Mr. Paul Howard (Hansard, 4 July 1990)

§ Mr. Jack Thompson (Wansbeck)

I am grateful to have the opportunity to introduce this Adjournment debate, even if this evening's experiences outside the House have not been pleasant. Having watched the match, I recommend that we do not go into extra time in the House tonight. I sympathise with you, Mr. Speaker, and with the Minister. We have to stay a little longer, despite the disappointing events outside.

Parliament is concerned with individual rights, and the case to which I shall refer has a bearing on those rights. The fact that we are debating it reflects the significance of the parliamentary system in Britain. I regret that I have had to seek an Adjournment debate to bring it to the attention of the House, because for two years now I have been trying to solve the problem with the Ministry of Defence and the Army medical authorities, but a response to my clear requests for information has not been forthcoming.

A constituent of mine, Paul Howard, was given a temporary discharge from the Scottish division on 28 December 1985. I have with me a copy of the relevant document which is entitled: Certificate of discharge issued to a soldier discharged with less than six months service or discharged from type 'O' engagement. The document lists his name, surname, army number and the place at which he enlisted. The service particulars on discharge specify that Paul Howard had served as a private and that his service on discharge was five months and 20 days, including 28 days on leave without pay before reporting for duty. The document states as the cause of his discharge: Ceasing to fulfil Army medical standards. His military conduct is described as Exemplary assessed on five months' service. The document is signed by the officer in charge of infantry and GSC manning, Imphal barracks, York.

The papers also include a temporary certificate of discharge or transfer to the reserve, which also gives his rank, number and name, and states that the cause o f his discharge was medical and that his military conduct was exemplary. That is the only information that has been made available about Paul Howard's discharge.

Paul Howard joined the Army on 5 August 1985. He underwent the normal medical examination required for those joining the armed forces and had a clean medical record. He was undertaking training with the Gordon Highlanders when he took ill and was transferred to the Royal Victoria infirmary in Edinburgh. He was diagnosed as having urinary tract infection, contusions of the soft tissue in the lower back and contusions of the scalp. Following his period in the Royal Victoria infirmary, a medical board held in November 1985 discharged him as

temporarily medically unfit. Two appointments were made for Mr. Howard to see Dr. Bates, a consultant neurologist, but he was unable to keep the appointment. The Ministry said that that was his fault, but in fact he was a patient in Catterick military hospital which would not release him for the appointment. He was then requested to obtain, at his own expense, 1095 reports from a neurologist and urologist. Mr. J. S. W. Feggetter, an eminent consultant urologist and a serving officer in the Territorial Army, was requested to examine him. Dr. David Bates, a consultant neurologist with the Northern regional health authority and a senior lecturer at the university of Newcastle, also examined Mr. Howard. I have copies of those reports and they suggest that there is nothing wrong with him. The Minister has also seen copies of the reports. Mr. Howard has a clean bill of health. Those examinations took place in February 1989 and the findings were supported as recently as March this year by Mr. Howard's general practitioner, Dr. Donald Irvine, who is a highly respected practitioner and a senior figure in national medical circles.

Since 1985, Paul Howard had been encouraged to believe that he would be allowed to re-enlist once his health situation was clarified. In his opinion and in mine, that clarification was forthcoming. However, in 1988 when he approached me, it was evident that that was not the case.

Despite evidence and correspondence between myself and three Under-Secretaries of State for Defence—the hon. Member for Kettering (Mr. Freeman), the hon. Member for Romford (Mr. Neubert) and the Earl of Arran—and a meeting with the hon. Member for Romford in his capacity as Under-Secretary of State for Defence Procurement, I was unable to obtain the reasons why Mr. Howard was unable to re-enlist. All that I learnt, in a letter from the Earl of Arran of 5 April 1990, was that Mr. Howard remains and will continue to remain below the minimum medical standards for service either with the regular or reserve forces. The position with the reserve forces was confirmed when Mr. Howard's application to join the Territorial Army was rejected.

In a letter to me, Dr. Irvine—Mr. Howard's GP—wrote: I have … made a careful re-exploration of his medical records … I can find no medical reason why he should not be accepted for service in the armed forces. The Minister has a copy of that letter.

I raise this issue on the Floor of the House in an attempt to obtain two pieces of information. I am sorry that I have reached this point because until now the discussions between myself, my constituents and the Minister have been in private as would normally be the case.

First, on behalf of Dr. Irvine, I would like to have the medical reasons for Mr. Howard's temporary discharge in detail. Mr. Howard is still only temporarily discharged. If he has a medical condition that warrants investigation by Dr. Irvine, he at least should know the circumstances. Secondly, why has Mr. Howard not been given a permanent discharge which should indicate specifically the reasons for ending his Army career so abruptly?

Although finding civilian employment in my constituency is not easy at the moment, it is not helped by the mystery surrounding Mr. Howard's discharge. His attempts to seek civilian employment are being seriously hampered by the bureaucratic attitude of the Army's recruiting and medical departments.

Mr. Howard is the kind of young enthusiastic person our forces need. I applaud his persistence in trying to ferret out information from behind the closed doors of those two departments. He and I have both failed to do that. When 1096 the Minister responds, I hope that he will finally come clean on behalf of the Ministry and explain why there has been a constant refusal to relieve the concerns of Mr. Howard about his health and his prospects in his attempts to resume his Army career and about the blight on his opportunities to take up a civilian career.

§ The Parliamentary Under-Secretary of State for Defence Procurement (Mr. Michael Neubert)

I begin by congratulating the hon. Member for Wansbeck (Mr. Thompson) on his commitment to his constituency and, in particular, to his constituent Mr. Paul Howard. The hon. Gentleman has displayed great tenacity in pursuing his constituent's case. As he said, it is more than two years since he first entered into correspondence with my hon. Friend the Member for Kettering (Mr. Freeman), now the Minister for Public Transport. The intensity of that correspondence increased with my arrival in December 1988 as Under-Secretary of State for the Armed Forces, and the dialogue has continued at full flow since last August under the tenure of my successor, my noble Friend the present Under-Secretary of State for the Armed Forces.

A few words by way of preface on the general policy of the armed forces towards medical matters may be helpful. The House will of course appreciate the demanding and stressful physical nature of service in the armed forces and how important it is that service men and women should be medically fit to withstand the full rigours of the varied and exacting life that the services offer. Medical fitness gives confidence that they can then perform their role in peace and war. But it is also essential, in the interests of an individual, and of those with whom he or she works as a unit, that they do not fall prey to avoidable mishaps or injury. In this context, it is only fair to remind the House that the services can be, and often are, severely criticised when young men, particularly those undergoing arduous training, suffer serious injury.

The Army, therefore, like the other two services, places great emphasis on maintaining high medical standards of fitness for service. Particular care is taken on entry and again in the early stages of training.

The central system of medical classification operated by each of the three services lays down employability standards by which to measure an individual's medical fitness. The system is designed to provide a functional assessment of an individual's capacity to work and to assist in expressing the physical and mental attributes appropriate to the various roles that service personnel may be called upon to perform. The system also helps in determining the fitness of personnel to undertake certain postings. It is applied equally to all ranks of the three services, both male and female, including officers. It is that system by which Paul Howard was not only discharged from the Gordon Highlanders in 1985 but was refused re- enlistment at various times during the period that has elapsed since that date.

It is important to say at this point, in particular in relation to the general practitioner's report, that, although the system of medical classification is operated by service medical authorities and is a medical responsibility, the various arms of the services set the minimum standards 1097 required for each of their services. Paul Howard was, therefore, medically assessed against the requirements of the infantry—in this case, the Gordon Highlanders.

It may be helpful if I too set out the history of Paul Howard's brief service as we have seen it during 1985 with the Gordon Highlanders.

Paul Howard first sought to enlist at the Army careers information office in Ashington, Northumberland. As is required of all potential recruits to the services, he had to undergo a pre-service medical examination. That took place on 22 March 1985, and was performed by a civilian medical practitioner working to military standards and regulations. Mr. Howard was advised that he would be examined again by a medical officer at the training unit within the first six days of service—the initial medical examination—and again at the conclusion of his basic training or the 16th week of training—the service medical examination. That comprehensive and well-tested procedure is designed expressly to expose, during training, obscure or dormant disabilities not evident in the pre-service medical examination. Mr. Howard reported for training at the Scottish Infantry depot and underwent his initial medical examination on 5 August 1985.

As the hon. Gentleman said, neither the pre-service nor initial medical examination showed any disabilities, and Mr. Howard revealed no history at that stage to show any medical reason why he should not be allowed to continue. Unfortunately, as we have heard, within six weeks of entry, he was taken ill and was admitted to Edinburgh royal infirmary, where he spent 20 days before being transferred to the medical reception station, Edinburgh, which he left on 5 October 1985. At that stage, a medical board was convened, and that board concluded that he was temporarily medically unfit and should be discharged. Just three days after his discharge from the medical reception station, he was readmitted to the royal infirmary with symptoms similar to those for which he had previously been an in-patient. He remained there for a further eight days.

During his time in hospital, he underwent a number of investigations and was also seen by a representative of the neurology department. He was then sent home on leave and, after having several similar attacks, did not return to barracks. Unfortunately, he was to return to hospital again on two more occasions before finally being transferred on 21 November 1985 to the Duchess of Kent's military hospital in Catterick, where he stayed until 26 November.

That same evening, following his release from the Duchess of Kent's military hospital, he reported himself to the accident and emergency department of the Edinburgh royal infirmary, complaining of further illness. He was examined once again and discharged to the care of the military authorities in order for him to follow up an appointment with a consultant in neurology at the Royal Victoria infirmary, Newcastle-upon-Tyne.

In the light of his medical history during his very short time in the Army, Mr. Howard was given examinations which were to form the basis for a second medical board at the Duchess of Kent's military hospital because the Duchess of Kent's military hospital did not at that stage have access to the results of the first board.

The House should know that there has been some confusion in previous correspondence with the hon. Gentleman as to whether or not these medical boards did in fact take place, as his constituent was not himself 1098 present. The hon. Gentleman has, however, been informed by my noble Friend the Under-Secretary of State for the Armed Forces, in his letter of 30 November 1989, that it is not a pre-requisite for a patient to be present for a medical board. It is often the case that evidence is collated and subsequently examined in turn by board members, who then give their findings and make their recommendations. Before the second medical board could be approved, authority for discharge had been given on the basis of the conclusions of the first medical board.

In this case, Mr. Howard was assessed by the first medical board as being below retention standards, and he was finally discharged from the services on 28 December 1985. This was in accordance with Queen's regulations for the Army and because he could not fulfil Army medical requirements. The hon. Gentleman will know that he was found by the first medical board to be temporarily unfit for Army service. In retrospect, and in the light of later medical reports, including that of the second medical board, it would perhaps have been more appropriate to have discharged him as permanently unfit for Army service. Had he not already been discharged on the basis of the first board, that is what would have happened.

While I cannot go into the medical details of the case for reasons of medical confidentiality, it will be obvious from what I have said that Mr. Howard was subject to a number of medical examinations while in hospital. It is not open to me to discuss the nature of his illness, his treatment or the results of the medical investigations, because it is not our practice to disclose personal medical details except to other medical personnel with responsibility for the continued care of the patient. That does not mean there is anything to hide. The medical records in this case have already been made available to Mr. Howard's GP following the hon. Gentleman's meeting with me last July.

Since his discharge, Mr. Howard has been persistent in his attempts to rejoin the Army and latterly the Reserves. He has been seen by a number of medical practitioners, both service and civilian, including civilian specialists in urology and neurology, and his case has, as the House knows, been vigorously represented by the hon. Member for Wansbeck.

The hon. Gentleman has concentrated his attention on the grounds on which Paul Howard's repeated applications to re-enlist have been turned down. He and his constituent appear to suggest that the medical reasons which have consistently been cited are not the true reasons, and that some other reasons lie behind the decision. That is not so. The House will appreciate that, again, medical confidentiality prevents me from giving full details of the medical grounds on which we have declined to accept Mr. Howard's applications, or indeed the full extent of any advice received from the civilian consultants involved.

Nevertheless, in the light of the hon. Gentleman's initial representations, my hon. Friend the Member for Kettering undertook in his letter of 30 April 1988 that the Army medical authorities would consider the case again on production of any favourable medical reports covering the period since his discharge to the present. After further correspondence, two reports from civilian urology and neurology consultants were then forwarded to me, as the then Under-Secretary of State for the Armed Forces, with the hon. Gentleman's letter of 7 March 1989.

While those civilian reports were favourable, there remained a need for them to be considered by the Army 1099 medical authorities alongside the service medical findings and service medical requirements. My letter of 22 March 1989, therefore, informed the hon. Gentleman that any application from Mr. Howard for re-enlistment would now be dealt with in the normal manner through the Army careers information office, Ashington. Unfortunately, the wrong impression was drawn from that letter, as the hon. Gentleman seems to have regarded it as some sort of guarantee that Mr. Howard would be able to rejoin his regiment, and that the Army medical authorities were now satisfied with the medical reports. I re-emphasise to the House that, while the Army medical authorities can and do take account of all medical information presented to them, the decision on the medical suitability of candidates for the Army must, ultimately, rest with them.

Mr. Howard then reapplied to AC10 Ashington and was referred by the examining civilian medical practitioner there for specialist neurological assessment. That took place at the Duchess of Kent's military hospital at Catterick on 30 March 1989. The consultant's report confirmed the earlier opinions of the members of the medical boards which recommended Mr. Howard's discharge in 1985, and concluded, in line with the standard system of medical classification, that Mr. Howard was below entry medical standards and that there was, furthermore, no evidence to suggest that he would in the future meet those standards.

Following that, Mr. Howard was again informed that he did not meet the very high standard of medical fitness required for the Army and that AC10 Ashington could not, therefore, proceed further with his application for re-enlistment. This assessment was also later held to be applicable to Army service in the reserves. I can quite understand that Mr. Howard will have been disappointed once again by this decision. Nevertheless, I hope that the House will agree that Mr. Howard has in fact been given every opportunity to prove to the Army medical authorities that he could meet the minimum standards required and that the authorities have fully considered and reconsidered his case.

1100 Finally, I would like to touch on the fears that Mr. Howard has expressed through the hon. Gentleman tonight and previously that his unfitness for the rigours of service life may have some adverse impact on his chances of civilian employment. No failure to satisfy the very high medical standards set by the services for their uniquely stressful and exacting requirements should be taken in itself to imply that an individual is unfit for a wide range of civilian employment. I am naturally pleased that Mr. Howard has obtained reassurance from civilian specialists on his state of health and I hope he will take comfort from this. If he does have any lingering doubts that being found unfit for the Army will affect his prospects of civilian employment, he can also take reassurance on that account from his civilian medical advisers.

With regard to his brief military experience, I assure the hon. Gentleman that the decision to discharge Mr. Howard as medically unfit was not taken lightly nor on the basis of a single incident or examination. Mr. Howard was an in-patient in more than one hospital and therefore subject to medical examination on several occasions between September and November 1985, and the service medical authorities then and later gave due weight to all the evidence before them on reaching their conclusion.

I should like to conclude by wishing Mr. Howard well in civil employment. It is a matter of regret to us all that he has been unable to pursue his chosen career in the services, but, as I hope has become clear from the detailed remarks I have made tonight and from the previous correspondence, the firm view of the competent service medical authorities is that it would not be in the interests either of the Army or of Mr. Howard himself for him to rejoin the forces. That view has been subject to repeated re-examination, and the conclusion of the service medical authorities is that Mr. Howard is not medically fit for service with the Army. But, as I have also made clear, that does not mean that he is not medically fit for a wide range of civil employment, and the views of his general practitioner should, I hope, serve to reassure him and any potential employer.