MEDICAL APPEAL TRIBUNALS (Hansard, 4 March 1964)

§ Mr. Stephen Swingler (Newcastle-under-Lyme)
The subject I wish to raise tonight arises out of an exchange at Question Time on 17th February and concerns the composition of medical appeal tribunals. I wish to raise a complaint about their composition which can be dealt with quite simply by a regulation of the Ministry of Pensions and National Insurance which would improve the system of justice under which claims for disablement benefits are dealt with.
Unfortunately, in some parts of the country these tribunals play an important part in the life of the community, those parts of the country where, because of the nature of the production, such as coal mining, many workers sustain industrial injuries or contract diseases at work and where controversy about the system of insurance and the level of social benefits and compensation for disease or disablement and the machinery for dealing with claims is widespread and considerable.
These medical appeal tribunals are staffed by expert consultants and have an extremely difficult and important job to do. No layman would underestimate the problems with which they are faced in assessing the degrees of disablement which determine the amount of social benefit which a man may get under our law. Certainly nobody from mining areas would underestimate the sense of frustration which exists among many citizens about the assessments and the present system. I am not suggesting that that is mainly due to the composition of tribunals or to the nature of the machinery. It is principally due to the state of the law.
In passing, I would tell the Parliamentary Secretary that until we have achieved recognition about the industrial cause of chronic bronchitis and emphysema and other things so frequently associated with pneumoconiosis, it will be impossible for those whom we represent to recognise as just the assessments which they are given and the social benefits 1486 they are granted. That is why those of us who represent mining areas so persistently agitate that these diseases, which, as a matter of common sense, are caused by men working in such occupations as coal mining and the production of steel, should be recognised in our legislation.
As explained by the Parliamentary Secretary on. 17th February, it is a rule that those who serve on pneumoconiosis panels and on medical boards to which claims are made by mineworkers who believe that they have contracted an industrial disease may not also serve on the tribunals to which men can appeal against assessments. Unfortunately, as revealed by the Parliamentary Secretary on 17th February, it is not a rule that a person may not serve twice or on more occasions on an appeal tribunal considering the same kind of claim from the same kind of citizen.
I draw attention to the case of Mr. Reginald Smith, of 20, Monument Road, Talke Pitts, in North Staffordshire. He is a constituent of my hon. Friend the Member for Leek (Mr. Harold Davies), but I have taken his case up because I raised the matter in 1956. In December 1961, Mr. Smith lodged an appeal against an assessment of 50 per cent. disablement for pneumoconiosis to a mining appeal tribunal. This was considered by the tribunal in March 1962. Mr. Smith was unable to attend the tribunal in person, but it considered X-ray photographs, hospital case notes and other material, including some evidence to which Mr. Smith subsequently objected. The tribunal rejected his appeal against the medical board's assessment.
Later, in August, 1963, Mr. Smith lodged a second appeal to a medical appeal tribunal. In this case he claimed to appeal against the medical board's giving him an assessment of 60 per cent. disablement for life on account of pneumoconiosis from working in the mines. He was notified that that would be dealt with in February of this year. When he was notified of the composition of the tribunal he discovered that one of the members was the very same consultant who had sat on the previous tribunal, in March, 1962, which had rejected his appeal against the 50 per cent. assessment.
Mr. Smith lodged an objection to this consultant being a member of the 1487 tribunal, not because he objected to him personally but because he considered—I think rightly—that his appeal should go before a fresh set of judges, since it was the same kind of appeal, about the same kind of claim on account of disablement from pneumoconiosis that had been dealt with in 1962. But that objection of Mr. Smith's was rejected by the clerk of the tribunal and the Minister.
Last month Mr. Smith, with the leave of the tribunal, withdrew his appeal, partly on account of a clarification given by the clerk to the tribunal about the nature of his assessment, but also, as he told me in a letter that I received this week, on account of the fact that his objection was brushed aside, and he felt very strongly indeed that it was unfair that he should have to face the same judge who had rejected his previous appeal.
Within the narrow limits of the terms of reference that are given to these tribunals and that operate in the case of assessments for disablement, it is not only important that justice should be done as far as possible but that it should be seen to be done. I put it to the Parliamentary Secretary that when a man feels that he has been given too low an assessment on account of his disablement and, therefore, makes an appeal to one of these tribunals, which may be the final authority to decide the amount of social benefit and compensation that he gets, and finds that he has to go before the same judge who had previously rejected the claim, with very similar elements within it, justice is not seen to be done. The only other appeal open to the man is to a commissioner, but then only on points of law.
I am therefore asking for a very simple reform of the rules which already rightly debar members of pneumoconiosis panels and medical boards from sitting on the tribunal. I am asking the Parliamentary Secretary to stipulate that where a claim is made and an appeal is lodged a second time by the claimant against a disablement assessment, the man should appear before a differently composed board.

§ Mr. Harold Davies (Leek)
It is not my intention to delay the house long. The case has been clearly and admir 1488 ably put by my hon. Friend the Member for Newcastle-under-Lyme (Mr. Swingler). I am aware of the case and both my hon. Friend and I know the gentleman concerned. Indeed, we know many others in the North Staffordshire district who suffer from this terrible complaint of pneumoconiosis which exaggerates bronchitis, emphysema and other types of disease that can be contracted in such areas.
Without reiterating the whole of the argument, I should like to ask the Parliamentary Secretary whether he feels that a man would be justified in feeling that justice appeared not to have been done when he makes a fresh appeal and finds that the second assessment is made by the same consultants who decided the first assessment. My remarks must by no means be taken as a castigation of the medical people concerned. But if a miner suffering from pneumoconiosis or a potter suffering from silicosis makes a fresh appeal and is confronted by the same judges who decided the case in the first instance, he is bound to feel uneasy.
When I heard about this case, I wholeheartedly supported my hon. Friend. I support this objection by Mr. Reginald Smith. I hope the Minister will give an assurance that a new formula will be found whereby miners and others suffering from this type of industrial disease may feel that they are at least getting a square deal.

§ The Joint Parliamentary Secretary to the Ministry of Pensions and National Insurance (Lieut.-Commander S. L. C. Maydon)
Medical appeal tribunals under the Industrial Injuries Act consist of a legal chairman and two medical members. The medical members are consultants of high standing appointed after consultation with the medical faculty of the appropriate university in the Provinces, or in London with the Royal College of Physicians or Royal College of Surgeons. These medical members are selected from small panels at each tribunal centre and are normally asked to serve in rotation.
More than one appeal arising out of some case may go before a tribunal. For instance, when there are provisional assessments for disablement, appeals may be made from each assessment. Or, as in the case referred to by the hon. 1489 Member for Newcastle-under-Lyme (Mr. Swingler) the claimant may appeal against a provisional assessment of his disablement and subsequently put in another and different appeal against a final assessment for life.
The question arises whether a medical member should sit on a tribunal if he had been concerned with the case in any way before. Certain aspects of this question are dealt with in the regulations governing the procedure of the tribunals. It is laid down that a person shall not act as a member of such a tribunal in any appeal, firstly if he has taken any part in the case as an assessor or, secondly, as a practitioner who has regularly attended the claimant, or thirdly, if he has been a member of a medical hoard, or fourthly, if any question arising out of the case has been referred to him for examination and report, or lastly, if he has been concerned in the case as a witness. These rules were made in 1948 after consultation with the Industrial Injuries Advisory Council.
A member is not debarred by any statutory provision from acting as a member of a medical appeal tribunal in considering a case in which he has taken part in a decision of a tribunal on a previous appeal, reference or application arising from the same claim. This is what the hon. Member is complaining about. In this case in December, 1961, Mr. Smith appealed against a provisional assessment. Again in September last year he appealed against a final assessment—two appeals on quite separate issues in consequence. The fact that one medical member of the appeal tribunal was the same is not forbidden by the regulations.

§ Mr. Swingler
I cannot accept that there are two separate issues. They are the same issue. The provisional and final assessment both had to do with assessing the degree of disablement from which the man suffers. A member of the tribunal who confirmed the view on a case, in fact put his name to that view in judging the provisional assessment, is 1490 in the view, of the citizen already committed and prejudiced when he considers the second case. That is the whole point.

§ Lieut.-Commander Maydon
I cannot accept that the mere fact that the tribunal member has been a member of a tribunal it deciding a previous assessment prejudices him in the eyes of the claimant. Nevertheless, we shall look at this matter again. It is a question, as I think the hon. Member for Leek (Mr. Harold Davies) said, of not only letting justice be done but of letting it be seen to be done.
We shall look at the matter again in the light of what has been said in this debate and also in the light of the Commissioner's observations on another case with some similarities which was raised recently at Question Time by the hon. Member for Lichfield and Tamworth (Mr. Snow).
Practical difficulties might arise. For instance, it might be necessary to transfer a case from the tribunal of one area where the claimant lives if, for example, the only dermatologist on the tribunal panel has already considered the claimant's case on an earlier appeal. Some claimant's might not think it desirable to have to go elsewhere to put their appeal before a tribunal.
Nevertheless, we will look into the whole matter again, consulting, if necessary, the Council on Tribunals, which is an independent body set up in 1959 to consider matters concerning the constitution and 'working of tribunals. The questions under consideration would seem to fall within that Council's province.

§ Mr. Harold Davies
On behalf of—

§ Mr. Deputy-Speaker (Sir William Anstruther-Gray)
The hon. Member may speak again only with the leave of the House.