HC Deb 08 February 1962 vol 653 cc767-76

Motion made, and Question proposed, That this House do now adjourn.—[Mr. Hughes-Young.]

10.37 p.m.

Mr. R. E. Winterbottom (Sheffield, Brightside)

I want to raise the case of Miss Audrey Bonser, who was a constituent of mine and died of cancer on 26th December, 1961. Two days ago, before I had time fully to examine this case, I felt that a recital of the facts and a few observations might be sufficient to do justice to this case, but since then information has been sent to me about this and other cases which make me feel much more truculent.

Miss Bonser went to the doctor for the first time last July. She was being treated for nervous disorder and received medicine for some time. On 17th September, she signed on as unfit for work. The doctor said that he diagnosed nervous disorder, but that he was not quite sure and if a period of rest did not cure her trouble she might have to go to hospital for a much more detailed examination.

On 16th October, she was sent to the regional medical board and was examined by a doctor. She told him that she had been suffering from pains which had increased in intensity over a period of time, and that her abdomen was swollen. In spite of this, the doctor recommended to the insurance officer that she was fit for work, and Miss Bonser was therefore pronounced guilty of virtually sponging on the National Insurance Fund.

She continued to visit the doctor, and went to work for a couple of days, but found that she was unable to carry on and stayed at home. She received no benefit at all while she was at home. She was then sent to a nerve specialist, and after, according to her, precisely the same kind of examination as she had been given by the regional doctor, she was told by him that she would have to go to the pathological department.

When she went there, it was found that she was suffering from this incurable disease, that it was in an advanced stage, and that it must have been in an advanced stage when she was originally examined by the regional doctor.

After she died, her father came to my home and reported the matter to me. He also got in touch with the Press. I asked him to put the case on paper, and I sent the letter that he wrote to the Ministry of Health for its comments. I wanted to get my facts right and not say anything that was out of place.

I am not saying this disrespectfully, but the letter that I sent to the Ministry of Health was treated almost like a shuttlecock between the Ministry of Health on one side and the Ministry of Pensions and National Insurance an the other. I eventually received replies from both Ministries. They were totally unsatisfactory both to me and the girl's father. In the father's opinion, and I agree with him, both letters avoided giving direct replies to the questions that he had asked.

I wrote to the Ministry of Health and expressed my dissatisfaction with the reply I had received and gave my opinion of the case. I asked that the doctor who had been engaged to examine patients at the regional board level should be removed from that task. I go further tonight. I repeat that request, and I ask publicly that his name should be given. I do not know his name, nor the name of the panel doctor who first prescribed for this young lady.

I make those demands, first, because the girl's abdomen was swollen and it therefore must have been obvious that she was in no condition to work, and secondly, because the second examination was similar to that which she underwent at the hospital.

The examination of the regional hospital doctor was exactly the same as that of the nerve specialist, and the father suggests—and I agree—that if the latter examination revealed that there was something of a very serious nature, the other one, made a short time before, should have revealed the same thing. In the opinion of the father, for whom I am speaking tonight, this was clearly a case of incompetence by the regional hospital doctor. I also want to discover whether the panel doctor was incompetent. I understand that when a patient is examined by a regional hospital doctor a report has to be submitted by the panel doctor who examined the patient previously, and I should like to know what was contained in the panel doctor's report on this occasion. It would help in understanding the case and also in apportioning blame, if any has to be apportioned.

Where do we go from here? The girl is dead, and we cannot do anything about that. I do not suggest that the regional hospital doctor or the panel doctor could have saved her life; that is beyond the bounds of possibility. But I assert, whether the Ministry likes it or not—and whether the B.M.A. likes it or not—that the examination of patients by regional hospital doctors leaves a great deal to be desired. It is shockingly bad. In many cases I submit that it is bad almost to the point of criminal neglect, and I am not saying that merely because of the evidence in this case.

It was, perhaps, fortunate that the first people to know of this case were the Press. It was the Press who made it public. My name was used by the Press, and the result has been a spate of letters dealing with all kinds of cases. The Parliamentary Secretary will appreciate that it has been impossible for me to examine them all in such a way as to be able to come to a conclusion whether they justify being mentioned in a report to her, but I have examined two cases in detail, both concerning patients who were sent back to work by regional hospital doctors but who died within a fortnight.

We cannot allow this situation to continue. I am not blaming anybody for making a mistake; it is very easy for a doctor to make a mistake. But where, as in the case of Miss Bonser and the two others to which I have referred, there is at least a prima facie case for absence from work but the panel doctor nevertheless recommends to the insurance officer that the patient concerned should return to work, that panel doctor should answer for the consequences.

I think that this case should be examined. I will go further, although this may not be to the liking of the British Medical Association. I think that there should be a responsible body in this country, apart from the B.M.A., which could examine these cases, to ensure that when such complaints as this are registered, the patient gets a fair deal. That happens in the case of dentists. I will not go into the details, but an examination takes place in relation to dentists. I do not think that it would be out of place if some Ministry of Health regulation provided for the setting up of a body to inquire into cases of this kind.

Miss Bonser is dead, and we can only express our sorrow to her parents. I suggest to the Parliamentary Secretary that the pain and suffering caused by this case extends beyond the family of Miss Bonser. Although I concede that this type of examination is necessary, these events have caused anxiety to many people who are concerned about the hasty way in which the examinations take place. I hope that the Parliamentary Secretary will inquire into the matter, if only to allay the fears of some people regarding the regional medical board particularly in the Sheffield area.

10.53 p.m.

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

This is a very sad case, and I appreciate the very natural desire of the hon. Member for Sheffield, Brightside (Mr. Winterbottom) to try to help the family of Miss Bonser. As he has said, her death was unavoidable. But I realise that her parents are troubled by the fact that while she was ill under the care of her own doctor, and away from work and drawing sick benefit, she was referred for independent medical examination and considered fit for work, despite the fact that later events proved that even at that time she must have been suffering from cancer of the stomach.

In order to help, I must explain what happens. Doctors from my Ministry's regional medical service provide an independent medical referee service for certain Government Departments, including the Ministry of Pensions and National Service. The Ministry of Pensions and National Service refers cases for advice on the insured person's fitness for work. This work is the responsibility of the whole-time regional medical staff of my Ministry, assisted as necessary by part-time medical referees. This service is not new. It was established as long ago as 1920 to meet the need for an independent referee service to help approved societies in the administration of the sickness benefit then available under the old National Health Insurance Scheme. It was continued under the present National Insurance Scheme which began to operate in 1948. I think the hon. Member would agree that it is an important and necessary measure for safeguarding National Insurance funds. I need not emphasise that the selection of patients for this further opinion is the responsibility of the Ministry of Pensions and National Service.

References are generally made where the illness shown on the medical certificate is normally one of short duration but has continued longer than usual. This is the normal method of dealing with short-time claims. Before a person is called for examination by one of the examining officers of my Department, the general practitioner is asked for an up-to-date opinion on the condition of the patient, whether the patient is fit to travel and whether the general practitioner wishes to be present at the examination. This is to protect the patient. Where the general practitioner says that the patient is not fit he or she is not called for examination. The opinions given by referees are entirely their own independent professional judgments and are given in an advisory capacity only. They report their conclusions to the Ministry of Pensions and National Insurance and the patient's own doctor. This again, I stress, is an important point. The general practitioner is under no compulsion to accept these views about his patient. He is entirely free to maintain his own opinions and may—and sometimes does—continue to certify that the patient is not fit for work.

To come to the particular case of Miss Bonser. As the hon. Member said, the first certificate for her was dated 19th September, 1961, and it showed the illness as nervous debility. She was referred under the arrangements I have just described, by the Ministry of Pensions and National Insurance for a second opinion on her capacity for work on 4th October. This was because the illness shown on her certificate was normally one of short duration. She was seen and examined on 16th October. Her own doctor had been advised and asked for a report and—this answers the point the hon. Member has put to me tonight—this report indicated dyspepsia of nervous origin. It made no reference to any hospital investigation or proposed reference to hospital.

The reports which I have examined show that our examining officer made a most careful examination with a view to ascertaining the precise cause of her symptoms. His responsibility, as I ask the hon. Member to remember, was to give an opinion on her capacity for work, and he reached the conclusion that at that date she was fit for her normal occupation of a clerk. The records show that nothing abnormal could be discovered on examination of the abdomen. Miss Bonser was described as of average height and build and her weight was normal at the time of examination. There seems no doubt that the examining doctor gave his opinion in good faith.

I am advised—and I made careful inquiry about this—that the diagnosis of carcinoma of the stomach is notoriously difficult in some cases where the characteristics of the disease do not show themselves outwardly. The notes made at the examination show that this was unfortunately the case with Miss Bonser, and her age was another reason which added to the difficulty of diagnosis. Cancer of the stomach apparently is most unusual at this comparatively early age of 31. Following this examination, Miss Bonser went back to her doctor who had been advised of the conclusions of the examining doctor. He, her own doctor, decided that she was fit for work and he gave her a final certificate on 17th October, 1961.

Mr. Winterbottom

Was that her own panel doctor?

Miss Pitt

Yes, indeed. That is the general practitioner, her own family doctor. He gave her a final certificate which brought sickness benefit to an end. Sickness benefit had been paid from 18th September to 17th October. Her own doctor told Miss Bonser that she could appeal if she were not satisfied, but she said that she did not want to appeal and would rather go back to work. I think that the hon. Member understands the appeal machinery of the Ministry of Pensions and National Insurance.

Her return to work, therefore, was on the responsibility and the certificate of her own doctor. Her case did not go to the insurance officer, the first of the independent authorities who decide claims, or any of the following machinery of the Ministry of Pensions and National Insurance, and even had it done so the responsibility would be on the Ministry of Pensions and National Insurance and not on the examining doctor.

Three weeks later Miss Bonser went to her own doctor again, with her mother, and her mother said that she was not satisfied.

Mr. Winterbottom

She had been every week in between.

Miss Pitt

This is the information which I have gained of the interim between her being signed off and eventually going to hospital for the consultations which the hon. Member described.

She went to her own doctor with her mother, and her mother said that she was not satisfied. Her doctor then sent her to a consultant psychiatrist who said that she was suffering from nervous dyspepsia. A week later her own doctor found that she had free fluid in the abdomen, and he sent her this time to a gynaecologist on 14th November. The specialist said that he could not tell whether this fluid came from the pelvis or higher up, and she had an operation, and the rest of the story we know, because the hon. Member explained it tonight.

The hon. Member referred to the question of sickness benefit. A further claim was made for sickness benefit from 13th November, when the certificate showed hospital investigation, and payment continued to the date of her death on 26th December. She therefore had payment of sickness benefit for the two periods for which certificates were presented. I gather that the hon. Member is worried about the intervening period, after she had seen the examining doctor and then her own general practitioner and had been signed off, and the date subsequently when she went to hospital. I have made some inquiries in order to try to help him, and I am told by the Ministry of Pensions and National Insurance that if in that intervening period she was not at work and if the father likes to put in a retrospective claim, it will be considered.

The hon. Member raised the question of giving the name of the doctor, but I think that such a question does not arise. The responsibility does not rest on the examining doctor for any of the relevant actions, and therefore I do not feel that his name should be given here tonight. But, of course, I have looked into the general position in Sheffield—another point which the hon. Member raised—in order to satisfy myself that the machinery which my Department operates as agents for the Ministry of Pensions and National Insurance is providing a proper service.

First, I would say that I am unable to discover any previous complaint from the Sheffield area. The hon. Member has said tonight that he has two other cases, and if he likes to send them to me or, more properly, to my hon. Friend the Parliamentary Secretary to the Ministry of Pensions and National Insurance, who is sitting here tonight, we are certainly prepared to look into them.

Mr. Winterbottom

There is only one from my division.

Miss Pitt

Perhaps the hon. Member will observe the courtesies of the House and send the other to the hon. Member concerned. In any event, it can be looked into. I want to reassure the hon. Member about his own area. In the past six months, 1,848 persons have been examined under this machinery in the Sheffield area. Of these, 30.9 per cent. were considered fit for work following the examination, and this figure is approximately the same as that for the country as a whole for 1961. This does not suggest that there is anything different in Sheffield. In fact, in the East Midlands division for the six months to 31st December, 1961, the appropriate corresponding figure was 34.29 per cent. Therefore, Sheffield is lower than the general figure for the East Midlands, though on a par with the country as a whole.

I assure the hon. Gentleman that there is no question of policy—deliberate or otherwise—of doctors of the regional medical service in Sheffield or elsewhere trying to send back to work people who are ill or unfit to resume their normal occupations.

I find this a sad case. I understand how the parents feel to lose a daughter at this age, and I can appreciate why the hon. Gentleman is so anxious that they should understand all that preceded her death. I am aware that sympathy is not enough. I have tried to make inquiries, and I hope that the explanation I have given tonight will be of some comfort to the parents of Miss Bonser.

Question put and agreed to.

Adjourned accordingly at six minutes past Eleven o'clock.