HC Deb 19 May 1961 vol 640 cc1788-96

3.48 p.m.

Mr. W. R. van Straubenzee (Wokingham)

I am deeply grateful to you, Mr. Speaker, for permitting me to raise a quite different matter from the one which has just been discussed, and I am obliged to my hon. Friend the Parliamentary Secretary for being present to answer the point I am anxious to raise.

It has always been a matter of wonder to me that the House of Commons which so often has to deal with great world matters, as we have over the last two days, is yet able and willing to find time for personal individual problems, and such is precisely the one on which for the moment I wish to detain the House.

My problem refers to only one man. By comparison with the great world events recently under our eye it is a matter of the merest detail, but it is a very human problem to him.

I am seeking to persuade my hon. Friend that it would be proper for her Ministry to issue a powered invalid tricycle to Mr. J. A. W. Lushington, who lives at Crowthorne, in my constituency. This has already been a matter of considerable correspondence between my constituent, my hon. Friend's Ministry, my hon. Friend herself and me, and anything that I am seeking to represent to her is in no way critical of herself and her Ministry. I want to place on record the fact that throughout this fairly lengthy correspondence I have received the greatest possible courtesy and sympathy.

I also want to make it quite clear how much I appreciate my hon. Friend's difficulty, not only in this but in other cases, in interpreting the rules which are relevant to the problem. I understand that her Ministry has to work under certain regulations, and that those regulations are not available to hon. Members in the sense of being contained in a Statutory Instrument, or something of that kind. I have made inquiries on that point, so that I might be as aware of the rules as possible.

It would be helpful, however, to start by quoting what I believe to be the guiding principles upon which my hon. Friend works, which she was kind enough to set out in her letter to me of 10th March last, when she said: Powered tricycles may be provided to those persons who suffer from amputation of both legs with one or both above the knee, paraplegia, or other disablements causing total or almost total loss of the use of both legs. Slightly less severely disabled persons who nevertheless have severe impairment of walking ability may be provided with a machine to help them to get to and from work I seek to persuade my hon. Friend that my constituent comes within the second paragraph of that set of principles. I draw her attention to her own words: Slightly less severely disabled persons who, nevertheless, have severe impairment of walking ability may be provided with a machine to help them to get to and from work. I have to show two things: first, that my constituent is a slightly less disabled person than one of those previously referred to; and, secondly, that the use of the machine has something to do with his work, as distinct, for example, from recreation. There is a plain inference that if that is the case it is in my constituent's favour.

My difficulty arises from the fact that there appears to be a conflict of medical evidence. In her last letter to me my hon. Friend, relying as she must upon her own medical advisers, expressed the view that my constituent can still walk quite a substantial distance. This is the nub of the problem. I should be very grateful if my hon. Friend can tell me what tests her medical advisers applied to Mr. Lushington before coming to the conclusion that he can still walk quite a substantial distance. There is no conflict here that he is a severely disabled person. I think there is no conflict that he is a reasonably borderline case, but my hon. Friend, in all possible good faith and on the advice of her medical advisers, has decided that he can still walk a substantial distance.

Quite obviously, my personal view on the matter is not worth much, because I have no medical training. I have, therefore, sought my own medical advice, which I have placed before my hon. Friend. It will not be unfair of me to quote from that medical advice which I have obtained, because my hon. Friend has already had the opportunity of considering it. My medical advice comes from the medical practitioner who has regularly been attending Mr. Lushington. He is Dr. Forbes Fraser, of Crowthorne, a senior doctor who, in fact, has just retired amid scenes of almost unprecedented good will and respect by those in a very wide area of the country that he serves. I think, therefore, that I can show that he is not an over-enthusiastic young medical practitioner whose heart might very easily have been wrung by the natural sympathies which he would feel towards a man severely disabled.

In his report to me, Dr. Fraser has conceded that my constituent is able to walk quite a substantial distance in his own time, but when writing to my constituent he added this potent sentence which I now quote: Short of testing you to exhaustion, what does this mean? In my opinion you are either unduly courageous or unduly optimistic in estimating that you could walk half a mile. I am sure you could then neither do any more work nor get home again. In other words, it is the considered view of the regular medical practitioner who has my constituent under his care that it would be unduly optimistic to expect my constituent to be able to walk half a mile in his own time and that, if he ever managed to do so, he would then neither do any more work nor get home. I respectfully suggest to my hon. Friend that this is very powerful advocacy from a medical man of repute.

Let me deal briefly with the second constituent factor in what my hon. Friend would require me to show her before she could alter her decision. I read into her letter—I hope properly—an inference that provided there is an element of getting to work that is a factor which is taken into account. I think that there is no dispute in her Ministry on the facts that my constituent is doing a job and needs some form of transport to get him to and from it. I have a feeling that my hon. Friend may be tempted to say to me—I accept, of course, that her personal sympathies are with my constituent—that the real problem is not so much that he needs something in the way of an invalid tricycle as that there is not sufficient transport in that part of the area which I represent.

Therefore, I come to my second point. My first point was, as my hon. Friend will remember: what tests were applied before this result was achieved? The second question is: has any consideration been given to Whether or not my constituent can get on and off public transport? Can he get on and off a bus, to put it quite simply? My medical evidence, again basing myself on the doctor who has had my constituent under care, is that he is not physically able to get on or off a bus, so that even if my hon. Friend does seek to persuade me——

It being Four 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. J. E. B. Hill.]

Mr. van Straubenzee

Even if my hon. Friend does seek to persuade me that the fault lies, as it were, not with her Ministry, but with the public transport system, my reply would be that even if there were a ten-minute bus service in that country district, he would not be in a medical condition to use it. I hope, therefore, that I have shown that he comes within that category.

To summarise, for I must not detain the House unduly, I submit that I have thrown doubt upon the medical advice which my hon. Friend has received and that if he is to be affected in his work it cannot be reasonably said that my constituent can walk quite a substantial distance. Secondly, I think that I have shown that he is not in a medical condition to be able to use public transport.

I repeat what I said at the beginning, that every thinking Member understands the very great difficulty for someone in my hon. Friend's position—dealing as she does with the whole of England and Wales and doubtless having many such difficult borderline cases to decide—of making up her mind finally, as she has to do, in the light of the advice that she receives.

I am not asking her this afternoon to change the view which she has so far intimated to me. What I am hoping for is something rather more modest, and I am immensely encouraged by what she and I heard my right hon. Friend the Colonial Secretary say not a quarter of an hour ago, when he said that he was sufficiently impressed by the case which had been put to him to have the matter looked at again. Therefore, I am making no more than the same modest request, and if my hon. Friend has any kind of reluctance about doing so I hope that she will feel that she is in very good and distinguished company in acceding to my request.

In those circumstances, I press with some earnestness, for I feel, without wearying the House, that inadvertently—and, of course, it is entirely inadvertently—a decision has been come to just on the wrong side of what is reasonable, and I hope that this time my hon. Friend will decide to come down on my side.

4.3 p.m.

The Parliamentary Secretary to the Ministry of Health (Miss Edith Pitt)

First, may I say to my hon. Friend the Member for Wokingham (Mr. van Straubenzee) that he has put his case extremely well and that his constituent should be grateful for such a good advocate?

If I may turn for a moment to the general position, I think that most hon. Members will, by now, be familiar with the various categories into which patients are divided for the purpose of deciding their eligibility for Ministry power-propelled vehicles, but I would like to go over them again because it is important to understand where we draw the line in this difficult matter, and the crux of this case is Where we draw the line.

There is little room for conflict of opinion about the first category, because it comprises those patients who have suffered a double leg amputation, one being above the knee.

The second category comprises patients suffering from paraplegia, or other defect of the locomotor system equivalent to the total or almost the total loss of use of both legs, so that the patient is, to all intents and purposes, unable to walk.

The third and final category comprises patients similarly, but slightly less severely, disabled with very limited walking ability who, because of the disability, need a machine to get to and from work. It is in this third category that my hon. Friend's constituent, as my hon. Friend rightly surmised, has been considered.

I want to emphasise that to qualify for a vehicle on grounds of employment the patient's walking ability must still be very limited. He must, that is to say, be only slightly less severely disabled than the person in Category 2 who is, to all intents and purposes, unable to walk.

These, then, are the standards we apply when deciding patients' eligibility. I shall have something more to say about them when I explain how they were applied in Mr. Lushington's case, but I would, first, like to describe, very briefly, the various stages which have to be gone through before a decision can be reached on a patient's eligibility for one of our motor tricycles.

The patient must first apply to his own doctor, who makes an appointment for him to be seen by a consultant at a nearby hospital. If the consultant considers that the patient needs some form of personal transport he will recommend the provision of a vehicle suitable for the patient's needs. If the recommendation is for a motor vehicle, the patient is called to one of our artificial limb and appliance centres, where he is given a complete medical examination by a Ministry doctor who forms an opinion on the patient's ability to walk and also the category of eligibility, if any, into which he falls.

Other matters which the doctor considers are the patient's ability to control a motor vehicle with the requisite degree of safety on the road and whether or not he can get in and out of one or other of the various types of machine which are available.

The doctor's report is then sent to our office at Norcross where all reports of this kind are considered centrally by a committee which meets regularly for this purpose. This is done to ensure, as far as possible, that the standards, to which I have already referred, are applied uniformly. The committee is composed of medical and lay members and I can assure the House that in arriving at its decisions it displays not only the wisdom which has come from long experience in these matters, but also a completely humane and sympathetic approach to the patient's difficulties.

Mr. Lushington's difficulties first came to my notice in February of this year, when my hon. Friend the Member for Wokingham wrote to my Department asking for our comments on Mr. Lushington's position in case there was anything he could do to assist him. I understand that Mr. Lushington, who has been disabled from birth, first applied for a Ministry motor tricycle in 1957, but, as he did not qualify in any of the eligible categories, his application had to be refused.

Before I replied to my hon. Friend, however, I wanted to be quite sure that there had been no material change in Mr. Lushington's physical condition since he was last examined and arrangements were made for him to have another medical examination, following which, I wrote to my hon. Friend informing him that Mr. Lushington could not be accepted as qualifying for a Ministry vehicle as he could still walk quite a substantial distance in his own time.

I understand that the patient was, at that time, using a privately owned motor tricycle to get to and from work. The machine was of a type which is no longer in production and, apparently, he was having the greatest difficulty in obtaining the spares necessary to keep it in good running order. I was not able to suggest where he might obtain spare parts, but I suggested that, if he had not already done so, Mr. Lushington might approach a local garage with good engineering facilities and explain the position. Such garages are frequently able to assist by adapting spare parts which are available.

On 23rd March, my hon. Friend wrote to me again enclosing a letter from Mr. Lushington's medical practitioner in which the doctor wrote strongly in support of his application for a motor tricycle. In view of the obvious difference of medical opinion, the application was referred to our Appeals Committee, comprising medical and lay officers, which sits to decide disputed cases and, in this instance, the committee sought the advice of one of our senior doctors, a man whose experience in these matters is very wide indeed.

I would emphasise most strongly that the doctor who considered this case has had perhaps the longest experience of anybody in this special kind of work, and I attach very great importance to the opinions Which he puts before me.

Nevertheless, I was advised that the previous rejection of Mr. Lushington's application should be maintained on the ground that he was still outside the classes of disabled persons for whom we can provide motor tricycles.

Those are the facts of the case, and in telling them I realise how completely they fail to convey the sympathy that one has for disabled people of this kind and the tremendous efforts that so many of them make to overcome their disabilities, still to earn their living and to play their part in the community. I should like to stress, also, the warmth of the consideration which I know has been given to this application throughout.

My hon. Friend mentioned that he thought his constituent could not use public transport. I looked at the medical evidence here—indeed, I have gone through all the papers—and I learned that no tests were applied as such to show whether or not Mr. Lushington could use public transport. However, I know that an experienced medical officer can form a fairly accurate assessment of a disabled person's ability to use public transport by studying all the other factors of the case; and here I found that the doctor who examined Mr. Lushington thought that he could use a bus, but with difficulty.

Had there been an element of doubt, I am quite sure that our doctors, by whom we must be guided in these matters—I am grateful to my hon. Friend for having appreciated that point—would have resolved it in favour of the patient. There appears to be no doubt that Mr. Lushington finds it difficult to get to and from work, and, of course, I am quite clear that he is doing a job of work. I can tell my hon. Friend what that job is. Mr. Lushington is a telephone operator in a hospital. That will show that I really have studied the details of the case. Unfortunately, Mr. Lushington's difficulties are increased by the absence of public transport services in the area in which he lives, and this—I am sorry to have to repeat what my hon. Friend anticipated—is not a matter which can be put right under the National Health Service.

In conclusion, I should like to say that our doctors who have examined Mr. Lushington have been impressed by his frankness and honesty and are quite satisfied that he does not exaggerate his condition. There is, therefore, no question of disagreement about the extent to which Mr. Lushington's disability has impaired his power to walk.

The difficulty arises from the simple fact that by the standards which we apply—there must be rules, and there will always be some people who come just on the wrong side of them—on the basis of which approximately 15,000 people have Ministry motor tricycles today, Mr. Lushington fails to qualify for one of these machines. He is, in fact, just on the wrong side of the border for this purpose, but should there be any deterioration in his condition in the future, which I sincerely hope for his sake, will not arise, I assure my hon. Friend that we shall be very willing to reconsider his constituent's application.

Question put and agreed to.

Adjourned accordingly at a quarter past Four o'clock, till Tuesday, 30th May, pursuant to the Resolution of the House of 17th May.