PNEUMOCONIOSIS (DISABLEMENT BENEFIT) (Hansard, 27 January 1975)

§ Mr. William Whitlock (Nottingham, North)

The men who win from the bowels of the earth the petrified sunshine of a bygone age frequently suffer badly because of their efforts to win for us the coal which the nation badly needs. The distressing respiratory diseases which take their toll of miners have many times been the subject of debate in this House, but I make no apology for raising the case of Mr. G. H. Marlow, a constituent of mine who has been denied disablement benefit as a pneumoconiotic.

Between 1958 and 1974 Mr. Marlow had made five separate claims for disablement benefit and on each occasion had his claim rejected by the pneumoconiosis medical board. In December 1974 172 his case was referred to the Central Pneumoconiosis Medical Board and was once again rejected by that body of experts, who said that his disability was due to a chronic inflammatory condition of unknown origin. Over the years Mr. Marlow has been examined and treated at various hospitals by a number of specialists, who have been unanimous in their verdict after extensive investigations that he was suffering from pneumoconiosis and no other respiratory disease. Two lung biopsies carried out in local hospitals have revealed the presence of pneumoconiosis in his lungs. During last year, prior to Mr. Marlow's appearance before the Central Pneumoconiosis Medical Board, a consultant chest physician in Nottingham considered every possible alternative disease to pneumoconiosis as the cause of Mr. Marlow's condition, and one by one he ruled out the alternatives. His report states: There is no alternative, in my view, to a diagnosis of pneumoconiosis … Not only is there therefore clinical and histological evidence against some other lung disease, but the two biopsies give convincing evidence of the presence of pneumoconiosis. In my view it is clearly certifiable. His disability is severe and deserves an assessment of 100 per cent.… There is no justification for the Panel's use of its favourite formula that pneumoconiosis of this degree does not produce disability, unless it can show that another severe disease is present. As we have seen, the Central Pneumoconiosis Medical Board adhered to its uncompromising, uninformative and unsatisfactory formula, and rejected the claim but hazarded no alternative diagnosis. These are the experts. These men of the regional and central boards are the specialists who under the regulations have the sole right to say whether a man is suffering from pneumoconiosis. They have been examining Mr. Marlow 173 for 16 years, yet still they cannot say what is wrong with him. All they will say, stubbornly and repeatedly, is that he is not suffering from pneumoconiosis.

This is not good enough. These men may be experts, but I would suggest that too often they are like priests of a present-day Sheffield or London oracle who appear to look back for guidance on the records of their previous divinations, and for the sake of preserving their mystique and their imagined reputation for infallibility utter the same incantation, against which there is no appeal to an independent body.

Every member of the medical profession who has examined Mr. Marlow over the last 16 years other than the members of the pneumoconiosis boards believes that my constituent is suffering from pneumoconiosis and not some other disease. In those circumstances the system seems totally unjust, not only to Mr. Marlow but to every single person who knows him and his case.

Here is a man who was once fit but who has for some years been robbed of the ability to enjoy life except in the most limited way, confined almost continuously within the four walls of a room in his home because the slightest exertion brings a terrifying shortness of breath. That condition, incurable and unrelievable, would be hard enough to bear had its cause been accepted and had the appropriate benefit—totally inadequate as it is by way of compensation—been paid to my constituent. But imagine his bitterness when year after year, in spite of the opinions of specialists who know his case intimately, he is refused benefit by a body which admits that he is severely disabled by disease but which cannot say in what way, although it can say that it is not the one disease which would qualify him for benefit. There is something wrong with a system which permits this kind of injustice.

A claimant for benefit as a pneumoconiotic has a right to appeal to a medical board against a pneumoconiosis panel's decision that he is not suffering from the disease. Experience shows that such appeals usually fail and the sufferer is left feeling cheated of justice because his appeal has been decided by the same doctors who disallowed his claim in the first place. To have his case referred to the Central Pneumoconiosis Medical Board a 174 claimant must have been rejected by two previous medical boards, must have a serious respiratory disability and must also produce an opinion of a chest physician "of repute" that he is suffering from pneumoconiosis.

Apart from dissatisfaction with the way in which pneumoconiosis medical boards deal with claims, there is also widespread critism of the central board's procedure. The hurdles that a claimant must surmount before getting his case referred to the central board are too great. This is especially so for younger men who may not have been seen by two previous medical boards, who have not yet reached the stage of severe respiratory disability but who may already be in the insidious grip of certifiable pneumoconiosis. Such men, in the absence of proper and timely attention to their claim, remain in an occupation which will inevitably bring a progression of the disease to very serious consequences.

The main criticism of the Central Pneumoconiosis Medical Board is that it is neither an independent nor an appellate body. In my view there should be a right of appeal on the question of diagnosis to a body which is seen to be completely independent. I know that the Minister will probably quote what the Industrial Injuries Advisory Council had to say on this in its report in 1973. It said: The absence of the right of appeal on the question of diagnosis stems from the fact that, because the Panels have a unique expertise in the diagnosis of pneumoconiosis, it would not be possible to set up an appellate body of superior status capable of dealing with the numbers of cases likely to arise if an automatic right of appeal was introduced. In my view that statement is absolute nonsense, because it infers that panel members cannot be wrong in their diagnosis and suggests that other chest specialists are unable to adjudicate on diagnosis cases.

Every member of the medical profession outside pneumoconiosis boards who knows Mr. Marlow believes that the statement is a nonsense, but whatever may be the diverging views of the medical profession and between those who serve on pneumoconiosis boards and those who do not, it is very clear that those who are employed in the mining industry will not feel that justice is being done in cases like Mr. 175 Marlow's unless those who suffer from the maiming effects of coal dust in their lungs have their cases considered under a procedure which has shed the faults of the present system.

I urge the Minister not to stand four square on the theme of the report of the Industrial Injuries Advisory Council but to understand that the recognition of a small handful of men as being exclusively expert in the diagnosis of pneumoconiosis is wrong. I ask him to look once again at the procedure which I feel is bound to be altered in time. Let the change come now, before more men have to die to provide material for post-mortem examinations of their tormented bodies to show that the pneumoconiosis boards have not been infallible in their cases.

I strongly urge the Minister to consider a thorough-going examination of these procedures and to come up with a solution along the lines I have suggested. If that is done, there will be great rejoicing in the coalfields throughout the country.

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

My hon. Friend the Member for Nottingham, North (Mr. Whitlock) said that he had no intention of apologising for raising this subject. I assure him that had he attempted to do so I should have felt that much more strongly than anything he has said, because both the specific case and the general case my hon. Friend has raised are close to my heart, representing as I do part of South Wales. As my hon. Friend knows, South Wales has a greater incidence of pneumoconiosis than has any other coalfield in the United Kingdom. That is not a proud record of which I boast, but it indicates my specific interest in the subject.

The first claim made by my hon. Friend's constituent, whose case he has raised tonight, was in 1958. Mr. Marlow was then X-rayed, and in accordance with the normal practice the X-ray was examined by a member of a pneumoconiosis medical panel other than the one from which pneumoconiosis medical boards for Mr. Marlow's area are drawn. This doctor decided that the X-ray showed no sign of diagnosable pneumoconiosis, and Mr. Marlow was informed 176 of this decision. At that time, if he had so wished, Mr. Marlow could have asked for his case to be examined by a full medical board, and this would have included a clinical examination.

However, it was 1960 before Mr. Marlow pursued his claim and then, because of his undoubted disability—no one doubts Mr. Marlow's suffering or his disability—he was visited at his home by a pneumoconiosis medical board. This board and the subsequent boards that have visited him in 1964 and January and July 1974, on the basis of their examinations of Mr. Marlow, his many X-rays and other medical reports, including those from the hospitals at which he has been a patient, have all decided that Mr. Marlow is not suffering from pneumoconiosis.

Mr. Marlow claimed again at the end of last year and he was examined by a Central Pneumoconiosis Medical Board on 12th December. This board, whose composition I shall describe a little later as it has been criticised by my hon. Friend, also came to the conclusion that, whatever Mr. Marlow was suffering from, he was not suffering from pneumoconiosis within the meaning of the Industrial Injuries Act.

My hon. Friend has referred to the medical aspects of Mr. Marlow's condition, and quoted from the findings of the central board. He referred to the passage: Disability is due to a chronic inflammatory condition of unknown origin … But he did not complete the finding, which said: … the appearances of the inflammatory condition are quite unlike those of pneumoconiosis. Pneumoconiosis is not diagnosed. Therefore, I repeat that the board found that the disability was due to a chronic inflammatory condition of unknown origin.

The various medical boards which have considered Mr. Marlow's case are statutory authorities over which Ministers have no control. My hon. Friend will appreciate that, despite one's own inclinations, it would not be proper for me to comment on their decisions, nor can I intervene in any way on them.

It is not, however, the case that because Mr. Marlow has not been found to have pneumoconiosis his disability is ignored. In July last year he was awarded the 177 lower rate of attendance allowance because of his respiratory difficulties, and the £5.35 a week is in addition to his normal retirement pension. Both of these will, of course, be uprated with other social security benefits in April this year.

I said that I would return to the subject of the Central Pneumoconiosis Medical Board. Perhaps I should explain something of the background. The arrangements for diagnosing pneumoconiosis for industrial injury purposes differ from those for most other prescribed diseases. Pneumoconiosis claims are submitted to special pneumoconiosis medical boards, and there is no right of appeal against their decisions or diagnosis. My hon. Friend made this point in his remarks.

This procedure was established from the start of the industrial injuries scheme in 1948, and it became established in this way because the difficulty of diagnosing the disease made it desirable to give the task to experts. I know that my hon. Friend is somewhat critical of these experts, but it is only fair to point out that the pneumoconiosis medical boards are composed of specially qualified doctors, most of whom are full-time on this work and thus acquire a great expertise in it. However, this creates a problem a right of appeal makes sense only if it is possible to form an appellate body of greater knowledge or status than the body that makes the initial decision.

The problem with pneumoconiosis is the lack of sufficient eminent specialists outside the boards who are familiar with the disease. The Franks Committee on Administrative Tribunals recognised that in the absence of the possibility of such a more expert appellate body a right of appeal could not be provided. For this reason, when, following the Franks Committee Report, changes were made in various social security adjudication arrangements, no appeal on diagnosis of pneumoconiosis was provided. But in 1967, after discussing the problem with the TUC—and we can well imagine that the council was well advised on this matter by the NUM—it was agreed that, in the absence of a formal appeal right, particular categories of cases of difficulty should, as an administrative arrangement, be referred to a newly-created Central Pneumoconiosis Medical Board. That board has an independent chest 178 consultant as one member, a senior medical officer from a pneumoconiosis medical board, who has not previously been involved in the claim, as the other member, and it is chaired by the principal medical officer, or his deputy, concerned with pneumoconiosis from the headquarters staff of my Department. The chairman normally takes no part in arriving at the decision but is available to provide information about particular features of the disease or the relevant law. It was a board of this sort that considered Mr. Marlow's claim last December.

My hon. Friend has referred to what he considers inadequacies in those arrangements. Coming as I do from the mining constituency of Rhondda, I am well aware of the criticisms which are made of the way in which claims for benefit for pneumoconiosis are decided, and particularly of the absence of a right of appeal on diagnosis. That seemed to me the main burden of my hon. Friend's case.

I should like to give an idea of the future thinking on this matter. When the central board was introduced it was an advance on the previous situation. It was a definite, though limited, advance, I agree. We have now had a number of years' experience of its working. I am sure it has been of great value. But, after a time, it is worth while looking at problems again. Ministers are only too ready to do this, and, if they are not, occasions such as tonight remind them that they should be ready to do so.

That does not mean that any problem is capable of solution to the satisfaction of all concerned. There will always be differences of opinion between doctors, and unsuccessful claimants will not all be satisfied that the correct decision has been given in their case. This feeling of dissatisfaction may well arise even where an appeal system is introduced. I feel that it is worth making further efforts to narrow the gap between the present system and the way in which the appeals and other sorts of claims for disablement benefit are handled.

Since my hon. Friend has called for a review, I can tell him that the possibilities of narrowing this gap between the present system and the system applied to other claims are now being thoroughly 179 reviewed in my Department. I obviously cannot say what the outcome will be. I cannot give a time limit for the investigations now taking place. However, I assure my hon. Friend that the investigation will be thorough and that his point of view and the points of view expressed on this issue by many other hon. Members in the past will be taken aboard.

I am sure that the House and those men and women who suspect that they have pneumoconisis will be grateful to my hon. Friend for raising the subject tonight. My hon. Friend has rightly 180 raised the subject as it affects his constituent, Mr. Marlow. I do not have a Mr. Marlow in my constituency, although I represent many people suffering from the same complaint. I assure my hon. Friend that I shall do all I can to ensure that those people receive justice and that the points which he has made will be borne in mind when my Department carries out the investigation into how these cases can best be treated.