Noise-induced Hearing Loss

HC Deb 03 March 1999 vol 326 cc1038-44 12.30 pm

Mr. Mark Oaten (Winchester)

I am grateful for the opportunity to raise the issue of war veterans who suffer from noise-induced hearing loss as a direct result of their service and who are campaigning to get their war pensions reinstated for this disability. I must make it clear at the outset that it is certainly not my intention to attack the Government; I simply want to keep the issue alive, perhaps push the Minister slightly if I can, and probe the Government's current thinking on the issue.

I am grateful to the Under-Secretary of State for Social Security, the hon. Member for City of York (Mr. Bayley), for the courtesy that he has shown me in the past couple of days, and especially for giving me as much warning as he could of the Government's announcement yesterday that they have, sadly, rejected some new medical evidence in this connection. At best, that has made today's debate topical; at worst, it probably means that my researcher had a very late night last night.

I know that the issue is of concern to many hon. Members. Indeed, my hon. Friend the Member for Weston-super-Mare (Mr. Cotter), who is in the Chamber, tabled an early-day motion which has received cross-party support from, I think, upwards of 60 Members of Parliament. Certainly, many of our constituents are concerned.

When I take up such issues for war veterans, I sometimes feel guilty that, as a young Member of Parliament, I have very little idea of what it must have been like for them to go through the wars in which they fought. These days, we regard war as very much a high-tech affair involving computers, and we assume that the loud noises and their impact have been greatly reduced. To a large extent, that is true. It is only by watching films such as "Saving Private Ryan" that I can begin to understand what it must have been like to experience what many of our constituents experienced.

I spoke to a constituent, Major Cassidy, who has retired, who told me of his experience of being in the armed forces for 47 years. When he joined the Army and first began firing rifles and using tanks, there was absolutely no noise protection. In fact, it was only when the Army adopted a great new invention—cotton wool—that any protection techniques were put in place. I understand, however, that even that proved counter-productive.

Let me give some background to the issue. Originally, the war pension regulations were interpreted in such a way that claimants would be compensated if, when leaving the services, they suffered a 20 per cent. loss of hearing as a result of excessive noise encountered during their service. In addition, those who had suffered lesser but notable hearing loss would be entitled to a rising increment in benefit over time as they, too, approached the 20 per cent. level. At the time, it was clearly acknowledged that noise encountered during their military service made premature deafness much more probable.

In 1996, the Conservative Government decided to introduce new medical evidence. They believed that that evidence showed that further deterioration in hearing loss was due to other factors, such as getting old, and had nothing to do with the individuals' exposure to noise during their service. As a result of that medical evidence, the regulations were changed. That decision has meant that people person can receive a war pension only if they are deemed to have reached the qualifying level of deafness at the point at which they left the service. That qualifying level is set at 50 decibels. Many experts believe that that level is too high anyway. Indeed, the Irish Republic has a qualifying level of just 20 decibels.

The result of the change introduced by the previous Government means that very few veterans now qualify for the war pension for deafness. In fact, more than 90 per cent. are turned down because they fail to reach the qualifying level. The Royal British Legion estimates that that means that around 8,000 new claimants a year are denied the pension. As a result of the change, the Treasury reckoned that it would save around £35 million a year.

When the change was announced, there was, quite rightly, a storm of criticism. Indeed, at the stormy Prime Minister's Question Time on 5 December 1996, the then Leader of the Opposition—now the Prime Minister—described the changes as "shabby and mean-minded". Similarly, the right hon. Member for South Shields (Dr. Clark), then a shadow Defence Minister, stated that the change ran against all conventional medical evidence and is a smokescreen to save money. It would be cheap and churlish of me to throw those remarks back at the new Labour Government without acknowledging that they have kept their election promise to review the situation. I commend the Government on having always been open to the issue. They seem to accept the fact that it is a source of controversy and that new medical evidence could dispute the change to the regulations made by the previous Government.

Indeed, an independent review, chaired by Sir Kenneth Calman, the chief medical officer, was set up not long after the new Government took office. It concluded, as previous reviews had, that current medical evidence showed that increases in hearing loss after service were not due to initial noise exposure during service, but there was certainly controversy about its findings. Some believe that the terms of reference of that inquiry were restricted to a narrow consideration of the effects on hearing threshold levels, so that the contentious issue of how that relates to hearing disability was excluded. They argue that, because of that remit, the existing regulations were always likely to be the outcome of the process.

Mr. Brian Cotter (Weston-super-Mare)

I am sure that, like me, my hon. Friend has many constituents who are in the 15 to 20 per cent. category of hearing loss. It seems unfair that they are ruled out although they are close to the 20 per cent. threshold. I hope that the Minister will consider that.

Mr. Oaten

I am grateful to my hon. Friend. I, too, hope that the Minister will respond to that point. There is certainly a sense that it is rather "mean-minded", to quote the Prime Minister, and calculating to have to differentiate between those who have reached a 15, 20 or 30 per cent. threshold.

To their credit, the Government have been prepared to pursue the issue and have considered new medical evidence. A further review has been undertaken. It included the work of Professor Davis, whose two recent papers called into question the current terms of reference and suggested that further research was needed. Yesterday, the Government announced that, based on the new research, they had concluded that the further evidence does not meet the standard required to raise a reasonable doubt", and they were rejecting the current medical evidence.

I shall not go into detail on the findings or question the medical background to them, but I ask the Minister to look carefully at the detail and conclusions of that work. Paragraph 5.7 of the conclusions states: Longitudinal studies in humans may finally resolve the age/noise interaction question but only if they have large numbers and well characterised populations, followed for an adequate period. Such undertaking in relation to a topic which is subject of an International Standard will need very careful consideration. The medical evidence that the Government have considered and the review itself raise some serious doubts. I put it to the Minister that that section alone suggests that we need to keep an open mind. It certainly suggests to me that the scientists are saying that they cannot be sure at this stage and that a longer period of research is needed.

The point that the Government should take on board is that today's pensioners do not have the time to wait for such research. A five or 10-year period of research means that today's war pensioners will not see a successful outcome. Surely it would be right for the Government to act now and to give those pensioners the benefit of the doubt. It will be of no comfort to them if, in five or 10 years' time, new research proves that they were right, because they will not be around.

I remind the Minister that, under the Irish scheme, the qualifying level is much lower. Critically, the Irish Government's decision was based on the very same medical evidence that our Government used to come to their conclusion. That suggests that their stance is too rigid.

I urge the Minister to remember the human perspective. It is often very easy to get bogged down in complicated medical evidence, but in this case it is important to remember the difference between hearing impairment and hearing disability. I press the Minister to note that thousands of war veterans who suffer from noise-induced hearing loss have what should be described and known as a disability, not a hearing impediment. The thousands of veterans who suffer from noise-induced hearing loss fought for our country and deserve a great deal more from Governments. They should, in the circumstances, be given the benefit of the doubt, and extra help in their old age. They deserve a better deal.

I hope that the Government will give a commitment to keeping an open mind, as I have acknowledged they have to date on this issue, and will review new research as it comes along. Would it not be better for the Minister to announce today that he is prepared to reinstate the pension until the review is completed and the Government can be definite about the fact that the new research has ruled out the possible link? Although the Government have kept their election promise to review the research, their response to the issue has been too cautious, too rigid and, perhaps, as the Prime Minister said, "mean-minded".

12.40 pm

The Parliamentary Under-Secretary of State for Social Security (Mr. Hugh Bayley)

I congratulate the hon. Member for Winchester (Mr. Oaten) on securing a debate on this very important issue, and thank him for his kind remarks at the start of his speech. The last time that I spoke immediately after him in this Chamber was following his maiden speech—I do not know whether he recalls this—when he had a majority of two. Now, his majority is more than 20,000, so he clearly knows how to build support for his cause and those he advocates. I stand warned of the persistence that I am likely to face on this issue. He marshalled the arguments well, and I shall do my best to respond to them.

I shall start by referring to the issue with which the hon. Gentleman concluded: the human dimension. I pay tribute to all the men and women who were killed or injured in service in the armed forces. Members of my generation must remember at all times that the democratic liberties that we enjoy in this country—and our freedom in the House as Members of Parliament—were secured by the sacrifices of earlier generations in two world wars. I also recognise the vital role played by ex-service organisations, such as the Royal British Legion and the Royal British Legion Scotland, the British Limbless Ex-Servicemen's Association, the Ex-Services Mental Welfare Society and the War Widows Association of Great Britain.

As the hon. Member for Winchester knows, yesterday we made public the outcome of the further review of the evidence on the relationship between age-related and noise-induced hearing loss. We received the report only on Friday, but wanted to make it available before today's debate.

The conclusion of the further review is that there is no new reliable evidence to raise a reasonable doubt that hearing losses due to noise and age are more than additive. The legal standard of proof required in this field is reasonable doubt. The same conclusion was reached last year by the expert panel. Before I turn to the points raised by the hon. Members for Winchester and for Weston-super-Mare (Mr. Cotter), it may be helpful to put the review in context.

The war pension scheme makes provision for a pension to be paid for any disablement attributable to, or aggravated by, service, whether in time of peace or war. The basic war pension is set at a higher rate than the social security equivalent—industrial injuries disablement benefit. In addition, the war pension scheme provides a wide range of allowances which may be paid in addition to the basic disablement pension. Those allowances are available in respect of such things as increasing age, reduced or lost earnings capability, and care and mobility needs. The scheme provides pensions for the widows and children of people who die as a result of their service.

To illustrate the advantage, a single, severely disabled war pensioner could receive more than £400 a week. Under the nearest comparator, the industrial injuries scheme, a person similarly injured at work would receive £55 a week less. A person with a similar disablement that is unrelated to employment, who receives incapacity benefit and disability living allowance, receives just over £165 a week—almost £235 less than the war pensioner.

All war pensions and allowances are tax free. They may be paid on top of the ex-service man or woman's earnings in civilian life, and on top of the state retirement pension. They may also be paid in addition to the pension paid under the Ministry of Defence armed forces pension scheme.

Some people question the preference given to war pensioners. I do not; it is wholly right that the sacrifice of those injured or killed in defending the country should be specially recognised. But such preferential treatment must depend on a clear link between disablement and military service. That is why, under the war pensions scheme, a pension is paid only for disablements that arise from service. It is not paid for disablements that arise from other causes, including natural processes, such as ageing. That rule dates from the very start of the scheme.

There can, of course, be many causes of hearing loss. Often, several types of loss are present in one person. We must view each separately because they are different medical conditions. Some hearing loss may be due to service, such as exposure to noise. Other loss has nothing to do with service; for instance, most people suffer from hearing loss as they get older.

More than half of all living ex-service people served as conscripts during the second world war or in national service. That means that they left the forces at least 35 years ago. The very youngest are close to retirement age, but most are considerably older. The average age of a war disablement pensioner is over 75. Anyone in this age group will be starting to feel the effects of time, and may suffer from diseases that we expect to find in a person of pension age, regardless of whether he or she was once in the armed forces. Considering whether such a disease might be due to experiences in service more than half a lifetime earlier can make deciding claims difficult. We must maintain the integrity of the scheme, and that means insisting on the link to service.

When we came to office, the Government immediately set up a review. The hon. Member for Winchester made comments about pledges made by my right hon. Friend the Prime Minister when he was Leader of the Opposition. We promised a review and, as soon as we were elected, we set one up. It considered the evidence on hearing loss, and involved a range of eminent experts. We quickly communicated the outcome of that first review to the Central Advisory Committee on War Pensions—the advisory body on the subject. My right hon. and noble Friend Baroness Hollis, the Minister with special responsibility for war pensions, met representatives of the Royal British Legion and the Royal British Legion Scotland to brief them on the matter.

The independent experts told us last year that hearing loss due to noise damage does not get worse after leaving the noise. They also said that hearing loss caused by noise does not increase as age-related loss is added to it.

Mr. Oaten

Does the Minister acknowledge that the most recent study has suggested that we need more time to clarify the research, and that, until we have a five-year or, perhaps, 10-year study, we cannot be absolutely sure about the outcome?

Mr. Bayley

I do not accept the conclusion that the hon. Gentleman draws from the latest study. The latest study reviewed a wide range of evidence, including 56 academic, independently reviewed papers, which have been outstanding for some time, certainly since the last review; two new papers by Mills and Miller, which were written in the past year and published in referred journals; and two papers from Professor Davis, a statistician and eminent scientist working at Nottingham university's Institute of Hearing. Professor Davis's papers reflected work in progress which suggested that, when the research was completed, a different conclusion could be drawn. One needs to set that against the bulk of the evidence—50 or so papers that point in an alternative direction.

The hon. Member for Winchester asked me whether the Government would give a commitment to keep an open mind. We certainly will. When the studies in which Professor Davis is engaged are published in refereed journals and his research is complete, we will look at that evidence. If it changes the balance of opinion, or suggests new lines of inquiry, we will follow those.

Mr. Oaten

If, in two or three years, different evidence came through and the Government decided that, on the balance of that evidence, they wished to change their view, would they consider retrospective payments to pensioners who, in the intervening time, had not received the payments? Would it not be easier to give them the benefit of the doubt now, rather than face the potential retrospective element when future evidence is considered?

Mr. Bayley

The hon. Gentleman gives an interesting hypothetical example, but he will understand why I am not drawn to it. The overwhelming bulk of scientific evidence—all the evidence apart from the new work by Professor Davis—points in one direction. A clear scientific conclusion is drawn from that evidence: hearing loss as a result of age is no more than additive to hearing loss that was caused earlier through exposure to noise. We must base our policy on the scientific and medical evidence. Of course we keep an open mind. We are aware of Professor Davis's work. We will look at that work and review the body of knowledge when his work is completed and formally published.

The review that was published yesterday involved an exhaustive search of the literature and was conducted by asking eminent experts, including those on the review panel last year—one of whom, of course, was Professor Davis—for their advice on the existence of any relevant evidence, and by carefully scrutinising that evidence. The conclusion of the further review is that no new evidence changes last year's findings by the expert team. I realise that that may be a disappointment, but we can, and should, proceed only on the basis of scientific evidence.

The hon. Member for Winchester raised several specific points. As he knows, in 1993, the war pensions scheme was amended to introduce a 20 per cent. "cut-off" below which an award would not be made for noise-induced hearing loss. As he told the House, previously, a lump sum gratuity was paid for losses at that level. The change brought the war pensions scheme more into line with the rules for occupational deafness under the industrial injuries scheme.

There are still considerable advantages in war pensions. For example, a claim may be made at any time and regardless of length of service. Under the occupational deafness scheme, the individual has to have worked for 10 years at least in a noisy occupation and the claim has to be made within five years of leaving that occupation.

The 20 per cent. "cut-off" was part of a package that included extra cash for war pensioners. As a result of it, from 12 April 1993, almost 250,000 war pensioners gained up to £5 a week on top of the usual uprating for the most severely disabled. It was the lower ranks who gained the most.

The hon. Member for Winchester asked me to consider whether 50 decibels is the right point at which to trigger a war pension. Fifty decibels is the point at which a person starts to have trouble following conversation in a noisy environment. We believe that that level, which has been used for a long time, is appropriate when we consider the percentage level of disability that is used in relation to other injuries and conditions.

Mr. Cotter

I wonder why—we have a close example—the Irish Government have taken a different stance on the decibel level.

Mr. Bayley

I imagine that all Governments use different standards. I have not looked at that aspect of the Irish scheme. I will look at the point and write perhaps to the hon. Member for Winchester.

I was asked why one should establish a cut-off, not just for hearing loss, but for any injury, at the 20 per cent. level. We could say that we would have a difficulty whether the cut-off was 15, 20 or 25 per cent. We could have the same argument about someone just above or below any of those cut-off points, but the reason why the 20 per cent. level is chosen is because it is used elsewhere in legislation, particularly in relation to the industrial injuries scheme. It seemed sensible to use that level as a benchmark.

The hon. Member for Winchester asked us to reinstate pensions until the position was clearer. I must be frank with him. Before the general election, we believed that the position was unclear because thorough reviews had not been made public. Since the election, we have conducted two thorough reviews of the scientific evidence, and it is clear—I make the point in relation to the Irish scheme—that, under the international standard used for medico-legal purposes, lower-level hearing losses of the sort that we are discussing are not eligible for compensation.

Therefore, although I will look at the Irish scheme and write to the hon. Gentleman, I must say that the changes that were introduced in 1993 brought British war pensions scheme practice into line with the rules for occupational deafness under the industrial injuries scheme.

When we came to office, we promised to undertake a review. That was done promptly and on time. One of the conclusions of the review was that there should be a further study. That has now taken place. It has confirmed the results of the first review.

Both reviews were undertaken in a totally professional manner, were informed by eminent experts and considered all the relevant evidence on the subject. We closely monitor medical and scientific evidence on any matter that may affect entitlement to a war pension. Of course, we will continue to do so for injuries relating to hearing loss.

I thank the hon. Member for Winchester for raising the matter. It is important. I am particularly glad that the timing of the debate was closely linked to the publication of the review report.