Army (Ordnance Factories), 1929.

Part of Orders of the Day — Supply. – in the House of Commons at on 8 May 1929.

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Dr. VERNON DAVIES:

The House is to be congratulated upon being able to deal with the subject of pensions purely from the non-party point of view, for we look back with gratitude to these men who fought for us and suffered, who did not go out because they believed in any particular party, but simply because they were Britons. We in this House regard them in that way and I am sure that from every side there is a wholehearted desire that they should get full and accurate justice meted out to them. Yet from the speeches which we have heard, from the records which have been given, from the questions which we very often see put down in the House, we feel that there are certain cases which are causing difficulties, and that there is a certain amount of dissatisfaction among Members and among the people of the country; and that a doubt has been expressed both here and elsewhere as to whether justice is being meted out to the ex-service men. It is a subject in which the medical profession is intimately concerned, because, when all is said and done, it depends upon the skill and accuracy of diagnosis and assessment of the profession as to whether any ex-service man can make a case or not. We have to remember that we have to hold the scales of justice with an equal poise, remembering on the one hand the taxpayer, and on the other the ex-service man.

I do not quite agree with my hon. and gallant Friend the member for North St. Pancras (Captain Fraser), who seemed to give the impression that there was only a certain definite sum of money, and that it was better to concentrate that upon the genuinely wounded than to fritter it out over the whole of the ex-service men. I do not regard the question in that way. I say that there is an unlimited sum of money, and that all the Minister has to do is to say what amount he requires for his service, and that this House will grant it to him. Although we have to hold the scales of justice, we have also to remember that the House upon more than one occasion has, by Statute and Royal Warrant, agreed to a certain course of action and to certain powers of the Minister. The Minister is bound by the Warrants and Statutes until the House in its wisdom sees fit to alter them. The one point upon which we are all agreed is that, in any case of doubt, the pensioner should receive the benefit of it. We may take it, speaking generally, that the great majority of these men who claim for pensions honestly believe that they have a genuine case. Yet it is so easy to make a mistake. May I show the House roughly what I mean.

There is a certain class of case which everybody, layman as well as medical man, would recognise as simply due to war injury, such as the loss of an eye, the loss of a limb, gunshot wound or shrapnel wound. Everybody would recognise that these were war injuries, and that the men suffering from them were entitled to pensions. We form our opinion from the knowledge that we have and from our common sense. There is a second class of case which we are quite convinced is not due to war injuries. We have to remember that because a man has been to the War, it does not necessarily follow that every illness and injury that he gets is the result of his having been to the War. For instance, if an ex-service man were to develop smallpox or scarlet fever, and then put in a claim for a pension, saying that it was due to war service, hon. Members would at once say that it was an illegitimate claim, because they would know from their own knowledge that it was impossible for such a thing to have been the result of war service.

Such cases as these, therefore, cases which are genuine from our knowledge and cases which are not genuine from our knowledge, should not arise. Medical men with a certain amount of experience are equally as certain in other classes of case whether they are due to war injury or not. Members have letters from constituents of ex-service men, apparently very sad cases, and perhaps cases of paralysis. A man will say that he was perfectly all right when he went to the War, and after five or six years he develops a certain form of paralysis, and thinks that it must be a case of injury or shock or nervous stress due to the War, but medical men know that that paralysis is definitely the result of venereal disease. Nothing can cause that paralysis but venereal disease, and therefore we say that it is not due to the War. The medical man by his knowledge is able to give an accurate diagnosis, but the layman or laywoman does not recognise this, and thinks that a certain act of injustice has been done.

There is the third class of the doubtful case, which is even doubtful to the medical man. Medicine is not an exact science. We are not yet masters of all disease; we do not always know the cause of disease and we do not always know the prognosis of disease. We have therefore a neutral ground where there is room for difference of opinion. What is the proper and right thing to do in this debatable ground? It is to see that we have the highest, the best and the most competent medical advice before confirming an opinion, because we must and we can only depend upon medical advice when we have to decide on the question of entitlement and assessment. People have wondered whether sometimes the Ministry have acted quite as leniently as they might, and whether they have been as humane as they might be. I should like to put in a tribute to the extreme courtesy, kindness and humanity of my right hon. and gallant Friend the Minister. Whenever I have gone to him he has received me with the greatest sympathy, and has done all that he possibly could. Last week I had the opportunity of meeting the Minister, and I expressed a certain amount of difficulty in which I was concerning the administration of his Medical Department. He kindly offered me the opportunity of interviewing any of his medical staff, and arranged for me to meet the Director-General of Medical Services in the Pensions Ministry and his Deputy.

Perhaps the House will allow me to state briefly the procedure, because it was new to me to a certain extent, and I am certain that there are Members in the House who do not know what happens. The Medical Department of the Ministry have three main duties. First, they deal with the boards and the assessment and entitlement of a man's award from the medical point of view. Second, certification and the necessity of treatment or for treatment allowances. Third, a non-medical branch which deals with the supply of hospital apparatus, artificial limbs, etc. The boards are held at board centres in the principal areas of the Ministry, which in turn are in the principal cities. The board consists of a chairman-assessor, who may be a whole-time or sessional man, who has been a whole-time medical officer of the Ministry. Then there is an appropriate specialist, who in the main is employed on a part-time basis. Thus you have on the area boards a chairman-assessor, a man of experience and knowledge, and of particular knowledge in the peculiar work belonging to the Ministry of Pensions; then there is a sort of rota from which a specialist assessor can be selected to deal with particular cases. If they are dealing with consumption, they have a man skilled in that class of case; or if dealing with neurasthenia a man skilled in neuasthenia. There is therefore on the area board two men who are expert medical men, fit and competent to give a decision.

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When they give a decision, it passes through the Deputy-Commissioner of Medical Services, and goes to the Awards Branch in London. At this branch the recommendations of the area board are considered. Further information may be asked for, and there are in the Ministry a number of trained medical assessors who can deal with particular types of cases again. They may be specialists on certain diseases, such as tuberculosis and neurasthenia, so that when these particular cases come up to the awards branch, if they are not quite satisfied, and if there be anything which they want explaining, they can refer it to another group of specialists. Further questions may be asked of the area board, and the long and short of it is that after it has passed through the area board and when it has been considered by the awards branch in London, we may safely say that every skill and medical attention has been given to the case under review by expert medical men. I was interested to find that the medical branch of the Ministry of Pensions is concerned solely with the matter of entitlement and assessment, and that the financial aspect never comes within their purview. After making the entitlement and assessment, they refer the case to another branch of the Ministry, the lay branch, which makes the financial interpretation of the medical men's decision. I think, therefore, we can say that the medical men attached to the Ministry are absolutely fair and unbiased and anxious to do the best they possibly can for the ex-service men. We have heard to-day that 96 per cent. of the people employed at the Ministry are ex-service men and women and it naturally follows that they would have a very sympathetic interest with these men.

As I have said, I had the privilege of meeting these two gentlemen, who received me very courteously, and, in answer to my inquiries, gave me all the information for which I asked. I went so far as to ask them what had been the decision in certain classes of cases, and they told me, and then I put hypothetical cases of my own. I said, "Suppose such and such a thing happened, what would be the attitude of the Department?" They said, "In such cases we have decided so and so." I came away from a very long interview perfectly convinced that the medical department of the Ministry were more than fair to the ex-service man. In fact, speaking as a medical man, I would not have passed some of the cases which they passed. I will give an example. There was a case of a man who had syphilis before the War and after the War developed symptoms of general paralysis of the insane, which came on, perhaps, a little sooner than might have been expected. The Ministry accepted that as a case in which there had been aggravation due to War service. I would not have accepted that case. On the other hand, you have to have a certain definite proof. You may have the case of a man who went through the War at somewhere round about 50 years of age, and since then, with the advance of years, has developed, say, arteriosclerosis. That man has a stroke and gets paralysis. Some people would say that that should be accepted as due to War service, and the man be pensioned accordingly. I was glad to find, in that particular case, that the Ministry did not regard it as one where the disease had been aggravated; they say the disease must absolutely be due to War injury or the result of War service and not due to the normal passage of time.

I would like Members of the House to remember in their criticisms that they are critcising with insufficient knowledge. They are laymen, who, as a rule, hear only one side of a case. They can take my assurance that all these cases are now examined most sympathetically by expert medical men, men who know their job, men with plenty of experience, men who have no say, in any shape or form, on the financial aspect of the case, and who are only anxious to do all they can to help the ex-service men. If we could get the idea to prevail throughout the country that the medical profession as a whole is a profession of honourable men who are anxious to do all they can for the ex-service men, I think it would create a better spirit and a better atmosphere and reduce suspicion among people. It is not uncommon at the present time to hear it said "But it is quite easy to get a doctor on one side to say one thing and another doctor on the other side to say exactly the opposite."

Hon. Members must bear in mind that in surgery and medicine, where we have not yet reached the confines of knowledge, one man may with perfect honesty interpret a symptom in a certain way and the next man may with equal honesty interpret that same system in a different way, and very often we do not know which man is right until there is an operation or a post-mortem examination. Yet both men have been perfectly honest in their opinons. When it is said here that cases have been referred to the Ministry accompanied by certificates from doctors, that does not necessarily mean that those medical men gave a false certificate. They gave a certificate according to the best of their ability on the symptoms they had observed, but when we also have the opinions of experts—experts on tuberculosis, or neurasthenia, or insanity, or wounds—it is only fair to regard the experience of such an expert, with all his experience, as of more value than that of the ordinary practitioner. I was always prepared to take the view of an expert, whether I agree with him or not, because I felt he had more knowledge.

The case submitted to-day by the right hon. Gentleman the Member for West Bromwich (Mr. F. O. Roberts) could, I think, very easily be answered from a medical point of view, speaking quite cursorily, and some of the other cases mentioned to-day—apparently so sincere, apparently so pitiful from the point of view of the men—when looked at strictly from the medical point of view are not as genuine as they seem. The Minister is carrying on his responsible position with all the sympathy and human understanding which are so necessary, and I would like to asure him and the House that having made a personal inquiry into the medical department of the Ministry and the type of cases they examine, I am absolutely convinced that they are doing all in their power for the men, that, if anything, they err on the side of the men. They are more than careful, and I imagine that no single genuine case would ever be turned down by them on medical grounds. I hope the House will recognise that in the medical profession we have a body of honourable men, and, equally, that the officials of the Ministry are honourable men.