§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Lightbown.]
§ 10 pm
§ Mr. Michael Clapham (Barnsley, West and Penistone)I am aware that you, Mr. Deputy Speaker, as the Back-Bench Member of Parliament for Pontefract and Castleford, played an enormous role in the fight to persuade the Government to accept chronic bronchitis and emphysema as an industrial disease. I pay tribute to that work.
I requested the debate tonight for three reasons—first, to look closely at the new regulation, which I shall call "Amendment No. 2 regulation"; secondly, to draw the attention of the House to the restrictive nature of the regulation, which is causing much concern in mining communities; and thirdly, to suggest how the regulations might be amended to provide a fairer test for diagnosing the disease.
I am aware that the "Amendment No. 2 regulation" is based on the recommendations of the Industrial Injuries Advisory Council, but the recommended prescription is clearly too harsh, particularly because the council reported that the prescription test should be rather tight. Although the council established for the first time a connection between the retention of coal dust in the lungs and the development of chronic bronchitis and emphysema, it nevertheless put forward a prescriptive test that we feel is much too restrictive.
The concern in our mining communities is highlighted markedly by the failure rate of that test. I am informed by the Yorkshire National Union of Mineworkers and by the DSS office in Doncaster that the failure rate in south Yorkshire is as high as 90 per cent. However, the DSS pointed out that there are some regional differences and that the failure rate in Scotland is even higher. I understand that the failure rate in Wales is slightly lower.
Hon. Members who represent mining communities are all too aware of the terrible, debilitating effect of chronic bronchitis and emphysema. We all know men who can hardly walk 100 yards without having to stop several times to fight for their breath. We are all aware of men who, having spent a lifetime in the colliery, cannot venture outside their doors and, in summer time, must sit watching television with an oxygen mask on to help to ease their fight for breath.
The cautious welcome that we gave to the regulations when they first appeared has turned to despair. There are several reasons for that, but the main one is the prescriptive criteria that are used in the diagnostic test.
In some instances, miners with 40-odd years' service underground, who have been treated by their doctors for chronic bronchitis and emphysema for many years, are now told by the examining authorities when they apply for a disablement assessment under the regulations that they do not have the disease. Naturally, that is causing considerable concern.
I feel that the problem arises from the prescription test of the Industrial Injuries Advisory Council, which I know that the Minister adopted and which is implemented in the new regulation. The Minister ought to be aware that it is 1173 possible under the test for a man who suffers from the disease to be ruled out of benefit because he does not meet other criteria laid down in the regulations.
As the Minister knows, a miner must pass three tests to proceed to full medical examination and then—hopefully —a disablement assessment. First, he must have the qualification of 20 years' work underground; secondly, there must be X-ray evidence of dust retention in his lungs; and thirdly, there must be a reduction of 1 litre in the forced expiration volume.
At the examination stage, miners are screened to eliminate those who do not meet the criteria. If a miner has worked underground for fewer than 20 years, he is ruled out, and no further examination is conducted. If he is successful at that stage, he is then given an X-ray. If he succeeds then, he proceeds to the FEV test. Only if he passes all three tests will he be referred to a doctor who will give him a full examination.
There are means of appeal to a special medical board, and, finally, to a medical appeal tribunal but there are flaws in the appeal procedure. I have not enough time to describe those flaws, but I will write to the Minister about them.
The procedure is clearly onerous and the prescriptive test is too restrictive, debarring genuine cases. An additional problem is caused by the difference between the pneumoconiosis principle of diagnosis and the new regulation principle. Let us suppose that two miners, A and B, have worked together underground for 17 years. Both leave the pit at the same time. Miner A takes a job outside the colliery, in an office, while miner B continues to work on the surface, in the coal preparation plant. At the time of retirement, both men have a respiratory disorder and apply to the pneumoconiosis medical board.
In the first instance, miner A is examined and found to have pneumoconiosis and attendant chronic bronchitis and emphysema. He is given an assessment for his pneumoconiosis and then an additional assessment, because his pneumoconiosis worsens his chronic bronchitis and emphysema. Let us say that he is given 20 per cent.—10 per cent. for his pneumoconiosis and 10 per cent. for his chronic bronchitis and emphysema.
Miner B, who has spent a lifetime working at the colliery, is examined and found to have dust retention with acute chronic bronchitis and emphysema. Because the dust retention does not meet the criteria for pneumoconiosis, he is referred for an examination for chronic bronchitis and emphysema, under the new regulation, but, because he does not meet the criterion of 20 years underground, he is ruled out. I am quite sure that that was not the intention of the Industrial Injuries Advisory Council.
There are other examples, one of which is a situation that confronts many miners. As the Minister is aware, tens of thousands of young miners have been made redundant over the past few years. Those miners worked, using new technology, in conditions that were more dusty than was the practice in the mines in a previous age. However, as a result of the implementation of the redundancy scheme, many of those miners will not be given the opportunity to work for 20 years in the industry, and will have worked for only 10 to 18 years. Yet, inevitably, many of those young men will develop chronic bronchitis and emphysema.
1174 Under the current regulation they will not be entitled to claim benefit. The Industrial Injuries Advisory Council could not have intended that.
I ask the Minister to consider three matters. First, I ask him to consider reducing the qualification condition to 10 years, to equal the pneumoconiosis qualification condition. Secondly, I ask him to consider reducing the threshold for disablement benefit under the regulation. The threshold is now 14 per cent. and it ought to be equal to the pneumoconiosis threshold, which is 10 per cent. There is no logical reason for the difference under the new regulation, compared with the threshold under the pneumoconiosis scheme. Finally, I ask the Minister to consider seriously replacing the FEV test with a much more sensitive test for detecting obstruction in the lungs. The FEV test is much too rigorous. It has proved so restrictive that very few cases pass it. I hope that the Minister will be able to tell us that he is prepared to take those three items on board and to review the situation regarding the prescription test.
I also ask the Minister to think about the compensation aspect. As he is proabably aware, in the mining industry we have a no-fault liability scheme for pneumoconiosis. We should like him to enter into discussions with his colleague, the Minister for Energy, to consider extending the scheme to cover chronic bronchitis and emphysema. There is no logical reason why chronic bronchitis and emphysema should be outside the no-fault liability scheme.
With your permission, Mr. Deputy Speaker, I shall invite my hon. Friend the Member for Midlothian (Mr. Clarke) to add to that.
§ Mr. Eric Clarke (Midlothian)I thank you, Mr. Deputy Speaker. I know the history of the matter and as an ex-National Union of Mineworkers activist, one of the reasons that I became a Member of Parliament was to try to alleviate the anomalies that cause pain to the sufferers of those two diseases. I was also delighted when the Government accepted the recommendation, because an academic medical argument was going on and many people who had a great deal of disability in the past were not covered by the pneumoconiotic or silicotic coverage.
I do not have much time to go into detail, but I support the arguments of my hon. Friend the Member for Barnsley, West and Pensitone (Mr. Clapham) because I am confronted in Scotland, as are many Members of Parliament in their constituencies, with ex-miners who are bitterly disappointed at having been turned down. At this stage, I must thank the people in the Department of Social Security, who have brought things forward very smoothly. Mr. John Strachan is in charge in my area and he and his team are doing the best that they can to alleviate the problem.
Many people feel disappointed because, even when they meet the 20 years requirement, the X-ray that is looked at could be an X-ray that was taken up to 18 months previously. The argument is that the X-ray does not show traces of retention of dust in the lungs and that fibrosis is not visible so people are being eliminated from the scheme. Many people were proved to have pneumonoconiosis only after a post-mortem had been carried out because nothing showed up on the X-ray.
1175 The National Union of Mineworkers asked five eminent chest consultants to produce a paper on the subject but two of them produced a minority report on the diseases and their elimination. I remember being part of a delegation that went to see Reg Prentice who was the Minister of State for Social Security. We were knocked back—because of the cost, he said.
I do not have time to read out the details, but I have reports of consultants and doctors from the hospitals attended by sufferers. They say that the people involved are chronically ill, some are in wheel-chairs. I have here a copy of a letter sent to a widow, which gives an example of the terminology being used. It states that the "customer" has not been suffering from the prescribed diseases known as chronic bronchitis and emphysema. However, many such people have "puffers" or other equipment to alleviate the hardship of merely drawing breath.
I must stop now in order to allow the Minister time to reply. I say only that the people to whom I have referred have given their lives and their health to make Britain "Great" Britain. They have created the wealth and energy that we needed to make our industries tick. We cannot replace their health but we can make their lives more tolerable. I shall not repeat all the arguments but the question of the time limit, the capacity of the lungs and the dust on them must be considered more compassionately. We cannot give people back their health but we can make their lives and those of their relatives more tolerable by providing the compensation that we seek. We are not seeking a fortune but it would help. The needs of these people are greater than those of healthy people.
I thank the Minister for allowing me to speak.
§ The Minister for Social Security and Disabled People (Mr. Nicholas Scott)I congratulate the hon. Member for Barnsley, West and Penistone (Mr. Clapham) on securing a debate on what I acknowledge is an important issue that deserves the attention of the House. I very much appreciate his concens and the way in which he expressed them. I am conscious of the distress experienced by those suffering from these unfortunate respiratory conditions. I also listened to the passion in the voice of the hon. Member for Midlothian (Mr. Clarke) as he expressed his concern on behalf of those with whom he has worked so closely and whose interests he holds close to his heart.
I echo the remarks of both hon. Gentlemen and acknowledge the tireless campaign that you, Mr. Deputy Speaker, as the hon. Member for Pontefract and Castleford, have conducted on behalf of miners to have chronic bronchitis and emphysema added to the list of prescribed industrial diseases. You have spoken and corresponded about those matters for a long time, but unable, because of your distinguished position in the House, to campaign as others have been able to do.
I know, however, that you met the Prime Minister to discuss the issue with him in March last year and I am well aware of your continuing close interest in the operation of the scheme and the fact that we have, after a long period —the history of which I shall deal with briefly in a moment —recognised that these conditions should rightly be prescribed as industrial diseases under the industrial injuries disablement benefit scheme.
Industrial injuries disablement benefit is payable only for prescribed diseases, as we all know. The legal basis for 1176 this prescription has remained unchanged since the industrial injuries scheme was introduced in 1946. The statutory provision, which is now in section 108 of the Social Security Contributions and Benefits Act 1992, states:
A disease or injury may be prescribed in relation to any employed earners if the Secretary of State is satisfied that—There are therefore two aspects to prescription, both of which must be satisfied. The first criterion requires unequivocal evidence of a causal relationship between occupational exposure and disease. The second criterion —attribution to occupation in the individual case "with reasonable certainty"—has in practice been interpreted as meaning "on the balance of probabilities", that is, more likely than not. Evidence of an increased incidence of disease in relation to a particular occupation or occupational hazard does not, on its own, necessarily justify prescription. The association with occupation must be sufficiently strong to show that the disease in the individual case is more likely than not to have been caused by the person's work, and that implies a relatively high risk.
- (a) it ought to be treated, having regard to its causes and incidence and any other relevant considerations, as a risk of their occupations and not as a risk common to all persons; and
- (b) it is such that, in the absence of special circumstances, the attribution of particular cases to the nature of the employment can be established or presumed with reasonable certainty."
I should like to move from that general outline of the scheme to the specific instance that we are discussing this evening. The Industrial Injuries Advisory Council first considered the prescription of chronic bronchitis and emphysema in coal miners in 1973, when it decided that it had insufficient evidence to recommend prescription. In 1985, it undertook a further study which culminated in a report in 1988. The limited information then available to the council suggested that the effects of coal dust exposure on lung function were less than those of cigarette smoke, and it was generally agreed at the time that tobacco smoke inhalation was a major cause of lung function impairment in coal miners as well as in the general population, and the council, therefore, again felt unable to recommend prescription.
In the following three years, however, as I think both hon. Gentlemen will recognise, reports were published in this country, in Belgium and in the United States which demonstrated that the risk of developing disabling impairment of the lung function increased more than twofold in coal miners, whether or not they were smokers, who had accumulated significant coal dust exposure, and it was with that evidence that the council felt able to recommend prescription of chronic bronchitis and emphysema in relation to those coal miners and former coal miners whose disability could most confidently be attributed to coal dust rather than to some other cause, such as tobacco smoking.
The council recommended the criteria to be used for evidence of sufficient exposure to coal dust for that to be the probable cause of the disability. Those were, as the hon. Gentleman identified, a minimum of 20 years' underground exposure and definite evidence. of coal dust retention on a chest X-ray of at least category 1 on the International Labour Organisation classification of pneumoconiosis. The council also recommended that prescriptions should be based on an objective measure of 1177 impairment associated with clincially important disablement. It recommended that that measure should be a loss of lung function of at least one litre on the expiratory test, commonly called the FEV1 test, against that predicted for a person of the same age, height and sex as the claimant. The Government accepted and implemented the council's recommendations in full from September last year.
I do not set myself up as an expert on chronic bronchitis and emphysema. I have had conversations with you, Mr. Deputy Speaker, and with other colleagues who have had much more direct experience of, and contact with, people who suffer from these conditions than I have ever had, and I have listened to them. But in this matter the Secretary of State and Ministers in the Department have always been governed by the expert opinion of the Industrial Injuries Advisory Council. It is right that we should look to its members to read the literature and to accumulate for themselves such evidence as they can discover about each of the individual matters of concern that are raised, and offer advice to the Secretary of State.
For the reasons that I have outlined, it is on that advice that we invariably depend when we make our decisions.
The covering leter from Professor Malcolm Harrington, the chairman of the Industrial Injuries Advisory Council, concludes by saying:
the Council suggest that the qualifying conditions should be reviewed after a suitable period of operation of say five years.So the IIAC and its chairman recognise that the judgment made on the qualifying conditions already outlined in the debate was not like the laws of the Medes and the Persians, but was something that should properly be reviewed after some experience.I cannot say whether the council was influenced in coming to that judgment by the knowledge that there had been a substantial take-on of case load in the initial stages of the introduction of the new scheme. However, at the end of the covering letter, the recommendation was clearly made that the conditions should be reviewed after a suitable period of operation. The period of five years was mentioned, but the council was not being especially prescriptive about that. The Government accepted and implemented, as we invariably do, the council's recommendations.
I understand the concern of Opposition Members, but in general my impression is that the addition of chronic bronchitis and emphysema to the list of prescribed diseases has been widely welcomed. Hon. Members on both sides of the House have appreciated it, as have the unions representing miners. I am glad to say that the new scheme has been successfully implemented, too. Indeed, the hon. Member for Barnsley, West and Penistone paid tribute to that fact.
The hon. Members for Barnsley, West and Penistone and for Midlothian came to see me before the scheme was launched, and impressed on me the importance of smooth 1178 implementation and of making proper administrative arrangements. We did that, both in terms of pure administration by the Benefits Agency and the Department of Social Security and by making arrangements for proper medical tests to be conducted smoothly and efficiently.
Special arrangements were set up with British Coal and the mining unions to help to make the operation a success. We can rightly claim that in administrative terms it certainly has been a success, however disappointed hon. Gentlemen may be at the moment by the number of miners and former miners who have satisfied the existing conditions for qualification. In my view, there continues to be a positive, constructive and successful dialogue between the unions and the Benefits Agency—a relationship that is valued by both sides.
We staggered the take-on of claims in two six-month stages. The first stage has just been completed and the second started on 1 March, two days ago. Manifestly, the burden of work has been largely confined to traditional mining areas, and we had to make a number of special arrangements, including setting up special centres in some areas to cope with the groups of applicants.
On the medical side, we have sought to design procedures to minimise the inconvenience to those who claim the benefits. The procedures ensure that they do not have to attend for tests or examinations more than once, whenever it is possible to arrange that, and handling arrangements have been enhanced to control the flow of cases throughout the organisation and to provide us with proper and valid criteria.
In the last two minutes or so, I shall emphasise a couple of points. First, whatever I may feel personally, the Government—and I, in view of my responsibilities—have to rely on the Industrial Injuries Advisory Council on the prescription of industrial diseases. The council in turn relies on acceptable scientific evidence. We have implemented in full its recommendations on chronic bronchitis and emphysema.
The scheme is still in its early days. We are still talking on the early cases. I read out Professor Harrington's advice on reviewing the conditions after a suitable period of operation, and I am certainly willing to receive correspondence from Opposition Members expressing any concerns that they have about their experience of the scheme.
However, we should be pleased that the council eventually came to the conclusion that it did, and I hope that the Government can get some credit for swiftly accepting the recommendation and implementing it successfully. The first phase has gone well, thanks to the careful planning, special resources and considerable effort that have been put into this extension of the industrial injuries scheme. We are committed to a similar successful implementation of the second phase, and we shall continue to see how it all works out in practice.
§ Question put and agreed to.
§ Adjourned accordingly at half-past Ten o'clock.