§ LORD SANDHLTRST had given Notice to ask His Majesty's Government whether it is the fact that ex-officers who are mentally incapacitated, and for that reason drawing disablement 'pensions, are, in addition to being examined from time to time by a Pensions Board, required as a condition of payment of each instalment of pension to obtain a certificate of their continued mental infirmity, not only from a magistrate or minister of religion, but also at their own expense from a medical practitioner, and whether this requirement may not safely be dispensed with?
§ The noble Lord said: My Lords, I shall add very few words to the terms of the Question which stands in my name, but perhaps I may mention the circumstance which called my attention to this matter. It was the case of a young officer of the Royal Naval Reserve, who, I think, was blown up in a vessel, and his mind was affected. After being for some time in asylums he was so far well that it was thought safe for him to return to the care of his parents. He is required three or four times a year, at irregular intervals, to present himself before the Pensions Board. In addition, whenever an instalment of the pension is applied for, a certificate has to be obtained from a magistrate or a minister of religion—and this costs him nothing—and also from a medical practitioner. The net result of this is that each instalment of pension costs him half a guines.
§ One is rather at a loss to see what is the utility of the medical certificate. It is a certificate of continued mental infirmity, and the difficulty one feels is that, assuming that at the moment the certificate i6 applied for the mental dis- 671 turbance is so far removed that a medical practitioner is unable to grant a certificate, this can only be conclusive at the moment at which the certificate is refused, and it would not be conclusive as to any part of the period during which the instalment of pension has been accruing. In any case there would have to be a period of observation during which the pensioner would be unable to offer himself for any employment. The duration of this period should be determined by the Pensions Board, who should be aide to cal] for such evidence as they require, including, probably, a report from the medical attendant of the pensioner.
THE EARL OF MALMESBURYMy Lords, before replying to the Question which has been raised by the noble Lord, perhaps your Lordships will allow me to ask your kind indulgence on this, the first occasion on which I have had the honour to reply from the Government bench to a question of a noble Lord. I have received that indulgence on many previous occasions when taking part in debates in your Lordships' House, and I hope it will not be denied me to-day. I am very glad that my noble friend Lord Sandhurst has thought fit to raise this question, because I know of no member of your Lordships' House more qualified than he is to deal with these most difficult and painful cases. He has had a long experience of these sad cases which come within the purview of the Board of Control.
Perhaps my noble friend will allow me to remind him that the position to which he has drawn attention arises out of the provision made by Section 335 of the Lunacy Act, 1890, for overcoming the legal difficulty of obtaining a valid receipt for monies due to a person incapable of managing his own affairs. Where a Receiver has been appointed on behalf of an officer, or where there is some person invested with authority to give a valid discharge for payment of pension, the difficulty does not arise. But in other cases it is necessary to have recourse to the procedure laid down by the Act, which provides substantially that where a pension is payable by a Government Department, and the person to whom the pension is payable is certified by a Justice or a minister of religion, and by a medical practitioner to be 672 unable by reason of mental disability to manage his affairs, the Department may pay such amount as it may think fit to the institution or person having the care of the pensioner, and may pay any surplus for the benefit of the pensioner's family. That is the position to-day. Consequently, where a pensioner is paid quarterly it is necessary to obtain a medical certificate quarterly.
I may say, however, before proceeding to explain further to my noble friend, that, as my noble friend well knows, these provisions are made entirely for the protection of the pensioner himself. One can imagine a case in which a pensioner may be drawing a pension but where the money may be made use of by other people who might be supposed to have charge of him, and there may come a period where the patient recovers and regains the control of his own affairs. Secondly, there is the question of the protection of the public funds, because a pensioner has a statutory right to his pension, and he might very easily bring an action against the public funds for the repayment of money of which he had not had the full use.
I believe that no charge for a certificate is ever made by medical officers in charge of approved mental institutions, and so far as I have been able to find out no charge is ever made by magistrates or ministers of religion. Unfortunately, in the more serious cases, which I believe are found to be very rare, the present procedure requiring these certificates cannot be departed from, and I think the noble Lord is unduly apprehensive upon the point. I may say that in the vast majority of the more serious cases the pensioners are at the present moment in approved institutions, and in those cases the medical certificate undoubtedly would be given by the medical officer in charge, without any additional expense to the patient. Then there are those cases where the mental incapacity is happily of a milder character. In those cases it will generally be found possible to dispense with the procedure prescribed by the Lunacy Act; to proceed under the authority of a Treasury warrant, which modifies the ordinary rule of the Appropriation Act regarding declarations: and to pay the pension on a certificate provided by one only of the 673 prescribed attestors, who need not be a medical practitioner. I have made inquiries, and I find it is the growing custom of the Ministry of Pensions to act under what is known as a Treasury warrant, which does not necessarily require a medical certificate, and I am advised that it is the intention of the Ministry in future to act even more fully upon Treasury warrants than it has done in the past. Lord Sandhurst alluded to the holding of medical boards. I am informed that these boards are now held very much less frequently than formerly. They rarely take place more often than once a year.
In reply to the second part of the noble Lord's question, I do not think that any medical certificate is required where the pension is paid to the pensioner himself. As your Lordships are aware, there are cases of mentally disabled officers who are quite capable of receiving their pensions, although they are unable to pursue any definite avocation or calling, owing to the condition of their nerves. With regard to the milder cases, to which I have alluded, in which the pension is not paid to the pensioner himself the Ministry of Pensions hopes to be able to avoid expense to the pensioner. For example, the pension will be paid quarterly, but in those cases where the pensioner has been seen by a medical board, although he has not been seen again for a very long time by the hoard, no doubt the Ministry will be satisfied with the report. of the medical board, and will pay the pension over to the person authorised upon a certificate signed by a magistrate or a minister of religion.
I have had the advantage of some conversation with my noble friend previous to to-day, and I think we have been able to trace the case to which he has alluded. I referred to the Ministry of Pensions, who went into the matter very carefully. It is the only case in which they can find any complaint. The case was a most distressing one, and naturally I do not wish to refer to it by name, but if the noble Lord, to-day, or at some other time, will spare me a few minutes, I can ascertain whether it is the case to which he has alluded. With regard to final awards, no further boarding is then necessary, but of course we must always be satisfied that the patient himself is receiving the full benefit of the money to which he is 674 entitled. If the noble Lord knows of any other case of hardship I hope he will be good enough to inform me. The Ministry have every intention to go carefully into every such case and give it the most sympathetic attention and consideration.
It is not quite relevant to the noble Lord's Question, but I may be permitted, perhaps, to indicate quite briefly to your Lordships the comprehensive measures adopted by the Ministry of Pensions in their endeavour to cure or alleviate the condition of those officers and men who, unfortunately, suffer from mental and nervous diseases, due to their war service. Approximately 75,000 officers and men have been pensioned for nervous diseases alone, and have been entitled to receive free medical treatment from the Ministry. The newest and most efficacious forms of treatment have been provided on the most adequate scale, and, I am glad to say, with the most gratifying results. In the early days of the Department there was great difficulty in obtaining the services of the requisite number of trained neurologists. The Ministry, however, instituted courses of training for doctors in one of their neurological hospitals, and thus were enabled to establish hospitals and clinics staffed by neurological specialists, sufficient to meet the very great demand for accommodation.
The Ministry have now fourteen neurological hospitals, besides a large number of clinics, conveniently situated for out-patient treatment. Eighteen months ago it was estimated that of the patients treated in several of the neurological hospitals belonging to the Ministry between 75 and 80 per cent. had obtained employment and no longer required treatment. As time goes on the cases remaining under treatment naturally show on the average a, tendency to less rapid recovery, but even so the results of treatment are still very remark able. In one neurological hospital, where the most serious cases are accommodated, 134 patients were treated during 1922, and of those only nine had to be certified as insane, whilst sixty-eight were discharged recovered and twelve were transferred to other institutions—some of them for industrial training. Your Lordships may be interested to know that an important part of the continuous treatment provided in the Ministry's neurological hospitals 675 consists of occupational training. Apart from its practical uses to the pensioner as a wage earner this training, which is carefully adjusted to the condition of each individual, has a high therapeutic value. It stimulates interest in constructive work and restores the work habit, whilst the patient is gradually brought to see that he is capable of achieving definite and useful results, and so is encouraged to make still greater efforts. Occupation and work are invaluable in the treatment of various nervous diseases.
LORD SANDHURSTI am very much obliged to the noble Earl for the trouble he has taken, and I am glad I asked the Question, because he has given us a great deal of very interesting information. I may add that in the case to which I alluded there was a Receiver appointed by the Court.