PNEUMOCONIOSIS PANELS (Hansard, 31 October 1974)

§ Mr. Max Madden (Sowerby)

I am grateful to you, Mr. Speaker, for this opportunity to suggest reforms in the composition and procedures of pneumoconiosis panels. The pressing need for such reforms can be witnessed in my constituency, where more than 30 of my constituents have died from asbestosis, another 150 to 200 are currently suffering from this disease and fresh cases are coming to our notice almost daily. All these people are former employees of Cape Asbestos Limited, a firm which closed four years ago after operating in Hebden Bridge for some 30 years.

There is strong local concern about this tragic situation and the circumstances which have led to it and there is pressure for an independent inquiry, which I support but on which I will not dwell this evening.

The number of my constituents suffering from asbestosis has revealed serious shortcomings and injustices in the composition of pneumoconiosis panels. The function of these panels is twofold—first to decide on the diagnosis, and secondly to decide on the degree of disablement from which any claimant is suffering. The board's decision on whether a claimant is suffering from the disease is final, although a claimant can make a fresh claim at a later date.

I argue this evening that there is urgent need for four major reforms of the procedures. First, I should like the pneumoconiosis panels to explain in detail their reasons for rejecting any claim. One of my constituents who has received more than £10,000 in compensation from Cape Asbestos Limited has been before pneumoconiosis panels on five occasions and each time his claim has been rejected, yet two of the most eminent consultants in the country in this sphere confirm that this man has asbestosis. Despite this overwhelming evidence, my constituent is still denied a disability pension. There are others of my constituents who find themselves in the same extraordinary and unfortunate situation.

Secondly, I urge that, as panels frequently disagree with the views of consultants, however eminent, there is a great need for claimants to have an automatic 535 and immediate right of appeal on the question of diagnosis and also on the degree of disablement from which they are suffering. At present, a claimant who is dissatisfied with an assessment has a right of appeal. If the assessment is provisional, the claimant can appeal after two years have elapsed from the original hearing at the medical board. Decisions may be reviewed at any time by a medical board, but this is allowed only—I quote from the regulations of the Department of Health and Social Security— if they are satisfied by fresh evidence that the decision was given in consequence of the nondisclosure or misrepresentation of a material fact. A decision on diagnosis may be reviewed—I again quote from the regulations— if the medical board is satisfied by fresh evidence that the original decision was given in ignorance or was based on a mistake as to some material fact. I believe that the very firm parameters within which an appeal can be lodged deny claimants who are suffering from this disease a proper opportunity to appeal. I believe that such appeals should be built into the procedures from the local panels right up to the central pneumoconiosis panel so that a claimant has an early and very clear opportunity to appeal against the decisions which are taken by the panels.

Thirdly, I believe that the local panels and the central panel should consist of independent consultants as opposed to the appointed full-time members who now occupy these positions. There is a suspicion—and from what I have told the House I am sure hon. Members appreciate why suspicion exists—that the present composition of the panels leads to fixed and arbitrary attitudes being struck by those who adjudicate on claims under the present arrangement. The suspicions and criticisms which are made of these panels and the way in which they operate are not confined to claimants. There are serious reservations about the whole procedures by medical people who come into contact professionally with these panels and by solicitors who act for complainants.

Typical of these criticisms is one which was recently given to the Yorkshire Post by a leading medical consultant in the 536 West Yorkshire region who said he thought it was wrong that there should be decisions of the pneumoconiosis panel which were incomprehensible because they were at variance with the findings of two or three consultant physicians acting as independent assessors. The doctors on the panel are employed by the Department of Health and Social Security. I take the view that it is imperative that there should be an independent medical assessor on the panel in order to ensure that justice is done and that it should be seen to be done.

Not only should these panels be composed solely of independent assessors. If this is not accepted by the Department, I hope that it will at least consider that doctors serving on these panels should not serve on them for very long periods. It would be helpful if there were rota systems operating so that the doctors could be switched to alternative occupations after a period of two years to avoid the sort of criticisms which I have been talking about. They can he satisfactorily overcome only if the whole system is changed completely and independent consultants are used by the Department in this area of work.

Fourthly, I should like to refer to the question of medical representation for claimants appearing before these panels. I was recently told by the Department that claimants could be medically represented before these panels by qualified medical consultants. This was a major advance which was welcomed in my area and by those who appeared before the panels. I believe, and those whom I represent also believe, that this concession is absolutely futile unless there are means by which the claimants can be financially enabled to have this medical representation.

I believe that a form of medical aid is needed to enable claimants going before pneumoconiosis panels to be medically represented by qualified people, because this is the very nub of the matter. They can be represented by trade union officials. Very rarely are these men or women medically qualified. The arguments which go on at these panels are obviously essentially medical arguments, and the claimants are at a serious disadvantage if they are not medically represented. I believe this is an aspect which is of paramount importance and I hope 537 that the Department will seriously consider this matter, because if it overlooks the matter much longer the whole scheme will be brought into serious disrepute.

The reforms which I have suggested are long overdue. They are possible, they are inexpensive and I believe that they would do much to help people suffering from asbestosis and also from the range of diseases which are considered by pneumoconiosis panels.

People who go before the panels are ill and are often most distressed. They are in no physical or mental condition to undertake the long and arduous battle that is often necessary to obtain justice and a disability pension.

A willingness by the Government to act in the way I suggest would be welcomed by my constituents and by many other people throughout the country. I speak for a West Yorkshire constituency, which has not come up against the difficulties of the pneumoconiosis panels in the past. I know from many colleagues who represent mining constituencies that the sort of criticisms I have made tonight have been aired by them for long periods in the past.

I hope that tonight we can have an indication that the Department is willing seriously to consider my suggestions. I believe that these suggestions are possible of implementation, and I am sure that there is no disagreement that they are desirable.

§ The Under-Secretary of State for Health and Social Security (Mr. Alec Jones)

I am sure that people of Hebden Bridge who suffer from asbestosis at present, as well as those who may suffer from it in future, are indebted for the keen interest shown by my hon. Friend the Member for Sowerby (Mr. Madden) in this subject. His interest has been shown not only in initiating this debate this evening but since he first came to the House.

I have read, for instance, the contributions he made in the debate on the Health and Safety at Work etc. Bill on 18th June. He has also tabled Parliamentary Questions seeking information on this subject.

I am sure that my hon. Friend will understand that while I appreciate his 538 interest in the need for improving safety regulations—which is not the main feature of tonight's debate—this is a matter for the Department of Employment.

My hon. Friend is aware that the regulations dealing with the safe handling of asbestos were extended and brought up to date by the Department of Employment in 1969. I understand that my hon. Friend is somewhat critical of the way that these regulations have been interpreted. I appreciate this point, but I wish to assure him that research is continuing into the health problems of asbestosis, including a prospective study of the health of workers in the industry which is now being undertaken by the employment medical advisory service.

I appreciate that asbestosis is a serious issue in Hebden Bridge. A local consultant, Dr. Mann, has taken a great interest in the matter, and I am pleased to hear of the activities of members of a group of general practitioners in the area who are now discussing with the Department of Employment the question of financial assistance for research into the disease. By way of background, I should explain that claims for disablement benefit for pneumoconiosis, including asbestosis, and for a rarer disease, diffuse mesothelioma, under the Industrial Injuries Act are dealt with by pneumoconiosis medical panels composed of doctors who specialise in this work. They have the duty of diagnosing the disease and assessing the degree of disablement. They also undertake the medical surveillance of certain workers in dusty industries, including the asbestos industry. Their opinoin as to the cause of death is sought by the statutory authorities—insurance officers, local tribunals and commissioners—when there is an industrial death benefit claim in respect of one of the diseases they deal with, and this range of work gives them the opportunity of obtaining a complete history of many cases of pneumoconiosis.

A claimant working in one of the prescribed occupations is X-rayed and the X-ray is scrutinised by a member of one of the pneumoconiosis panels. Automatically the case of asbestos workers, and in other industries if there are any signs of disease, or if the claimant does not accept that there is no such sign, he is clinically 539 examined by a pneumonconiosis medical board, normally by two doctors. In the case of asbestosis, the examination includes comprehensive lung function tests.

On the basis of its tests and examination and any other medical information, the board has to decide whether to diagnose pneumoconiosis or diffuse mesothelioma. If it diagnoses one of these diseases, it then has to make an assessment of the degree of disablement the disease causes. It does this by comparing the claimant with a normal person of the same age and sex. The board normally makes an assessment for a limited period so that the claimant is examined regularly, and, if necessary, the assessment can be increased if the disability caused by the disease becomes worse. In 1973 the latest date for which figures are available 824 new cases were diagnosed by the Pneumoconiosis Medical Board and 1,917 cases not diagnosed. About 38,000 sufferers from diseases were dealt with by pneumoconiosis boards and are now receiving benefit.

I turn to the specific points raised by my hon. Friend. First, he asked that in advising claimants of their decisions pneumoconiosis medical boards should give detailed reasons. I am advised that, although it is not normally automatically undertaken, a claimant may on request be supplied with a copy of the board's report, which gives a summary of the board's findings. If the claimant is still dissatisfied, the panel members are willing to discuss the clinical details of the case with the claimant's medical advisers.

My hon. Friend referred to the right of appeal, which is one of the most difficult aspects. As with other industrial diseases, a claimant who is dissatisfied with his assessment may appeal to an independent medical appeal tribunal, and in the case of a death benefit claim there is a right of appeal from the insurance officer's decision to a local tribunal and from there to the commissioner. However, because the members of the panels specialise in these chest diseases they gain considerable experience in recognising them, and because it would be difficult to find a more expert body there is no right of appeal from their diagnosis decisions. It is open to a man to make a fresh claim.

540 This situation obviously does not meet with the satisfaction of my hon. Friend. It was not felt to be entirely satisfactory, and in 1967, following consultation with the TUC, a Central Pneumoconiosis Medical Panel was established to deal with claims of particular doubt or difficulty. Boards drawn from this panel consist of a chairman, who normally takes no active part in the question of diagnosis and assessment, people from headquarters staff of the Department, a senior medical officer and a consultant chest physican.

To give some idea of the working of the Central Pneumoconiosis Medical Panel, I would add that cases are submitted to it where there is reasonable ground for doubt or dissatisfaction. Normally this covers claimants with serious respiratory disabilities whose claims have been rejected twice by the Pneumoconiosis Medical Board or those whose claims have been rejected five times by the board, and with a medical opinion from a chest physician that they are suffering from pneumoconiosis. A further category are those who suffer from diffuse mesothelioma. Where these claims are rejected they should also be seen by the central panel on the second claim, as this is a particularly difficult disease to diagnose.

In 1973, of 45 cases boarded nine were diagnosed. My Department is considering the possibility of extending these criteria to enable a greater number of cases to be reviewed by the central panel.

My hon. Friend expressed the fear that full-time members of the pneumoconiosis medical boards employed by my Department or those who have served for too long on them can develop—I think these were his words—a fixed and arbitrary attitude. As the Industrial Injuries Advisory Council made clear in its 1973 report, Command 5443, it is important to maintain the calibre and standing of panels at a high level. For that reason it is desirable that each panel should continue to include at least a nucleus of experienced full-time members. In addition, however, panels contain part-time members who have outside hospital appointments and experience. I stress that these panels take active steps to maintain good and close liaison with all interested bodies and other medical 541 authorities concerned with matters relating to occupational chest diseases both in this country and overseas.

For example, the panels have local contacts with National Coal Board doctors, the Employment Medical Advisory Service of the Department of Employment, university medical departments and the Medical Research Council. They are also closely in touch with local pathologists and general practitioners and with employers.

My hon. Friend referred to representation. He will know that doctors may attend medical boards if the boards feel that their presence is likely to be helpful. At central panel level trade union representatives frequently provide aid which often takes the form of medical advice. Although there is currently no provision for financial assistance, my hon. Friend will be aware that the whole question of representation before tribunals is now being considered by the Lord Chancellor's Advisory Committee on Legal Aid. I am sure that when the report becomes available it will be studied not only by my Department but by my hon. Friend and all who share concern in these matters.

The working of the pneumoconiosis medical panel system—I have in the past been one who has been somewhat critical —was examined closely by the Industrial Injuries Advisory Council. Its report, which I mentioned earlier, makes no major recommendation to change the system. I do not want to bother the House with quotations but it was said in the report that the council was generally satisfied with the proceedings of the panels. Despite the findings of the council, there 542 must inevitably be people who think that they suffer from a disease when, in fact, they do not. It is only to be expected that in dealing with these complicated and difficult diseases to diagnose medical opinions will differ from time to time.

I have considerable sympathy with people who think that they suffer from one of the serious diseases with which the pneumoconiosis medical panels deal. Despite deep and careful thought, it has not proved possible to devise a better system. I have not closed my mind to changes. When I use that phrase I do so sincerely and genuinely. However, I am afraid that I can see no early prospect of developing beneficial changes. It is not a question of my Department or anyone being unwilling to act. We must be sure that if there are changes they will bring about the improvements which we all desire.

In my constituency, the Rhondda, pneumoconiosis is a disease with which I am only too familiar. I would naturally have complete sympathy and understanding with my hon. Friend. I am sorry that in this debate I cannot immediately accept the recommendations that he has put forward. I am sorry if he feels that I am not being helpful enough. This is an important issue, and we are indebted to him for raising it. If he would like to discuss the matter further with some of the officials of my Department and myself I shall be only too delighted to meet him at any time he cares to suggest.