§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Fitch.]
§ 10.0 p.m.
§ Dr. Hugh Gray (Yarmouth)
It is not unusual for citizens to feel that they are wronged. It is perhaps more unusual when a citizen not only feels that he is wronged but knows that his Member of Parliament, his doctor and all the citizens of the village in which he lives share that view.
The facts of the case are as follows. Mr. Armes, who is an agricultural worker, was injured on 24th December, 1964, in the course of his work. He was felling a tree, a rope broke, and he fell over backwards and suffered an injury to his foot. He has never been the same man since. Previously he was extremely healthy and active. He had worked for the same employer, except for a short break, for more than 14 years, he had attended work regularly and had never been ill. In fact, he was a healthy and fit man. But since that day this has not been so, and in 1965, as his employer tells me in a letter, he limped a great deal. He can no longer climb a ladder and cannot cut grass all day and at the end of his day's work he is a tired man.
Following his injury, Mr. Armes was examined by a medical board on 11th February, 1966, which awarded him an assessment of 20 per cent. provisionally from 14th March, 1965, to 13th March, 1967. The Minister apparently disagreed with this not very generous finding, and referred the case to the medical appeals tribunal, which eventually decided that the award should be reduced to 5 per cent., it reaching this decision because it considered that Mr. Armes's disablement was due to a prior osteoarthritic condition in his foot.
It is commonly thought that most of us have potential arthritic conditions in our bones. Doctors share this view. Perhaps in years to come my hon. Friend the Parliamentary Secretary and I will suffer from arthritis. But to claim that this condition existed overtly previously—it did not manifest itself in the man for a single moment—and that his 1112 accident precipitated it further seems patently absurd. It would be as ridiculous to hold that women by their very nature are subject to pregnancy. As far as I know, no man taken to court for a maintenance order has yet pleaded this as a ground for the order not being made against him.
Mr. Armes's doctor has given me permission to read his letter, which says:I casually noticed how badly this man walked as we were both going to see Norwich City play football at Norwich about 25.1.65. It appeared that he had consulted a partner of mine on 27.12.64"—three days after the accident—after he had an ankle injury on the 24th. My partner did not think the injury sufficient enough to warrant sending him to casualty for investigation, such as X-ray, and so you can understand how I felt when I saw him limping. On 4.2.65 an orthopaedic surgeon who saw him reported that, 'X-ray of ankle and foot shows no boney injury, but arthritic changes in the ankle'. Despite considerable treatment ever since this man continues to have pain and discomfort in his left ankle joint. A new orthopaedic surgeon, who has recently come to live here, saw him on 30.3.66 and on reviewing the case said he felt that to ease his pain he was prepared to fix the joint by the operation of arthrodesis. He saw no other way of easing his pain. Mr. Armes is to consider this at the end of the holiday season.When I examined him tonight"—
12th May, 1966—I found the ankle joint stiff and limited in all movements. The hallux rigidus which was noted by the Medical Board is in fact an arthritic joint, as all the signs of arthritis are present there. I think this man has a good case. He is not a malingerer, and even if he might have developed arthritis in this ankle joint at some later date, I have no doubt that his injury precipitated the traumatic arthritis which has subsequently developed. I think this chap has done very well indeed in carrying on his job and suffering this pain and misery, when many patients I know would have been sitting down and resting the joint and drawing their insurance money by now. and the Medical Board could have done nothing about it.I have put the case in simple terms and I am sure that people will agree with me that it cannot be argued, when a man has been perfectly fit before an accident and that accident precipitates a condition that he has never experienced before and which continues for years afterwards, that the injury can be treated as a 5 per cent. injury. I have written to my hon. Friend about this case on a number of occasions, but it often happens that, when one exchanges ideas with people through the 1113 medium of the voice rather than the pen, they understand the underlying conditions better. I am not suggesting that this is a case of Antigone, in which one should make a desperate appeal to natural law, but this case involves a basic principle of justice and I appeal to my hon. Friend, who has all the facts before him, to reconsider them now and say that he will do something about this case.
I appeal to him not to dismiss the case by some kind of formality, by saying that a further appeal cannot be entertained. Surely my hon. Friend can refer the case back to the board. Along general lines, I suggest that, in future, there is obviously a case for consulting general practitioners about their patients, particularly when they have known them for many years—known them intimately and well.
One realises that, in such cases, there may be people who take advantage of a pre-existing condition but that brings me back to the original point. In Mr. Armes's case, this condition had never manifested itself before. One must admit that at least it was precipitated by the accident. That is why the original award of 20 per cent., with which the Minister apparently did not agree, was not very generous but at least it was along approximately the right lines. But 5 per cent. is not. I appeal to my hon. Friend to reconsider the case and say that he will do something which will convince not only Mr. Armes but my constituents and the citizens of this country that, when an injustice is exposed, whatever the technical objections, the Minister will act.
§ 10.10 p.m.
§ The Joint Parliamentary Secretary to the Ministry of Social Security (Mr. Harold Davies)
I know full well the concern of my hon. Friend the Member for Yarmouth (Dr. Gray) with this case. He has written to me—he has done more than that for on a number of occasions we have spoken about it. I want briefly to set out the facts and then lead to my summing up of the points at issue.
As my hon. Friend has said, on 24th December, 1964, Mr. Armes fell and injured his ankle while tree clearing at work. He claimed and was paid injury benefit under the Industrial Injuries Scheme for two periods between 28th December, 1964, and 13th June, 1965. Then, on 15th April, 1965, he claimed disablement benefit. As it is required 1114 to be, his claim was referred to an independent medical board, which decided that he was suffering a loss of faculty, due to his accident, which it provisionally assessed at 20 per cent. for one year ending 13th March, 1966.
He was awarded a disablement pension for this of 23s. a week in accordance with the board's decision. He was examined by another board on 11th February, 1966, which found his condition unchanged and made a further provisional assessment of 20 per cent. extending up to 13th March, 1967, a little later date than my hon. Friend mentioned. He was awarded a further disablement pension, now at the rate of 27s. a week, on the basis of this decision, but as there was some doubt as to the correctness of the board's decision, his case was referred to the Medical Appeal Tribunal for consideration.
At their hearing on 5th April, 1966, when Mr. Armes was represented by an official of his union, the National Union of Agricultural Workers, the medical appeal tribunal decided that Mr. Armes was no longer suffering a loss of faculty from his accident and set aside the medical board's decision, substituting a final assessment of 5 per cent. for one month from 14th March, 1966. His disablement pension, therefore, ceased.
In giving their reasons for this decision, the medical appeal tribunal said:All the movements of the ankle joint are full and free, and there is no wasting or swelling over foot or ankle. There is a hallux rigidus"—or stiff big toe—which is unconnected with the accident and has not been affected by it. There is no longer any assessable disability which is properly attributable to the relevant accident.The Industrial Injuries Acts—and the Minister and I are limited by them—provide that where a person has sustained an accident at work, the question whether he has been, or is, suffering a loss of faculty—and, if so, the extent of his disablement—is decided by a medical board in the first instance, or, on appeal by the claimant or reference at the instance of the Minister, by the medical appeal tribunal. Both of these bodies are independent of the Ministry. Neither the Minister nor I have any power to influence or interfere with the decision. 1115 That is how the 1946 Industrial Injuries Act laid it down.
The medical board consists of two general practitioners, and the medical appeal tribunal consists of a chairman who is a lawyer of standing, appointed by the Lord Chancellor and two medical members, who are invariably of consultant status, nominated by the Royal College of Physicians or Surgeons or by the medical faculties of the universities. By the Statute, the decision of the medical appeal tribunal on a case is final on the medical merits, the only further right of appeal being, with leave, to the Commissioner on a point of law. There is a limited power of review.
The decision of a medical board or medical appeal tribunal may be reviewed by a board or tribunal either if they are satisfied by fresh evidence that the original decision was given by reason of the non-disclosure or misrepresentation of a material fact or if they are satisfied that since the original decision has been given there has been unforeseen aggravation of the results of the relevant injury.
My hon. Friend has told us that he thinks the decision of the medical appeal tribunal in Mr. Armes's case is wrong and that Mr. Armes has been done an injustice. He says that Dr. Rochford, Mr. Armes's own doctor, is convinced that Mr. Armes's present condition results from his accident and that everyone in Winterton, where Mr. Armes lives, knows that he was completely fit and healthy before his accident.
I accept that my hon. Friend speaks from conviction on this, but as I have explained under the Act it is for the independent authorities to decide to what extent a claimant's condition results from an accident. While they may listen to any opinion which may be expressed they are not bound to accept it. As my hon. Friend will appreciate, it would be quite improper for me to comment on or seek to explain the merits of the tribunal's decision, even if I were competent to do so, but he will have noted that they do not say that Mr. Armes is not disabled. They say only that,… there is no longer any assessable disability which is properly attributable to the accident.1116 My hon. Friend has suggested that he may now have some new evidence from Dr. Rochford. As I have said, it is possible for the decision of the medical appeal tribunal to be reviewed by a medical board or the medical appeal tribunal if they are satisfied by fresh evidence that the original decision was given by reason of the non-disclosure or misrepresentation of a material fact.
The question whether any particular document constitutes fresh evidence and also meets the other conditions for review on this ground is for the board or tribunal. If Mr. Armes wishes to seek review of the medical appeal tribunal's decision on the basis of new evidence, his local office will be pleased to assist him to complete the form of application. His case will then be referred to the medical board. I would only add that medicine is not an exact science, like economics and others and at times there are bound to be conflicting opinions among doctors.
§ Mr. John Horner (Oldbury and Halesowen)
Can my hon. Friend say whether this case will be referred to the same medical board? Do I understand that the process is that the original medical board determines whether new facts have been adduced?
§ Mr. Davies
I apologise, Mr. Speaker.
It is very difficult, in setting up some of these tribunals, when we are limited to nominations from the Royal College of Physicians or Surgeons, and we are also limited by the fact that these men, top consultants, are very busy. At different times, however, the tribunals may well consist of different consultants. They have no possible reason for being other than completely impartial in arriving at their decisions.
It was precisely because of the unsavoury situation under the old Workmen's Compensation Acts, that the present 1117 industrial injuries scheme was introduced to replace it. Then, representatives of employers and employees vied with each other to produce medical opinion and medical witnesses to support their case in the hope of influencing lay courts, when, under the Industrial Injuries Acts, decisions were entrusted by Parliament to these expert and impartial bodies, which could, from their expert knowledge and experience, arrive at decisions on the question at issue.
With the Industrial Injuries Acts, we wanted to correct some of the errors of the old Workmen's Compensation Acts. I can therefore understand the disappointment and appreciate the way in which my hon. Friend has worked for his constituent. I understand the disappointment which may result when a constituent who sincerely believes that his disablement is a result of an accident at work and possibly has a medical opinion to support his belief finds that the medical appeal tribunal does not accept this view. I understand that, in those circumstances, it is natural to argue that there should be provision 1118 for a further right of appeal on the medical merits or a rehearing by a different tribunal. But, in any form of adjudication there must be finality at some point. It is in the interests of claimants themselves that a truly authoritative and final decision should be reached as expeditiously as possible.
For this reason, it has always been the principle that the medical appeal tribunal should be staffed by medical men of the highest possible qualifications. But it is illusory to suppose that one could add even more highly qualified stage to this hierarchy or, even if we could, that it would necessarily give any greater satisfaction to claimants generally. Nevertheless, despite what I have said, I would repeat that, if my hon. Friend believes that there are new facts in this case, the local office and my Ministry would be pleased to look at this case again.
§ Question put and agreed to.
§ Adjourned accordingly at twenty-two minutes past Ten o'clock.