§ Mr. Bill Etherington (Sunderland, North)Like many other Opposition Members, before the Christmas recess I voted against what were loosely called the Jopling proposals for the so-called modernisation of Parliament. However, I am pleased to take part in today's debate, because I regard these debates as perhaps the only positive thing that came out of the decision taken before Christmas.
I notice that my hon. Friend the Member for Jarrow (Mr. Dixon) is present. I am pleased about that, because the subject about which I intend to speak affects many of his constituents as well as constituents in the whole of the former Tyne and Wear metropolitan authority area.
It does not give me any joy to have to raise this subject today. There are many disturbing aspects on which I hope the Minister can reassure me. Although the prescribed industrial disease, mucous membrane disease, has been with us for a long time, only in relatively recent years—from about 1990—has it become better known, as medical knowledge of it has improved.
There are various welfare rights agencies throughout Britain. I am sure that they do a good job in advising people on how to claim benefits and find their way through the maze of legislation. I imagine that there is none better than Sunderland centre for the unemployed, run by Dave Towler. I have the utmost admiration for him. He has done a tremendous job for the people whom he represents. He will always have my support whenever he requires it, because I am aware of the quality of his work.
There is a close relationship between the Liverpool centre for the unemployed and the one in Sunderland. In many ways, there is an interrelationship between the industrial backgrounds and heritages of Merseyside and Wearside and Tyneside. In April 1992, it was agreed that there would be a mass campaign to make claims in respect of prescribed disease D4, or mucous membrane disease.
After a few months, a total of 18,000 claims had been made, of which 5,000 were from Merseyside and 13,000 from the Tyne and Wear area. Early in the campaign, it became obvious that there was a tremendous disparity between the decisions made in Liverpool and those made in Sunderland. For example, we found that at the level of the adjudicating medical authority—which sounded much better when we called it a medical board—85 per cent. of those who claimed in Liverpool received satisfaction while in Tyne and Wear fewer than 1 per cent. did so. We are not talking about some inconsequential difference. There is a tremendous disparity. It begs a question that until now certainly has not been answered.
Many of those who underwent medicals for the adjudicating medical authority had received reports from ear, nose and throat consultants that they were suffering from the disease; yet the general practitioners employed by the DSS largely disregarded those reports. We found that somewhat unusual. I have always understood that a consultant's report should take precedence over what a GP might think on a subject of which he probably does not have so much knowledge.
My hon. Friend the Member for Sunderland, South (Mr. Mullin) and I wrote joint letters to Mr. Tinnion, regional chairman of the independent tribunal service, Judge 973 Thorpe, who was in charge of the national tribunal system, the Secretary of State for Social Security and the Lord Chancellor. We drew attention to the disparity. The replies that we received suggested that there was nothing to worry about; indeed, they appeared to deplore any parliamentary interference in their jealously guarded system of justice.
Following that response, Sunderland centre for the unemployed commissioned a statistical survey by Dr. Peter Kelly who lectures in statistics at Newcastle university medical school. The aim was to find some pattern between what happened in Liverpool and in Tyne and Wear. We have all the information, which I shall be only too pleased to make available to the Minister should he require it in order to take some action.
The survey highlighted the fact that, following the refusal of either the industrial tribunal service or the Department of Social Security to take action on the matter, some of the medical appeal tribunal consultants in the Tyne and Wear area began to be more favourable to appellants, even though we were told that there was nothing wrong and nothing needed to be changed.
My hon. Friend the Member for Sunderland, South and I wrote again to the various authorities that I mentioned. We received much the same sort of response. The fact that things seemed to have improved was ignored. Eventually, the various advice centres and Sunderland centre for the unemployed decided that the only way ahead, in view of the response that we had had—to say that it was tardy would be to suggest that it was rather better than it was—was to make use of the proper procedures of the full majesty of the law.
Between 150 and 180 appeals made from various offices were sent to the social security commissioner. The commissioner considered two cases. They are known as the Greer decision and the Blackwell decision. The decision was almost unprecedented for the commission. I shall read it out in full. It said:
The medical appeal tribunals who re-hear the cases should be composed of a different Chairman and different members all of whom have never sat on a medical appeal tribunal in Tyne and Wear in relation to the prescribed disease D4.It is fair to say that, despite all the reassurances that my hon. Friend and I received from the various bodies, the commissioner most certainly thought that there was something wrong which needed to be put right.
§ Mr. Chris Mullin (Sunderland, South)Does my hon. Friend agree that one of the odd things about the case is the way in which the decisions made by medical people, who are presumably there as scientists rather than politicians, appear to reflect the political needs of the hour rather than the actual condition of the people whom they are supposed to examine?
§ Mr. EtheringtonMy hon. Friend makes a fair point. I am afraid that I am too cynical an individual to give him the answer that he requires. It should be surprising. Unfortunately, I do not find it surprising. The point that he makes is one of which the Minister should certainly take note.
The commissioner was saying that there was something sadly wrong with the system in the north-east. The decision dealt with both adjudicating medical authorities and the medical appeal tribunals—two bodies which are 974 supposed to be completely independent in every way—yet it would appear that the commissioner was not prepared to accept that they were independent.
I am sorry, Mr. Deputy Speaker, that I must use so many terms in the debate. It must be perplexing for people who are trying to follow the debate. It is easy enough for the likes of me, the Minister or other hon. Members who know the system well. There are so many sets of initials. It is sometimes difficult to keep up. It had been stated consistently in writing by the Benefits Agency medical service that no research had been done into mucous membrane disease, except the research that involved chromate-related damage to the mucous membrane. That is not true. A great deal seems to have been overlooked by the Benefits Agency medical service, certainly in the north-east of England.
Consultants acting on behalf of appellants throughout the sorry saga were so worried about the matter that a symposium was held on 20 June 1994 in York. It was attended by many ear, nose and throat consultants from Britain. They were addressed by eminent colleagues from Scandinavia and the United States who had carried out in-depth research into mucous membrane disease.
The symposium concluded that there was a condition called industrial rhinitis. I was pleased to have the privilege of attending that symposium. I do not pretend that it is a subject about which I know very much. I found the symposium enlightening but disturbing in some ways in view of what had happened before it took place. In attendance at the symposium was a representative from the Industrial Injuries Advisory Council who later advised the Secretary of State on the list of prescribed diseases. Following the symposium and as a result of information that had been sent to the council by consultants, trade unions, and so on, in September 1994 the IIAC recommended to the Secretary of State that mucous membrane disease, prescribed disease D4, should be broadened to include industrial rhinitis. Out of this whole sorry saga, that is the one consolation.
I should be pleased to give the Minister all the information that I have in my possession—much of which came from his Department. A number of questions need to be answered. Those with the disease in the north-east have suffered an injustice and we want that to be put right along the lines set out by the commissioner. That has not yet happened and it shows no sign of happening.
My first point is how do the Government explain the difference between Liverpool and Tyne and Wear when the industrial backgrounds are the same? Secondly, we have proof that the full-time medical adviser gave misleading information to the Wearside adjudicating officer's department. I am pleased that one of my constituents, Brenda Jackson, has given me permission to use her name. Obviously, I will not name the doctor concerned. That is not for me to do; it is for the Department to find out and do something about him. I would never say anything in this place that I was not prepared to say outside it. However, the information is available if the Minister wants it. There has been a similar occurrence with a constituent of my hon. Friend the Member for Houghton and Washington (Mr. Boyes), with which I have no doubt he will deal in due course. I have appraised him of the situation. It is believed that my hon. Friend's constituent lost his case because of misleading information.
975 Thirdly, the adjudicating medical authority is still not complying with the commission's written directions. When can we expect some progress on that? Fourthly, how can an organisation such as the DSS, with all its resources, not fund research, yet advice centres and independent consultants—sometimes even charitable bodies—seem able to do some research and produce tangible, worldwide evidence on the disease?
Fifthly, in some agreed minutes between the DSS and the advice centre in Sunderland about a meeting held on 3 August 1994, it was recognised that there was a need for uniformity in decision making. It was said that training was required, through the Benefits Agency, of the Department's general practitioners—the majority of whom are either part time or retired. Why has that not been done?
Sixthly, why are consultants' reports treated with such disregard—I might almost call it disdain—by those general practitioners? If they were in the mainstream of medicine and referring their patients to consultants, they would abide by the consultants' opinions. Why are there different standards?
Seventhly, because of fresh evidence supplied to the DSS and because of the threat of advice centres pursuing the matter to judicial review, has the DSS now agreed to review all prescribed disease D4 cases?
Eighthly, after the re-boarding of medicals there is documented evidence that appellants were deemed by the adjudicating medical authority to be suffering from various forms of rhinitis at their original medicals two years ago. As those decisions would now be brought within the commissioner's interpretation of prescribed disease D4, the review medicals by the same general practitioners show that those people are suddenly not suffering from any form of rhinitis.
Ninthly, boarding doctors are refusing to abide by even DSS policy division directives on how they are to proceed at review medicals. Doctors are refusing to examine appellants on review.
The impression that I get—I say this with some sadness—is that there is a force of opinion within the medical section of the Benefits Agency medical service in Tyne and Wear that has taken it upon itself to ensure that, come what may, appellants suffering from distressing conditions do not get their rightful entitlement. We can reach no other conclusion.
§ Mr. Ronnie Campbell (Blyth Valley)Is there a case for sending the evidence to the ombudsman? It appears that there is some malpractice which should be investigated.
§ Mr. EtheringtonI have to give my hon. Friend a somewhat cautious reply. So many things are wrong that I can honestly say that I do not know what is the best way forward. I hope that today's debate is the best way. I am just sorry that it has had to come to this.
I want to refer to the proceedings of a social security appeal tribunal held on 31 January, which involved my constituent to whom I referred earlier. I shall read out the relevant passage about misinformation from a doctor employed by the Benefits Agency. It states:
Mr. Towler invited clarification about document 28"—976 which is the misleading document. It continues:He submits that Mrs. Jackson has clearly not been examined by Department of Social Security consultants, only doctors of GP status. To this extent the document carries a wholly false (not just misleading) impression.Miss Guthrie, the adjudication officer, conceded that point. It is a sorry state of affairs when I have to come to the House and report something that is basically the equivalent of perjury.I know that the Minister is a sympathetic person, because of his involvement with bronchitis and emphysema. I hope that he will ensure that my constituent and the other 13,000 people in the north-east who are claiming in respect of the disease will have their claims reheard and that they will receive the same sort of justice as that received by the people on Merseyside.
§ The Minister for Social Security and Disabled People (Mr. William Hague)I congratulate the hon. Member for Sunderland, North (Mr. Etherington) on securing the Adjournment debate. From the presence of several of his hon. Friends, I recognise that there is widespread concern that goes beyond his constituency alone. I appreciate his concerns and I am aware of his active interest in this matter over a considerable time.
The prescribed disease in question, known as prescribed disease D4, has a long history and raises some difficult issues. I should like briefly to explain the background. The origins of the present prescription are to be found in the Workmen's Compensation Act 1906. It provided, from 1907 onwards, for compensation for ulceration of the mucous membranes of the nose and mouth. The original occurrence which led to the condition being added to the list of diseases at that time was the adverse effect—bleeding from the gums—found to be experienced by men unloading a certain type of iron ore.
It was recognised even then that because the condition prescribed was common among the general population, a clear link with a particular job could not be assumed in the individual case. The burden of proof that the disease arose as a result of work was, therefore, always left with the worker.
When the industrial injuries scheme was introduced in 1948, the present PD D4 was included as part of the adoption of the prescribed list of occupational diseases used by the Workmen's Compensation Acts, which the new scheme replaced. The disease is presently defined as:
inflammation or ulceration of the mucous membrane of the upper respiratory passages or mouth produced by dust, liquid or vapour".The occupational requirements are:any occupation involving exposure to dust, liquid or vapour".It can be readily appreciated from what I have just said that both the disease and the occupational cover are in very general and wide terms.One of the major problems with the present prescription of PD D4 is that the signs of the disease, such as running nose, feeling of nasal obstruction, occasional bleeding and loss of smell, are extremely common among the general population and have a multitude of possible causes. The disease is usually short-lived and generally causes very little disability of any serious or lasting nature. Furthermore, it can be extremely difficult to identify the specific cause of the condition. There are many different causes and other general factors, such as smoking or the 977 drying effects of central heating, which can worsen it. It is not surprising, therefore, that consistent diagnosis of the condition is very difficult; making a clear link with an occupational cause is even more difficult.
Until fairly recently, as the hon. Gentleman said, there were in fact very few claims made each year for PD D4. Then, in the spring of 1992, local trade unions and unemployment centres in the north-east of England mounted a campaign to encourage people to claim for the prescribed disease. The campaign subsequently spread to the north-west.
It was the increased number of claims received as a result of the campaign which highlighted the very general nature of the prescription and the difficulty that it presents in deciding claims. This, in turn, raised questions about the precise nature, causes and effects of the disease, since, if they could be laid down more precisely, much of the confusion to which the hon. Gentleman referred could perhaps be avoided.
My predecessor, my right hon. Friend the Member for Chelsea (Sir N. Scott), looked into the problem in 1993 and rightly decided in September 1993 to ask the Industrial Injuries Advisory Council to consider and advise on the question of whether the present prescription of PD D4 should be changed and, if the council concluded that it should, to ask it for recommendations on revised terms of prescription. The council is the independent, expert body which has the statutory role to provide such advice; Ministers rely on it for advice. It has examined all the relevant scientific evidence that was available—the hon. Gentleman referred to members of the council taking an interest in these matters. The council completed its report towards the end of last year.
My officials are considering the implications of the council's findings. I expect to receive the report shortly and will respond in due course. However, any changes proposed by the council will not have retrospective effect and current claims must be decided on the basis of current legislation.
I should like at this point to explain the decision-making process for industrial injuries claims, because the hon. Gentleman asked several questions about that matter. The first question, which is decided by an independent lay adjudication officer, is whether the claimant satisfies the prescribed occupational requirements. Because the present prescription covers any occupation involving exposure to dust, liquid or vapour, few claims for PD D4 fail at this stage. Claims which satisfy the occupational requirements are then referred for medical examination. In the north-east, these examinations have been carried out by medical practitioners with higher qualifications in the specialty of ear, nose and throat surgery.
If the examining medical practitioner considers that the claimant is suffering from PD D4, he then acts as an independent adjudicating medical authority and assesses the degree and likely duration of any resulting disability. Where a prescribed disease has been diagnosed, adjudicating medical authorities also give advice to the lay adjudication officer on whether they consider the prescribed disease is due to the nature of the claimant's occupation. For most prescribed diseases, if the claimant satisfies the occupational test and is diagnosed as suffering from the disease, it is presumed that the disease was caused by the relevant occupation, if the claimant worked in it shortly before developing the disease. But as 978 I explained earlier, there is no such presumption for PD D4, because of its very common nature, and the link between the occupation and disease needs to be proved on the balance of probability in each case.
The claimant has a right of appeal to a medical appeal tribunal against the decision of an adjudicating medical authority, and to the social security commissioner—but only on a point of law. The adjudicating medical authority may review the decision if it is satisfied by fresh evidence that the original decision was given in ignorance of a material fact or was based on a mistake as to a material fact. I shall say a little more about that later.
I should make it absolutely clear to the House, especially in view of the intervention by the hon. Member for Sunderland, South (Mr. Mullin), that the adjudicating authorities, both lay and medical, are entirely independent. Neither Ministers nor officials can intervene in their decisions.
As I have already said, the characteristic features of PD D4 are very common indeed among the general population. Sometimes, it is not an easy task to determine whether these symptoms are due to a specific agent when they occur so commonly and widely. In these circumstances, diagnosis and clinical assessment are not an exact science; it is a matter of clinical judgment by the experienced independent doctors dealing with the cases who take account of the facts in each individual case.
Comprehensive training and continuing medical education programmes are pursued by Benefits Agency medical services to ensure that their doctors are expert both in the legal aspects and in the disablement assessment issues of all prescribed diseases. The training received for assessing PD D4 is part of that.
Doctors who serve as members of the adjudicating medical authorities are also trained by senior Benefits Agency doctors according to a well-established programme. Senior managers in Benefits Agency medical services regularly undertake quality assurance of the work of adjudicating medical authorities and set standards of performance.
Since 1992, as far as I know, there have been more than 8,000 claims for PD D4 in the north-east. In the vast majority of cases, the adjudicating medical authority has not found the claimant to be suffering from PD D4. Even where the disease has been diagnosed, in most cases the degree of disablement assessed has been below the 14 per cent. threshold which qualifies for payment of disablement benefit. On the latest figures available, less than 0.5 per cent. of the north-east claims have attracted an assessment of 14 per cent. or more.
The hon. Gentleman asked about differences between the north-east and the north-west, mentioning Liverpool in particular. Even in the north-west, fewer than 1.5 per cent. have had an assessment of 14 per cent. or more. In both cases, the proportions are very small. This low success rate reflects the fact that the disease is not generally very disabling. It is true that there is some difference between the level of diagnosis of PD D4 in the north-east and that in the north-west. This is a sign of the difficulty that medical authorities have had in deciding claims, for all the reasons that I described. That is why we asked the Industrial Injuries Advisory Council to review the present prescription.
I mentioned earlier that reviews of medical authorities' decisions may be sought on the basis of fresh evidence. Last April, the Sunderland branch of the Trades Union 979 Congress, acting on behalf of claimants, sought fresh evidence reviews of a number of such decisions on the basis of a series of research papers from abroad. As from May, instructions were issued to all Benefits Agency medical service doctors on the interpretation of what constitutes fresh evidence. This information has been imparted to all authorities. I understand that the authorities have accepted that there is fresh evidence, enabling a review of earlier decisions. On review, however, in most cases they have not found that the earlier unfavourable decision should be revised.
The hon. Gentleman explained the principles laid down by the social security commissioner in two cases, and referred to the ruling given last November. The commissioner set out how, in his view, the medical adjudicating authorities should proceed when considering the diagnosis of PD D4. The Benefits Agency medical service issued guidance to adjudicating medical authorities on 19 January, four weeks ago, in the light of the commissioner's decisions.
Review cases still held at the medical board centre in Newcastle or at district offices in Wearside awaiting action will be scrutinised by the BAMS and any decisions that do not appear to comply with the principles laid down 980 by the commissioner will be referred to a fresh adjudicating medical authority for consideration of review on the ground of error of law. Where the fresh evidence review decision has already been communicated to the claimant, it is open to him, if he is unhappy with that decision, to apply for an error of law review or to appeal to the tribunal. Redress is available if people feel aggrieved, but I do not want to raise undue hopes that, as a consequence of further reviews, significantly more cases will result in payment of benefit, because—for all the reasons that I gave—occupational cause of the disease is difficult to demonstrate.
I assure the hon. Gentleman that the BAMS will continue to monitor the situation. I particularly welcome the good local liaison arrangements that are in place, particularly with Sunderland TUC. I shall ensure that the hon. Gentleman's concerns are brought to the attention of the appropriate people in the Benefits Agency, and I shall bear in mind his remarks when I consider the Industrial Injuries Advisory Council report in the near future.
I believe that the hon. Gentleman asked nine questions, I shall read the debate in Hansard, to make sure that I answered them all. If I have not, I shall write to the hon. Gentleman with the answers.
§ It being half-past Two o'clock, the motion for the Adjournment of the House lapsed, pursuant to Order [19 December].