§ 11.8 a.m.
§ Mr. S. O. Davies (Merthyr Tydvil)
I beg to move, That the Bill be now read a Second time.
It might have been more appropriate had I entitled this brief Bill Amendment of the National Insurance (Industrial Injuries) Act, 1965. The National Insurance Acts, 1946 and 1948, have long been our unhappy preoccupation, particularly in the mining industry, because of their serious shortcomings. The 1965 Act, as far as my Bill is concerned, repeats what is said in the 1946 and 1948 Acts. This little technicality, I am informed, can be adjusted if the Bill reaches Committee.
I am asking that Section 58(1) of the National Insurance (Industrial Injuries) Act, 1965, should be amended with the insertion after the word "tuberculosis", both times it occurs, of the words emphysema or bronchitis". Section 58(1,a) says:… where any person is found to he suffering from pneumoconiosis accompanied by tuberculosis, the effects of tuberculosis shall be treated for the purpose of this Part of the Act as if they were effects of the pneumoconiosis;The cost, I must emphasise, will be relatively very small. In this estimate, in which I am very generous, I suggest that it would be from £15 million to £20 million which, as the Bill states, will be reimbursed out of the Industrial Injuries Fund, a fund compilable by the workers, the employers and Government contributions. I should like the House to pay attention to this point. As far back as March, 1965, that fund reached the astronomical figure of £327,678,000, a figure which is increasing rapidly every year. We are asking that as a maximum only about 6 per cent. of this vast sum be granted in terms of this Bill to those who suffer and have suffered because of their employment. Should this not be done then the Government will be guilty of extreme and unpardonable meanness.
I am very proud to say that in no industrial area in the country has a more intensive research been carried out into pneumoconiosis and associated diseases, their origins and consequences, than in 811 the South Wales coalfields. Had Ministries in the past paid attention to the advice and findings, say, of Professor Gough, and his splendid team at the Wales School of Medicine, and others associated with them, far more effective progress would have been made in reducing the incidence of pneumoconiosis and its associated fatal diseases.
May I give one or two instances of how Governments in the past have been misled—this must be said—by the Medical Research Council's Committee. For example, in 1934 this Committee concluded that there was no evidence that the inhalation of anthracite or other coal dust caused fibrosis of the lungs in coal trimmers. This conclusion was subsequently proved to be utterly wrong, but unfortunately this wrong and grossly misleading conclusion, which any practical coal miner would have corrected—there is no doubt about that—had most serious consequences among us as coal miners. It was not only extended to coal workers and others exposed to this hazard, but it was reported to the international conference on silicosis in Geneva in 1938 that a Medical Research Council's Committee in this country had concluded that coal dust in itself did not produce fibrosis of the lungs.
I am speaking from experience when I say that this had literally fateful consequences among our miners. For instance, it delayed the suppression of coal dust in mines for almost a generation, at goodness knows what expense in human lives. It should also be noted that in the early part of the Report it was stated that the Ministry—then the Ministry of Pensions and National Insurance—requested information on the possible role of occupation in the etiology of chronic bronchitis and emphysema with particular reference to the coal mining industry. But there is no further reference to emphysema in this precious and had report.
This has been used against us in the past. This precious Medical Research Council was used against us before ever I came to the House where, if I may say so, I hold some measure of responsibility for the then workmen's compensation under the old National Federation of Miners.
812 Another piece of evidence which can be quoted in support of this Committee's contention was that the incidence of bronchitis in coal miners' wives is also high and that the cause of bronchitis in miners is, therefore, due to social or economic factors and not due to occupation. It was assumed by the Medical Research Council's Committee that these symptoms of bronchitis in women indicated conditions which would lead to death. The fact has been proved to be otherwise. This study to which I have referred, if it can be called a study, was conducted in what is known to us as the Rhondda Fach, Rhondda East, a part of the Glamorgan and of the South Wales coalfields.
The Annual Report of the Medical Officer for Glamorgan, published in 1964, for the period of five years 1960–64, both years inclusive, showed that the death rate of females within the county of Glamorgan was well below the average for England and Wales, whereas the death rate for males in the county was greatly in excess of the national average. It was obvious that bronchitis found in miners' wives was mild and far less fatal than that which killed so many of their husbands.
I should like to appeal to hon. Members—and this is no party point—that they should read Professor Gough's rather lengthy letter on chronic bronchitis and occupation in the British Medical Journal of 19th February this year. I found it extremely illuminating on this unhappy subject and was aware, from long experience, that Professor Gough was one of the leading research workers in this branch of industrial diseases.
On emphysema, I quote from a reputable work on this and other diseases. It states:People suffering from emphysema should be careful not to over-exercise or tire themselves in any way".Here is some good advice:Walking along dusty roads should be avoided, as dust will tend to irritate the bronchial tubes. There is no cure for this condition.The first place to avoid is a coal mine, where this disease is contracted and where the conditions can, and do, kill.
In my small Bill my hon. Friends and I are merely asking for the obvious. 813 Had I attempted to give the House all the expert evidence that has come my way in favour of this Measure, I would keep hon. Members here for very many hours. I content myself with the knowledge that many hon. Members, particularly on this side of the House, know from experience the theme of the Bill.
I remind my hon. Friend the Joint Parliamentary Secretary that in Australia and South Africa emphysema and bronchitis are accepted as occupational diseases or hazards and that their victims are compensated. Several European countries, Socialist and non-Socialist, are also well in advance of Britain in this respect. Many of my hon. Friends and others are with me in urging the Government to accept this modest but absolutely necessary and urgent Bill.
§ 11.24 a.m.
§ Mr. Richard Sharples (Sutton and Cheam)
The whole House will wish to congratulate the hon. Member for Merythr Tydvil (Mr. S. O. Davies) for having chosen as the subject of his Bill—having been lucky to draw a place in the Ballot—a matter which is close to the hearts of many of his constituents and to hon. Members who are in any way connected with the coal mining industry. I welcome the Bill, certainly in principle.
When the Joint Parliamentary Secretary replies—and I speak with some feeling, because I was in an equivalent position at one time—he may have to urge some caution on us. I hope, however, that he will accept in principle and in spirit what lies behind the Bill, even if he may have to suggest certain drafting Amendments.
When I occupied an office similar to that held by the Parliamentary Secretary I found that the most difficult cases coming before me were those where bronchitis or emphysema were associated with pneumoconiosis. Whatever the medical diagnosis of a person who has been working in dusty conditions and who is suffering from bronchitis or emphysema, the sufferer feels certain that his disease has been contributed to in one way or another by the dusty conditions in which he has been working.
When, at the Ministry, certain cases came my way, fortunately very few in number, which caused me a great deal 814 of difficulty. They concerned men who had been refused benefit during their lifetime because of a diagnosis of bronchitis or emphysema but who, as a result of post-mortem examination, were found to be suffering from pneumoconiosis.
§ Mr. Sharples
We were able in cases of that kind to allow death benefit to be paid to their widows, for there was no means—and this particularly worried me—of making restitution to those who had lost so much during their lifetime.
§ Mr. Hale
I always listen with avid interest to the hon. Gentleman and I particularly recall that my relations with him, when he was in office, were singularly happy when I brought cases of this type to his attention. However, I had the impression that my hon. Friend the Joint Parliamentary Secretary was nodding in assent while the hon. Gentleman was just speaking. Is not one of the real causes of difficulty the fact that the legislation which it is now sought to slightly expand was so narrow that the Minister felt constrained to refuse cases which he knew ought, in justice, to be granted? Is not that the point of this debate, as well as the point of my previous comments on another lung disease?
§ Mr. Sharples
I have great respect for the hon. Gentleman and listen to him with interest, because he speaks with much knowledge of the subject. I say frankly that there have been a number of cases in the past about which I have been extremely unhappy indeed. I am glad, therefore, that the hon. Member for Merthyr Tydvil has given us this opportunity of discussing this issue in a non-party spirit so that we may see what progress can be made to improve the existing legislation.
The mining community has always felt that bronchitis and emphysema should be prescribed as industrial diseases, as is the case in Australia and some other countries. We appreciate, however, the difficulties that exist in making such a wide prescription, although the Bill would go some way towards meeting that difficulty. It is not for me to judge whether or not the solution proposed by the hon. Member for Merthyr Tydvil is a practical one. I hope that something 815 along the lines proposed by the Bill will be found practical and that the Joint Parliamentary Secretary will accept the principle and spirit of the Measure, even if he must propose some drafting Amendment.
There are one or two questions to which I would like an answer when the Parliamentary Secretary replies. The hon. Member for Merthyr Tydvil spoke of the cost of this proposal. He gave the figures as being between £15 million and £20 million if the proposals were to be implemented in full. Perhaps we could have some information on this matter of costs when the Parliamentary Secretary replies.
If the Bill were passed as it stands, without substantial Amendment, would the Parliamentary Secretary tell us whether or not benefit will be payable in full if bronchitis and emphysema are the main diseases and the condition is aggravated even to a comparatively small degree by pneumoconiosis? It would help hon. Members considerably to have this information when this question is considered in Committee. My second question, relating to the previous one, is that where the same conditions apply, but the certified cause of death is bronchitis or emphysema, will death benefit be payable in full where there has been a condition of pneumoconiosis, no matter to what degree?
I well remember, in one of the debates, the hon. Member for Bedwellty (Mr. Finch) telling us of the difficulty which arises from a decision of the coroner's court, where a coroner finds that death was the result of pneumoconiosis, yet the medical diagnosis is one of death by bronchitis or emphysema. Perhaps the Parliamentary Secretary could tell the House a little more about what has happened with regard to this since we debated that matter—I think it was some time in 1961.
Perhaps he could also tell us what estimate he has made of the number of people who are likely to be affected by the Bill as it stands. That information would help hon. Members considerably. Could he also tell the House what arrangements would be made by the Ministry, if the Bill were accepted in its 'present form, for reassessing those people 816 who would become entitled to additional benefit? I do not think that any particular problem arises for those people who are still in the industry, but what will be the arrangements for those who have left the industry and who are no longer members of the National Union of Mineworkers, or some similar organisation?
I should like to say a few words about pneumoconiosis. I am sure that all hon. Members are pleased that the number of new cases diagnosed is falling fairly steadily. When I last spoke on the subject, in 1961, I referred to new cases being in the region of 4,000 a year. I looked up the figures last night and discovered that in 1965 the number of new cases diagnosed had fallen to something a little over 1,000. This is something about which we are very pleased, but I am sure that no hon. Member will be satisfied or content until this horrible disease has been eliminated entirely from our industrial system.
We must remember that even though the number of new cases is falling—and we are glad to see that it is—there are still about 54,000 people in this country receiving benefit of one kind or another. This is something which reflects upon us all for allowing such conditions to exist in the past.
I realise that this is slightly outside the Parliamentary Secretary's field, but it would help hon. Members if he could tell the House what progress is being made in the long-term treatment of the condition of massive fibrosis set up by the National Coal Board in 1962. I discovered a reference to this in paragraph 166 of the 1962 Report of the Board. It would be helpful if we were told what progress is being made in the discovery of a treatment for this disease.
Could the Parliamentary Secretary tell us also what progress is being made by the Pneumoconiosis Research Unit, at Llandough? I well remember visiting the unit when I was Parliamentary Secretary, and I was immensely impressed by the work that was being done. Is there still a contribution—I think I am right in saying that there was a contribution—being made by the Ministry of Social Security to the work of the unit under Section 71 of the Industrial Injuries Act? Would the hon. Gentleman also tell the 817 House what progress has been made by the working party, set up by the National Joint Pneumoconiosis Committee of 1965, toconduct a review of the progress of recent research and development in regard to the prevent of pneumoconiosis and to make such recommendations as may be desirable."?Could the Parliamentary Secretary tell the House what progress has been made since February, 1965? I am sure that the House would be interested to learn anything he may have to say on this most important subject.
Finally, may I say that I support the Bill in principle. Even though Amendments may be recommended by the Parliamentary Secretary, I hope that it will pass through all stages in the House and will, in due course, be placed on the Statute Book.
§ 11.37 a.m.
§ Mr. Harold Finch (Bedwellty)
I join with the hon. Member for Sutton and Cheam (Mr. Sharples) in congratulating my hon. Friend the Member for Merthyr Tydvil (Mr. S. O. Davies) in his success in the Ballot for Private Members' Bills. I thank him sincerely for bringing in this Measure which, if accepted by the Government, will go a great deal further in providing social justice for men whom the miners describe from time to time as suffering from dust on the lungs.
My hon. Friend gave a great deal of detailed information in support of his case. The evidence which he submitted is sufficient to warrant the Parliamentary Secretary responding by adopting the Bill. My hon. Friend the Member for Merthyr Tydvil is to be further commended on bringing this matter before us, today, because I know that he has been very distressed in recent weeks by the Aberfan disaster, in his own constituency. I know that he has been very upset about this, as we all have.
Aberfan is a very important part of the Merthyr Tydvil constituency. The Aberfan disaster, the colliery disasters, the injuries which occur, and the incidence of pneumoconiosis, are reminders of the hazards which men have to face in the coal mining industry.
The hon. Member for Sutton and Cheam gave the House some figures, but let me remind hon. Members that for the past 12 years, until 1965—I have 818 not got the figures for 1966—there have been 37,203 men certified as suffering from pneumoconiosis. That does not take into consideration the many re-examinations made by medical boards of men previously certified as suffering from the disease, where the finding is that the condition has deteriorated.
While I agree that the cases are declining, they are still running at an average of over 1,000 a year, and it must also be remembered that fewer men are now employed in the industry. There is nothing like this state of things in any other industry. The figures are appalling. The disability, the suffering, the deaths from chest affections give us a great deal of cause for thought.
But this is not the whole of the sombre picture. Many men are suffering from emphysema and bronchitis, which many of us, and we have a great deal of medical support, contend are associated with employment in the coal-mining industry. It is generally agreed that there are different kinds of emphysema. Focal emphysema already qualifies for disablement benefit, but in its diagnosis there is a requirement of X-ray abnormality. The fact remains that such emphysema may be present without any X-ray change, and it is felt that emphysema in the presence of pneumoconiosis should be accepted as an occupational disease. There is much medical support for that view.
Bronchitis is increased by pneumoconiosis. The bronchial tubes are damaged. It does not require experts to appreciate that the constant inhalation of dust underground must result, as it so often does, in men coughing, and that, in turn, must affect the bronchial tubes. We who live in the mining areas know of rugby players, healthy men, going into the industry and falling victim in this way. I have known of a whole rugby team wiped out in South Wales by pneumoconiosis, emphysema and bronchitis. I tell my hon. Friend the Parliamentary Secretary, quite frankly, that we, as mining M.P.s, are getting very impatient at the long delay in deciding that emphysema and bronchitis should be prescribed as industrial diseases.
It may be fairly argued that other factors, such as air pollution, contribute 819 to bronchitis. I know that I always like to get back to Wales after a spell in London, from its smog and smoke. It is good to get back to the valleys, where air pollution is not so acute as it is in the towns and cities. It can be very bad in Manchester, Birmingham, and other big places in the winter time. It is true that air pollution contributes to bronchitis, but the air is not so polluted in the valleys. We have our collieries there, but we do not yet have sufficient industries to create fog and smoke. Relatively, therefore, air polution does not present a serious hazard in our valleys.
What is the cause of this disease? We know that wherever the incidence of pneumoconiosis is high, so is the incidence of bronchitis. Statistics show that in the Rhondda Valley, where pneumoconiosis runs at a high rate, so does the associated bronchitis. It therefore seems that, on probability alone, pneumoconiosis and bronchitis should be prescribed as mining industrial diseases. When my right hon. Friend the Member for Llanelly (Mr. James Griffiths) introduced the National Insurance Act he said that cases of doubt should be decided in favour of the applicant. In the same way, I say that if there is any doubt, then, on the basis of probability, these diseases should be prescribed as industrial injuries.
The case is far stronger when we look at the evidence of cases of emphysema and bronchitis existing with pneumoconiosis. Here it is not even a manor of the law of probability. Medical evidence very strongly supports the view that where pneumoconiosis is accompanied by bronchitis and emphysema, disablement benefit should be paid, for even medical specialists who have serious doubts about this condition as a cause of bronchitis say that even though they cannot decide in favour of bronchitis being due to mining or emphysema, the industrial conditions at least accelerate and aggravate it.
I cannot understand the Ministry's attitude. Dr. Howells was appointed some time ago by the National Union of Mineworkers to investigate pneumoconiosis in the mining industry, and the then Ministry of Pensions and National Insurance gave him every facility for his work. He went from one medical panel to another, 820 studied X-ray prints, and examined men, and he quotes the opinions of medical officers attached to what is now the Ministry of Social Security.
Dr. McNair, of the Swansea panel, suggested that a patient with emphysema and pneumoconiosis was worse off than a patient with emphysema alone. That seemed to him to be the crux of the whole question. That is the view of an official of the then Ministry of Pensions.
Dr. McVitie, also of the Swansea panel, is reported to have said that general emphysema and bronchitis were very common among miners and twice as common among elderly miners, as it was among similar people in the rest of the population. His view was that mining perpetuates bronchitis and emphysema.
Dr. W. W. Jones, of the Stoke panel, said that the causes of emphysema might help to accelerate the development of general emphysema or precipitate its appearance.
Dr. Howells therefore came to the conclusion, apart from his own examinations, that many of these difficulties could be resolved by so changing the legislation that general emphysema and bronchitis occurring in the presence of pneumoconiosis would be recognised as industrial hazards, and the total disablement benefit granted to those applicants in whom the two conditions were present in combination.
Dr. Rogan, the Chief Medical Officer of the National Coal Board, is very cautious in his approach, but in page 16 of his paper on the prevention of pneumoconiosis in Great Britain, he said:Bronchitis diagnosis by questionnaire also varies widely in prevalence, ranging from 9 per cent. to 43 per cent. Though the relationship between bronchitis and pneumoconiosis may still be unsure, we have concluded that a high prevalence of pneumoconiosis tends to be associated with a high prevalence of bronchitis. We have also noted when we correct our data to allow for the effects of age, that the symptoms of bronchitis tend to increase as the pneumoconiotic conditions advance.What are the Government waiting for? Here is the medical evidence of officers under the administration of the Ministry. While they are very cautious about the causation of bronchitis and emphysema, they are not so cautious when they deal with the question of aggravation.
821 We are getting a little "fed up" in raising this matter. Men have died, men are suffering, and widows are not paid the adequate rates of compensation to which they are entitled in these circumstances. My hon. Friend has pointed out that already in the Act pneumoconiosis accompanied by tuberculosis is provided for. There should be included in the Act a provision covering bronchitis accompanied by pneumoconiosis and emphysema.
I view with great concern the decisions of Commissioners and the whole administration of the problem under the present Industrial Injuries Act. In earlier days, I had some experience as a layman of going to the county court, courts of appeal, and even to the House of Lords, on matters affecting workmen's compensation. There is the well-known case of Moore v. Tredegar Colliery. That case was turned down in the county court. A man had died when walking up the gradient of Tredegar Colliery. A post mortem examination was conducted and it was found that he had had very serious heart trouble. Their Lordships said that he could have died when walking upstairs, so serious was his heart trouble. They found that he walked up a gradient underground and collapsed at the top of it. They held the view that the heart trouble had been accelerated and aggravated by that exertion.
There are many cases where a man is already suffering from a natural complaint and in addition has an accident. There have been decisions under the old workmen's compensation legislation where on the issue of aggravation a man's general disability should be taken into consideration as distinct from consideration of a case where a man is suffering only from an accident.
The present Act is a vast improvement on the old one, but under the old Workmen's Compensation Act the provisions in this respect were better. A doctor could then be cross-examined in the witness box and under cross-examination these facts were brought out. In the case of Moore v. Tredegar Colliery, the doctors said that death was due to a diseased heart, but under cross-examination they admitted that there could have been aggravation of the condition. It is often the last straw which breaks the camel's back. Mr. Parliamentary Secretary, 822 under the Workmen's Compensation Act——
§ Mr. Finch
I am sorry, Mr. Speaker.
There is no case for the Parliamentary Secretary to resist the Bill. I understood that under the Industrial Injuries Act the principles of workmen's compensation as referring to industrial injuries were to be followed. The Commissioners are not following the principles of the Workmen's Compensation Act. Had they done so, I do not think we would be agitating to the extent to which we are today.
If a man has emphysema or bronchitis and in addition pneumoconiosis, the combination of those disabilities must be taken into consideration in arriving at the extent of his disability. Whatever the views of medical men on aggravation, we are on very firm ground here. I have had many years' experience of this matter. As my right hon. Friend the Member for Llanelly knows, we had a long struggle in the early days to get silicosis established as an industrial disease.
Bernard Shaw wrote the play "The Doctor's Dilemma". We had all kinds of dilemma. The doctors said that silicosis was not due to working in the mines. After years of argument, they admitted that there was such a thing as silicosis but it was connected with silica. Then men were certified as suffering from silicosis although they had not been handling silica. The medical men found by examination that such men had died from silicosis. Representatives of the Medical Council came to South Wales. They came to the conclusion that any dust on the lungs was injurious and they extended the diagnosis to one of pneumoconiosis.
This has been a long struggle over the years. Now we are having the old arguments trotted out by medical men that they have to be very cautious. On the medical evidence which the Ministry has there is an unanswerable case for bronchitis and emphysema to be included on the lines suggested by my hon. Friend the Member for Merthyr Tydvil. I thank him for bringing the Bill forward and I hope that it will have the support of the House.
§ Several Hon. Members rose——
§ Mr. Speaker
Order. I remind the House that many hon. Members wish to speak in this debate and I hope to be able to call all of them.
§ 11.58 a.m.
§ Mr. Marcus Worsley (Chelsea)
I shall be very pleased to respond to that invitation, Mr. Speaker, because I wish to address the House only briefly. I start, as others have started, by congratulating the hon. Member for Merthyr Tydvil (Mr. S. O. Davies).
I do not speak with first-hand knowledge of this subject, but many hon. Members who will address the House have first-hand knowledge of it. I wish to make a more limited contribution. Perhaps it is of some value that an hon. Member who represents a constituency which is not a mining constituency should say this.
This is not a matter upon which there is any difference of opinion between the two sides of the House, or within the community. We are all agreed that these and other industrial diseases should, as far as possible, be prevented by measures of industrial hygiene. If diseases of this character are contracted the whole machinery of the State must be used to help those who suffer from these diseases currently, or as a result of diseases contracted in the past.
I hope that the Parliamentary Secretary will be able to answer two questions. First, is our knowledge of these diseases as good as it ought to be? Hon. Members have indicated that perhaps that is not so. Secondly, is the knowledge we have being translated into Government action rapidly enough? Hon. Members have clearly indicated that it is not.
I hope that the Parliamentary Secretary will say something about how the Government approach an issue of this character. I ask him specifically whether, when the Government considers matters of this kind, they take into account the enormous amount of work and research which are taking place in other countries. The hon. Member for Merythr Tydvil briefly mentioned some of the work in other countries. I want specifically to mention the work being done in the European Coal and Steel Community. I am one of those who 824 regard it as one of the historical tragedies that we were not signatories to the Treaty of Paris in April, 1951.
One of the beneficial effects of our being a signatory would have been that we should have been involved in all the work which has been done by the High Authority on all the questions relating to social welfare in the industries under its supervision. It is very much part of the purpose of all the members of the Community that there should be a social side to their activities. Social matters include retraining, housing, and so on. In other words, "social" is perhaps used rather more widely than we use it.
To what extent are the Government in touch with the research being carried out by the Community in particular, but also by other international institutions? For instance, are we in touch through the Council of Europe with other research? To what extent are we using the World Health Organisation? To what extent is work being done in this respect? Or do we, as I think is one of our national faults, tend to regard the work being done in this country as the best and carry on in our own sweet way?
All these matters are international problems. All industrial diseases occur in all industrial countries where the particular industries exist. It would be tragic if any benefit which could accrue to individuals in this country is not accruing merely because there is not a sufficiently wide dissemination of the type of information which is becoming increasingly available. I know that the Coal and Steel Community has, to begin with, made a lot of money available for research into industrial diseases. I am told that up to the end of last year about 25 million dollars had been spent directly by the Community on research.
The hon. Member for Merthyr Tydvil referred to the research carried out in South Wales. We are entitled to ask the Government this question. Whether the research is conducted in South Wales, on the Continent or elsewhere, is all the resulting information satisfactorily pooled? Are we getting the best of international research? One of the great benefits of the Community organisation is that it specifically provides for such a pooling of information. The High Authority has 825 organised seminars and discussions, including Governments, experts, representatives of employers and trade unions, on these very matters. To what extent have we been able to take part in such discussions? I know that we have been able to act as observers, but to what extent have we been able to take our experience to the Community and share it with that of the Community members?
In all social matters in the past this country and others have tended to look at their own problems in an isolated way. However, a new approach is developing. I can imagine no more important field where this approach should be applied than that which we are discussing. This new approach tries to select and adopt the best of the experience of all the different developed countries. Both the Treaty of Paris and the Treaty of Rome employ a phrase about the improvement of social conditions in an upward direction. The conception is that whatever any country does best should be adopted as an example by other countries—in other words, that there should be a levelling up. This is the idea that we ought to follow. We shall find in many cases that our provision is the best. In others we shall find that we lag behind.
I hope that the Joint Parliamentary Secretary will be able to give us some information on this. I beg the Government to make absolutely crystal certain that the very best of knowledge is gleaned from the Continent of Europe and the whole world and that, this knowledge having been gleaned, Government action will follow as soon as it is revealed to be necessary. If this is done, the Government will fully live up to their responsibilities. If it is not done, they will not be living up to their responsibilities.
§ 12.6 p.m.
§ Mr. James Griffiths (Llanelly)
I shall respond to your appeal, Mr. Speaker, and be very brief. I wish to say a few words on this subject, as I had the privilege of piloting the National Insurance (Industrial Injuries) Act, 1946, through the House almost exactly 21 years ago. I am glad that after 21 years' experience everyone agrees that the new approach to this problem embodied in that Act was such a beneficial change 826 from the old Workmen's Compensation Act that there is no call to return to the old system. 'The Act embodied a very big break from the past. On the whole, I think that the new approach has been well proven.
There was, and still is, a school of thought amongst students of our social services that a separate Industrial Injuries Scheme is a mistake. They contend that there should be one comprehensive social insurance scheme to cover all illnesses and all the contingencies of life. Many people argue strenuously against there being a differentiation between the payments made for different forms of accidents or diseases. Sir William Beveridge rejected that view saying, for reasons which I shall not elaborate, that there should be a separate Industrial Injuries Scheme.
One of the most difficult problems is that of industrial disease. If there are to be separate provisions for disability arising from accident, it has been strongly argued in the past that when a disease is scheduled as an industrial disease, a casual relationship must be shown between the disease and the occupation. The Act was passed on that principle. Arguments can arise about whether the principle should be removed. Even on that basis, narrow as it may be, there are strong grounds for urging the Ministry to consider the extension of criteria in the way the Bill proposes.
Much research work has taken place in the last 21 years. Llandough has been referred to. I am sure the whole House will join me in paying tribute to Dr. Morgan who, we heard with regret, recently passed away. In the great service he rendered for the whole of that period he brought great gifts of mind and of humanity. In these 21 years, all the evidence has shown that there is a casual relationship in miners between bronchitis, emphysema and pneumoconiosis. I hope, therefore, that my hon. Friend the Parliamentary Secretary will consider this. It may be that he cannot accept the precise drafting of the Bill, but he could accept it in principle on Second Reading and let it go to a Committee upstairs, where it could be examined by hon. Members, from all sides, with experience in this matter. 827 I think that it is now beyond question that there is a casual relationship between the incidence of bronchitis, emphysema and pneumoconiosis among coal miners, and, it may be, among others, too. I speak as one with coal-mining experience. We all know of the need not only for justice to be done, but for it to be seen to be done. One of the biggest difficulties which I and my colleagues who represent mining constituencies have had is to explain to somebody why one man has been certified and receives industrial injury benefit whereas the man living next door, whose symptoms and disability might be exactly the same, does not. It is beyond any of us to be able to explain to those two men why one is entitled to receive industrial injury benefit but the other is denied it. Therefore, the case for the principle embodied in this short Bill has been established.
I have always had a healthy scepticism for experts in this field. They have not always been right. I have had long experience of dealing with silicosis and pneumoconiosis from the very first. The first statutory provision was made in 1928. Looking back on it, it was the most stupid Measure ever passed. The decision was made that a man could not be disabled by the disease unless it was the so-called classical definition of silicosis, which did not arise in this country. Even if a man was disabled by the disease, he had to prove also that he had worked in rock containing 50 per cent. of free silica. It was only as a result of pressure in this House—I was one of those who exercised it—that an investigation was conducted by a special team appointed by the Medical Research Council. As a result of the Council's investigation in South Wales, a good deal of it in my own anthracite district, the criterion was widened to include the reticulation of the lungs and the new term "pneumoconiosis" was introduced.
I have always had scepticism about the views of experts, but even the experts are now coming strongly to the view from all the evidence available that there is a causal relationship between pneumoconiosis, emphysema and bronchitis in miners. I hope, therefore, that my hon. Friend the Parliamentary Secretary will say that the Ministry accepts the Bill 828 on Second Reading, reserving the right to consider in Committee how these matters can best be expressed in detailed terms in the Bill.
One of the most important changes in the National Insurance (Industrial Injuries) Act compared with the old Workmen's Compensation Act was that we changed radically the judicial procedure and the method for settling disputes. It is, I think, accepted—I was determined about this—that much of the money was wasted in the courts. I do not know how much my old union, the National Union of Mineworkers, paid over the generations on court procedure before the new Act came into operation. On the whole, the present arrangement is accepted as being better.
My doubt was not whether we should take cases away from the county court. My one doubt was whether, when the new legislation was introduced, I should leave out the right of appeal to the House of Lords as a judicial tribunal. The reason for this is related to something which my hon. Friend the Member for Bedwellty (Mr. Finch) and my hon. Friend the Member for Merthyr Tydvil (Mr. S. O. Davies) have said. Incidentally, I congratulate both of them on their speeches and my hon. Friend the Member for Merthyr Tydvil on his luck in the Ballot and for the use he has made of his opportunity.
There were some 3,000 cases which constituted what was called judge-made law or interpretation of the old Workmen's Compensation Act. The one field in which the House of Lords as the judicial tribunal had been generous or had leaned over on the side of the workman was in deciding cases in which the claim was that death had been accelerated by an accident or disease. I said during the proceedings on the National Insurance Bill in 1946 that my desire as Minister was that that practice should be followed.
I must tell my hon. Friend the Parliamentary Secretary that in cases of acceleration of death, particularly in cases of pneumoconiosis, the commissioner is far less generous than was the House of Lords. I have at times conveyed this view to successive successors of mine in the interesting and enjoyable post of Minister of National Insurance. That is 829 my conclusion, but I find it difficult to explain this to ordinary people.
Speaking as an old collier with a lot of experience, I refuse to accept the verdict of even the highest expert in the land that pneumoconiosis does not hasten death. From all my experience, I am sure that it does. It would have to be carefully worked out, but I should like to see a provision by which a miner certified as being disabled during life should be deemed to have died of the disease. Otherwise, we get back to the old method of deciding whether or not death was accelerated by the disease. It may be that we could agree that in cases where the miner has been certified at a given percentage, it should be accepted that he would have lived longer but for the disease.
I remember a case in which I had to negotiate. We failed and we went to the county court. The man in question collapsed in a tram and was taken to hospital and died. In court, the medical evidence, with which my generation was familiar, was given on both sides. It was found that the man was suffering from leukaemia. I remember the judge saying to the doctor in court, "Accepting what you say, that this man had leukaemia and had at most only another year to live"—there was evidence that on the day he died an accident had occurred—"tell me, doctor, would he have died that day but for the accident? The doctor replied, "No." That is the kind of interpretation we want, and my intention as Minister was that this interpretation should be used. I hope, therefore, that the Joint Parliamentary Secretary will do that. I think there is already in the House today a desire now that we should accept the principle of the Bill, leaving the details to be worked out afterwards.
Estimates have been given about the costs to the Fund. The Fund has reached over £300 million, and it is a Fund to which workmen contribute, too——
§ Mr. Griffiths
—as well as employers and the State.
I believe, therefore, that on these grounds the case in principle has been made out, and I hope it will be accepted, and that my hon. Friend the Joint Parlia- 830 mentary Secretary will look at the matter of acceleration, to which I have referred, and which is not distinctly covered by the Bill. I congratulate my hon. Friend the Member for Merthyr Tydvil. If he gets this Bill through, as I hope he will, it will not have been the first, nor will it be the last, service which, through this House he has given to the people.
§ 12.20 p.m.
§ Mr. Emlyn Hooson (Montgomery)
I should like to follow the right hon. Gentleman the Member for Llanelly (Mr. James Griffiths) and the hon. Member for Bedwellty (Mr. Finch) in what they have raised, namely, the interpretation of the law. I found it fascinating to learn from the right hon. Gentleman that when he was Minister he had toyed with the idea of allowing the right of appeal to the House of Lords to remain, and I wish he had, because I believe that the history of the Workmen's Compensation Acts showed that the higher the quality of the tribunal the more ready it was to take the law into its own hands and to give it a more liberal interpretation.
The hon. Member for Bedwellty referred to the case of Moore v. Tredegar Iron and Coal Company where the Court of Appeal accepted that where a man aged 45 died after walking 180 yards in the pit at his work underground and was later found to have heart disease after he had fallen, his fall at work had to be regarded as a contributory cause of his death. On the evidence there was a presumption that a contributory cause of his death was his occupation, and he was entitled to damages; and his widow got damages.
§ Mr. Hale
Yes, nystagmus—and the various medical theories, and so on, and if he will look up the case in which a boy of 14, for whom I appeared, was refused compensation for crippling osteomyelitis on the ground that he failed to give notice in a week after his 831 doctor had told him that he would be better in a couple of days, he would not take so liberal a view.
§ Mr. Hooson
I think that the hon. Gentleman is not doing justice to the judges here, because in the very case which the hon. Member for Bedwellty raised the Court of Appeal held that it was bound by the decision of the House of Lords which had been made a little before in a case of very similar circumstances. I have no doubt that in fact there was scope for far more liberal interpretation, but by and large, in many cases a liberal interpretation was given, and the higher one went among the courts the more likely one was to have a very liberal interpretation.
I must add my congratulations to those already proffered to the hon. Member for Merthyr Tydvil (Mr. S. O. Davies) for bringing in the Bill. I know that this is a matter close to his heart, and we Welsh Members of the House in particular, have a very warm affection for him, and congratulate him both on his luck in the Ballot and on his choice of subject.
I was extremely interested in the point raised by the hon. Member for Chelsea (Mr. Worsley) about pooling our experience and the experience of European and other countries. It is a very odd thing that bronchitis is known in international medical circles generally as the English disease. It is not the only disease which has been known as the English disease from time to time, but the probability is that for this particular description there is greater justification.
However, it could also be called the Welsh disease, or the Scottish disease, because the incidence of this disease in Great Britain as a whole is about 20 times that in any comparable country on the Continent. It is fascinating to learn that if one took a map of Britain showing the incidence of bronchitis and emphysema, it would be seen that that incidence would almost exactly correspond with those areas where there is the highest degree of air pollution.
I have spoken to two or three medical men on this matter, but in the end I went for a definition of bronchitis to the latest edition of the Encyclopaedia Britannica, the 1966 edition: 832Acute bronchitis may be precipitated by a variety of physical and chemical agents. These include hot or toxic gases inhaled by fire victims, fumes of strong acids, ammonia, certain volatile organic solvents, war gases such as mustard and chlorine and irritating dusts such as silica and beryllium.Now that is the definition of bronchitis.
If we look at the statistics of mining areas we see that there is a high incidence of bronchitis and emphysema as well as of pneumoconiosis. It stands to reason that we must find a high incidence of bronchitis in areas where people are inhaling dust from the air. So how much more likely is it to find bronchitis among men working under ground where larger silica particles are trapped in the bronchus while the smaller particles tend to reach the lungs, and cause pneumoconiosis. Where there is already a condition of pneumoconiosis, which, normally takes some years to manifest itself, but the man appears to be normal, and then there is on top of that an onset of bronchitis it is a matter of common sense that there must be an almost inevitable causal connection between the work he is doing and the condition from which he is suffering.
I would have thought it absolutely right that the Ministry should accept that where a man already is suffering from pneumoconiosis and it is then discovered that he is suffering from either emphysema or bronchitis, the effects of either of the latter should be interpreted as the effects of the former. After all, this principle has already been accepted in relation to tuberculosis, and I should have thought that at least the Ministry could accept the added liberal interpretation suggested by this Bill.
Where it is already established that a man is suffering from pneumoconiosis, and then it is established that he is suffering from bronchitis and emphysema, it follows in an overwhelming number of cases that he must be suffering from this as a result of his work. I think that it is absolutely right that in countries like Australia and several Continental countries they have accepted bronchitis and emphysema in themselves as occupational diseases. I should have thought that there is an overwhelming case for accepting this in this country—alone, unconnected with pneumoconiosis—because of the geographical correlation of the incidence of 833 bronchitis and emphysema with the industrial areas of high air pollution.
This is a case where I should have thought that the only argument any Ministry could have for refusing this short, simple Bill, which, for all its shortness, is so very important to a considerable number of people—the only possible argument the Ministry could have against accepting the Bill would be the money argument, and that is an argument which this House in 1966 should not accept.
I am absolutely convinced that, whatever the, medical evidence has been in the past, there is a relationship between these diseases of the lungs and the chest. Where people are working in an occupation such as mining, which causes the terrible disease of pneumoconiosis, they were also likely to suffer bronchitis or emphysema. Not only is the risk of their contracting either far greater, but if they do contract either, then the effects are likely to be much greater because of the underlying conditions of pneumoconiosis, even when it has not manifested itself up to that stage.
I hope that the Joint Parliamentary Secretary will not only accept the principle of the Bill introduced by—I would call him my hon Friend, certainly for today—the Member for Merthyr Tydvil but will accept it in its total effect. There may be some tidying up to do as a matter of expertise by the Ministry, but surely the overwhelming wish on both sides of the House is that bronchitis and emphysema should be added to tuberculosis for these purposes, as it should have been, I believe, even years ago.
§ 12.30 p.m.
§ Mr. Leslie Hale (Oldham, West)
Justifiably, my right hon. Friend the Member for Llanelly (Mr. James Griffiths) has the right to claim the praise which was given to all supporters of William III. The transition from the old king to the new, and the old Workmen's Compensation Act to something new, was bound to be welcomed. The Workmen's Compensation Act suffered from many defects, a major one of which was the hopeless inadequacy of the compensation, and the treatment of industrial diseases was perhaps its worst feature.
I have checked my memory, and I find that I made my maiden speech in this 834 House 21 years ago on the Second Reading of the National Insurance (Industrial Injuries) Bill in October, 1945. I said, sadly:I have observed with some surprise that, although there appears to be universal rejoicing at the obsequies of workmen's compensation, there appears to be a great deal of gloom at the christening of the National Insurance Act. It is a child born of mixed political parentage, conceived in time of strain and stress and, in my respectful opinion, prematurely delivered to the House this week. Let us be quite frank about what we are doing. We promised to give the workers additional social insurance. We are not giving it to them, but selling it to them, and selling it at a fairly high price. The whole of the additional benefits under this scheme are being paid for by the worker and paid for in advance.Mr. Speaker, my hearing is now so bad that I have to speak with some hesitancy when I refer to what other hon. Members have said during a debate. I thought that I heard my hon. Friend the Member for Bedwellty (Mr. Finch) say, in his speech, something which I have been waiting to hear said in this House for 21 years.
I concluded my maiden speech with these words:We are proposing State ownership of the mines which I wholly support; we are proposing nationalisation of the health services, and I wholly support that. But I want hon. Members to understand that when a workman has to go to a State doctor, after an accident incurred in the service of a State employer, and then has to go to a State official to decide whether he is entitled to compensation, there will be a great deal of dissatisfaction about the result. In my respectful view that is not a Socialist dream, but a Marxist nightmare …"—[OFFICIAL REPORT', 11th October, 1945; Vol. 414, c. 518, 523.]We have lived through it in these years. With great respect to the hon. and learned Member for Montgomery (Mr. Hooson), who, I understand, is a bachelor of medicine——
§ Mr. Hooson indicated dissent.
§ Mr. Hale
—I beg his pardon; I thought that he was.
Emphysema is part of this. It is true that it can be argued that it is not invariably associated with this sort of disease, but it is part of a dust disease of the lung and, in many ways, the worst part of it.
In Oldham, we have byssinosis. The vital difference between byssinosis and what used to be called anthracosis, 835 silicosis and the various coses is that byssinosis results from a vegetable dust and the others result from a metal dust. However, no one has found very much difference in the suffering of the patient or in the relation with emphysema.
A soft vegetable dust begins to be absorbed or disposed of. If a post mortem is performed on a person who has suffered from anthracosis, his lungs will be found to be filled with dust. In the case of a person who suffered from byssinosis, the soft tiny pieces of vegetable are invisible, and necessarily so because they can be absorbed.
My constituents used to say that emphysema feels like an iron band round the chest. The sufferer from emphysema is the victim of a terrible disease because, in a sense, all his efforts to get better make him worse. He is suffering from a respiratory deficiency. We do not know whether it is inspirational or aspirational, although we know that the inspirational muscles of the lungs are stronger than the aspirational muscles. Either way, the effort becomes a burden, part of the general deterioration and part of the increasing debility, distress and physical decay.
Since 1921, we have built up a nice balance in the Industrial Injuries Fund. It had reached £100 million when I last heard of it. For 21 years we have had the National Insurance Fund, and always a great statistician from somewhere like Hungary comes along saying that we have to prepare for extraordinary eventualities, that there are manifestations of a great increase in births taking place in the country, that people are living too long, and, whereas decent people used to die at 70, they now insist on living to 80 out of a perverse desire to put the fund in jeopardy. As a result, we have to keep an enormous balance.
However, none of those arguments applies to the £100 million sitting in the Industrial Injuries Fund.
§ Mr. S. O. Davies
May I remind my hon. Friend that I said in my speech that the fund had reached what I described as the astronomical total of over £327 million by the end of March of last year?
§ Mr. Hale
That is heartening news. It is about the only thing that has increased under the present Chancellor of the Exchequer.
I admit that the last time I looked at it was a couple of years ago. It seemed to have gone down substantially under the Tories, having been invested in all sorts of extraordinary things like 3½ per cent. transport stock. If my bank manager knew that I had any shares in 3½ per cent. transport stock, he would ask me to shift my account somewhere else; and I do not find it easy to maintain it where it is at the moment.
The other symptom associated with emphysema—and I now have before me a medical encyclopaedia, although I do not propose to quote from it—places emphasis on dyspnoea. That is characteristic. According to the greatest experts on byssinosis, it is the one symptom which can be measured, calculated and identified.
If a man comes out of a cotton mill on a Friday, has a rather cheerful day at Oldham Athletic, who are doing well now, and has a weekend in the open air with a walk on the moors, when he goes back to the cotton mill on Monday he will at once be affected by the excessive, heavy breathing which the new dusty conditions impose upon him. That can be measured. It is said to be one of the things which do not so happen with ordinary bronchitis. It happens with industrial bronchitis, because that is very largely what it is. It happens in the dusty lung-disease form of bronchitis which has its own symptoms and its own additional sufferings, but, pathologically speaking, the two bear a considerable resemblance.
The hon. and learned Member for Montgomery said that we have exempted tuberculosis as being associated with pneumoconiosis, and he is right. But the same does not apply to byssinosis. I have introduced Bills on the subject in relation to byssinosis, and on each occasion I have apologised to my hon. Friends and colleagues for leaving out pneumoconiosis, because there is a definite special problem of diagnosis. I have said that, although this should apply to all coal disease, the problem of diagnosis is that a vegetable dust cannot be detected by X-ray examination while a man is alive.
837 If my hon. Friend the Member for Merthyr Tydvil, who moved the Second Reading, of the Bill so movingly, had continued his investigations, he would have found that no one gets a 100 per cent. pension for byssinosis. They are all written off. People come to see me, panting and puffing, but have to qualify for 10 years in the most limited occupation. We have to establish 10 years of work. There are more ways of avoiding paying Industrial Injuries Benefit under the Act as it stands than there has ever been. The burden on the sufferer has become absolute in these cases.
The doctors may say that it is bronchitis to start with, and if they do the matter is never put right. I think that it was the hon. Member for Sutton and Cheam (Mr. Sharples) who said that when people are dead and a post mortem is held and the symptoms are found it is too late to put things right. There is no back pay. There is no going back on a decision. Why not?
In this country we are short of doctors, but there are stacks of doctors in the Ministry of Social Security. The other thing is that these people are always said to be independent. Application is made to "independent" officials whose position is like that of a Juge d'Instruclion, who is responsible to nobody. He can arrest the emperor. He can have an investigation against a Prime Minister. During these last few weeks of the Ben Barka case he has nevertheless had regard to General de Gaulle as his salary comes from the Treasury and if they do not behave they can get shifted to a disagreeable place. I do not say that the Ministry of Social Security does this, but when it talks about an independent official who is paid and appointed by the Department, and who is transferred by it, that is not what I was brought up to believe was independent.
We are told that they are examined by independent doctors. I get case after case in which doctors send the report to the Ministry of Social Security, and refuse to give it to the patient himself. I have case after case of this kind in which I am seeking to get medical evidence, and I cannot afford to go on paying fees for medical evidence in cases which I do not expect to win, in cases in which I am engaged merely as a Member of 838 Parliament, unpaid, and in a voluntary capacity. One cannot go on doing it.
They drift into Manchester without a doctor on their side. They are told to take off their shirts, and they come back and say that they were out in four or five minutes. Admittedly, with byssinosis there is radiological examination by an expert team, and that is it. I am talking about normal cases. They call for an examination and report. One thing that one can say is that the methods of diagnosis have improved, but I wonder how many people would really like to say that more workers are getting this today?
§ Mr. Tam Dalyell (West Lothian)
With his unparalleled knowledge of byssinosis, how would my hon. Friend answer a constituent who comes to a Member and says, "I gather that there is a 20-year rule which applies to byssinosis. Why cannot it apply to me as a pneumoconiotic?" With his unparalleled knowledge, can my hon. Friend answer that?
§ Mr. Hale
This is true. Byssinosis was Custer's last stand on lung disease. Everybody else had got it. It was gradually applied to this process, to that process, and to the other process but the cotton industry is a nice industry, not to work in, but they are nice people. They are uncontentious people. They fought this fight over the years with great ability. Cotton commands only four or five Members' votes in this House. Cotton is always last in the queue. Cotton today is supporting the Government keenly, and, I might almost say, blindly, on some things. It has not had an ounce of reward or recognition.
Cotton disease was the last disease to be scheduled, and it was scheduled on such limited conditions that 75 per cent. of cotton workers could not qualify in any circumstances. They do not even work in the limited process in card rooms and blowing rooms where the percentage of dust establishes the right to the disease. This is the position in cotton.
I wish my hon. Friend well with his Bill. I hope, Mr. Speaker, that you will permit me one sentence which goes a little near the boundary, but I think that it is a reply to the hon. and learned Gentleman opposite. Of course, we should get to the situation in which every 839 disabled man, every chronically sick man, gets a pension, instead of providing employment for 10,000 contentious doctors to argue about what it is. If a man has silicosis, he has it. If he gets it in the sands of the desert, he gets one pension. If he was on the sea off the desert, he does not get one at all. If he gets it in a mine with a certain percentage of dust, he gets another type of pension. If he gets it in a mine with not that percentage, he is not entitled to benefit, and if he gets it somewhere else, he gets National sickness benefit. It takes 12 months after 12 months of applications to refuse it. This is money for which he has paid for. He is being compulsorily charged for it. He has an insurance contribution imposed on him by this House, and he is constantly bilked of his rights.
I have been a little controversial. I hope that it will not redound on my hon. Friend the Member for Merthyr Tydvil, who speaks not only with great experience and authority, but with great support. I hope that he will not have the experience which I had on byssinosis, when I was told on a Friday, four o'clock, that someone had said "Object". I ventured to say to the late Speaker, whose word I would never dream of doubting, that I had not heard it, and I was assured by everyone who came out of the House that they had not heard it, either.
We conducted a mild inquiry into the geographical potentialities of the Chamber and found that only a Whip could have whispered that word, and a Labour Whip at that. So, on the following Friday, I was there with my hearing aid on with another Member sitting next to me who would listen well. It was again whispered so inaudibly, and, I would say, with such feeling of unease about performing a difficult duty, that one of the Bills got upstairs and two got killed by a slightly louder whisper.
When we got upstairs the Minister made a two-minute speech saying that there would be no Whip, because I had already whipped everybody on to the Committee anyway, and it was a rather hopeless proposition. We passed Clauses 1 to 4 without discussion. I made a two-minute vote of thanks speech to the Chairman, and at 11.4 the Bill passed to 840 its next stage. But, unhappily, in July, 1965, there was pressure of business, and with the coming of the grouse and salmon season it meant that no Parliamentary time could be found. In July, 1966, when I was, unhappily, or happily, absent, as the case may be, the House was sitting all night up to the opening of the grouse season, though I think that it found time to attend to the partridges.
I wish the Bill well, and I hope that it will be received very much more generously.
§ 12.49 p.m.
§ Mr. Robert Woof (Blaydon)
I think that the House will appreciate the great human feelings expressed by my hon. Friend the Member for Merthyr Tydvil (Mr. S. O. Davies) and the sincere manner in which he has introduced the Bill. We know that for many years my hon. Friend has dedicated himself and kept face to face with problems of industrial diseases, and when he addresses the House on such serious matters as this, he does so from a great depth of personal knowledge and varied experience.
What I always find refreshing is that all the mental and social influences help to create an insatiable demand for thinking. It is a physical process and it cannot exist or produce anything without materials any more than can any process of labour. My hon. Friends the Members for Merthyr Tydvil and Bedwellty (Mr. Finch), together with my right hon. Friend the Member for Llanelly (Mr. James Griffiths), have submitted a great deal of evidence which is undoubtedly the product of serious thinking.
I suppose that the way we set about the affairs of life is conditioned by the way we think, but I join in welcoming the Bill and I hoped to respond to your appeal, Mr. Speaker, by keeping my speech short. I do not intend to deal with the matter at any length, except to say that while the measures proposed may be regarded as controversial I am of the opinion that it is right to seek to remedy an injustice and bring about an improvement in respect of many who fall by the wayside. We all realise that health is the soul that animates enjoyment but there are a thousand doors to bad health. There is no more sorry sight than to see a person's strength degenerate—to see him lose his vigour, as when the bright glowing 841 hue of hope has passed away and in its place dark shadows fall. It is then that the spirit breaks and energy gives way to despondency.
Some of the facts of health and diseases are not isolated realities they are aspects of life, seen from a particular angle, and because of their complexities and significance they call for much more adequate recognition. We naturally shrink from the idea that our daily working life is becoming more and more mechanical and that men are becoming more and more part and parcel of great machines. The whole conception, or as much of it as mental and physical intolerance will permit, must always be given up to the struggle for a living in strenuous occupations. The great bulk of the population labouring in productive activity must submit to whatever conditions render health risks and try to avoid the ravages of industrial diseases.
We fully recognise that mental and emotional disturbances are more prevalent in times of individual and social distress, but chronic ill health, with its train of acute diseases, is the inevitable lot of those who have to live and work in conditions and circumstances ill-adapted for life. Unfortunately, in respect of nearly all legislation we learn by experience that certain defects arise. We nevertheless appreciate that much has been done to advance the cause of industrial injuries benefit and that a great deal of research work has resulted in obtaining much solid information. Government Departments have improved enormously. We could also say, most fortunately, that we have moved a long way away from those hard and difficult times when, looking back with nostalgic sadness and sentiments, we remember the time when, acting on behalf of fellow union members, we had to face very heavy financial expense in taking legal action to establish claims, by fighting every inch of the way. But stumbling after truth is always a painful process. I well remember the time when it was said that coal dust did not cause pneumoconiosis. It is only in the last 20 years that the nature of the disease as it affects the living body has come to be recognised.
I will go so far as to say that there may be a dividing line between coal mining and other occupations, such as 842 work in refractories, with sandstone, pottery, asbestos, and in the iron and steel industries, but in trying to find the relationships between chest complaints as a result of following employment, I should like to remind my hon. Friend the Parliamentary Secretary of the powers at the disposal of his right hon. Friend the Minister.
Section 71 of the National Insurance (Industrial Injuries) Act, 1965, which deals with the prevention of accidents and the after care of injured persons, provides that:The Minister may promote research into the causes and incidence, and methods of prevention, of accidents, injuries and diseases against which persons are insured under this Act or which it is contemplated might be prescribed for the purpose of part IV of this Act, either by himself employing persons to conduct such research or by contributing to the expenses of, or otherwise assisting, other persons engaged in such research.In view of those powers I ask my hon. Friend what research the Minister is now undertaking. Surely it cannot be a matter of money standing in the way since, according to my hon. Friend the Member for Merthyr Tydvil, the Fund now stands at over £327 million. This is a matter of life and death, and the ruin and destruction of the human body.
This is of great significance. Life is always functioning under some sort of handicap, and I am conscious of the widespread feeling of dissatisfaction among claimants for industrial injuries benefit. There are a great number of casualties of industry who suffer from emphysema and bronchitis, and they are penalised because of a process of work or disease not covered by the National Insurance (Industrial Injuries) Act.
We know that most of the major epidemic diseases are no longer the formidable agents of destruction that they were in the past, but we are well aware of much human suffering through chest and lung complaints, and an increasing number of cases are continually drawn to my attention. They come under the purpose of the Bill and from the point of view of being unable to receive any benefit under existing regulations legislation the mitigating circumstances are really pathetic. I do not want to get bogged down in a mass of medical surveillance, but to use a layman's common language, it is known that focal 843 emphysema is closely associated with the dust foci which are typical of pneumoconiosis. It is scattered throughout the lungs around the dust nodules, and is informally included in pneumoconiosis assessments. It is recognised that this is caused where a portion of the lung has become wasted, or its vesicular structure has become permanently obliterated by disease.
Much eminent medical opinion has been gathered on the subject of emphysema and bronchitis. My hon. Friends have mentioned eminent persons and have quoted from eminent opinions such as those of Professor Gough and Doctor Howells. I should like to take the opportunity to quote from what was said by Sir Thomas Holmes Sellors, a distinguished thoracic surgeon, in a report to the Industrial Injuries Commissioner on 6th December, 1965. He wrote:I have little doubt that pneumoconiosis is an irritant fibrotic disease predisposing the subject to bronchitis and lung inflammation. The chronic damage to the lung renders it more susceptible to infection than in the healthy.This very important statement should be taken at its full value. It should be accepted as reasonable from such an eminent medical authority.
We appreciate that diseases like emphysema and bronchitis can be contracted other than in industry, but a start must be made somewhere. It is the view of the National Union of Mineworkers and the Trades Union Congress that the disease should be prescribed where on the balance of probability, it can be attributed to the occupation. They are of the opinion that, if a man has pneumoconiosis and emphysema or bronchitis, it is an arbitrary exercise to try to decide what degree of disablement is attributable to what cause.
However, the important point is that since dust in the lungs predisposes a man to emphysema and bronchitis, he should receive an assessment for his whole disability. The union emphasises most strongly that we should not forget that the presence of emphysema may lessen the dust shadow on the X-ray and that, thus, it is possible to have a situation where the presence of emphysema, a disabling affliction in itself, could cause the extent of a man's pneumoconiosis to be underestimated.
844 In conclusion, I should like to stress that there is no stimulus like hope. Never in the long, sad story of those who are victims of chest and lung diseases has there been a hope that the alterations suggested and the pleas which we make today will be received favourably and sympathetically by the Government and those forgotten men will not be left behind.
§ 1.3 p.m.
§ Mr. Adam Hunter (Dunfermline Burghs)
It gives me great pleasure to support the Bill of the hon. Member for Merthyr Tydvil (Mr. S. O. Davies), although I come from the other end of the United Kingdom, Scotland. I will not follow other hon. Gentlemen on both sides in giving supporting medical evidence or descriptive symptoms of the disease. I will simply give my experience of the disease as I have known it in Scotland. Everyone knows, of course, that dust diseases are common in many industries, like the steel industry, foundries and so on. Many are scheduled under the Industrial Injuries Act, but others are not, and in those industries are people with emphysema and bronchitis.
Many people are campaigning for an occupational health service, which is important, as such a service will show in the early stages whether injury and sickness can be prevented. These are laudable aims and grand objectives. After all, it is estimated that 20 million working days are lost through injury every year and the huge total of 285 million days are lost through sickness. I am sure that much of that figure is due to bronchitis and emphysema.
There will always be people, despite any occupational health service, who will suffer from diseases. I have heard the interesting theory that certain people are psychologically susceptible to certain diseases. I do not support that theory, but if it were so, an occupational health service would discover when a young person started his employment whether he was susceptible. The two types of disease which my hon. Friend the Member for Merthyr Tydvil wishes to bring into the Industrial Injuries Act are emphysema and bronchitis.
It is difficult to convince a man—almost impossible, in fact—that he is not suffering from an industrial disease. He might 845 be told that he has not got pneumoconiosis but empheysema and bronchitis. This man would be correct in thinking that if he had been exposed for a long time to a variable atmospheric environment in his work, this must have brought on the disease. For example, in the coal mining industry with which I am connected, men work in an atmosphere of concentrated coal dust. There is also the case of the man in a smoke-laden atmosphere caused by explosives and of the man who works in a wet and confined space with very little ventilation, in a pit.
There are other diseases which have not been scheduled. The Scottish miners have been campaigning for some time and have year after year claimed that artio-arthritis is also an industrial disease, particularly for miners who have to work in wet and draughty conditions.
I am only a layman and will not try to contradict expert medical opinion. The miners themselves feel that they have an industrial disease when they have emphysema or bronchitis. Our trade union thinks the same. Many medical experts feel the same. There is a conflict of medical opinion here, but, as has been stressed by many of my hon. Friends, the balance is strongly in favour of these diseases being caused by industry.
I have been a miner for 40 years—until very recently—and I saw some years ago a man suffering from byssinosis, and to me this was dreadful. The man was in the most progressive stages of the disease and I thought, what a terrible condition for a human being to get into. He died a few days later. I also encountered, a few weeks ago, a man suffering from asbestosis. This disease was not in an advanced stage, but it was a tragic spectacle, and the prospects of tolerable health in the years to come for this man are not very encouraging.
As a Minister, I have had personal experience of these problems, for I have worked side by side with men suffering to a lesser or greater degree from pneumoconiosis. I have worked with men who have had what they considered to be emphysema and bronchitis, and in certain stages of the work schedule these men sometimes found themselves scarcely able to draw breath. I have no doubt at all that emphysema and bron- 846 chitis should be scheduled as industrial diseases.
I have been lucky, with my long experience in the pits, in keeping my health and being robust almost in every way, but I have been with men coming up roadways and out of roadways before and after a shift, on levels or on steep or light gradients, when we have passed workmen who were compelled to rest because they were unable to walk even on level ground. That was a tragic thing to see. As miners we gave them our compassion, but they do not need compassion. What they need is compensation and certain arrangements made for them to work in dust-free conditions.
I will not speak at length because I know that a number of my hon. Friends are anxious to take part in the debate. I want to draw attention to a minute of the Scottish Union of Mineworkers from which we learn that the Minister of Social Security has made a concession. It is not very much, because I am mainly concerned with the category 1 pneumoconiotic. We have the man who is told, when he has an ex-ray at the colliery, that he has a certain degree of pneumoconiosis. He goes to the doctor, is given a clinical examination and is certified as having category 1 of the disease. In many of these cases the man's own doctor feels strongly that the man is suffering from a great disability because of the amount of pneumoconiosis from which he is suffering. The trade union is compaigning to have category 1 of the disease introduced into the Industrial Injuries Act. Often a man who has category 1 pneumoconiosis also has emphysema and bronchitis, but he is nevertheless not considered to be suffering from an industrial disease.
I am pleased that the Minister proposes to undertake a pilot scheme which involves setting up a special pneumoconiosis panel to deal with certain categories of cases. That is a step forward, but not enough, and I plead with my hon. Friend to go further and to support this Bill.
§ 1.14 p.m.
§ Mr. Leo Abse (Pontypool)
I am sure that it is regarded by all of us as sadly appropriate that my hon. Friend the Member for Merthyr Tydvil—and for Aberfan—(Mr. S. O. Davies) should have 847 brought in this Bill today, and I feel privileged that he has permitted me to act as one of his co-sponsors to the Bill.
When the Government are considering whether to make this refinement of the law, which will ensure that chronic bronchitis and emphysema will be part of the scheduled diseases under the Industrial Injuries Act, it would be well for them to take into account the fact that the protection afforded generally by law to the miner against accidents and diseases is such that the miner is far from being cossetted.
My hon. Friends have described how the miner may be plunged into Stygian darkness and consequently exposed to the hazard of nystagmus. We know too that even though we have converted the mines so that they are no longer the rat holes they were under the old coal owners, the figures show how prevalent dermatitis is, and we know that this inevitability arises from some of the dirty conditions which exist in the mines. Again, we have been hearing today how lungs may be turned into stone as a consequence of the hazards of pneumoconiosis.
Those of us who are lawyers and are thus brought into contact with common law industrial accidents are well aware that the law which covers the miners is far from satisfactory. It should be known to the House that the Act which governs the working conditions of miners was brought in 16 years or more after a Royal Commission had been sitting. When the Royal Commission was sitting we had 40,000 pit ponies underneath the ground. By the time that the Mines and Quarries Act came into existence we had hundreds of miles of conveyor belting. In considering, therefore, whether we should give this little extra protection to the miners we should bear in mind that it is disgraceful that, perhaps because factory legislation has been introduced later or because it has been more vigorously pressed, factory workers now have far more protection under the common law than have miners. It cannot be, for example, right that a Section of the Mines and Quarries Act should be so oppressive that it can deprive miners from compensation for accidents arising out of unfenced machinery in the mines. It is long overdue that the Section was repealed so 848 that miners were offered the same protection as is enjoyed by factory workers under Section 14 of the Factories Act.
In my view it is unsatisfactory that, as a result of the considerable mechanisation which has taken place since the Act, and particularly since the Royal Commission, again and again decisions are taken in the courts which reveal the disadvantages under which the miners suffer. The miner should be under no less legal protection than are the factory workers in a factory. If that is to be done, an absolute duty should be placed on the mines management to ensure that roads and passing places in mines are made and left secure. In view of the many accidents which have occurred, it is also wrong that there is no accepted method of dealing with faulty belts. There should also be regulations analogous to those dealing with the operation of unfenced machinery in factories. I could cite many more instances of the legal disadvantages of the miner.
When a plea is being made for what miners regard as an urgent reform of the existing law, the Government should remember not only that these men are being compelled to live hazardous lives but also that mining communities, as we know only too well from recent events, have to endure special difficulties and hazards. All this should be borne in mind when considering this very little demand which we are making.
There was a time when miners could be obtained very easily. Today, even in areas of high unemployment, that is no longer the case. Miners' wives are making themselves heard, particularly when the choice must be made about where the man should be employed. With the cannibalisation of mines taking place and with men being told that moves must he made, we are seeing a nose dive in the number of men employed in the mines and great difficulty will, no doubt, arise before we have alternative sources of power in this country, simply because we will not have the miners to man the pits. This is clear in such areas as Monmouthshire, which I represent, where it is desperately difficult to obtain miners, despite some unemployment.
The modern miner will not tolerate the conditions which his parents tolerated. 849 It is absurd that factory workers and lorry drivers should have more legal protection than a man who risks his life by going down the pits. Why, if a man contracts pneumoconiosis, this wretched disease, should he not be able to show that he has been working for, say, three years in the mines and, as a result of that, has contracted pneumoconiosis? Why should he not then have a claim at common law, apart from the question of the industrial injuries legislation?
The community expects a miner to expose himself to hazards of the kind I have described. Why should he be expected to be denied the lawful protection which is given to other sections of workers? Hon. Members who represent mining constituencies, particularly those in the generation to which my hon. Friend the Member for Merthyr Tydvil belongs, have fought many battles on behalf of their constituents. But today, under a Labour Government, more than half way through the twentieth century, to expect any man to expose himself to the dangers of pneumoconiosis and not have an absolute presumption of his right to claim for common law damages if he has worked in the mines and has contracted this disease—with only the question of the quantum of damages to be decided—is more than puzzling.
This present reform, placing emphysema and bronchitis on the scheduled list, is long overdue. I say to my hon. Friend the Member for Merthyr Tydvil and his fellow hon. Members of the older generation that, great as their demands have been, they have not been great enough. It is intolerable any longer to expect people to carry on in the way in which they were compelled to act as a result of unemployment in years gone by. Why should there be any quibble about introducing this reform? Is it not a fact that nearly all the investigations have shown that miners suffer from bronchitis more than non-miners? Is it not a fact that the mortality rate of chronic bronchitis among miners is well above average? Is it not established that the prevalence of these diseases in urban areas is twice as high as in rural areas but that for miners and ex-miners the figure is even double that for urban areas?
A great deal of international work on this matter has been done by such distinguished people as Costain in Germany 850 who, in recent years, has been examining a series of sickness insurance claims. He has been showing how the claims for bronchitis were at least twice as frequent from miners as from other men in the same age group. Other work has been done in Germany by Worth and his colleagues. Their findings have shown that the prevalence of bronchitis and emphysema among miners is much higher than for the rest of the population, even in the most congested urban areas.
The people of Wales do not need this corroboration. They witness these happenings every day of the week. I feel ashamed, when confronted by someone seeking an explanation from me about our present system, because I must tell people who are monstrously incapacitated why they have no right as the regulations now stand to benefit. Indeed, I have with me a letter from a miner's widow living in Blaenavon in my constituency. She writes stating that her husband was a miner for many years and had been certified as having pneumoconiosis. He died at the age of 65. She encloses with the letter the customary ambiguous death certificate about her husband's condition; there was a delay of many months in the issue of the certificate. Although her husband had been certified as having pneumoconiosis, the cause of death on the certificate is given as chronic bronchitis and emphysema of the lungs. That was said to be revealed after a post mortem. How can I explain to this widow that she has no entitlement under our legislation? How does my hon. Friend the Joint Parliamentary Secretary expect me to reply to letters like that? With this sort of thing happening all the time, it is certainly more than overdue that we found a remedy to the situation, and I suggest, therefore, that as a start we should accept the suggestion of my hon. Friend the Member for Merthyr Tydvil.
§ Mr. Hale
My hon. Friend may have been luckier than I was. In the case to which I referred the coroner found that death was due to byssinosis and that it had arisen out of the man's employment. That was confirmed. When we went to appeal to the Statutory Commissioner, he said that the Medical Appeal Tribunal was right in having accepted the fact that the first doctor, who did not 851 know that the man had worked in the cotton industry, had said that he was suffering from bronchitis.
§ Mr. Abse
That is one of the sad consequences that arise.
When one looks back and sees on how many occasions we must wait for medical research to take place, one is bound to feel deep dismay, particularly if further obstructions are to be placed in the way of the implementation of the suggestion which my hon. Friend the Member for Merthyr Tydvil is making. We know what happens when the Industrial Injuries Advisory Council says that new diseases should be added to the prescription. I recall that in 1958 it was suggested that bursitis of the shoulder—referring to the toxic effects of a substance described as "BHC"—should be added to the list. Again, the Council wanted to widen the prescription from acute bursitis to chronic bursitis. Suddenly no doubt the mining community will find that new medical discoveries are made and something in their interests will be added to the list, but why should we have to wait upon such medical research?
The position now is that one treats the causative agent as if that agent was somebody who was innocent but facing a criminal charge. One presumes that the causative agent is innocent and that the burden must fall on the sufferer to prove the causative agent's guilt. There is no logic in treating the causative agent in that way. Nor is that necessarily the way which always applies in our laws. What a difference there is between this type of approach and the approach which one finds in common law, with its well-established rule that, at least from the point of view of the physical condition of the victim, the abnormal circumstances existing at the time do not count.
This is what the lawyers call "the egg shell skull rule", meaning that if the personal injuries are aggravated by the state of health of the person injured, the wrongdoer who caused the injury is none the less liable to the full extent. This is a principle which is well understood and it is high time that we accepted it when talking in terms of emphysema and bronchitis. If we are unable to unravel the causitive effects of one disease upon the other; if we know what the exposure 852 to dust, to somebody who is suffering from bronchitis, is likely to cause, why should it be that under these devilish conditions, which clearly exacerbated some pre-existing conditions, there should be such a heavy onus of proof placed upon the sufferer of these diseases?
There should be no more hesitation. We have to go back to our valleys and explain to our people that with a Labour Government in power we can no longer tolerate people being deprived of benefits, when they, after working for years in the mines, are suffering so clearly from emphysema and chronic bronchitis.
The suggestion that there is no causitive relation between working in a mine and chronic bronchitis and emphysema is in defiance of all that we can see and hear; and, because medical research may lag behind what is intuitively and empirically known, that is no excuse or reason for further delay.
§ 1.31 p.m.
§ Mr. Eric G. Varley (Chesterfield)
I, too, would like to congratulate my hon. Friend the Member for Merthyr Tydvil (Mr. S. O. Davies) on the introduction of his Bill. Those of us who have entered this House relatively recently respect the understanding and compassion of my hon. Friend. It is typical of him to introduce a Measure of this kind.
I am not an expert on this particular subject, but I have lived for 30 years in a mining village. My father was a miner for 50 years and he now suffers from pneumoconiosis. The question of emphysema and bronchitis being associated with pneumoconiosis is the subject of great controversy within mining areas. Each year about 1,000 people die through pneumoconiosis, and, as the hon. Member for Sutton and Cheam (Mr. Sharples) pointed out, last year alone 1,007 new sufferers were diagnosed.
The important question is: how many sufferers are there from associated causes of bronchitis and emphysema who do not benefit under the National Insurance Act? It is now known that bronchitis and emphysema are associated with pneumoconiosis, and recent evidence seems to point in that direction. I received a communication recently from the North Derbyshire miners, in which they said that about 50 per cent. of their 853 pneumoconiotics are suffering from bronchitis and emphysema.
My hon. Friend the Member for Bedwellty (Mr. Finch) referred to the Howell report on a study undertaken on behalf of the National Union of Mineworkers. I have had an opportunity of studying this report, and all the evidence now suggest that bronchitis and emphysema which have their origins in the coal-mining industry can be exacerbated. The problem at this time, as was pointed out by the right hon. Member for Llanelly (Mr. James Griffiths), is the criteria for subscription. In the view of the National Union of Mineworkers—and that view is supported by the Trades Union Congress, which is a cautious and conservative body in some respects—these two complaints should be subscribed where the balance of probability can be attributed to a particular occupation.
My hon. Friend the Member for Bedwellty referred to whole rugby teams in South Wales being wiped out. We in Chesterfield do not play very much rugby, but we do play a civilised game of soccer. However, I do not know of whole soccer teams being wiped out. Entrants to the mining industry have to be extremely fit or they are unable to get a job in the industry. They have to undergo rigorous tests before they are employed, yet there is a likelihood that a miner will have more time off work because of sickness than any person engaged in any other occupation.
As I have already said, the T.U.C. has made repeated representations to my right hon. Friend the Minister of Social Security and to her predecessors, to have emphysema and bronchitis prescribed. My hon. Friend the Member for Blaydon (Mr. Woof) pointed out that the problem of trying to attribute how much emphysema or bronchitis is associated with pneumoconiosis is an extremely difficult one and is quite arbitrary. I am told that in some cases, when bronchitis is associated with pneumoconiosis, the dust shadow on the X-ray is actually lessened. Thus, it is possible to have a situation where the presence of emphysema, a disabling affliction in itself, actually causes the existence of pneumoconiosis to be underestimated. It is, in fact, a very arbitrary way of trying to distinguish between the two.
854 My hon. Friend the Member for Dunfermline Burghs (Mr. Adam Hunter) referred to Category I cases. Such a case is where a man has had an initial X-ray and has been told that he should make an application to the pneumoconiosis panel that he could be suffering from pneumoconiosis. The man goes to the pneumoconiosis panel and is told that he is in the Category I status. It is very difficult, when that man returns, to tell him that he is not eligible for benefit—especially if he has been told that he is suffering from bronchitis and emphysema.
In the majority of cases, we find that such men—thinking they have pneumoconiosis, having been told that they are Category I, and realing they will not get compensation benefit—decide to go back to the coal face. They involve themselves in very dangerous conditions, and they say to themselves—and I know this goes on—"I will apply in a couple of years' time, when I have more dust on my chest". That is a cynical way of looking at the matter, but it is the only way open to them. They have a little dust on their chest; they go back to the coal face to get more dust on their lungs, and then they make a new application to the pneumoconiosis medical panel, hoping that the disease will be prescribed on a later occasion.
It is a difficult question, and, as I have said, I am not an expert on this matter. I only know that my hon. Friend the Parliamentary Secretary is a man of compassion, and that he will have listened with great understanding to the many powerful speeches which have been made. I know also that if it is possible he will want to give his assistance in this matter. I hope that the Bill will receive a Second Reading and will proceed to Committee. If there are technicalities in Committee which cannot be fully met, I hope that we shall get the assistance of the Ministry of Social Security so that we may straighten this matter out once and for all.
§ 1.39 p.m.
§ Mr. John Forrester (Stoke-on-Trent, North)
Very often, hon. Members who are experts in the subject listen to a debate on a long and complicated Bill. The layman sitting in the House wonders how he and the general public can benefit by the subject being debated.
855 My hon. Friend the Member for Merthyr Tydvil (Mr. S. O. Davies) has devised a short and very simple Bill, but one which, nevertheless, is of vital importance to thousands of people up and down the country. In Stoke-on-Trent we are thrice cursed, because we have a large mining population. I am happy to say that it is not a declining area. It is the centre of the pottery industry, which employs about 70,000 operatives. Those people are confronted with a dust which is possibly more aggravating and more killing than even the dust which affects miners.
In Stoke, a dust has been belched forth for many generations from the bottle kilns—which are now, fortunately, disappearing rapidly—that has had its effect on the whole population of the city. It is true to say that were this Bill to get a favourable response from the Minister this afternoon, every family in Stoke-on-Trent would come within its provisions. The Bill, if passed, would bring added relief to these many sufferers.
The Bill seeks to establish a connection between pneumoconiosis, emphysema and bronchitis. I have received from the North Staffordshire miners a list of 43 cases of miners who were in receipt of varying amounts of pneumoconiosis benefit, and who died between 1962 and 1966. On the list, also, are three miners who were not in receipt of benefit, but whose post mortems showed them to be suffering from dust diseases—in two cases, they had pneumoconiosis, emphysema and bronchitis all at the same time—but who had not been in receipt of a pension. This spotlights the present difficulties of protection.
Not one of the 43 widows was successful in an application for industrial death benefit. Where they succeeded before the local appeal tribunal, they lost before the commissioner in London. Some of the miners had been in receipt of 100 per cent. pneumoconiosis benefit in life, but the death certificates said that other factors were responsible for death.
A layman can deduce some interesting things from a study of this list. In 20 per cent. of the cases, cancer was accepted as a cause of death, and industrial disease only as a contributory factor. It may or may not be significant that of the four 856 miners who had been receiving 100 per cent. disability pension for pneumoconiosis, three were deemed to have died of cancer.
It is very difficult at present to say precisely what causes cancer. Ten years ago, many people—including myself, as a smoker then—would have denied any connection between cancer and smoking. This is a matter which is to be discussed next week, but can we definitely say now that there is no connection between the dust breathed by the miners, the potters and the cotton workers and the incidence of cancer or the aggravation of growths within the body? This 20 per cent. may be a significant figure, and the Ministry might at some date be able to initiate some research.
The second significant fact is that in about half of the cases it was deemed that diseases of the heart had caused death, and not an industrial disease. I would not claim that dust was directly responsible for the heart diseases, but I am more than tempted to ask how much the presence of the dust disease contributed to the final heart failure. I make no apology for repeating the point that the tremendous strain put upon the heart by dust in the lungs, and the constant coughing, no doubt accelerate death. Yet, as the law stands, a widow would fail in a claim for industrial death benefit.
A third rather significant point is that in nearly 25 per cent. of the cases of men who had been paid benefit for pneumoconiosis, the post mortem revealed that they also suffered from emphysema and bronchitis in sufficient degree to warrant being recorded on the death certificate. This very high percentage indicates a very definite connection between the three diseases; and that they have their origin in the same killer dust in the mines and potteries—and, possibly, in the cotton industry, too.
It is true that the cases I have quoted are from a very small sample, but I am sure that even the most doubting Thomas, when faced with these figures, would want to look again at the whole position. In saying that, I do not refer for a moment to my hon. Friend the Parliamentary Secretary, because I know that for a very long time he has campaigned to get these diseases recognised by the Ministry. I hope that he will be able 857 to give us some encouragement this afternoon.
In many ways the medical profession is adventurous and ultra-modern, but its members are sometimes very reluctant to accept theories when the probabilities are such that to pretend they do not exist is incomprehensible. There has always been medical conflict, and I suppose there always will be. That, in itself, is not a bad thing, but where does a layman stand when the hospital doctor or his own doctor says, "You are suffering from a dust complaint" but the pneumoconiosis panel says "We cannot find any trace, or very little trace, so we cannot pay you".
That is a common enough complaint that hon. Members representing the type of constituency concerned have to face. I was pleased to hear that the Ministry is not satisfied with the detection in this class of case, and are setting up an experiment in the hope of getting more accurate diagnosis of pneumoconiosis. Perhaps my hon. Friend will tell us more about it.
Anyone living in the areas we have in mind that has seen people walking about obviously suffering from these complaints, but it is just those people who are told, "We are sorry, but we cannot do anything for you". Can the Ministry not look into this aspect, and take into account—as we have been told it does in connection with byssinosis—length of service in the mines or the potteries? Cannot length of service be taken into account in borderline cases?
It often happens in Stoke-on-Trent that a coroner says, "Your husband's death was due to or accelerated by industrial disease", but the tribunal turns down the widow's appeal. We must question the whole basis of the woman having to face a tribunal. I have some sympathy with the representative of the man's trade union when he has to go with a recently-bereaved woman and hear the intimate details of her husband's complaint discussed in front of her.
Can the Ministry not find another way of assessing the amount of pneumoconiosis from which a person was suffering? Can it not employ some completely independent medical practitioner to decide the issue? It is difficult—as my 858 hon. Friend the Member for Oldham, West (Mr. Hale) has pointed out—for a person who is employed and paid by the Ministry to be independent. I was thinking in terms of someone who was not on the pneumoconiosis panel, who had not seen the man in life, and who was completely independent.
I hope that the Ministry will be able to implement the Bill, or at least part of it. I know that finding the money is a difficulty, but we are dealing with human problems. If possible, we should get round the question of finding the money. I hope that we shall so improve the extraction processes that the Ministry will not be able to say, "We have money, but not enough customers to whom to pay the money." I hope that happy day will not be too far off and that it will be speeded up. Only then can we be happy about the situation.
§ 1.50 p.m.
§ Mr. William Edwards (Merioneth)
I am very pleased to support my hon. Friend the Member for Merthyr Tydvil (Mr. S. O. Davis) in submitting this Bill for Second Reading. Often politicians, as is the nature of politicians, profess humility. On this occasion I have a great feeling of humility in speaking on this subject. I represent the new generation of Welsh hon. Members in this House. After hearing today's debate I think it will be a very sad day for the valleys of Wales and the slate-quarrying areas of Wales if they are to be represented entirely by people with university education who cannot speak with the compassion and understanding about the human problems of Wales such as we have heard in speeches by my fellow Welsh Members today.
There remains very little to be said in actual support of the Bill or to propose by way of constructive improvement after the excellent speeches we have had. The speech I am about to deliver and speeches such as those which have been delivered by my hon. Friends are of a kind which the Parliamentary Secretary would have delivered had he been on these back benches. I am convinced that the speeches we are addressing today are not really addressed to him but to his right hon. Friends in the Treasury. The one constructive thing I can say in support of the plea which I am sure he will have to make in time to the bankers of this 859 Government, is that it they are not concerned about political accountability—about which we should all be concerned in Government—then let them be concerned about the very real practical consideration mentioned by my hon. Friend the Member for Pontypool (Mr. Abse).
I represent a county which has two areas entirely dependent on slate quarrying. Although these industries are important and although there is a demand for their products, it is quite impossible to get young men to work in them. The work is there, but young men will not go there. They will not do so because, whatever the doctors and the Ministry of Social Security may say about the lack of dangers and risk to health in those industries, their fathers know from experience that there is great risk to health in them. I heard it said during the election campaign by quarry owners that there were no great risks to health attached to the slate-quarrying industry. A quarry worker told me that the best evidence that there was great risk to health was the fact that not one son of a quarry owner or of a quarry manager was employed in the industry.
We are not asking in this Bill for great generosity. The money which has been talked about and the benefits which men get under the social security legislation is not like a king's ransom but is merely a pittance. It does not compare with the kind of benefit one can get in a civil action. We are not asking for great generosity, but only for small sums of money. The figure gets out of proportion when we talk of a global sum and the total cost of the amendments in terms of millions of pounds. If we regard this in terms of actual benefits which men will receive, we find that it amounts to paltry sums. They are paltry sums which have to be paid as part of the benefits we can get by working in these very dangerous industries.
I intend to speak very briefly because I cannot contribute to this debate from personal experience, and many other hon. Members can do so. As a lawyer I have come across some problems connected with this subject. First, there is the whole procedure under which people get these benefits. Mention has been made of doctors. I make an appeal on behalf of 860 the general practitioner and the part he plays in these applications. Time after time I come across cases in which a man's general practitioner is convinced that the man suffers from industrial disease. His report indicates that there is no doubt in his mind about it. The lay panel accepts that the man is suffering from industrial disease.
I should like to know how many of these cases where the Ministry appeals against its own panel go to the man who is politically accountable in the Ministry. There is an appeal and then some consultant, who has never seen the man concerned and does not know what kind of man he is, completely reverses the decision of the general practitioner. We speak of the general need to give the general practitioner greater status. Surely he is the only man who can give a true assessment, not only of the illness but of the man complaining of the illness. When we intend, as I hope the Government intend, to adopt bronchitis as an industrial disease, it is of the utmost importance that the general practitioner shall be consulted and his opinion respected when he assesses whether bronchitis was due to industrial disease.
There is a sense of injustice among people who apply for industrial benefits under these Acts. They go before a panel entirely unaided, or perhaps aided by their trade union. They may get accepted and then the matter goes to appeal and they get no legal aid when they want to be represented. They get no legal aid covering the case, but a consultant represents the Ministry.
It is the privilege of this House that a man can speak his mind without the danger of having to face proceedings for doing so. I have acted in a number of cases in which I have made a claim for civil damages. I am quite convinced—I think the High Court said this by implication—that the medical opinion of consultants often suits the case of the man who pays for that opinion. This may not be true in the case of the Ministry, but many men feel that they do not get justice when the assessment of their case has been made by a man who has been paid by the Ministry.
I promised to be brief, and I shall be, but I urge the Parliamentary Secretary and my hon. Friend the Member for 861 Merthyr Tydvil to let this Bill go through as it is presented. Then, if the men from the Treasury want to be accountable to their accountants, their lawyers and bankers, let them come to the Committee and destroy the Bill there. Let them tell us that they have destroyed it because they are looking more at money than at men. Then let them come in five years' time to the slate quarry men and miners and ask them for political support again.
§ 2.0 p.m.
§ Mr. Paul Dean (Somerset, North)
I intervene with some hesitation, because those who have spoken from both sides have displayed obvious knowledge and experience. I cannot attempt to rival the knowledge which they have put before the House, but I can claim a great interest in, and I hope a growing, although still small, knowledge of, these problems, because I have the privilege of representing most of the men who work in the Somerset coalfield, and in my work as their Member I very often come into contact with these problems.
It is often said that some of the best debates in the House take place on Fridays on Private Members' Bills and Private Members' Motions. This debate has proved most clearly how true that claim is. I add my congratulations to those which have been expressed to the hon. Member for Merthyr Tydvil (Mr. S. O. Davies) on his luck in the Ballot and on bringing forward the Bill. I should also add my support of it and of the strong arguments which have been advanced from both sides. I am sure that we shall get from the Joint Parliamentary Secretary, as we have had in recent Answers to Questions, a sympathetic and, I hope, positive response.
I intend to speak very briefly, because I know that there are a number of hon. Members who still want to speak and I am sure that the Joint Parliamentary Secretary will want quite a lot of time to deal with the many questions and points of substance which have been put forward.
The right hon. Member for Llanelly (Mr. James Griffiths) referred to the 1946 Act, which he piloted through the House. I was struck when I read that Act again yesterday by the improvements which have been made by Governments from both main parties on that original Act. 862 As the right hon. Gentleman rightly said, in this field, above all others, there is always room for improvement and this subject has focussed attention on one aspect where there is now a need to move forward.
We know from our constituency correspondence that this is a case where real grievance is felt by those who are concerned. At present it is utterly impossible to answer the letters and cases one gets in a manner which an ordinary man or an ordinary woman, in the case of a widow, can feel makes sense and can feel is just. I have a letter here from one of my constituents. He is not a man who would fall precisely within the category of the Bill. He is suffering from emphysema. He has been before the Board. The Board has said, "No pneumoconiosis. Therefore, no benefit". He does not fall exactly within the Bill, but as a result of emphysema, having worked 40 years at the coalface, the only work he can now do is on the surface. He is one of the more fortunate ones, if that description can ever be applied in these cases. Treatment has helped him greatly and he is now able to work on the surface.
The result is that, even in this perhaps fortunate case, he is now earning more than £5 a week less than he was before he contracted this disease. Almost inevitably he will suffer a permanent loss of income for the rest of his life. This is how he puts the case to me in his letter:The doctors fully accept that my disease has been caused by working at the coalface, but is not covered by the Industrial Injuries Act. This seems to be just a play on words. Surely if a permanent disability is caused by one's work, does it really matter what one calls it?I am sure that hon. Members on both sides have received similar letters. We just cannot explain to such people why they should be debarred from benefit when they have a permanent disability which, in their view, and I think in the view of most people of experience, is directly associated with the work they have been doing.
The Joint Parliamentary Secretary will remember that there have been a number of Questions on the subject of emphysema in the last few weeks. He will remember that I asked him a Question about this 863 on 21st November. In his Answer he referred me to the Answer he had given to the hon. Member for Ince (Mr. McGuire) on 8th August. On that occasion the Parliamentary Secretary gave the standard answer that some types of emphysema are covered where they are associated with pneumoconiosis, but in other cases not. The hon. Gentleman went on to say that these difficult problems are still receiving attention. As the hon. Gentleman's answer brought out very clearly, some cases are covered; others are not. It is those which are not covered that we are concerned with in the Bill.
This point was pursued in a further friendly exchange at Question Time last week. I was glad that the Joint Parliamentary Secretary again told us that research was going on, and in particular he mentioned a visit by some of his principal medical officers to the Vienna Industrial Medicine Conference recently. I hope that the hon. Gentleman will be able to tell us a little more about the lessons which were learned at that Conference and also about any research which is coming to fruition and which will help to throw more light on this problem.
My hon. Friend the Member for Chelsea (Mr. Worsley) stressed the importance of co-operation on a worldwide basis. He mentioned the research being done into these matters in the Coal and Steel Community. It is generally recognised that diagnosis in these matters is extremely difficult and that the borderline between pneumoconiosis, emphysema, bronchitis and a number of other respiratory diseases is very difficult to establish.
None the less, as the right hon. Member for Llanelly and others have emphasised, there is growing evidence now—not only the practical evidence of people who know because they have lived with this for years, but also growing medical evidence—that there is a casual relationship between these diseases. As this evidence accumulates it is up to us, and, in particular, up to those who run these schemes, to take this into account and, where there is a doubt, to ensure that the benefit of that doubt goes to the man concerned.
864 The Joint Parliamentary Secretary will remember that this was one of the points I emphasised in an intervention at Question Time last Monday. There is still a very strong feeling that, where there is a doubt, far too often it is decided against the man rather than in his favour. This may to some extent be a criticism of those who run these schemes, but the feeling is so strongly held that it is only right to emphasise it again. It is partly—this is our immediate concern—a fault in the present law. I believe that the proposal in the Bill would do much to deal with at any rate the particular aspect we are discussing today. There is a strong presumption, particularly in the case of miners, that respiratory diseases of all kinds are caused, or at least aggravated, by the conditions in which they work.
The hon. Member for Bedwellty (Mr. Finch) mentioned air pollution. How right he is when he says that there is far more air pollution in a great city like London or Birmingham than in most of the mining areas. He knows, as I know, that when we go home to our constituencies at the weekend, although our constituencies may be coalmining areas we breathe the first bit of real fresh air that we have had the chance to breathe since we came to London at the beginning of the week. There is no doubt that on the whole the air is clearer, and yet we still get a much greater incidence of these diseases.
I wish to quote only one figure which has been referred to, and that is from the Registrar General's supplemental report dealing with occupational mortality. In his last report, the Registrar General shows clearly that mortality from bronchitis among coalminers under the age of 65 was 35 per cent. higher than in the general male poulation of the same age. If, as I think we agree, one cannot ascribe that to a much greater level of air pollution in the mining areas than in, say, London, this is another strong point which emphasises the direct connection between the occupation of the miner and these diseases. If this applies to respiratory diseases in general, surely the presumption is even stronger when we are dealing with pneumoconiosis associated with emphysema and bronchitis.
I realise that this is a difficult question. It is one with which all Governments 865 have grappled. We have made progress over the years in trying to extend the range of benefits. I hope that the Parliamentary Secretary will recognise, as I am sure he does, that the Bill does not ask for the whole floodgates to be opened. It does not ask for replacement of the basic principles on which the original Industrial Injuries Act was based. It still retains the two fundamental principles. First, the disease concerned must not be common to the population as a whole. It in no way undermines that principle, and it in no way undermines the second basic principle of the original Act that the disease can be attributed with reasonable certainty to the occupations concerned. The Bill therefore preserves these principles. It merely asks that we should do now for emphysema and bronchitis associated with pneumoconiosis what we already do in the case of tuberculosis. It goes no further than that.
I hope, therefore, that we shall get, as I am sure we shall, a sympathetic response from the Parliamentary Secretary. I hope that he will find time to deal with the various questions which have been raised from both sides of the House, including the questions raised by my hon. Friend the Member for Sutton and Cheam (Mr. Sharples) with his experience of these matters as a former Parliamentary Secretary.
I am glad, therefore, to welcome the principle of the Bill. I hope that the Parliamentary Secretary will tell us that even if he cannot accept every line, dot and comma of it, at least he believes that the time is now ripe and that the Ministry has seen its way through these problems to make another advance with these extremely distressing diseases.
§ 2.13 p.m.
§ Mr. Michael McGuire (Ince)
I am grateful for the opportunity to speak in this debate. I know that there is other business to follow, so I will be as admirably brief as was the hon. Member for Somerset, North (Mr. Dean) in speaking from the Opposition Front Bench.
I start by adding my congratulations to my hon. Friend the Member for Merthyr Tydvil (Mr. S. O. Davies). I congratulate him on his luck in the Ballot and, even more, on his choice of subject. I support the Bill to amend the National Insurance Act in the way that it proposes.
866 The hon. Member for Somerset, North referred to my Question on 8th August, when I asked the Minister whether emphysema could be scheduled as an industrial disease. I did not get a dusty answer from my hon. Friend the Parliamentary Secretary—he does not give dusty answers; he is full of compassion and understanding—but, at least, he was not able to meet the point. The gist of his reply was that emphysema did not fulfil certain necessary conditions to become scheduled.
Those conditions are set out in Section 56(2) of the National Insurance (Industrial Injuries) Act, 1965, paragraph (b) of which is as follows: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.This has always been the biggest hurdle that advocates of this kind of amending Bill have had to overcome. The definition of "reasonable certainty" is, to me at least, a seemingly insuperable barrier.
I much prefer the term "balance of probabilities", which was first used in this debate by my hon. Friend the Member for Bedwellty (Mr. Finch) It is not new. I represented miners on tribunals for about 7½ years. When arguing cases of men who had suffered an accident and special hardship, one had to prove that the balance of probability supported one's contention. One did not, as it were, have to satisfy the requirement of the criminal court in terms of "beyond reasonable doubt". I prefer the phrase "balance of probabilities" rather than "beyond reasonable doubt", although the words of the Act are "with reasonable certainty". The Bill does not seek to schedule emphysema. It seeks to bring in emphysema when pneumoconiosis is established as a condition. It is a modest measure. Progress is often best made by stealth and doing things slowly rather than asking, as I am prone to do, for the lot.
One of the arguments that is used against us is that we could not support our contention. For example, a person in Bournemouth, Bristol, or anywhere away from the coalfields might suffer from emphysema, and, therefore, this illness would not be peculiar to the mines. There is, however, sufficient evidence now available to fortify us in our contention 867 that working in conditions of dust—and there is no more dusty place than a pit—aggravates this condition.
I pray in aid of the old but none the less valid report of the third international conference of experts on pneumoconiosis held under the auspices of the International Labour Organisation in February and March, 1950. From the sum total of all the expert opinion, one could reasonably infer that emphysema and bronchitis are aggravated, and quite grossly so, by work in dusty conditions; and as I have said, there is no more dusty place than a pit. The reasonable inference is that it should be scheduled, as it is in many countries as my hon. Friend mentioned, as an industrial disease, and I hope that my hon. Friend the Joint Parliamentary Secretary will tell us that even if the Government will not schedule emphysema as such, at least they will accede to this modest request.
I want to condense my speech. I had thought that perhaps I should not be called. I felt like the man who, going on holiday, travelled 200 miles to catch a boat and found when he reached the port that it had just sailed. I have spent a little time waiting, and I had begun to think that I had "had it". I therefore very much appreciate being called now, and I do not want to take too much advantage of that.
My right hon. Friend the Member for Llanelly (Mr. James Griffiths) referred to the first recorded case of workmen's compensation—in 1925—and how that led to the 1928 Act, and he said that the criterion was absolutely barmy and that it was mainly based on the then expert opinion that silica, stone dust, did the damage. I have often heard miners' agents and old men say that years ago the experts believed that though stone dust did harm coal dust was beneficial to the human body, that while it did not do one a very great deal of good it did some good and did not do any harm. This is an example of how experts are not always to be trusted, and the healthy scepticism which my right hon. Friend the Member for Llanelly said he always felt about them I endorse completely.
I believe that we in this House, as ordinary laymen, but able to read and 868 write and to express our views—perhaps not always with the best of accents—should always judge expert opinion rather as did King Charles II, who founded the Royal Society, and when, in his day, it was discussing the question whether a dead fish weighed more than a live one. All the experts there assembled were in no doubt that a dead fish did weigh more than a live fish. The debate went on, when Professor—was Peanutt his name?—got up and said, "There can be no doubt that a dead fish weighs more than a live one", and he trotted out the reasons; and then another man was called and he supported this opinion and he started off by saying, "Of course a dead fish weighs more than a live one. It is one of the facts of life." However, he said the reasons were not, as his friend had said (a). (b) and (c), but (a) (x) and (y). Everybody who spoke was convinced that a dead fish weighed more than a live one. Then they asked King Charles to sum up, and he said, as we might have said. "Does it?" And he weighed a dead fish and a live fish—and there was no difference.
So when we get experts telling us, as they did in the days of our youth, and as our forefathers did, that coal dust is in some degree beneficial we may be as unbelieving of them. All these arguments now have been refuted. I have a father-in-law I love dearly, an old man, now 81, and he has suffered from pneumoconiosis for a long, long time. He is suffering greatly still, and, of course, as he grows older he will suffer still more. He comes from a family distinguished for longevity they live, on average, to 95, and in his family they have been rescued from death many times so I shall not make any predictions about my father-in-law, but anybody who lives in a mining village, anybody who knows miners, realises what causes these diseases and how dreadful their effects are. I do not want to develop all the arguments. We can see with our own eyes the living testimony to the fact that working in dusty conditions will contribute further to the breakdown of anyone suffering from the natural ills man is heir to.
I know, in saying this, that it is difficult to describe and impossible to justify some of the things that happen—as when the widow of a man who had 100 per cent. pension in his lifetime is deprived because after his death it emerged that 869 he died from some other cause. I agree this is difficult, but we are arguing in this place about going into Europe. One thing I hope, and that is that whether we go in or not we shall copy at least one part of the system they have in some countries—as in France, where, if a man is certified for a disablement pension his pension is based on the assumption that it must be held that he will die quicker than another man without that disease. I think we can do likewise.
I believe that this Bill, this modest Bill, will be a further step in the history of this country as well as the history of workmen's compensation, and that it will add another great chapter in the story of the work of the party I belong to, which has done such good work in putting on the Statute Book legislation which has uplifted the ordinary man. My right hon. Friend the Member for Llanelly spoke of the Acts of 1946 and 1948 and the Industrial Injuries Act, and we have removed may anomalies. The greatest thing, I believe, that we did was to remove what up to then anyway was one difficulty in a long struggle; we did away with the unequal contest between an injured and penniless worker on one hand, and a wealthy employer, on the other, without any loss of a workman's rights under the common law, his loss of his compensation.
I believe that this modest Bill—and it is a modest Bill—will be a further step in that long story, and we shall all, I am sure, be very happy if my hon. Friend the Joint Parliamentary Secretary will tell us that the Government have decided to accept this modest Measure. Then we shall all bask in the good fortune of my hon. Friend the Member for Merthyr Tydvil (Mr. S. O. Davies), and I think that justice will be seen to be done, and manifestly so.
§ 2.27 p.m.
§ Mr. Arthur Probert (Aberdare)
Speaking at the end of this very informative debate I am at a loss to find anything new to say, but I am very pleased that I have waited so long if only to hear the speech we have just heard by my hon. Friend the Member for Ince (Mr. McGuire). My hon. Friend need not be afraid of possessing a very distinctive accent. The only thing is that he has not got the best one, which is a Welsh accent.
870 One thing which has struck me about this debate is that so far there has been not a single dissentient voice. I should like to reiterate what has been said by one of my hon. Friends, that my hon. Friend the Joint Parliamentary Secretary, if he were to speak from the back benches, would certainly make a speech on the same lines as those which we ourselves have followed. I thank him for his courtesy in having listened to every single word that has been said in this debate.
I know that this is a very difficult subject indeed, not because of any abstruse legalities or anything of that kind, but for the reasons my hon. Friend the Member for Pontypool (Mr. Abse) showed so clearly in portraying the death certificate. I am not a miner, but all of us who represent mining constituencies know that figuratively, as it were, we could paper the walls with such pathetic documents. I am certain that the great trade unions of this country have in their files evidence on which a future Engels describing in, say, the year 2000, conditions suffered through industrial injury in this country, would show a very highly discreditable picture of the present generation, in this regard particularly.
As has been pointed out, we are debating a rather narrow and specific subject, but, nevertheless, as has also been indicated, there are deep principles involved. I shall touch briefly on a number of the principles and I shall also touch briefly on the question of emphysema particularly, and its inclusion as my hon. Friend the Member for Merthyr Tydvil (Mr. S. O. Davies) is asking to be done and which is so worth while. I think the inclusion of any disease for the purpose of scheduling or prescription is not an easy matter. It has taken many years for the gradual awakening of the British public to the necessity of including many of the industrial injuries which are now already included.
We are all aware of the great work being done by medical research but, without digressing upon the scepticism that we have for the medical profession in general, side by side with it and preceding it there is always great industrial and political agitation to get certain diseases prescribed, as has been evidenced today. To get that done is a long and tedious 871 process taking many years. During that process, we find that thousands of innocent people suffer terrible pain and even death without redress or compensation. It is necessary to say that, because, whatever success we get and however small it is, it has been very hard won.
I come now to a question of principle. One of the great difficulties is that, often, pathological and clinical results do not conform to a pattern. My own view is that greater emphasis must be given to clinical examination. As my hon. Friend the Member for Oldham, West (Mr. Hale) indicated, this point has been recognised in the cotton industry in relation particularly to byssinosis, where clinical examination is fundamentally of greater importance than radiological examinations. A radiological examination cannot reveal that disease, and reliance has to be placed upon a clinical examination.
If a person develops bronchitis and emphysema after a number of years in the mining industry and, at the same time, pneumoconiosis is present, no evidence is required from x-ray plates to tell us that the emphysema and bronchitis has had something to do with aggravating the disease.
Some years ago, the hon. Member for Essex, South-East (Mr. Braine), who was then Parliamentary Secretary to the Ministry of Pensions, had this to say, and I am not using it for any political point: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."—[OFFTCIAL REPORT, 3rd February, 1961; Vol. 633, c. 1407.]There are one or two points which I should like to raise on that. I use that quotation because it is that type of opinion which has weighed so heavily against the inclusion of diseases of the type which my hon. Friend is asking for today.
In the case of pneumoconiosis, there are wide variations in a geographical sense, as the hon. Member for Essex, 872 South-East said there were in the case of bronchitis and emphysema. A survey made of 83 collieries from 1959 to 1964 showed that, for men over 55, it varied from 14.2 per cent. in the Scottish Division to 41.2 per cent. in the South West Division. In other words, in pneumoconiosis itself there are wide variations in a geographical sense. In fact the percentage in the South West Division, of which my constituency is part, is three times as much as in the Scottish Division. There at least one cannot use the excuse of variation in the geographical pattern to deny the acceptance of what we seek to do.
Then, in relation to the incidence of bronchitis in miners' wives and the high incidence in the husbands themselves, in my opinion there is an argument for a causal relationship, and it should not have been used as something to weigh against the evidence which we are seeking to produce for the Bill today.
Important medical opinion is indicative of the effects of pneumoconiosis upon the lungs and predisposing to other diseases. That is not denied anywhere, and I must reiterate what my hon. Friend the Member for Blaydon (Mr. Woof) said in quoting Sir Thomas Holmes Sellors. It is worth repeating. He wrote:I have little doubt that pneumoconiosis is an irritant fibrotic disease predisposing the subject to bronchitis and lung inflamation. The chronic damage to the lung renders it more susceptible to infection than in the healthy.If anything clinches the argument, it is that. That is very authoritative opinion, and we are all aware from our files that we can produce evidence of the same results.
My hon. Friend the Member for Pontypool referred to the common law and the question of the causative agent. In my opinion, we are treating the disease much as we treat an innocent person in court; in other words, he has to be proved guilty, otherwise he is considered innocent. Is the disease subject to cross-examination? In any case, the weight of evidence should always be in favour of the innocent victim.
For my part, I have been greatly influenced by a Report of the Medical Research Council numbered 290 which was published just as I entered this 873 House in 1955. It has had an important effect on my interest and attitude towards industrial disease. It is entitled "Lung Function in Coalworkers' Pneumoconiosis." We have not time to discuss this important and highly relevant Report, but there are two matters in it relating to emphysema to which I want to refer.
It says on page 139:The occupation of mining, with or without heavy dust exposure, might produce or accelerate in susceptible individuals the onset of emphysema, without their developing radiological evidence of pneumoconiosis.Two things can be deducted from that evidence. The first is that there is an association of emphysema with mining, and that is very important. The second is the point which I mentioned earlier on of the importance of clinical evidence, as distinct from radiological evidence. In the cases which I have mentioned, even when there was no radiological evidence of pneumoconiosis, there was evidence of emphysema due to the industry concerned.
The other interesting evidence in the Report is of the progressive increase in emphysema in men with complicated pneumoconiosis. The increase is shown as suggestive evidence, though not proof—and, as has been indicated earlier, we know that doctors are very cautious people in this regard—that men with simple and complicated pneumoconiosis also have some degree of emphysema.
That is very important evidence. There is also evidence that men with simple pneumoconiosis have more evidence of emphysema than those without pneumoconiosis, and the general trend of evidence suggests that that does not arise by chance.
That Report is more than 11 years old, and it was based on findings in preceding years. I am certain that later evidence which I have read and the evidence which has been produced in today's debate substantiates it.
I agree with my hon. Friend the Member for Merioneth (Mr. William Edwards) that far more weight must be given to clinical evidence than appears to be the case now. In this regard, I am not referring only to emphysema or bronchitis, but more importantly perhaps to pneumoconiosis. In my opinion, 874 the general practitioner is the best guide, and it is disgraceful to think that a medical certificate from a general practitioner, who has known his patient year in and year out and knows his whole history, is almost completely disregarded and becomes just a scrap of paper.
The evidence of general practitioners must be regarded as carrying more weight than any other evidence. I am told that the general practitioners themselves would like to see a system established of once-a-year examinations for lung function tests. That would be very important in relation to preventive medicine.
I conclude with a quotation from a book by John Williams entitled "Accidents and Ill Health at Work in 1960", one of the greatest works which I have read on this subject. He said:It is curious that there should be so much resistance to the view that it should not be essential to demonstrate beyond doubt that symptoms are occupational and officially prescribed before recognition for compensation purposes—when the opposite policy is followed in regard to employment in the Armed Forces. The Serviceman recovers a pension for any disability shown to be due to service or aggravated by it. The T.U.C. view on this question is supported by the U.S.A. Government and is practised in France and Sweden.That is the kind of approach which we must adopt. I am an ex-Serviceman. I have nothing against them. I think that they have been treated correctly, and all that we ask for is parity for those injured in industry.
§ 2.40 p.m.
§ The Joint Parliamentary Secretary to the Ministry of Social Security (Mr. Harold Davies)
Today's debate has been one of the most interesting that I have heard during the 22 years that I have been in this House. It has been a well-informed debate, and I think that the hon. Member for Somerset, North (Mr. Dean) will agree with me when I say that both sides of the House welcome this important Measure, and agree about the kind of support which it should receive.
I have listened to everything that has been said since the debate began this morning. I have listened to the massive amount of well-informed opinion which has been presented to us. If I am not now able to answer all the points which have been raised, I undertake to reply later to any hon. Member who feels that his question has not been answered. 875 I undertake in particular to reply to the hon. Member for Sutton and Cheam (Mr. Sharples), because at one time he occupied the position which I now hold. I am sure that he would like my answers to be as direct and as accurate as it is humanly possible to make them. Another debate is scheduled to follow this one, so I hope that hon. Members will understand if I do not answer every question which has been asked.
This debate has been purposeful, and distinctive. Most important of all, it has been conducted with humanity and understanding, and I am sure that we are all grateful to my hon. Friend the Member for Merthyr Tydvil (Mr. S. O. Davies) for raising this matter. I hope that I shall not be thought patronizing—after all, who am I to talk patronisingly to a man who has served the mining industry and the House for so long in a well-informed and constructive way?—if I say that he presented his case in such a way that it made it easy for me to follow it.
The sponsors of the Bill are my hon. Friends the Members for Merthyr Tydvil, Rhondda, East (Mr. G. Elfed Davies), Bedwellty (Mr. Finch), Pontypool (Mr. Abse), Derbyshire, North-East (Mr. Swain), Dearne Valley (Mr. Edwin Wainwright), Blaydon (Mr. Woof), Dunfermline Burgs (Mr. Adam Hunter), Chesterfield (Mr. Varley), and Ince (Mr. McGuire). I remember the great and gallant former Member for Ince, Mr. Tom Brown. He always took part in our debates on miners and old-age pensioners, and when I look down the list of the sponsors of this Measure, it looks to me like a guidebook to the coalfields of Britain. Having been shot through a little with the fervour of Dylan Thomas, I can see him in his famous play, "Under Milk Wood", describing the colliers moving up the valley wheezing and coughing like nannygoats sucking mintoes.
Nobody in this House need think that we in the Ministry are not concerned about this Bill. I appreciate the motives which have led my hon. Friend to introduce it, and I congratulate him on the persuasive and eloquent way in which he made his case. The subject matter of the Bill is close to the heart of my right hon. Friend the Minister who, as a collier's daughter, has coal dust in her veins. My hon. Friend the Joint Parliamentary Sec- 876 retary, the Member for Chester-le-Street (Mr. Pentland) is also a miner. For my part, I used to live in South Wales on the edge of a farm, and the farmhouse looked down the chimney stack of the pit. Therefore, no one need feel that on the Ministerial side we do not understand what we are talking about in the Ministry when we discuss this difficult and abstruse problem of the relationship of bronchitis and emphysema to the basic condition of pneumoconiosis. We appreciate the difficulties which we have to meet.
We are anxious to do what we can to help, but there are many difficulties confronting us. This is basically a human problem, directly affecting the lives of thousands of our fellow countrymen, and the speeches which we have heard today show the great sincerity, the wide knowledge, and the deep interest of the House in this subject.
A number of points have been raised in the debate. I shall touch on them before I conclude my speech, and, as I have said, I undertake to reply in writing to those which I do not answer fully now.
This is not a new problem. Indeed, because it is a long-standing one, we are convinced of the need to study the matter carefully, and since the Government came to power we have been giving a great deal of thought to the difficult questions which arise in connection with respiratory diseases among workers in dusty occupations.
I am sure that hon. Members are aware of the developments which have taken place to tackle the problem of the diagnosis of pneumoconiosis and the many suggestions which have been made in this connection. Believe it or not, I think that about 70 per cent. of the suggestions which I have heard in this debate have been churned over and discussed with the T.U.C., with the miners' group and with our own experts for a couple of years. But I believe that the time has come when something constructive should be done, because, while we are talking, men are dying.
I was glad to hear my hon. Friend the Member for Stoke-on-Trent, North (Mr. Forrester) talk about the pottery industry, because we also have this industry in our area, and I think that it is well worth publicising this more 877 fully. I should therefore, like to say a few words about the pilot scheme which we propose shortly to launch in South Wales. This scheme has come to fruition after long discussions with the T.U.C., and an experimental scheme has been drawn up to try to get over some of the stumbling blocks which have hitherto prevented progress.
The scheme will operate from January, 1967, mainly in the South Wales coalfields. A special panel, to be known as the Central Pneumoconiosis Medical Panel, has been set up. This will consist of doctors of higher status than those of the existing panels and will be drawn from the senior medical officers of existing panels and senior chest specialists outside the Ministry.
§ Mr. Davies
I should like to think about that. I believe it will, but I do not want to give an inaccurate reply.
§ Mr. Davies
We will do our best. Knowing the hon. Member very well, I am sure that if I give him an inaccurate reply I am liable to be shot at with all guns blazing.
The proceedings of this Panel will as nearly as possible parallel those of a medical appeal tribunal. Full x-ray and clinical examinations will be carried out and claimants can be represented at hearings if they wish. We could not have done this without the fullest co-operation of the trade unions concerned, and also the T.U.C., to whose activities hon. Members on both sides of the House have paid tribute. They are letting the Ministry know about cases which have attracted the most concern and have raised the most difficulties. Broadly, the men concerned are those with serious respiratory disabilities whose claims have been rejected twice following clinical examination but who are able to produce opinions from chest physicians of repute that they are suffering from pneumoconiosis. In other words, this goes a long way to meet the criticism that has come from hon. Members on both sides today on the issue of opinions.
878 To gain experience of the problems involved in all forms of the disease, some cases in the Midlands other than those of coal workers will be brought before the Central Panel. We are concerning ourselves not only with pneumoconiotics and people from the coal fields; we are taking people from the Midlands, for example, from among pottery workers. After six months, the results of the scheme will be reviewed and if it is successful it is hoped to extend it to the whole country.
§ Mr. Davies
It would be wiser if I gave a precise answer in writing to my hon. Friend, giving him the full details. At the moment we have set up this panel with the co-operation of the T.U.C. in order to try to avoid some of the stumbling blocks of the past, which have held up progress. Different opinions naturally mean changes in the assessment of disabilities, but I should prefer to write to the hon. Member giving him a little more detail.
§ Mr. Hale
I appreciate my hon. Friend's point, but it seems to me that the intervention of my hon. Friend the Member for Pontypool was very important. I speak purely about byssinosis. Research has been conducted by Dr. Schilling with a team of research students of immense devotion, first from Manchester University and then from London University, for about seven years. This has produced all the evidence which one would have thought it was humanly possible to produce concerning the connection of emphysema and dust diseases with dyspnoea, and so on.
§ Mr. Davies
Let me make it crystal clear with what we are dealing today. I am replying to the Second Reading debate of my hon. Friend's Bill. Consequently, I am not prepared at this juncture to deal with very difficult medical problems concerning byssinosis or other problems outside the purposes of this small Bill. If my hon. Friends will forgive me, I would much prefer to have 879 time to think about this, and to see that they have accurate replies rather than give a loose and perhaps misleading piece of information that might do more damage than good.
§ Mr. Davies
I agree. It is not a secret organisation. The information is there and it will be made public. At this point my hon. Friend the Member for Merthyr Tydvil will want to know what I think about his Bill. I will now state the Government's view. I should make it clear at the outset—and here I must be specific—that in its present form it would impose substantial new duties on my Department, at considerable additional cost. We are concerned to see that the acceptance of these obligations is practicable both financially and administratively.
As drafted, the general intention of the Bill is to enable the Minister to make regulations to provide that any person suffering from pneumoconiosis should have the effects of any accompanying bronchitis or emphysema taken into account for the purpose of the Industrial Injuries Act as if they were the effects of pneumoconiosis. That is a description of the general purpose of the Bill. The debate has shown that there exists longstanding and widespread concern about these respiratory diseases. My hon. Friend the Member for Pontypool put this aptly and succinctly in the phrase, "the issue of intuition against medical opinion". That phrase sums up the situation, but, unfortunately, it does not enable us to go outside the scope of the Act.
The problems are complex and not capable of a simple solution. In the present state of medical knowledge, the principle underlying my hon. Friend's Bill runs counter to the principles of the Industrial Injuries Act, namely, that there must be a clearly-established connection between disablement and its alleged industrial origin. It still has to be established that bronchitis and emphysema are caused by occupation. I should like to explain what the Government have been doing to overcome these problems 880 of establishing occupational causation. We have not been standing still.
My right hon. Friend has always recognised the deep concern about this subject. I believe that her record over the years would satisfy everyone that she shares this concern in the fullest measure and has long striven to find answers to these persistent problems. When we came to power, the Minister was, therefore, anxious to secure the best medical opinion available to support action on behalf of these disabled workers. To this end, she secured the appointment, by the Medical Research Council, of an expert committee.
The committee was asked to consider the rôle of occupation in the causation of chronic bronchitis, with particular reference to coal mining. Its report was published on 8th January, 1966, in the British Medical Journal. The report concluded that chronic bronchitis displayed the same clinical characteristics irrespective of the occupation of the individual affected, and that in consequence it was not possible to determine the extent to which particular employment had contributed to the development of the illness.
This was the finding of the Medical Research Council, whose opinions are expert and to which, like it or not, the layman has to listen. Personal and environmental factors were blamed rather than the occupational factors. Hon. Members will recognise that the report failed to provide any basis for special provisions for these men. I should like hon. Members to know that the matter did not rest there, although they will appreciate that the report constituted a severe setback to our hopes. That was the exact position which we faced——
§ Mr. McGuire
How would my hon. Friend relate this proposition to the fact that tuberculosis is taken into consideration as a condition in pneumoconiosis? Would he not agree that many of these committees could be described, as my hon. Friend the Member for Ebbw Vale (Mr. Michael Foot) once described Royal Commissions—as a broody hen sitting on a china egg——
§ Mr. Davies
I am not trying to voice an opinion. I am saying, I repeat, 881 only that hon. Members will realise that the report failed to provide any basis for special provisions for these men. I then said that I would like hon. Members to know that the matter did not rest there, although they will realise that the report constituted a severe setback to our hopes——
§ Mr. Abse
All that report, so far as we have heard of it, does is say that there was no clinical finding which could distinguish between people suffering from chronic bronchitis, whether in the mining industry or in any other. That is a totally negative finding. My hon. Friend should know that some of us are getting increasingly disturbed at the tone of his speech.
§ Mr. Davies
I cannot help how disturbed my hon. Friend is; I want to tell him the truth. I am not arguing, but I am voicing the facts—in the same way as my hon. Friend would, with his training as a lawyer—that the Minister was confronted——
§ Mr. Davies
I am not concerned with who picked the doctors. This was a distinguished, learned society of individuals representing the highest scientific research in medicine, and I do not know who personally picked them. All I know is that these people were responsible for some of the finest research which has been done in the world in certain branches of medicine. We asked them to undertake this work. It so happened that their report did not help in this matter and in no way provided a basis for the special provisions which we were seeking to make for these men. If my hon. Friend the Member for Pontypool is worried about the tone of my speech, perhaps he will change his mind before I reach the end of it. He has been trained in dealing with facts as much as any other hon. Member. Facts are what I have to put before the House. We have to deal with facts and not with intuition.
Without labouring it too much, I would say that the Minister and our officials in the Ministry have all worked for many years among those who suffer from pneumoconiosis. We can say without exaggeration that we have an intimate knowledge of these matters and deep sympathy for the feeling of the workers 882 concerned, trade unionists and, not least, my hon. Friends. We have been deeply moved by the distressing picture of workers who have suffered from respiratory diseases and who, for reasons which are not understood, have escaped pneumoconiosis itself. We feel that there is a problem to be met. There is a third group of those who are long-term pneumoconiotics and who suffer seriously from bronchitis.
It is difficult for those who live with the problem to understand why these three groups receive different treatment under the Industrial Injuries Act. I readily appreciate how exasperating it is to many who are convinced that it would be right to treat them similarly to others but who do not receive that same treatment. We fully understand this feeling, but in the present evidence of medical experts bronchitis cannot satisfactorily be related to occupation. However, doctors have always accepted in cases of severe pneumoconiosis under the Act that there was a much more intimate connection—this is a point which will interest the House—between the pneumoconiosis and any accompanying respiratory diseases in that they make disablement due to pneumoconiosis much worse.
§ Mr. Davies
We have first to deal with the facts and then we consider how we can use the facts. I will repeat that statement. Doctors have always accepted in cases of severe pneumoconiosis under the Act that there was a much more intimate connection between the pneumoconiosis and any accompanying respiratory diseases in that they make disablement due to pneumoconiosis so much worse. The result, in effect, has been that some added respiratory disablement due to bronchitis is often taken into account. To do this calls for the exercise of a very difficult medical judgment in each case. My hon. Friend the Member for Oldham, West (Mr. Hale) admitted that radiographic examination cannot give all the answers.
§ Mr. Davies
To do this calls for the exercise of very difficult medical judgments in each individual case. The Government have considered if it could now be arranged that all bronchitis and emphysema should be taken into account in such cases. Our medical advisers tell us that the 50 per cent. level of disablement corresponds to the point at which this severe form of pneumoconiosis begins.
In addition to these medical difficulties, it has been calculated that, as drafted, the Bill would result in an additional charge on the Industrial Injuries Fund of upwards of £20 million per annum. This is a formidable sum. If, on the other hand, we limit the provisions to those suffering from severely disabling pneumoconiosis assessed at 50 per cent. or more and give the benefits proposed in my hon. Friend's Bill, the additional cost to the Industrial Injuries Fund would be about £300,000.
With respect to my hon. Friend, there is another objection to the Bill as drafted. It overlooks certain time-barred pneumoconiotics who are now receiving benefit for pneumoconiosis arising as a result of employment before 5th July, 1948, when the Industrial Injuries Scheme came into effect. Hon. Members will be aware that, in recent years, many of these men have qualified for allowances which are payable from the Industrial Injuries Scheme, and we have done our best to bring their benefits more into line with their industrial injuries counterparts. We feel that they must be included in the provisions of a Bill of this nature, but in terms of cost, it would cost almost as much to look after them as the Industrial Injuries Scheme cases, although they are fewer in number. They have, however, been included in the estimate of £300,000 to which I referred.
§ Mr. Davies
Yes. That is exactly it. These are cases now receiving benefit aris- 884 ing as a result of their employment before 1948, and we want to bring those in.
§ Mr. James Griffiths
Could my hon. Friend give the figures for the last year, or the most recent period for which he has statistics, of the number of persons certified at 50 per cent. or over?
§ Mr. Davies
I will. I am delighted to see my right hon. Friend the Member for Llanelly (Mr. James Griffiths) in his place. He is a pioneer of the Bill and has great knowledge of this subject. The number of assessments in respect of pneumoconiosis and associated conditions current at 30th September, 1964, was 49,360, the average assessment being 26 per cent. The number of assessments of hardship allowances that were payable to 30th September, 1964, in addition to pneumoconiosis pensions, were 27,290. The number of those who in 1964 were around the 50 per cent. category were about 2,005 of the total number of pneumoconiotics at that period. I will not detail each succeeding step over 50 per cent.
Regarding Clause 1(2), which extends the power to suspend from work men suffering from pneumoconiosis accompanied by bronchitis or emphysema, I should explain that the provisions for suspending workmen suffering from pneumoconiosis accompanied by tuberculosis originated in days when tuberculosis was not so easily diagnosed or treated as it is now. At that time, workmen—particularly those in the pits—who were suffering from tuberculosis presented a substantial risk to their fellow workmen. The existing suspension provisions were used to get them out of the pits and into safer working conditions. However, we have no reason to think that bronchitis and emphysema give rise to risks similar to tuberculosis, and therefore the Government could not support that subsection.
The Government have given thought to how they might make a positive contribution towards dealing with this difficult subject in the light of present knowledge. Here I should like the sponsors of the Bill to listen carefully. The Government are prepared to consider Amendments, but I must make it quite clear that we could not make available the very large sums of money required to give effect to the provisions in the Bill as it is at present drafted. The kind of Amendments that we would support at 885 the Committee stage would be those which would help people who are most hard hit by pneumoconiosis—namely, those with an assessment of 50 per cent. or more, including the time-barred to whom I have just referred.
If proposals of this kind are acceptable to the sponsors, then the Government will not stand in the way of the Bill. In this event, the sponsors will have achieved an historic step forward in dealing with this difficult and important matter, which has the greatest sympathy, particularly of those who are associated with people in the mining, quarrying, and pottery industries. To all those hon. Members who are worried about this matter, I would say that the duty of hon. Members, and my own duty, has been solely to face the facts, to try and present those facts, and to see how we have tried to surmount at least one of those difficulties. We believe that as a result of the initiative of the hon. Member for Merthyr Tydvil, who made a notable contribution to the debate today—as did his colleagues—this is a new step forward which miners, and all those who throughout Britain work in dusty occuptions, will welcome.
I could summarise by saying that the Government will do all they can to bring success to the type of Bill which I have mentioned. I hope that I have said enough to show that my right hon. Friend the Minister, the Joint Parliamentary Secretary and I are fully aware of the importance of this matter, and that we have it under constant and careful review.
At this stage I want to pay a tribute to our officials. We have spent hours trying to find an answer, and I would not have been able to speak as I have done today had it not been for the devoted and expert help of the officials in our own Ministry in seeking a solution to one of the most difficult problems that has confronted this Government and other Governments for a generation and a half. What I have offered is a step in the right direction, and I hope that the House and the sponsors of the Bill will accept it.
§ Question put and agreed to.
§ Bill accordingly read a Second time.
§ Bill committed to a Standing Committee pursuant to Standing Order No. 40 (Committal of Bills).