Vibration White Finger

HC Deb 21 January 2003 vol 398 cc23-9WH 10.59 am

Liz Blackman (Erewash)

I was extremely pleased to secure this debate and had sought it for quite some time. The subject is vibration white finger. That term is commonly recognised, but the correct term is hand-arm vibration syndrome, or HAVS.

I shall concentrate on what I consider to be the out-of-date nature of the prescribed list, PD A11; the prevalence of HAVS in occupations outside the prescribed list; new developments in assessment procedures; the differences in practices between the Department of Trade and Industry and the Department for Work and Pensions; aggregated disability; and, if I have time, health and safety practices.

The list of those in certain occupations and the use of certain related tools that creates entitlement to industrial injuries disablement benefit for HAVS was prescribed in 1985 and is very limited. It came about on the recommendation of the Industrial Injuries Advisory Council. The IIAC is an independent body that was set up to advise the DWP on matters relating to the industrial injuries scheme. It comprises representatives of the Confederation of British Industry and the TUC, and experts in occupational medicine and epidemiology. According to its website, the major part of its work is considering whether the list of prescribed diseases for which benefits should be given should be amended.

My hon. Friend the Member for Ellesmere Port and Neston (Mr. Miller), in early-day motion 160 in 1993–94, expressed concern that the prescribed list did not embrace certain victims of the disease who had indisputably contracted it as a result of their work". He went on to urge the extension of the list to include all occupations which cause vibration white finger to correct this anomaly". In 1995, the IIAC produced a report on HAVS for Parliament that recommended changes.

In a letter to the then Secretary of State for Social Security—the right hon. Member for Hitchin and Harpenden (Mr. Lilley)—Professor Harrington, the then chair of the IIAC, made a number of pertinent points and recommendations, which I shall outline. Although the prescription covered vascular effects—blanching and numbness—it should also cover the well recognised neurological effects. At the 1986 Stockholm workshop held under the auspices of the International Commission on Occupational Health, conclusive evidence was presented that exposure to vibration causes neurological disturbances as well as blanching of the fingers. Science and medical knowledge of the condition had improved and should be reflected in the way in which the condition was covered in legislation.

The syndrome should be linked to a list of tools, or rigid material held against those tools, rather than to occupational exposures. That would recognise the fact that the use of a tool may not be confined to a particular industry. Current working practices make it more likely that a worker will be exposed to a range of tools than was previously the case, so identifying tools instead of occupations was a more realistic approach to prescription for this condition.

The IIAC recognised, however, that the administrative costs of the industrial injuries scheme could be increased, and a 14 per cent. disability threshold for payment of benefit might produce few additional payments. It also recognised that a small assessment of HAVS could be aggregated with another award to satisfy the 14 per cent. rule or to increase a current benefit payment for another industrial injury. The council pointed out, however, that recognition of the condition in the prescribed list and for the individual had important preventive implications for industry and employees.

On 31 January 1996, the Conservative Government rejected those recommendations in a written answer. They were not persuaded that the additional benefits to individuals would be sufficient to warrant the high administrative costs". They were also concerned about the costs associated with developing a usable, repeatable and acceptable test for diagnosing the condition and assessing a person's disability."—[Official Report, 31 January 1996; Vol. 270, c. 823W.] Nevertheless, the Government were confident that the council would continue to monitor scientific advances and literature on the condition and developments in diagnostic and assessment techniques, and would give careful consideration to further advice from the council. It has been seven years since the council's report was published, and six years since the Government's response. I would like to know whether there have been any advances.

I wrote to the DWP last year on behalf of a constituent who had spent his working life in the upholstery industry and suffers from HAVS as well as bilateral carpal tunnel syndrome, as evidenced by his consultant plastic and hand surgeon. I received the same response from the then Minister that I received in 1996. However, I think that further evidence, developments and contradictions have emerged since then, and I would like to draw them to the Minister's attention.

There is evidence that the prevalence of HAVS is significant in a greater number of occupations and tools than in the prescribed list. The Health and Safety Executive website presents detailed statistics on that. Additional areas affected include construction, manufacturing, agriculture and fishing, and people using industrial sewing machines, grinders and floor polishers.

A Medical Research Council survey commissioned by the HSE, and carried out in 1997–98, gave a national prevalence estimate of 301,000 sufferers from vibration white finger, of which 268,000 were male and 33,400 female. That survey indicated that many occupations outside the prescribed list were affected. Moreover, working practices have changed, particularly because of the development of the flexible job market. Many employees are therefore exposed to a variety of tools as they move from one job to another in related industries.

I became interested in the limitations of the prescribed list when I was contacted by a local union representative, who had been supporting another constituent of mine at a tribunal. There was no question but that the man concerned suffered from HAVS, caused by the vapour-blasting machine that he had used since 1976. Copies of the tribunal documents, which I studied carefully, detailed engineers' reports, and the medical reports clearly showed that that was the case. However, the appeal had to be withdrawn because the machine was not a hand-held rotary tool, as required under PD A11. That constituent became part of a study carried out by Dr. Ian Lawson into nine sufferers from HAVS who had used high-pressure hoses alone or with other tools. His study was published in Occupational Medicine in September 2001. He concluded: In all cases this group presented with the disease when their use of high-pressure hoses became a significant or exclusive part of their job. These hoses fall outside PD A11. The constituent whom I mentioned earlier who has HAVS has worked in the upholstery trade for 38 years, using a variety of compression tools: sanding tools, frame, staple and matting guns, and what he calls "the big gun" for putting in seat springs. When he first started work, the tools were bigger and heavier than they are today, although in one of his letters to me he writes, quite poignantly, that with today's tools you still get the thumping in your hands from the power. Clinically, there is general agreement that HAVS may have at least two separate components, the vascular and the neurological. The internationally agreed Stockholm classification, which includes neurological effects, is now the most widely used method of grading the disease. It is known that vibration can also cause damage to nerves, and that 20 to 25 per cent. of those who have HAVS experience only those neurological effects—altered sensation in the fingers such as tingling and numbness. Compensation to workers thus affected is now available in many countries, but not in the United Kingdom through industrial injuries disablement benefit.

I will now discuss the mismatch between the DTI and the DWP in their approach to the disease. There is a clash of medical opinion supported by two different legal decisions. The DTI miners health compensation scheme has a judicial underpinning. Compensation is based on agreements between claimants and acting solicitors and extensive tests. In the DWP scheme, which is set out in legislation, the claimant has to show a link between the disease and occupation, loss of faculty and 14 per cent. disability. There is a reliance on medical reports and discussion.

The miners compensation scheme is functioning well. Sensory testing, which was flagged up as a reason for not accepting the 1995 report, is already carried out to determine entitlement to compensation under that scheme. The DWP awards IIDB for HAVS only if a person's occupational background fits within the prescribed list and they have episodic blanching and/or circulatory or vascular effects. There is no test under the DWP for the neurological component because the factor is not recognised. Miners getting compensation cannot get IIDB for all those reasons.

In any event, the DTI uses a different vascular test from that used by the DWP, which causes duplication. To complicate matters further, the social security commissioners report recommendation states that in assessing disablement the Benefits Agency must take account of neurological as well as vascular damage.

Less than 14 per cent. of claims are given an assessment of disablement. The recommendation on aggregation in the 1995 report by the Medical Research Council still stands: it would make a difference to sufferers if compensation were aggregated with other industrial disease assessments or with existing industrial benefits. My constituent has carpal tunnel syndrome and has just had two operations. He received sick pay only when he was having his operations, and has to return to work on the same "thumping" machines, as he puts it.

I shall briefly touch on health and safety, which is the other side of the issue. In the study to which I have already referred, Dr. Lawson concludes that the ultimate goal for tool manufacturers, hygienists and engineers should be to reduce workplace vibration levels to meet national and international standards and guidelines, including HSE guidelines and EU directives. The HSE 1994 advisory booklet "Hand-Arm Vibration" recommends preventive measures where workers' exposure regularly exceeds the recommended level. To date, the proposals have not been adopted by regulation, which means that when inspectors investigate work sites with potential vibration problems they may only recommend specific corrective action.

The Medical Research Council's research working group is looking again at HAVS, and I gather that a further meeting is scheduled for next month. That work has been urged on by my hon. Friend the Member for Barnsley, West and Penistone (Mr. Clapham), who is so active in this field. The working group is looking at using information on a sufferer's work history to back up diagnosis. We hope that it will recommend that the DWP adopt the DTI scheme tests as a low-cost way to deal with those who come into the miners compensation scheme, although that would not address those who are outside the scheme. In any event, it is looking at a functional test of neurological damage for which the DTI already has a test.

Will the Minister undertake to look again at the issue? In particular, will he look at the evidence of the wide number of tools and occupations in which HAVS is significant? Will he consider the issue of aggregated disability in the light of international practice, the mismatch between DWP and DTI practices and the health and safety issues? Above all, will he look carefully and sympathetically at the council's recommendations?

11.14 am

The Parliamentary Under-Secretary of State for Work and Pensions (Malcolm Wicks)

It is a pleasure to serve under your chairmanship again, Mr. O'Hara. I congratulate my hon. Friend the Member for Erewash (Liz Blackman) on securing the debate and on raising this important issue on behalf of her constituent. It is a wider constituency matter, too, and I acknowledge that Government Back Benchers have been interested in it for some while.

As my hon. Friend will be aware, our approach towards work and disability is focused on preventing injuries through health and safety action—she acknowledged the importance of prevention—and enabling people with health problems and disabilities to return to work through the help offered by Jobcentre Plus. However, the industrial injuries scheme, which dates back to the foundation of the post-war welfare state in 1948, is a vital part of the support that we offer to people who have become disabled as a result of an accident at work or an industrial disease. That is a non-means-tested, tax-free, non-contributory benefit, payable even if the person continues in or returns to work. It is effectively a no-fault insurance scheme. In 2001–02, that benefit cost £775 million and there were 377,000 recipients.

Not everyone with vibration white finger, to use one description of the condition, has a prescribed disease for which industrial injuries disablement benefit is payable. Only the most severe forms of the condition are compensated through the industrial injuries scheme. In those cases, the condition is so advanced that it causes disablement in the sufferer, by comparison with someone else of the same age and sex. Hence the prescription of prescribed diseases A11 equates to a more advanced state of the disease.

As my hon. Friend rightly points out, PD A11 has been prescribed as an industrial disease in relation to specific occupations since 1985. As she acknowledged, the disease was reviewed by the Industrial Injuries Advisory Council in 1994. It recommended that the list of prescribed occupational exposures should be replaced with a list of tools and rigid materials held against such tools. It also recommended changes in the way in which the disease is diagnosed and assessed for benefit purposes. Careful consideration was, of course, given to those recommendations, but the then Conservative Government were not persuaded that the additional benefit to individuals would be sufficient to warrant the high administrative costs of implementing the recommendations.

My hon. Friend asked why some people with the disease pass assessments carried out by the DTI but are not awarded benefit. That is because, in compensation claims, the degree of disablement does not have to be as severe as that required under the strict qualifying criteria laid down in the industrial injuries scheme. It is not possible, therefore, to compare the two schemes directly.

My hon. Friend noted the apparent disparity between the tests used by the DWP to determine entitlement to industrial injuries disablement benefit and those used by the DTI to diagnose and assess the disablement caused by vibration white finger. The fact is that there is no simple, reliable and universally accepted test for vibration white finger. Diagnostic procedures must be viewed in the context of the high volume of applications to the industrial injuries scheme. Claims need to be resolved speedily and consistently.

Jeff Ennis (Barnsley, East and Mexborough)

I thank my hon. Friend for giving way and I congratulate my hon. Friend the Member for Erewash (Liz Blackman) on securing this important debate.

As I am sure the Minister is aware, my constituency has received the highest level of compensation for vibration white finger through the DTI in the country, because of its number of former miners. The difference between the approach of the two Departments causes difficulties. Miners go through two detailed and excruciating DTI medicals to qualify for compensation for VWF. When they go to see a doctor from the DWP, the assessment is usually very quick. Few questions are asked and the person's hands are looked at very briefly. The miners have difficulty understanding why some of them get benefit and others do not. Some of the decisions seem to me to be wrong. Will the Minister comment on that?

Malcolm Wicks

I certainly acknowledge that having two schemes appears perplexing at first sight, not least to those who are directly affected and to hon. Members. However, the two schemes are not the same; otherwise, they would be one. One is about compensation; the other is about possible entitlement to a regular weekly benefit, regardless of whether one is in work. The nature of the schemes is different. I acknowledge my hon. Friend's role in raising the issue. As he said, it is important to his constituents, and I recognise his interest in and conviction about the matter.

Having said that, because concerned Members of all parties continue to raise the matter, my right hon. Friend the Minister for Work felt that it would be appropriate to ask the Industrial Injuries Advisory Council to review it. It is the council's role to monitor developments in medical knowledge and improved diagnostic procedures, and to provide sound evidence-based recommendations to the Government. Medical knowledge has moved on and new industrial trends have appeared since the council last made recommendations. The council also advises on whether the extent of occupational cover needs revising in the light of changes to working practices.

The Government approached the council in March 2002 and asked it to carry out a review of prescribed disease A11. I understand that the council will meet on Thursday to discuss progress. Once we have seen its report, which we expect to be finalised this year, we shall consider what changes to the scheme would be appropriate.

My hon. Friend the Member for Erewash raised the issue of employment activity, in which we are particularly interested. She may be aware that my Department is now the sponsoring Department for the Health and Safety Executive, which has published extensive guidance on hand-arm vibration syndrome. It has also mounted two campaigns on the hazards of vibration, most recently targeting the manufacturers of vibrating tools. My hon. Friend may be aware also of the vibration directive, which will further reinforce the HSE's action and set legal requirements for action at certain levels of exposure. That will come into force in 2005.

We continue to monitor and advise employers on good practice. We believe that we have the good will and support of industry—those who make the tools and those who use them.

My hon. Friend also touched on aggregated disability. Although the majority of assessments for vibration white finger are under the threshold of 14 per cent., as she said, benefits can be awarded if the disabled person has an assessment or assessments for other accidents or diseases and the aggregate amounts to 14 per cent. or more. I hope that that is some comfort to her.

I appreciate that it is difficult at first sight to understand the logic of two schemes, and I understand the difficulty that hon. Members have in communicating it to their constituents.

Liz Blackman

Before the Minister sits down—

Malcolm Wicks

I am not about to sit down. Let me finish, as I am enjoying the debate.

The schemes apparently assess the same disease. However, as I said earlier, they have somewhat different purposes. I hope that that helps to explain the logic of having two schemes.

Liz Blackman

Does the DWP accept in principle that the disease causes neurological effects? At present, the scheme does not. Will the Minister look favourably on reviewing the situation if and when the council decides on the functional tests of neurological damages, which it is now considering?

One problem is that the DTI and the DWP define the disease differently. The DWP must accept that there are neurological implications, as has been recognised internationally.

Mr. Edward O'Hara (in the Chair)

Order. This is becoming a very long intervention.

Liz Blackman

I beg your pardon, Mr. O'Hara. I believe that the Minister gets my point.

Malcolm Wicks

I am advised that neurological effects are taken into account because of case law. However, if I feel that it would be useful to write to my hon. Friend on this or other points that she raised, I will do so.

Although the council will monitor the debate, I give the assurance that I shall send it a copy of the Hansard record so that it can take fully into account the issues raised by my hon. Friends the Members for Erewash and for Barnsley, East and Mexborough (Jeff Ennis).

I conclude by thanking my hon. Friend the Member for Erewash for raising an issue of great importance to her constituents and to others, and by assuring her that the council's report, which is expected later this year, will be taken very seriously by the Government.

11.26 am

Sitting suspended until Two o'clock.