WAR DISABLEMENT PENSION (MR. TURNBULL) (Hansard, 11 November 1965)

§ Mr. Arnold Gregory (Stockport, North)

I want to draw the attention of the House to the case of one of my constituents, Mr. James Turnbull, of Heaton Chapel, Stockport. It is a long-standing matter, but it is well known to my hon. Friend the Parliamentary Secretary, and I must say that my hon. Friend has given much of his time over the last few months and afforded me a number of interviews to discuss the intricacies involved, and I am much obliged to him.

Mr. Turnbull's own words can be best used to describe the beginnings of this case. In a statement dated February, 1964, he gives the following points: I was wounded in France in February 1917 and was in hospital until December of that year when I was discharged with five pieces of shell in me: one piece 3 ins. long, one piece 2½ ins. long, and three medium size pieces. I was in receipt of a pension until it was stopped in 1921. I protested at the time, stating that I still had five pieces of shell in me and that it was a violation of the Royal Warrant to do so, but as I did not receive a reply to my protest I did not bother further in the matter. Approximately two years later one piece of shell turned septic and I was rushed to Grangethorpe Hospital where one large piece 3 ins. long was removed. Since that time I have been greatly troubled with the remaining foreign bodies. Between March and June, 1964, which was before I came to the House, Mr. Charles Royle, then Member for Salford, West and now Lord Royle of Pendleton, approached the then Minister with the case. In the reply of the Parliamentary Secretary of the time the developments of the Turnbull case were catalogued and the whole history from the Ministry standpoint was run over. That attitude largely holds today, and it is the basis of the Ministry's reasoning in the affair.

For the interest of the House, I will quote the relevant part of their communication dated 12th May, 1964, for it is most important in subsequent developments: Following his discharge from the Army Mr. Turnbull was awarded a war pension at the 60 per cent. disablement rate for the 504 gunshot wounds. A medical board in October, 1918, reported a considerable improvement in his condition and his pension was reduced to the 20 per cent. rate. In July, 1920, Mr. Turnbull was examined by a further medical board which included a surgical specialist. His wounds were reported to be sound and not adherent or tender and his gait was normal. Our doctors advised that there had been a further improvement in Mr. Turnbull's condition and assessed his disablement at 4 per cent. permanent He was awarded the appropriate compensation which took the form of a lump sum of £48 15s. in final settlement of his claim. This meant that further compensation could only be awarded if there was a permanent and material worsening in his war disability. From that, it will be seen that the door was left open for further consideration of Mr. Turnbull's entitlement, and that presumably on the assumption that, having first been granted a 60 per cent. disablement rate, then a 20 per cent. rate, then a 4 per cent. rate and then nothing at all, Mr. Turnbull would be bound to have trouble of some sort for ever after which, in the Ministry's opinion, might or might not qualify for pensionable rights.

The letter goes on: Since 1949 Mr. Turnbull has asked on many occasions for his claim to be reconsidered, as he thought that his war disability had worsened. Medical boards have been held in 1950, 1957, and 1959 and reports were obtained from specialists. On no occasion, however, has the war disability ever been found to have worsened. In 1957 Mr. Turnbull was found to be suffering from swelling of the testicles and osteo-arthritis of the right hip, but in the opinion of our doctors these further conditions were entirely unconnected with the war disability or any factor of Mr. Turnbull's 1914 war service. He could not, therefore, be awarded any further compensation. In 1959, Mr. Turnbull was also found to be suffering from psycho-neurosis but our doctors stated that this condition was of recent origin and also entirely unconnected with the war disability or any service factors. In the circumstances, we had to tell Mr. Turnbull again that we could not award him any compensation. These decisions were reconsidered in 1960 after Mr. Turnbull had written to the Prime Minister and then referred his case to his local War Pensions Committee. Our doctors remained firmly of the opinion that there had been no worsening of the accepted disability and that the further conditions from which Mr. Turnbull was unfortunately suffering had no connection with it or any factor of his 1914 service. This trend has been taken up by my hon. Friend the Joint Parliamentary Secretary in the various letters received over the past few months. Fortunately, 505 there has been no repetition of the suggestion that Mr. Turnbull was suffering from psychoneurosis. This was a needless and troublesome additive, for it had no bearing on Mr. Turnbull's claim. The Ministry, in any case, forecast a "no liability" clause and it only gave my constituent a few wretched moments, for he could not recall any interview or examination to assess this particular condition either in 1959 or at any other time before or since then.

However we must take events as they come, and, indeed, in conformity to the pattern already described, on the whole they form a very interesting and detailed pattern in Mr. Turnbull's case. I would at this stage emphasise that I have no criticism or question of the ability, the integrity or purpose in the findings of these eminent and learned people. The whole matter rests on the doubt and disagreement which is found on one side and then the other in the process of Mr. Turnbull's pursuing his rights.

As we know, Mr. Turnbull had between 1950 and 1959 appeared before a number of boards, and specialist reports have been issued on his case. Before and during these years Mr. Turnbull had been receiving quite a lot of treatment and a number of medical statements were issued during this period to illustrate the opinion and feelings of those attending him, and the positive nature of this opinion as to where liability lay in the matter.

There is the opinion of his famliy doctor who wrote on 4th May, 1951: Whilst being in this district up to 1947 Mr. Turnbull had frequent trouble with pieces of shrapnel in the left buttock and in 1944 he was X-rayed and four pieces were found deeply embedded. That was signed by Dr. Vipont Brown.

We know from the Ministry's letter that in 1957 Mr. Turnbull was found to be suffering from swelling of the testicles and osteoarthritis of the right hip. but in the opinion of the Ministry doctors these further conditions were entirely unconnected with war disability or any factor of Mr. Turnbull's 1914 war service.

Yet during February of that year he was examined by Dr. Norman W. Bolton, consultant surgeon to Stockport Infirmary who wrote to the chairman of the Stockport War Pensions Commitee on February 13, 1957: 506 This man sustained a war injury in the First World War and had three pieces of retained shrapnel in the perineum for which he was in receipt of a pension 25 years ago. Periodically since then he has complained of pain in the left hip and right groin and also in the perineum. We have periodically during the last six years investigated him. Dr. Bolton then goes on to describe this condition and concludes: He is still complaining of pain in the outer part of the left hip and the right groin and X-ray examination revealed scattered, opaque foreign bodies are present. One lies over the lesser trochanter on the left side, another occupies the left pelvis posteriorily. The smallest is seen below the left pubic symphysis.' He concludes: I think these attacks of pain that he is getting are due to the retained pieces of shrapnel. I believe he is making a claim to see if there is any possibility of granting him some further pension. I fel his case is a genuine one. Mr. Turnbull was then 63 years of age, and this refers to a period of consultation and treatment extending over six years when he was 57 years of age, still in active, working life. Yet he was bearing a non-pensionable disability in the Ministry's eyes which I understand led him to lose some five to six weeks' work from time to time.

In addition to this there is a tremendous amount of medical opinion in Mr. Turn-bull's favour, particularly from his family doctor, Dr. J. Neill Shepherd, and there is another important note from Mr. Thomas, chief consultant of Mossley Hall Hospital, Liverpool, issued in January, 1960.

Mr. Turnbull describes the incident as follows: Three years ago the Ministry of Pensions ordered me into Mossley Hall Hospital, from December 1959 to November 1960, when I had one more piece of shell removed from my left hip. (The sciatic knotch.) My condition was very much deteriorated, and I was again admitted to Mossley Hall Hospital on 19th November to 22nd December, 1962. After examination by the specialist there, a surgical boot was provided, which I now have to wear. At the time of Mr. Turnbull's visit to Mossley Hall Hospital the following observations were made in the report of Mr. Thomas, the chief consultant to the hospital: Mr. Thomas also considers that he (Mr. Turnbull) has had recurrent periods of disability over the years and it is impossible to dissociate this, in part at any rate, from the effect of the injuries and the presence of foreign bodies. 507 In a further note to the Ministry dated 11th February, 1964, Dr. Shepherd wrote: I have seen Mr. Turnbull today and do not agree that his pain, which he has had intermittently for 30 years, is due to arthritis. There is no doubt at the moment you are trying to shelve liability for something which is your responsibility in this case, and which you have up to now never failed to admit. It is clear that there has been a steady hardening of the Ministry's stand in the Turnbull case. Indeed, I would refer to the letters received from the Parliamentary Secretary dated 13th August and 23rd September. On 13th August he referred to the further consultations with medical consultants both from his own Ministry and another appointed for independent opinion. After dealing with the nature of the complaint he states that Mr. Turnbull: is, unfortunately, like many other people in their seventies, suffering, from an all too common degenerative condition which has nothing to do with his service. I need not assure you that we have, as has our consultant also, taken full account of the medical opinions which Mr. Turnbull has submitted, particularly Mr. Thomas's opinion of January, 1960. But we must have regard to the whole of the evidence —in many cases, as you will understand, there may be a conflict of medical opinion—and, quite frankly, out senior doctors have no doubt about the evidence in Mr. Turnbull's case. If it were anywhere near the borderline, we would give Mr. Turnbull the benefit of the doubt. One might well ask what has Mr. Turnbull yet to do to prove his position in this matter, and, furthermore, to prove how near the borderline he has yet to get, or what he has to do to prove it. It is the hardening attitude of the Ministry in this case that disturbs me. The reference to a man in his seventies and the possibility of a degenerative condition at such an age is, I feel, to be well taken by the House.

But we must remember that this is the tail end of things. All this began in Mr. Turnbull's youth. It wrecked his normal activities, particularly a bright football career, a matter which Mr. Turnbull personally considers of greater importance than his battle for pension rights. These, of course, cannot be restored. Neither is it an issue today. I think it was Keyserling who implied that it is much worse to deprive a man of his living than to take away his life. Who knows? Who can really tally up the damages and ravages 508 of war and its total inhumanity to man? This is a question very close to our minds in more than one way today. The whole point that I wish to make to the House is that my hon. Friend cannot say that his is a cast-iron case, tightly sewn up and beyond dispute. It will always remain one of doubt. In fact, nothing could be more borderline.

Opinion that has been on Mr. Turn-bull's side for so long remains firmly so today. It queries and questions the hopelessness of the case. After all, Mr. Turn-bull shows the sign of a man in later years, supported by sticks, and of being disabled. That cannot be doubted. However, medical evidence is called upon to prove only the disability and where liability lies—not the pain. One can only hope that my hon. Friend will look again at this case, to break through the barriers of resistance that have apparently built around the whole thing. I hope, too, that my hon. Friend will consult the Minister in this way.

I conclude on the note adopted by Dr. Shepherd when still further evidence was being sought on the case. He said on 15th June, 1965: I believe it is impossible to prove one way or the other whether it is in fact the result of his war service, but there is no doubt that bis foreign bodies are from service in the 1914–18 War. Indeed, doubt is the underlying thing about the whole case.

§ The Joint Parliamentary Secretary to the Ministry of Pensions and National Insurance (Mr. Harold Davies)

I would like to begin by paying tribute to the temperate yet forceful way in which my hon. Friend has put the case on behalf of Mr. Turnbull. I know, too, how hard my hon. Friend has worked on this case. However, there is one point in his speech—and he was kind enough to inform me of some of the things that he would say—on which I would take issue with him. He spoke of the "barriers of resistance that have apparently been built"—as he put it— "around the whole thing". There are no such barriers.

I think that it is fair to say that we administer the war pensions scheme with generosity and concern for the pensioner and not at all in any niggardly 509 spirit. I do not think that there is any dispute in the House about that. I do not need, therefore, to assure my hon. Friend or the House that, if Mr. Turnbull's case had been anywhere near the borderline, if there had been any real doubt about it, we should gladly have given him the benefit of that doubt.

Unfortunately, I am bound to say, with emphasis, that the weight of the evidence leaves us in no doubt at all—and I have been into the case several times very carefully indeed with our doctors and have seen my hon. Friend with them—that Mr. Turnbull's difficulties, for which we must all have great sympathy, are not in any way caused by the worsening of his war disablement. It would be an inadequate recognition of the force and sincerity of my hon. Friend's case on behalf of Mr. Turnbull if I did not make this clear.

Before I come to the arguments put forward by my hon. Friend I would like to fill out the background. Mr. Turnbull joined the Army in January, 1915. In March, 1917, he sustained some shrapnel wounds to his buttocks and one across the back of his right thigh as a result of an accident. By July the wounds were healed and he was discharged from hospital. He was however readmitted the following month because he complained of some stiffness of his left hip.

Examination of the hip joint under anaesthetic revealed that movements of the hip were absolutely normal. X-rays showed, however, the presence of some foreign bodies—there is no question of there being pieces of shrapnel two or three inches long—and an operation to remove one of them was recommended. Mr. Turnbull declined to have an operation—his refusal was quite reasonable— and on 5th December, 1917, he was discharged as unfit for service.

Following his discharge, he was granted a 60 per cent. pension in respect of the wounds. In October, 1918, a medical board found a considerable improvement in his condition and his assessment was then reduced to 20 per cent. In July, 1920, another medical board found further improvement and assessed the degree of disablement at 4 per cent. permanent. As pension is not paid where disablement is below 20 per 510 cent., Mr. Turnbull was then awarded a gratuity. This gratuity did not mean that we thought that there would be no continuing disablement from his wounds at all, or that if he should need any treatment for them we would not give it. This gratuity meant that the disablement arising from the presence of the foreign bodies, though it would be permanent, would be relatively slight. Mr. Turnbull in fact had some treatment in 1921 when two pieces of shrapnel were removed. He had the right of appeal for one year against the award, but he did not exercise that right.

For many years, Mr. Turnbull has sought restoration of his war pension. He has renewed his claims, sometimes directly and sometimes with the help of bodies such as the British Legion and the Red Cross. He has discussed his case with his local war pension committee and others. He has been medically examined on numerous occasions and reports have been obtained from specialists. I need not go into details. Suffice it to say that on no occasion was his war disablement ever found to be permanently worse, though at the end of 1959 a small piece of shapnel came to the surface and was removed. When this was done, Mr. Turnbull received treatment allowance at a rate equivalent to 100 per cent. pension.

My hon. Friend also mentioned that Mr. Turnbull went into hospital in 1962, when a pair of surgical shoes were prescribed for him. But the treatment he had then and the shoes which were prescribed were not for his war wounds but for his arthritis. This was fully explained to Mr. Turnbull at the time.

In January this year, my hon. Friend wrote to us about Mr. Turnbull. He considered that he still remained dissatisfied. We therefore thought it right, in order that justice might be seen to be done, to submit a statement of all the evidence in his case, including the full range of X-rays over many years, to an independent consultant, and this we did. We referred the papers to one of the most eminent orthopaedic surgeons in the country, director of the department of orthopaedic surgery of a major university. I emphasise that this gentleman had nothing to do with my Department. He 511 was completely and entirely independent and we were content to abide by what he said.

He gave Mr. Turnbull a full examination on 19th March and his opinion was as follows: This patient is suffering from osteoarthritis of both hips. The osteo-arthritis is more marked on the right side than on the left. It is to be attributed to constitutional causes and is not, in my view, in any way due to the effects of the injury sustained in 1917. The various small metallic foreign bodies in the left buttock and upper part of the left thigh are making no contribution whatever to Mr. Turnbull's disability. We submitted every scrap of evidence. It is a clear and unambiguous opinion. Furthermore it is accompanied by detailed reasons, and in the light of it, I must tell the House, quite frankly, that there are no grounds at all upon which we can say that there is any worsening of Mr. Turnbull's war disablement. The plain fact is, as I have indicated in my letters to my hon. Friend, that Mr. Turn-bull's war injury consisted of some deep flesh wounds which, within a few months, were satisfactorily healed. There was no artery or nerve damage. The X-rays show quite clearly, and we took the trouble to get a lot of them, that though there are some very small fragments of shrapnel remaining, they do not lie near the joints. Many people carry such small fragments around with them, encapsulated in fibrous tissues, and normally they cause no trouble. The X-rays also showed quite clearly that Mr. Turnbull is suffering from bilateral osteoarthritis, of constitutional origin which has nothing to do with his war service. This was beginning to manifest itself when he first claimed restoration of his pension. An X-ray taken in 1949 showed arthritic changes. My hon. Friend says that his present condition is the tailend of things. It is a condition which has been developing for many years, and I must say would 512 have been just the same whether he had been wounded or not.

In essence my hon. Friend's arguments amount to the claim that, since the medical evidence was conflicting—and that is the nub of it—and because Mr. Turnbull has adduced a certificate from his own doctor and two local hospital specialists in his favour, the case, in my hon. Friend's own words, will always remain one of doubt. With great respect to my hon. Friend, this does not follow. What matters is not the volume of the evidence but the weight of it. No one has ever denied that there are some foreign bodies present, but the X-rays over the years show quite clearly that they are in the flesh only and are not interfering, and never have interfered, with any joint, nerve or artery.

The disablement from the wound is not serious. It is not worse now than it was in 1920. The main condition with which we have to deal is an entirely unrelated one, namely, degenerative joint disease of the hips. This is Mr. Turnbull's serious condition, and it is the condition which is causing the trouble. Foreign bodies have nothing to do with it. I would emphasise that we prepared for the consultant a full unedited statement of all the evidence. This is a long and expensive process. We make no complaints about that. If there is the slightest possibility of a feeling of injustice we do all we can to remove it. We have done so here and, as I have said more than once to my hon. Friend, though I have the greatest sympathy in Mr. Turnbull's situation, and were it possible I would like to acquiesce in his demand, I am sorry, but that is the conclusion to which I have to come in the light of the weighty evidence in Mr. Turnbull's case, and that is where I must leave it this evening.