§ 11.30 p.m.
§ Mr. Arthur Palmer (Bristol, Central)
I want to raise the case of a constituent of mine, Mr. Charles Ashworth, who, as the Under-Secretary of State knows, is the subject of a war pension dating from the First World War.
Mr. Ashworth is now 77 years of age. He was severely wounded at Ypres in 1916 and is, therefore, one of the falling number of wounded survivors of the First World War. His disability, due to injury, was finally assessed at 30 per cent. in 1918—54 years ago—and that assessment remains today. My constituent has always challenged the assessment as insufficient in relation to his injuries, but without success. Indeed, he has claimed that there was in his body undiscovered shrapnel.
Mr. Ashworth came to see me in 1971 and, as the Minister knows, I have since been conducting correspondence with the Department on and off on his behalf.
Previous to my interest, Mr. Ashworth's case had been looked into by the local war pension committee, which in the end was unable to recommend in his favour. This was largely due to the Department's medical advisers who argued that Mr. Ashworth's severe kidney condition was the result of a gunshot wound aggravated by the natural decline in life of an elderly man. The doctors stated that there was no shrapnel anywhere in Mr. Ashworth's body, having studied the available x-ray plates and that the assessment was perfectly appropriate for a gunshot wound, and for good measure, I believe, added that he had recently fallen from his bicycle.
I confess that I might have accepted that view, as did the Minister, if it were not that Mr. Ashworth had practical evidence about the shrapnel. In fact I have in my possession the piece of shrapnel which Mr. Ashworth claims emerged from behind his knee about three years ago. I am no judge perhaps, but it is a fairly considerable piece of shrapnel and obviously a most uncomfortable object to have in one's body. It is about half an inch long and very pointed. That piece of shrapnel had been in my constituent's body for a very long time indeed.
1250 In view of this practical evidence I asked for a new independent examination. I received an answer which is not untypical at times of what I call the bureaucratic medical mind, particularly when it is found in a Government Department.
The first answer I received on this point contained this passage:With regard to your request that Mr. Ashworth should have another independent medical examination, we have asked our senior doctors about this, but they advise that there is sufficient medical evidence in his papers and that no useful purpose would be served by further specialist examination. They are also of the opinion that further x-rays of his spine are not required and they have pointed out the risks involved in x-ray examinations.I told Mr. Ashworth about this answer and he was very much distressed. I therefore wrote again to the Minister and said that it would be a great help emotionally to my constituent if he could be examined afresh. I pay tribute to the hon. Gentleman: he then made the necessary arrangements.
This was just as well, because the hon. Gentleman then wrote to me again to say that there had been something of a departmental confession. In a letter dated 24th March last year, he said:When I first wrote to you in February of this year, I said that there was no evidence of Mr. Ashworth having sustained any wounds other than to his back, right loin. A further search of his medical records, however, has shown that we failed to identify that there had also been several small flesh wounds in his legs, with two small foreign bodies retained in the left thigh. I do apologise for having overlooked this.This vindicated what Mr. Ashworth had been saying for many years. My faith in the departmental methods, in a medical sense, was very much shaken. I wonder whether there is more of this in relation to other long-standing war-wounded cases of this kind.
I thought in my innocence that now that this had been discovered there would be a new figure for the assessment of the disability, but this was not the case. At one time, it should be remembered, it had been said as a matter of absolute fact by the doctors that there was no shrapnel at all in Mr. Ashworth's body. But I had a further letter in which the hon. Gentleman said that it was still 30 per cent., shrapnel or no shrapnel.
My disquiet about the medical system as practised in the Department in relation 1251 to cases such as Mr. Ashworth's remains. Also, I am sure that my constituent's doubts have been reinforced by his experience. I put down a Question, to which I had a summary of the replies which had been given to me before, and again no progress was made in favour of Mr. Ashworth's claim. Now I have taken what I suppose is the final step open to me in raising the matter on the Adjournment.
Mr. Ashworth comes of an older and perhaps more harshly-treated generation. After all, it is some time since I was a small child, but both I and the Minister were small children at the time that Mr. Ashworth was wounded in Ypres. With the passing of the years, disablement of all kinds has become a much greater charge on the public conscience. We are now sympathetic to disability of all kinds, not simply that due to war experiences but with that brought about by an accident of birth or by an industrial injury. Perhaps by some civilian standards of industrial injury Mr. Ashworth's handicap has not been excessive. I want to be fair about that. Nevertheless he was disabled, let it be remembered, in risking his life in service for his country as a volunteer in the Army all those years ago.
It seems wrong that there should be this apparent reluctance by the Department to make fresh medical examinations. There seems to be a tendency simply to look at the old records and for one generation of doctors to build upon the medical views of their predecessors. This is a great pity and is wrong.
It is also wrong in a case of this kind—and there must be many similar cases—for an assessment to remain fixed over such a period and that the same kind of norm is taken in spite of the passing of 54 years. Surely age should be taken into account. I should have thought that pain and inconvenience because of a wound or other injury could be borne more easily at the age of 30 or 40 than later on; it is nothing like as easy for a man who is nearly 80 to bear pain due to an old wound.
I should be glad to hear the Minister's comments on this case. Because of what resulted from the correspondence—and perhaps, if I may say so, my persistence in the matter—I should welcome, as 1252 would my constituent, even at this stage, an improved assessment of his disability.
§ 11.42 p.m.
§ The Under-Secretary of State for Health and Social Security (Mr. Paul Dean)
I am grateful to the hon. Member for Bristol, Central (Mr. Palmer) for raising the case of Mr. Ashworth. As the hon. Member said, we have corresponded about this case on a number of occasions. I assure the hon. Gentleman that I have looked at it with the greatest care and sympathy. Indeed we look at all these cases in that light, whatever the age of the person may be; but in the case of someone of 77 years of age, which is Mr. Ashworth's age, we look at such cases particularly carefully. Indeed it is the tradition of the war pension service to lean over backwards and to give the benefit of the doubt, wherever that can reasonably be given, to the person concerned.
Equally, however, we have to observe the essential foundation on which the preferential arrangements within the war pension scheme rest, namely, that the wound or disability concerned has either been caused by or been made worse by service.
The hon. Gentleman said that from this case, and possibly from others, we appeared to have a marked reluctance to make fresh examinations. I assure him that that is not so. There are clearly some cases where we feel, on medical advice, that all the evidence which is likely to be of value is there already. There will be cases where that is felt to be so and to go through the whole process again when there is near certainty that nothing new will arise would only arouse the hopes of the person concerned for those hopes to be dashed later on. I am sure the hon. Gentleman would agree that that is a reasonable point to take into account in deciding whether there should be further examinations.
Before coming to Mr. Ashworth's case, as the hon. Gentleman mentioned that Mr. Ashworth was a 1914 war pensioner, it may be helpful if I outlined the differences which exist between the arrangements for a 1914 man and those for a 1939 man. Under the War Pensions Act, 1921, claims for disablement had to be made within seven years of the end of service or of termination of the 1914 war. 1253 Moreover the majority of disablement awards were finalised shortly after the end of the war. That meant that the assessment was to remain unaltered permanently regardless of whether the pensioner got worse or recovered. There was, of course, a right of appeal against the level of final assessment but it had to be exercised at the time. The corollary is that there are now no formal appeal rights in respect of 1914 awards. That was the original theory but the practice has been different. One hundred and twenty new pensions were awarded last year to 1914 men. In other words, claims were made and succeeded 50 years after the end of the First World War. That shows how flexible the arrangements are.
The same applies to cases of substantial worsening of an accepted disablement. A total of 950 pensioners from the First World War received increased awards last year under those provisions. I hope the figures show that the scheme is still responsive to the needs and changing conditions of the 1914 men and is always ready and prepared to increase assessments or to pay completely new pensions where they appear to be justified.
Although the 1914 man has no formal right of appeal to the appeal tribunal lie can discuss the case with his local war pension committee. There are 115 such committees, consisting of representatives from ex-Service organisations, local welfare bodies, local government and both sides of industry. The pensioner can discuss his complaint with committee members in a helpful and sympathetic atmosphere. The members are empowered to make representations to the Department and those representations are given careful consideration since the Department knows from experience that the committees take up cases only where they consider a further review necessary. Therefore, although the appeal procedures are different, in practice the pensioner has broadly speaking the same procedures and certainly the same sympathetic treatment from the Department as is available to the 1939 men.
Mr. Charles Ashworth served in the 1914 war and receives a 30 per cent. pension for gunshot wound to the right kidney, which was removed. The hon. Member said that was when I was a small boy, 1254 but I was not then born. Mr. Ashworth's pension award was made final in 1918 but it could be increased under special sanction if it could be established by medical evidence that serious and permanent worsening has occurred.
In 1962 Mr. Ashworth asked for his pension to be increased, and after a medical board examination our doctors advised that an assessment of 30 per cent. was still appropriate. Mr. Ashworth was dissatisfied with the result and in June, 1962, discussed his case with his local war pension committee, when he stated that he had back pain caused by a piece of shrapnel near his spine. An x-ray examination was made but revealed no foreign body in that region. Mr. Ashworth was told of this.
In December, 1962, Mr. Ashworth's own doctor submitted an opinion from a consultant orthopaedic surgeon that an old crush fracture of the first lumbar vertebra was the cause of his back pain. Mr. Ashworth claimed that the shrapnel had caused the fracture. However, the records the Department obtained showed that Mr. Ashworth had fallen off his bicycle in December, 1961, and had complained of pain ever since. Our doctors pointed out that there were degenerative changes in his spine which could not be related to the gunshot wound, and x-rays of his back taken in 1957 did not show the crush fracture; this really could not therefore be associated with the old gunshot wound. The doctors confirmed that there was no shrapnel near Mr. Ashworth's spine, and the only evidence of wounding was in his back—right loin—and several small flesh wounds of his legs with two small foreign bodies retained in the left thigh. The assessment of 30 per cent. was appropriate for his disablement from the gunshot wound right kidney—removed. His generalised osteo-arthritis of the lower limbs was not connected with his service in the 1914 war.
Mr. Ashworth's case was subsequently considered on several occasions—twice by the war pension committee which was unable to recommend in his favour—but despite medical examination and x-ray scrutiny our doctors were, and still are, of the firm opinion that there was no shrapnel lodged near Mr. Ashworth's spine, nor was there any other condition of his spine which could be associated 1255 with his accepted disablement or with service in the 1914 war.
It was at this point that the hon. Member began to correspond with me. He first wrote in January, 1971, requesting a review of the pension. He came back to me a second time on this and, as the hon. Member has said, a further examination took place, largely to relieve Mr. Ashworth's mind. He felt that the previous examination had taken place some time ago. We arranged for the medical examination to take place. The medical board was held in October, 1971, when every aspect of his claim was fully reviewed.
The hon. Gentleman has mentioned the error which we made in not finding in his records, until about that time, the two other points in the medical history to which I had not hitherto referred. I apologise to the hon. Gentleman for overlooking that. I think he will accept that they did not make any difference to the position with regard to Mr. Ashworth's assessment. This may not be the case for the future. The position therefore became that the superficial shrapnel wounds of the soft tissue of both legs were causing little trouble and did not serve to increase the assessment of 30 per cent. Mr. Ashworth also suffers from other conditions but none of these is due to service in the 1914 war. There is no evidence of shrapnel lodged near his spine.
Mr. Ashworth's accepted disability was amended to include "shrapnel wounds of soft tissues in both legs" but as our doctors advised that his overall disablement from these and the already accepted 1256 back wound did not amount to more than 30 per cent. he was not entitled to an increase in his pension. Our senior doctors are satisfied that 30 per cent. correctly reflects the current degree of disablement due to his service in the 1914 war.
I know the hon. Gentleman will he disappointed that I am not able to say more. I hope he will at least feel that in the way in which he has taken up this case and persisted in it he has ensured that we have looked not only once but many times to satisfy ourselves on the best medical advice available that Mr. Ashworth is getting all he is entitled to at present under our pension arrangements.
Having said that, I do not want this in any way to be the final word. I shall always be ready to look at any further evidence which the hon. Gentleman may have. If for example, unhappily, Mr. Ashworth's accepted disablement worsened, of course there would be a case for his position to be looked at again. So I hope the hon. Gentleman will feel that although, alas, I cannot give him a happier outcome tonight, the case is not closed, and I hope that he and Mr. Ashworth will feel at any time, if there is further evidence, if there is evidence of his accepted disablement worsening, entirely free to approach us. I can assure him that in those circumstances we will gladly and sympathetically have a look at the case again.
§ Question put and agreed to.
§ Adjourned accordingly at five minutes to Twelve o'clock.