratulating my hon. Friend the Member for St. Helens (Mr. Spriggs) on the able and sincere manner in which he has put forward his case concerning the problem of pneumoconiosis. I think that I voice the opinion of the House when I say that we are indebted to him for asking the House seriously to consider the diagnosis of pneumoconiosis. It is an important matter and one which is not free from difficulty.

I know of no industrial disease which has been responsible for so many cases of disablement and death in industry as pneumoconiosis. Over the last ten years thousands of men, particularly in the South Wales coalfields, have been certified as suffering from this disease. Hundreds have died from it. There is an average of approximately 3,000 cases a year in the coal mining industry. That is a very serious position. Although many strenuous efforts have been made in the mining industry to combat the disease, the figures are still alarming.

I know that there has been a great deal of research into this problem, and I cannot speak too highly of the pneumoconiosis medical unit at Llandough Hospital, Cardiff. The staff at that hospital do a great deal in relieving the distress of men suffering acutely from this disease. Many medical men and scientists have made valuable contributions to dealing with this problem. Professor Gough at Cardiff, an international expert in this matter, has rendered great service in trying to grapple with it.

There is, however, one factor above all others to which my hon. Friends have not referred. Quite a high proportion of men in the mining industry are suffering from bronchitis and emphysema. When men come before the medical boards— and I ask the Parliamentary Secretary to take particular note of this point—who say that they are suffering from bronchitis or emphysema as well as pneumoconiosis, it is impossible properly to apportion the extent of the disablement resulting from pneumoconiosis. Take, for example, a man who is supposed to be suffering from general emphysema. He comes before the medical board which is of the opinion that he has general emphysema as well as pneumoconiosis. It is the board's function to try to apportion the amount of disability due only to pneumoconiosis. That is a matter of pure guesswork. I defy anyone, however able he may be, to say what is the extent of disablement from pneumoconiosis of a man suffering from general emphysema or bronchitis and pneumoconiosis. It is entirely a matter of guesswork.

This gives rise to dissatisfaction among miners. Men who are in serious distress are unfit for hardly any work. They go before the board and are given an assessment in respect of pneumoconiosis of 10, 15 or perhaps 20 per cent. In the case of a man who, the board says, is suffering entirely from pneumoconiosis his assessment, rightly, is 30, 40 or 50 per cent. Here are two men who may have been working in the same district underground. One is more seriously disabled than the other, it is said, through emphysema and bronchitis, yet the allocation in respect of pneumoconiosis is purely arbitrary.

I therefore say to the Parliamentary Secretary that when men who are suffering from bronchitis and emphysema as well as pneumoconiosis come before the medical board, they should be classed as suffering from pneumoconiosis and should be assessed on the extent of their disability. I draw the Parliamentary Secretary's attention to the fact that it is already the practice that, when a man is suffering from tuberculosis and pneumoconiosis, it is described as tuberculosis associated with pneumoconiosis. The same practice could be adopted for a man who has bronchitis accompanied by pneumoconiosis, or emphysema accompanied by pneumoconiosis, and he should be assessed on that basis.

As my hon. Friend the Member for Stoke-on-Trent, Central has pointed out, men contract bronchitis and emphysema without showing radiological signs of pneumoconiosis. There are no signs of it by radiological examination. We have raised this matter before and the Trades Union Congress has made representations on it to the Ministry. Having regard to the evidence at our disposal, we contend that men suffering from bronchitis and emphysema in industry should be classified as such. While we appreciate that there are diseases like emphysema and bronchitis which can be contracted other than in industry, nevertheless there is evidence in many of these cases that the men suffering from them should be classified in that way.

Dr. Stross

I wonder whether my hon. Friend remembers that for at least a generation doctors have been talking about miners' emphysema in the mining districts.

Mr. Finch

I appreciate that. Over a period of years, as my hon. Friend has rightly pointed out, they have declared that men suffer from a form of emphysema as a result of working in the industry.

Other diseases like, for example, cancer of the bladder, dermatitis, and tuberculosis are not confined to one occupation. It is admitted that tuberculosis can be contracted outside industry. The Ministry has provided by regulation that when a person suffers from tuberculosis as a result of working in industry, he is classified accordingly. We are asking for entirely the same treatment for those suffering from pneumoconiosis.

My hon. Friend the Member for St. Helens has referred to medical boards and to the medical profession. In many cases, a man who is suffering from the early stages of pneumoconiosis is classified as suffering from what the boards describe as simple pneumoconiosis. This is a very unfortunate term. The men are divided into three categories. A man may be examined by a medical board and placed in Category 1. He may have some pneumoconiosis and, perhaps, his disability is not regarded as serious, but he is told that he does not have pneumoconiosis. One does not know the extent of his disability. Instead of telling the man that he has slight pneumoconiosis, the board tells him that he has none, although there is evidence that some of these men in fact have it. Another man may be placed in Category 2 and told that he has pneumoconiosis. As a result of these variations, many men come away from the board believing that they do not have pneumoconiosis.

This cannot be regarded as a satisfactory arrangement. It should not be for the Ministry to apply the law of averages or to deal with generalities. Each man should be examined on his merits. Our contention is that every man who is placed in Category I should be automatically examined and if he shows any loss of faculty in his lung processes, should be awarded disablement benefit.

There may not be many men in this category, but the National Union of Mineworkers has made representations on this important matter on a number of occasions. Furthermore, Dr. Meiklejohn, the union's medical adviser, has pointed out that a man with Category 1 classical silicosis—silicosis is more severe than pneumoconiosis—is in a different position to a Category 1 general pneumoconiosis man.

I should like the Parliamentary Secretary to inform us what progress has been made in this matter. When the position was taken up with the Minister, the T.U.C. and the National Union of Mineworkers were promised an investigation. I hope that the Parliamentary Secretary will be able today to tell us how it is proceeding. My hon. Friend the Member for St. Helens has referred to the Report of Dr. Howells, which has been placed before the Ministry. Here again, we should like to know the intentions of the Ministry. I repeat that the Minister, in his reply to the Trades Union Congress on this point, did promise to have a special inquiry on this matter

In conclusion I want to repeat that this is a big problem in industry generally and that it causes such discontent that a large-scale research effort is the only way in which we feel we can be sure that reliable evidence will be produced in the foreseeable future. We beg the Joint Parliamentary Secretary first of all to tell us what progress he is making in studying the background of the matter, and also that he will consider what my hon. Friend the Member for Stoke-on-Trent, Central and my hon. Friend the Member for St. Helens have said. We hope we shall get from him some information that he is prepared to embark upon the inquiry with the Trades Union Congress and the National Union of Mineworkers. Let us really get down to tackling this problem. We have raised it time and time again in this House. Hundreds of men are suffering from emphysema and bronchitis and we are convinced that those sicknesses are due to their employment in industry. We hope to get some definite reply today from the Parliamentary Secretary.

Dr. Alan Glyn (Clapham)

Will the hon. Gentleman clear up a point before he concludes? He has said that the highest incidence of emphysema is in mining. I agree, but is it not equally the case with bronchitis, and would he agree that the incidence of both bronchitis and emphysema is higher in mining areas than anywhere else?

Mr. Finch

I certainly agree. I did mention bronchitis. If I did not make it quite clear let me do so now. Let there be no doubt that in the mining industry there is a high incidence of bronchitis from which many men are suffering. As my hon. Friend the Member for Stoke-on-Trent, Central has pointed out, continual coughing, the continual coughing up of dust, is bound to affect the lungs.

I would also mention this question of aggravation under the Industrial Injuries Act. A man's employment may aggravate a pre-existing natural cause. There is aggravation. A man may have a weakness in the chest, and that may be aggravated by the conditions of his employment. To what extent do the Ministry take into consideration acceleration and aggravation by his work in industry of a man's condition of health?

3.12 p.m.

The Joint Parliamentary Secretary to the Ministry of Pensions and National Insurance (Mr. Bernard Braine)

All of us are very grateful indeed to the hon. Member for St. Helens (Mr. Spriggs) for raising this matter today and for raising it in the way he did. This is a difficult subject, as, I think, will have been gathered from the speeches we have already heard, but, of course, it is one of very great importance to our industrial community.

If I may give an immediate answer to the hon. Gentleman the Member for Bedwellty (Mr. Finch), who has such great knowledge and experience of these matters, I will bring to the attention of my right hon. Friend the specific points he has raised.

It may be helpful if at this stage I make a few general remarks by way of background. The National Insurance (Industrial Injuries) Acts, as hon. Members know, not only provide benefits for insured persons who have had the misfortune to suffer personal injury from an accident arising out of their employment but also for those who suffer from certain prescribed diseases due to the nature of their employment. These prescribed diseases range over a fairly wide field. They include various forms of poisoning, inflammation and ulceration due to the use and handling of, or exposure to, the fumes, dust or vapour of various industrial raw materials, decompression sickness, anthrax, certain forms of carcinoma, tuberculosis, byssinosis and, of course, pneumoconiosis—the group of dust diseases which we are discussing now, and which attack the lungs.

On prescription of a disease the Industrial Injuries Act, 1946, is quite explicit and clear. Section 55 (2) empowers my right hon. Friend to prescribe a disease in relation to insured persons if he is satisfied on two counts. The first is 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 a risk common to all persons". The second is that it is such that, in the absence of special circumstances, the attribution of particular cases to the nature of the employment can be established or presumed with reasonable certainty. The Act is also explicit on another point. Pneumoconiosis is unique among prescribed diseases in alone being statutorily defined. Section 57 (3) describes it as fibrosis of the lungs due to silica dust, asbestos dust or other dust, and includes the condition of the lungs known as dust-reticulation. There is a long history behind this definition which goes back to the days of the old workmen's compensation scheme and which the right hon. Member for Llanelly (Mr. J. Griffiths) knows better than most of us.

Why was it necessary for this particular group of diseases to be statutorily defined in this way? It seems that the reason was that in the past there had been considerable argument about what conditions should be covered by the term "pneumoconiosis." Even today difficulties are encountered in diagnosing the disease, at least during life, with any degree of certainty.

This is why specialists on the subject base their diagnosis not on one but upon three foundations—radiological examination, industrial history, and clinical examination. The radiograph reveals the presence of abnormalities in the lung. The industrial history suggests the degree of exposure at work to forms of dust which are known to be or are suspected to be dangerous. Clinical examination enables the diagnosis to be completed by excluding or taking into account physical conditions other than pneumoconiosis.

Hon. Members will accept readily that these are matters on which a layman should be guarded in expressing an opinion. It is appropriate at this point to remind the House that there exists a clear line of demarcation between the responsibilities of my right hon. Friend the Minister of Pensions and National Insurance in administering the Industrial Injuries Scheme and questions of medical judgment, such as the diagnosis of an industrial injury or disease and the assessment of its disabling effect, which by Statute must be left to the medical authorities over whom my right hon. Friend has no control.

Perhaps I could now deal with the procedure that takes place when a diagnosis has to be made in connection with a claim for pneurnoconiosis benefit. The insurance officer; the independent statutory authority who has to decide claims in the first instance, refers the claimant for examination and report to one or more medical practitioners who must be members of the pneumoconiosis medical panel. These specialists are empowered to order a radiological examination of the man's lungs. On receipt of their report the insurance officer may himself determine the diagnosis or refer it for decision to the medical board.

If the insurance officer determines the claim, the claimant has a right of appeal to the pneumoconiosis medical board which, if exercised, ensures that he is given a clinical examination. Although it is not necessary for me to do so for those who are knowledgeable on the subject, I might say for the record that these authorities have an unrivalled wealth of experience and specialist knowledge. They include some of the most eminent specialists on pneumoconiosis who are constantly in closest touch with the latest developments in research and techniques.

Dr. Stross

The seriousness of our charge or request today, however, is concerned with the fact that of those rejected in the first place, namely 50 per cent., by X-ray examination alone and without clinical examination, only 5 per cent. ultimately appeal, because they are disheartened, and it is only they who get this wealth of clinical experience turned on them.

Mr. Braine

I must be careful in what I say, but I am advised that it is very rare indeed for X-ray examination not to reveal pneumoconiosis.

To return to the pneumoconiosis specialists, may I say that I saw some of them at work when I went to the Birmingham area recently. I was enormously impressed by their intense enthusiasm and devotion to their task. Now, if I hesitate to enter into argument and debate upon questions which obviously must be left to medical judgment, I note that the Motion throws all caution to the winds in that respect. It proposes radical changes which strike at the heart of the Industrial Injuries Scheme. It attacks the present method of diagnosing pneumoconiosis, and it seeks to bring within the scope of the Industrial Injuries Act certain more general chest complaints, such as asthma and emphysema which are common among the population at large.

Mr. Finch

When a man goes before a medical board and it is convinced that he has some pneumoconiosis but he is also suffering from emphysema and bronchitis, how is it possible for the board to determine the extent of the damage to the lung in respect of pneumoconiosis only and give a fair assessment? That was my point.

Mr. Braine

I am subject to correction, but I am fairly certain that if a man has pneumoconiosis and emphysema, which is often a complication of chronic bronchitis—we are bandying these terms across the House, but not every hon. Member may know what they mean—or one of the other respiratory diseases, the effect of the latter condition on the pneumoconiosis is incorporated in the assessment because the combination of the two conditions must disable a man more than would appear from the arithmetical addition of the two disabilities—that is to say, more than, from pneumoconiosis alone.

Now the fact is that what the Motion is asking us to do is to bring within the scope of the Industrial Injuries Act certain more general chest complaints, such as emphysema and asthma. I am advised that any action in regard to emphysema would clearly bring in the associated question of bronchitis, and yet these complaints are known to be common among the population at large. Quite frankly, there is as yet no evidence of industrial causation strong enough to form the basis for prescription. For example, even within the mining industry itself it is known that there are large variations between one geographical area and another. It is also known that in areas where there is a high incidence of bronchitis among miners, miners' wives have a high incidence of it too. It would seem to suggest—I would not be dogmatic about it—that there are factors other than the occupational one causing this disease.

Mr. James Griffiths (Llanelly)

I do not know how much time will be left for other hon. Members to speak before four o'clock, but perhaps I might just say that I asked the Minister earlier in the week if he could give me the figures for the comparable incidence of bronchitis among miners and others and he said that the Ministry had not got them yet. Therefore, the figures the hon. Gentleman is using are guesswork.

Mr. Braine

I am not using any figures at all. I am being careful about what I say. The right hon. Gentleman is anticipating me, because I want to say something a little later on about the necessity for research and inquiry into the matter.

Dr. Alan Glyn (Clapham)

Will my hon. Friend say whether there is or is not higher incidence of emphysema and bronchitis in mining areas as distinct from any other areas?

Mr. Braine

Speaking from memory I would say that in most mining areas the answer would undoubtedly be "Yes". But I do not think one can take that by itself and jump to the conclusion that this is anything necessarily to do with the occupation of mining as such, because, as I have already indicated, there are known to be variations geographically and variations affecting both men and women—the men engaged in the industry and the women who are not.

We have to be very careful about this. True, there is nothing new in the proposals put to us today. There have been previous attempts to change the statutory definition, or to remove it altogether, or to include conditions which do not arise directly from the hazards of employment in industry and elsewhere. Indeed, hon. Members may recall that in 1950 Dr. Edith Summerskill, who was then Minister of National Insurance, referred to the Industrial Injuries Advisory Council for consideration and advice the question of the method of prescribing pneumoconiosis.

The Council, which includes not only eminent medical specialists but also trade union leaders, presented a report in July, 1953, recommending no change in the definition. It said In a field where there is scope for wide differences of opinion we think that there are substantial advantages in having some statutory indication of the interpretation to be adopted. The Council went further. After noting that the evidence it had received indicated that the definition was satisfactory in practice, it observed that, within its terms, the doctors on pneumoconiosis medical panels were free to make their findings in the light of current medical knowledge, and it appeared that their practice accorded with the general consensus of informed medical opinion in this country about pneumoconiosis.

In arriving at this conclusion the Council had considered what we have just been discussing—whether the definition should be widened to bring under the heading of pneumoconiosis other respiratory conditions, such as bronchitis, which might be due to or aggravated by dust but which also occurred commonly from various other causes unconnected with occupational conditions.

Dr. Stross

Could the hon. Gentleman say whether the Council knew at the time that already in South Africa, in the gold mining industry, the very thing that we are asking for was common practice?

Mr. Braine

These expert committees, of course, have access to all available information from all sources. I cannot answer the hon. Member's question offhand. I think it is extremely unlikely that the Council, or later, the expert committee—the Beney Committee—which sat on this subject, were not in possession of all relevant information, such as that mentioned by the hon. Gentleman.

What we are asked to do in this Motion is to include some of those diseases which are undoubtedly prevalent among coal miners but which are also widespread among the population as a whole. The Industrial Injuries Advisory Council was quite emphatic about this. It expressed the view that it would be wrong to cover such conditions under the industrial diseases provisions of the Act unless they could be found to satisfy the tests in Section 55 (2) of the Act and added that it would be contrary to the intention and the spirit of the Act if these other diseases were brought in, as it were, through the back door under the guise of pneumoconiosis. According to the advice I have been given, although an enormous amount of interesting and rewarding work has been done on pneumoconiosis since that Report was published, nothing has emerged to alter the firm views it then expressed.

The other suggestion is that the present rules governing the prescription of industrial diseases are too restrictive. This is not a new suggestion. It has been examined before. It was carefully examined by the Committee appointed to review the provisions of the Act in 1953—commonly known as the Beney Committee, after its Chairman, a distinguished lawyer.

In its Report, published in 1955, that Committee said: We find no evidence that the statutory conditions which must be satisfied before a disease can be prescribed have proved unnecessarily restrictive; nor do we recommend any change in those conditions. The Committee devoted a great deal of attention to the question of bronchitis but found it impracticable to bring it within the terms of Section 55 (2).

It is important that we should keep these matters in perspective. Of course we should not close our minds to the possibility of extending the cover of the Industrial Injuries Scheme where that is justified by the facts. But this afternoon we have first to decide what it is practicable to do now. Secondly, we have to decide what it is right to do, having regard to the fact that we are here dealing with an industrial injuries scheme. Thirdly, we have to be sure about the facts. Let me take each requirement in turn.

What is it practicable to do? Judgment here must be based on medical opinion. Although I would hesitate to say this myself, the Beney Committee rightly warned: … a layman's assumptions upon these medical matters are not a reliable guide. But I can say that if the connection between a man's disease and the conditions of his employment is to be blurred which is what I think in our present state of knowledge would be the case if we accepted the suggestion made in the Motion, then outdoor work might be held by a claimant to have caused his arthritis, indoor work, involving mental strain and stress, might be held to have caused a peptic ulcer or even neurosis, and heavy manual work might be held to have led to a variety of degenerative changes amounting to premature ageing.

Mr. Finch

The hon. Gentleman's right hon. Friend promised that he would institute an inquiry into the general incidence of lung disease in industry. What information has the hon. Gentleman on that?

Mr. Braine

The hon. Member for Bedwellty (Mr. Finch) will recall that on Monday of this week my right hon. Friend announced a statistical inquiry with a scope much wider than that which the Motion envisages but with substantially the object which the hon. Member has in mind.

I want to get back to what the Beney Committee, an expert committee, said about the present lack of knowledge on this subject. At paragraph 36 it held that it would be futile to expect individual doctors to provide satisfactory answers to questions which the medical profession as a whole could not answer. But if decisions on individual claims turned on questions such as these, doctors might feel constrained to try and answer them even though the answer was in fact beyond medical knowledge and based on speculation. This could lead to a progressive debasing of the currency of medical certification which the medical profession itself would be the first to deplore and which would have effects far beyond the Industrial Injuries scheme. In this field, as in others, a counterpart of Gresham's law might be found to operate—'bad' certificates tending to drive out 'good.' In the circumstances envisaged, decisions would depend to an undue extent upon chance and upon the skill with which the claimant's case was presented. That, we can be sure, would certainly lead to great dissatisfaction and, indeed, unhappiness among the population.

As to what it is right to do, we must not forget that here we are concerned with a social insurance scheme specifically designed to provide cover for an industrial disease or injury. This is a scheme which provides higher rates of benefit for accidents or diseases which arise specifically out of and in the course of employment. Clearly, there are some diseases which are occupational and which can be distinguished from the ordinary run of diseases, just as an industrial accident can be distinguished from an ordinary accident. What the hon. Member for Stoke-on-Trent, Central (Dr. Stross) said about byssinosis was not strictly analogous, because, after very considerable research, byssinosis was established as a disease which arises directly from work in cotton carding rooms and as such it completely satisfies the conditions of Section 55 (2).

If, however, we get away from this clear-cut industrial causation, as we must with diseases which at the moment we find to be common to the population at large, and to have no clear connection with industrial conditions, a different picture emerges. Compensation for such diseases would arise on such a scale that the number of claims would equal, or even surpass, those dealt with under the whole of the accident provisions. If this happened the present sharp boundary of industrial risks would become so blurred that the need for a scheme separate from ordinary National Insurance sickness provisions would disappear.

One can envisage the outcry which would ensue if half the population acquired benefits for bronchitis said to be caused by their work, while the other half, for some reason, could not similarly benefit. It may be of interest to hon. Members to know that claims for respiratory diseases account for about one-quarter of the total claims for sickness benefit. Claims for sickness benefit in turn run roughly at ten times the number of claims for industrial injuries benefit. The sickness benefit claims for respiratory diseases are two and a half times the total of industrial injuries claims.

Thus, although we are not asked to accept the Motion in its entirety—that was the point made fairly by the hon. Member for St. Helens and the hon. Member for Stoke-on-Trent, Central—if we did accept it we might be faced with a vastly increased number of claims on the industrial injuries scheme. As I mentioned earlier, where a man is suffering from pneumoconiosis and also some other disease not prescribed, the other disease is not ignored. On the contrary, where a man is found to be suffering from pneumoconiosis and also from some other respiratory condition, the assessment of disablement from pneumoconiosis is increased if the other condition makes the effects of pneumoconiosis more disabling than they otherwise would be.

I agree that we should avoid being dogmatic in a matter of this kind. I do not want to close the door on any useful and constructive suggestions, but equally we should be on guard against rushing to conclusions which are not based on verified facts. That brings me to the question of research and inquiry which is obviously very much in the minds of the hon. Member for St. Helens and the hon. Member for Stoke-on-Trent, Central. After all, nothing stands still in human affairs, particularly in the sphere of medical research. Scientists are constantly pushing forward the frontiers of knowledge. Hon. Members are entitled to ask what research is being done into the causes of the conditions mentioned in the Motion, all of which are widespread in the population as a whole, and are influenced by such diverse factors as geographical location, environment, age, and even smoking habits.

I am bound to say that there is little sound evidence suggesting that these conditions are special risks in any occupation. There is nothing in the clinical nature of any of them which could establish with reasonable certainty that it alone was the true villain of the piece. It therefore seems to me that it is extremely important that we should press ahead with research in order to make sure one way or the other.

Hon. Members will appreciate, I am sure, that the scope, quality and effectiveness of research will be governed by the resources and manpower available. One of the major units in this is the Pneumoconiosis Research Unit of the Medical Research Council. It is also engaged in inquiries into bronchitis and other respiratory conditions. There is no question of dealing with pneumoconiosis in a restricted compartment. This body is doing a fine job. I am glad to sing its praises. My right hon. Friend has visited it, and I know that he is deeply impressed by the work being done and watches its progress with the greatest of interest.

One should also pay tribute to the National Coal Board for the work it is doing, waging war in its own way on the problem with the advice of some of the leading experts in the country.

That I think leads us naturally to ask what is being done about research into the possibility of occupational causation of some of the diseases not at present prescribed. I refer again to an announcement my right hon. Friend made on Monday when he said that we were making arrangements for a sample of the sickness records of individual persons to be taken so that an analysis could be made of the nature and extent of the incapacity for work by occupation and geographical location. This analysis will cover wider ground than that envisaged by the hon. Member for St. Helens, because we shall be taking into consideration sickness due to common complaints such as bronchitis, mental disorder, rheumatism and arthritis, all of which can be terribly disabling.

The importance of this analysis can be judged from the fact that between them these four diseases account for more than a quarter of the sickness recorded among the working population. The analysis will 'begin in the twelve months starting in June. It should provide research workers with useful information on the distribution of illnesses. It may help to focus attention on particular aspects of the problem, especially those presented this afternoon, by providing factual information which at the moment is missing.

There is, of course, no short-cut to prescription. The solution is to be found only through painstaking research, which obviously must take time. If we want reliable results on which to base worthwhile action, we must make sure that the work is undertaken by sufficiently experienced workers in the field of industrial medicine. Whether we like it or not, there is a limit to the number of men available and, with all the good will in the world, their work cannot be hurried or expedited by order, without affecting its worth and quality.

I am sure that the whole House appreciates the motives of the mover and secondary of this Motion. They want to be satisfied that, in dealing with workers who succumb to a disease as disabling as pneumoconiosis can be and who may suffer from other crippling diseases as well, our provisions are not only fair, but are seen to be fair to the men concerned. That is only right and proper and the action of hon. Members in bringing this matter to our notice this afternoon is to be warmly commended. I know that my right hon. Friend will read what they have said with the greatest interest. I hope, too, that what I have said has helped to put this important issue into clearer perspective and will make it unnecessary for them to press the matter further today.

3.42 p.m.

Mr. James Griffiths (Llanelly)

There is no time left to deploy an argument because, as a firm believer in fair shares, I have agreed to share my time with the hon. and learned Member for Darwen (Mr. Fletcher-Cooke), who is to move the next Motion. Therefore, I shall make only a few assertions.

Unless this industrial injuries scheme is better and fairer and more just than the old workmen's compensation scheme. it will break down. I put that very seriously to the Ministry. It is against that background that I want to say a word or two about this problem. I have been in it from the very beginning in the coalmining industry. With every respect to all the doctors, I say they have not all been progressive. I would not accept the views of the doctors as final, and I do not expect them to accept mine as final. It took a long time to convince them, however, that silica was not the only offending material. They resisted any change for a long time until the Medical Research Council issued its report on an inquiry headed by a young doctor, Dr. d'Arcy Hart. Then we got this wonderful word "reticulation" and it was found that miners were affected by a disease but it was not silicosis, which was affecting miners in South Africa.

The time has come to make a new investigation, and to make it very quickly not as a long-term procedure. We—the National Union of Mineworkers—asked Dr. Howells about bringing in a Bill quickly because what we wanted was legislation for a new criterion. The new criterion would be something on the following lines: Emphysema and bronchitis occurring in the presence of pneumoconiosis would be recognised as an industrial hazard permitting the Board to grant the total amount of the assessment to the claimant where these are present in combination. I put that before the House. There is no time to argue it; but more and more doctors are coming to the view that it is the right thing to do. The evidence is that the incidence of bronchitis and emphysema among miners is greater than among the general population, and if that be true, what can account for it except occupation? I therefore ask the Minister, the Parliamentary Secretary and the Department to realise that there is a growing discontent over this matter.

One of the things which at some time I should like to discuss—I hope that on some occasion we may have a day to debate it—is the fact that I, with many others, am disturbed at the low level of assessment in the case of pneumoconiosis. I am sure that the Parliamentary Secretary and doctors would not deny that when assessing the percentage of disablement caused by pneumoconiosis in cases where emphysema and bronchitis are involved, it is to a very considerable extent a matter of guesswork. We are asking the doctors to do something which—as a layman I say this frankly—is beyond them, in my opinion. It is almost impossible to separate what proportion of disability is caused by bronchitis, emphysema and pneumoconiosis. I say that we should stop dividing it out and treat it as one industrial hazard and one industrial disease. We ought to do that in a scheme of this kind.

I had to argue with my hon. Friends that it was a desirable thing to substitute the new procedure for dealing with workmen's compensation in place of the old procedure in the courts, including the House of Lords. I understood the fears which were expressed at that time. I must say that there is a widespread discontent now about the decisions which are given in cases in which claims are made under the new industrial injuries legislation for the dependents of workmen certified as having pneumoconiosis, but the primary cause of whose death is something different. Under the old legislation and the decisions laid down by the House of Lords, there was a liberal interpretation in such cases, and I will give one example.

I remember a certain court in a South Wales town, which shall be nameless, and a judge, who also shall be nameless because now he has gone to his reward. He adjudicated in the case of a man who was lifting a tram in a pit and who collapsed. The man was taken to hospital and he died the same evening. A post mortem examination disclosed that this man was suffering from leukemia and the medical evidence was that he was doomed to die in any event. The claim was resisted in court because it was argued that death was not accelerated by the accident. I remember that the judge said to the doctor who appeared for the employers, "The evidence before me is that this man was lifting a tram in the pit and sustained an accident and collapsed. You tell me that the medical evidence shows that he would have died anyhow. Would he have died that night but for the accident?" The doctor said, "No." The judge then said, "Very well, that is all I wanted to know—death was accelerated by the accident, and I award a full benefit to the applicants". Today, decisions are not so generous, so fair or so just.

There is a widespread feeling of discontent regarding methods of diagnosis and the assessments in cases where men have been disabled by pneumoconiosis and when they have died it was held that the pneumoconiosis did not accelerate death.

I remind the Parliamentary Secretary that the men have to contribute to this scheme, whereas they did not have to contribute to the old scheme. The points which I have mentioned are those about which these men are disturbed. I give the Parliamentary Secretary notice that we hope to return to this subject very shortly, and I beg him to tell the Minister that these two matters need urgent action. I congratulate my hon. Friend the Member for St. Helens and thank him. I am sure that he, my hon. Friend the Member for Stoke-on-Trent, Central (Dr. Stross) and the hon. Member for Clapham (Dr. Glyn), who intends to follow me in the debate, will join me in saying that the time for investigation and argument on these two points has gone and that the time for action has come.

3.51 p.m.

Dr. Alan Glyn (Clapham)

I thank the right hon. Member for Llanelly (Mr. J. Griffiths) for keeping to his bargain. If I am correct, he kept it to the second. I do not agree with him that doctors are always wrong in diagnosing; they are sometimes right. We are indebted to the hon. Member for St. Helens (Mr. Spriggs) for bringing this matter to the attention of the House and the general public, because if one looks at it purely in abstract terms of the number of men working throughout the country in one of our most important industries, it is clearly a matter which deserves the serious consideration which we have given it today.

As a medical man I rarely dare to speak in the House on medical matters. All hon. Members will agree that this is an extremely technical subject. Looking at the Motion carefully, I divided it into two sections. First, there is the diagnosis of pneumoconiosis and, secondly, there is the question whether other pulmonary diseases can be attributed to working in the mines.

I will deal first with the diagnosis of pneumoconiosis. I am not a chest physician, but I have asked various of my friends about this matter. I have always been of the opinion that the X-ray is not always correct. In this day of modern medicine we are far too apt to look only at the mechanical tests when diagnosing a patient. In many cases doctors think that the blood test, the X-ray and various other wonderful devices which medicine now has are the be-all and end-all, but in my humble opinion there are other things which matter. The day has not gone when the clinician himself is able to find some small or even significant deterioration of the state of the lungs which is not always detectable by the eye of the X-ray. Nevertheless, I do not think that that is frequent.

Without going into the technical details, I understand that in pneumoconiosis it is a question of carbon and fibrosis. I say that with some trepidation, because there is an hon. Member opposite who will correct me if I am wrong. Those two factors show up principally against the X-ray screen. When the initial research was done on the effect of cotton on the lungs, it was discovered after a great deal of work that cotton did not give rise to the same degree of fibrosis, and, in fact, did not show on the X-ray screen. With respect, I suggest that somewhat similar conditions may be present in the mining industry which make it extraordinarily difficult for the X-ray to detect every defect in the lung.

The hon. Member for Stoke-on-Trent, Central (Dr. Stross) spoke of the research being done in the gold mining industry. Possibly the conditions there are somewhat different. I think that they are connected more with the silica and the slightly different atmosphere. One should not use that argument too much.

That this industrial disease arises from working in the mines was proved conclusively from the digging of the Metropolitan underground railway in New York, when the incidence of silicosis was even greater than in the mines of this country. The reason for that was that Manhattan Island is of extremely hard rock and the particles were even more severe in their action on the lung than is the ordinary carbon in a coal mine. There we have the different factors—something which has a very harsh action on the lung, such as silica, and the softer action of carbon. We may have another example here in which possibly there is no sign shown on the X-ray screen. I think there is possibly a case whereby we might be able to do a certain amount of research on this, and I am very glad that my hon. Friend agreed that this would be one of the matters which would be considered, because frankly there is room for research in this respect.

May I now turn to the second division—that is to say, whether emphysema, bronchitis and the other diseases can be in any way attributable to working in a mine. I think that my hon. Friend was very fair here. He said, "It is all very well, but these diseases vary throughout the country anyway, and it may well be that in the mining areas there is a preponderance". I will go with him as far as that. But I will go a little further and say that possibly, having found this incidence to be greater in these areas, now is the time to do the research on the matter.

Up to this point we have all been at a great disadvantage because originally when a man entered a pit no medical examination whatsoever was given, so that when he said, "I have an industrial disease as a result of working in the mines" everybody, including the doctor, was completely in the dark about his condition when he started working in the mine. I understand that there is now a system in the coal mining industry whereby men are inspected. That helps considerably.

I know that hon. Members opposite are just as genuine in their feelings as I am. One wants to get the maximum amount of compensation for the man, but there is no reason why he should get compensation for something that is not attributable to the work that he does. We now have a much better yardstick. When a man has been working in a pit for five or ten years one can say, "Here was his lung condition before he started, and here is his lung condition now. He has had three or four attacks of pneumonia", or whatever the disease is, and one has a clear clinical picture of his present medical condition. In many of the old cases, doctors were to a great extent in the dark about a man's history. It may well have been that long before the man came into the pit he had bronchitis.

I think there may be—and this is one of the chief points that I should like to bring out—some noxious fumes or material in the atmosphere which could very well account for this high incidence of bronchial trouble. I have not the experience which hon. Members opposite have of working in the mines, but I imagine that in the confined space, the dust and the various factors which are circulating in the air—

Mr. J. Griffiths

Explosive fumes.

Dr. Glyn

—exactly—all those things could well give rise to some sort of irritation of the lung which in itself will not show on an X-ray but from which the clinician can say whether a man has suffered from an industrial disease peculiarly associated with working in the mine. Then I think we have got something to work on.

I have not the time to mention the findings of the committees, but they have been mentioned already. Those who served on those committees were staggered when they found that cotton could cause an industrial disease. Before the clock strikes may I say that I hope that when my hon. Friend goes into the four groups of diseases he will instruct those concerned to ensure that every research is given to this particular disease—

It being Four o'clock, the debate stood adjourned.

Debate to be resumed upon Friday next.