Mr. Michael Starrs (Mobility Allowance) (Hansard, 18 July 1985)

§ Mr. Tom Clarke (Monklands, West)
I am particularly grateful for this opportunity to debate the case of Michael Starrs, and I welcome the interest which the Minister's Department has shown and look forward to the hon. Gentleman's response.
Michael Starrs is a father, aged 47. Clearly he is very severely disabled and an extremely ill man. Until his first serious illness struck in 1965, the year when a fateful operation for a duodenal ulcer was performed, Michael was extremely fit and far from work shy. As a national service man, he served in the 15/19 King's Royal Hussars in Northern Ireland in the late 1950's. Apart from that period, and until his illness, he worked as an apprentice and then as a welder in Tollcross foundry.
Prior to his illness, Michael's average weight was 10 stone 7 pound. Now it is just 8 stone. He has twice applied for mobility allowance and had been refused on both occasions.
Tonight I have to ask the Minister why and, grateful though I am that the hon. Gentleman is present to reply to the date, I have to tell him that I shall listen very carefully, as will my constituents, to his reply, because it is a case which has baffled many people and continues to baffle me.
I have to ask the Minister why there should be a refusal in the case of a man who is qualified for and has been given a wheelchair by the National Health Service, presented by Belvedere hospital. Why should there be a refusal in the case of a man who was informed by letter on 8 March 1983 by the Ministry of Transport that the restricted condition of his legs meant that his driving licence would cover hand controls only? Why should a man who is fed intravenously or who is otherwise dependent on baby food or a liquid diet be judged so harshly? Why, when a man suffers from such obvious fatigue that his walking is considerably impaired and when it would be cruel in the extreme to make demands beyond his present limited capacity, is this not taken into account?
Those questions are also being asked by my constituents, 3,500 of whom have petitioned me to insist on a full inquiry into the whole of Michael Starrs' case, including his medical history, and some of those people themselves receive mobility allowance. Some of them are the same constituents who got together in a local social club and presented Michael with a hand-controlled car, which gives him the little comfort that he has when he can afford to run it.
Last year the local newspaper in my constituency, the Airdrie and Coatbridge Advertiser, published a prominent article headed Michael's 19 years of hell. It reflected, quite properly, the views of those in my community and strong views generally that those involved in social security have not yet found a satisfactory conclusion.
In March 1965, at the age of 26 years, Michael was admitted to Hairmyres hospital, East Kilbride. He underwent an operation for a duodenal ulcer. From that date until now he has never had a normal meal because his 624 digestive system cannot cope with one. As it was not in his nature to be voluntarily without work, he applied for and was given a light job in the Gartcosh strip mill from 1965 to 1970. However, even that became too much for him and his consultant wrote to British Steel and told them so. After a lengthy period as an out-patient and sometimes as a in-patient, yet another operation, the third in all, took place in 1970 to deal with the complications which had arisen from the earlier operation in 1965. It is a matter of medical history that a piece of silk, which lingered from Michael's first encounter with surgery, had to be removed. Michael tried to resume work but found that his condition had deteriorated so badly that he experienced a burning sensation every time that he attempted to swallow, a condition which persists to this day.
Michael finally accepted early redundancy and left his employment with £800 for his 20 years' service. With that he was left to face the future. Michael has existed on invalidity benefit since then. It is not surprising that his faith in social services has been somewhat shattered. Astonishing though it may seem, in 1976 he was called before a medical tribunal and his invalidity benefit was discontinued. He appealed to the health commissioner, who restored it. That establishes that tribunals are not always right, and certainly have not been so in Michael's case.
The first tribunal that heard Michael's application for mobility allowance sat on 13 October 1980. It concluded: We have considered the evidence and observed the claimant walking out of doors. He walks slowly with a hesitant gait and with the aid of a stick hut without apparent pain or severe discomfort. The best person to make a judgment on his ability to walk and his discomfort is Michael. On that evidence, which is supported by all who know him, there is and has been considerable discomfort. I find it incredible that the tribunal could have reached such a conclusion.
I gave evidence at the second tribunal hearing in January. It had before it a great deal of information, including the opinion of Dr. Ian Bone, a consultant neurologist, who said: 'He walks in an extraordinary manner, bent forward as though walking on a treadmill. The walking is symmetrically abnormal but becomes more bizarre when the stick is held in the left hand. On general examination, he is a small emaciated man. Having heard the evidence and made my contribution to the tribunal. I believe that my constituent suffered in the conclusions reached because of aconflict of medical evidence about his condition. There were several diagnoses from various doctors. Doctor No. 1 said that Michael suffered from multiple sclerosis, doctor No. 2 said that it was post-gastric surgery debility: ataxia and a third doctor concluded that Michael's condition was caused by a psychosomatic illness.
The doctor who knows most about the case is Mr. Starrs' own medical practitioner, Dr. Edward McCabe, a man who does not use words lightly and thinks carefully before he reaches a conclusion and offers it for consideration. He said: Mr. Starrs suffers from a difficulty in locomotion which I feel qualifies him for a mobility allowance. That is the unreserved view of a doctor who knows Michael and has seen the condition develop and Michael's health deteriorate.
Unfortunately, the tribunal did not share that opinion. It concluded: 625 We have observed the claimant walking a distance in excess of 100 yards outside. The claimant can walk such a distance, as was confirmed by Mr. Clarke, slowly and gingerly with frequent short pauses for no apparent reason and without any evidence of distress. I found that conclusion astonishing and I regret to have to say that it was a distortion of the evidence that I gave. I made it clear that on a very cold winter's morning I walked 100 yards with Michael Starrs and I had to stop with him on five or six occasions. He was unable to continue and was caused considerable distress. I was cold and Michael, in his condition, must have felt much colder. How the tribunal could have reached that conclusion is a mystery which still invites an explanation.
I have discussed all the papers in the case and the facts known to me with my right hon. Friend the Member for Manchester, Wythenshawe (Mr. Morris), who introduced the legislation that provided the mobility allowance. He would have spoken in the debate. but unfortunately he has to be out of the country on parliamentary business. However, he has encouraged me to say that he finds it astonishing that Michael Starrs has not been given a mobility allowance. He would have supported my case, and I find that support a great comfort.
On the basis of the evidence in this case, there must be a suspicion that applicants for the allowance, at least in Scotland, if not elsewhere, are being subjected to more stringent tests than many people would feel are desirable. I know of the independence of adjudication authorities, yet there is a clear injustice in the case of Michael Starrs and it worries me that similar injustices might be occurring in other cases.
If the Minister tells the House that he cannot intervene in the case, there will be considerable disquiet amounting, yes, to disgust in Coatbridge and throughout my constituency.
I invite the Minister to share my contempt for the procedures which have condemned Michael Starrs to immobility and dependence whereas with the allowance which the thousands of people who know him think he should have he could be mobile and independent.
I cannot believe that a man and his family who are experiencing such stress and pressure will not be compelled later to make even greater demands upon the National Health Service. No saving is made by not granting the allowance.
I say to the Minister and to the adjudicating authorities that I cannot accept their view. I cannot accept that Michael Starrs should be treated in this way. The fight will continue beyond this debate.
I sought the opportunity to ensure that we had an Adjournment debate on the issue because I profoundly believe that the case speaks for itself and invites correction. I should be delighted if the Minister responded positively, not just in the interest of Michael Starrs and his family, important though that is, but in the interests of humanity.

§ The Parliamentary Under-Secretary of State for Health and Social Security (Mr. Ray Whitney)
I am grateful to the hon. Member for Monklands, West (Mr. Clarke) for raising the case tonight. I congratulate him on the eloquence and sincerity with which he put the case. He has pursued Mr. Starrs' claim for mobility allowance with great assiduity for some time.
626 It will be no surprise to the hon. Gentleman to learn that great as my sympathy is for Mr. Starrs and his difficulties, I cannot make any decision on his claim. I hope that the hon. Gentleman will understand.
The reason is that mobility allowance claims, in common with claims for other social security benefits, are decided by independent adjudicating authorities. An adjudication officer examines a case in the light of a medical report prepared by a doctor, in the first instance. If the claimant appeals, a medical board reconsiders the case. There is a further right of appeal to a medical appeal tribunal whose decision is final on the medical questions.
I accept that mistakes can be made at any stage in that process and changes in decisions can be made. However, over many years under all Governments the independent nature of the adjudicating authorities has been preserved. Ministers cannot intervene. I recognise the hon. Gentleman's argument about the view of a particular doctor, but I hope that he will accept that the views which we collect through the medical appeal tribunal system offer a wide range of experience and knowledge which must be accepted as being valid.
A decision by a medical appeal tribunal can be challenged only by way of an appeal on a question of law to the Social Security Commissioner. Neither Ministers nor officials of the Department can decide claims, nor cart they alter or try to affect decisions given by those authorities.
Before I deal with the specific case of Mr. Starrs it might be helpful if I explain briefly the medical qualifying conditions for the allowance.

§ Mr. Clarke
At the second tribunal the chairman was Queen's Counsel. If Michael Starrs appeals, can he be represented by a Queen's Counsel and have legal aid?

§ Mr. Whitney
I would need to write to the hon. Gentleman on that precise point. Mr. Starrs has the right of appeal, but I would not want to mislead the House on the detail.
The medical qualifying conditions were set out in 1976. The hon. Member for Monklands, West referred to his colleague the right hon. Member for Manchester, Wythenshawe (Mr. Morris), who was intimately connected with the introduction of the benefit in 1976. Careful consideration was given to the conditions in the light of the resources available and the need to provide a cash allowance which would be a worthwhile contribution towards the additional expenses which disabled people incur in getting about. It was decided that the allowance should be available to those severely disabled people who are unable, or virtually unable, to walk due to physical disablement.
Virtual inability to walk is not defined in the legislation, but regulations lay down the kind of factors that are to be taken into account in assessing a claimant's walking ability. These include the distance a claimant can walk and the speed, length of time and manner in which he can make progress without severe discomfort.
I must emphasise that the adjudicating authorities are responsible for the interpretation of these conditions and for their application in individual cases. They can, for instance, decide that a mental handicap has a physical cause or that its effect is to produce a physical disablement but the test for the allowance remains one of walking ability.
627 The first claim by Mr. Starrs was received on 13 October 1980. The decisions, in turn, of the insurance officer, medical board and the medical appeal tribunal were that he was not unable or virtually unable to walk and thus not entitled to the allowance. He was refused leave to appeal against the decision of the medical appeal tribunal on a question of law by both the medical appeal tribunal and the social security commissioner.
Mr. Starrs subsequently made a fresh claim for the allowance which was received on 1 June 1983. Again, an insurance officer, medical board and medical appeal tribunal, in turn, decided that he was not unable or virtually unable to walk. He has now sought leave to appeal to the social security commissioner on a question of law and we currently await the decision of the medical appeal tribunal chairman on this application. If such leave is refused, Mr. Starrs will still have the opportunity of seeking leave direct from the commissioner.
The hon. Gentleman will thus see that a final decision has not, as yet, been given on the claim made by Mr. Starrs and I cannot, of course, anticipate the likely outcome.
The question whether the qualifying conditions are satisfied are considered as at the date on which the claim is received by the Department. If Mr. Starrs considers that his walking ability has become worse since he made his 628 last claim, it is open to him to make a fresh claim which will be considered in the light of his walking ability at the time that it is received.
I recognise that Mr. Starrs' case had taken a long time to resolve. It is inevitable that such cases should be protracted because of the importance both for the claimant and the Department of gathering all the facts, of obtaining medical reports and of considering all the evidence carefully. However, we have been concerned about the length of time cases like Mr. Starrs' take and we have been considering what we can do to speed up the process of adjudicating on claims. I am glad that we have made some progress, although there is more to do.
Mr. Starrs' claim has not beeen finally decided. He has applied for leave to appeal to the social security commissioner against refusal of mobility allowance. In any case, if the decision goes against him and Mr. Starrs believes that he now satisfies the criteria, he can apply again.
I have carefully noted the points made by the hon. Member for Monklands, West and shall write to him on the specific point he raised. He has argued Mr. Starrs' claim cogently and effectively. I shall note his continuing interest and keep closely in touch with him about this case. The lessons that may be learnt about the handling of this case will be taken to heart by the Department.