Orders of the Day — Medical Appeals, Wrexham

– in the House of Commons at 12:00 am on 24th November 1960.

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Motion made, and Question proposed, That this House do now adjourn.—[Mr. Chichester-Clark.]

10.0 p.m.

Photo of Mr James Jones Mr James Jones , Wrexham

On 7th November, in answer to a Question which I tabled to the Minister of Pensions and National Insurance with regard to the decisions of the Medical Appeal Tribunal, I was told that in Wales, of 1,518 appeals submitted, only 577, just over one-third, had decisions favourable to the claimants. I would have liked to know how many had less favourable decisions as the result of their appeals, but those figures, I was told, were not available. Alongside these figures is the other striking fact that, according to the second quinquennial Report of the Government Actuary, the Industrial Injuries Fund was doing very well indeed; and by the end of the century there will be a surplus of £600 million in the Fund.

In the light of these facts and of cases brought to my notice from time to time, I am compelled to ask whether the medical appeal tribunals are not sometimes too inelastic in their decisions, especially in cases of great doubt. I am fully aware of the exactness of science; at the same time I am aware that doctors sometimes differ. That is why I believe that only when there is no shadow of doubt the decisions should go against the claimants. It is from these considerations that I wish to draw the attention of the House to two specific cases from my division.

Case No. 1. This is the case of one who had been engaged at a colliery near Wrexham all his working days, covering a period of over forty years. Throughout that period he had enjoyed excellent health. From time to time he submitted himself to the X-ray unit for chest examination. He was officially informed that his chest was clear. I want to stress this point because of its relevance to the case.

On 1st April, 1958, when coming down some steps, he stepped on a grease patch and fell to the bottom of a ladder, twisting his right knee. He was given treatment but there was no improvement, and by the following August the pain in the knee had spread up the right thigh to the right shoulder and across the back to the left shoulder. He was taken for treatment to Maelor Hospital, Wrexham. On 6th February, 1959, ten months after the accident, we are given an official picture of this unfortunate man who, up to the day of the accident, had enjoyed extraordinarily good health. He was now reduced to a state of—I quote— a pale, anaemic, shrunken man, sitting by the fire. Standing up is quite an effort and he stands with a forward tilt on his hips With regard to his chest, there was a dullness at right base with diminished breath sounds, but previous X-ray plates do not reveal this. The medical board assessed the disablement resulting from loss of faculty at 30 per cent. at 4th April, 1958, to 29th September following and 100 per cent. from 30th September to 4th April, 1960. This was a provisional assessment.

The board states: The right knee joint became swollen immediately after the injury, and was never symptom free when some months later a rheumatoid process became obvious. In view of his excellent health record we are unable to presume that a diathesis existed I would emphasise the last observation: … in view of his excellent health record . . He was made a provisional award of 100 per cent. On 21st February of this year he was further examined. Meanwhile, according to the medical board's report, there had been some improvement. On this occasion he was assessed at 10 per cent. disablement resulting from loss of faculty. This decision, like the previous one, was provisional, to hold until 4th April, 1961. This was fair enough. We make no complaint against this, because it was subject to review. But the Ministry referred the findings of the medical board to the medical appeal tribunal and requested it to consider whether the claimant was suffering a loss of faculty as a result of the relevant accident.

Why this hurry on the part of the Ministry to obtain the opinion of the appeal tribunal against whose decision there is no appeal? I do not know, but the inevitable followed. I use the word "inevitable" advisedly because, as the figures that I have quoted show, the chance of a favourable assessment is smaller than that of an unfavourable one. The Tribunal's panel examined the X-ray plates and perused the hospital notes and the decision of the medical board was set aside. The tribunal was satisfied, so it said, that any part played by the relevant accident in the claimant's present constitutional condition had long passed away.

Is it not strange that the medical board, consisting of qualified men, did not suspect this? The decision, however, is final and cannot be challenged on medical ground. The fact remains that here is a man who had enjoyed excellent health right up to the date of the accident. Since the accident he has deteriorated in health and is now a completely broken man. In view of his previous health record, is the tribunal certain beyond all shadow of doubt that he would have developed his present complaint had he not met with the relevant accident? Is it not true that some doctors claim that a knock or a blow or even a shock can trigger off rheumatoid-arthritis? If that is so, have we not here a case of a man who has not only suffered a knock or a blow on his knee, but also shock from falling down a flight of steps? I would have thought that this point should have received due consideration.

The second case to which I wish to refer is that of a man who was engaged on work with a concrete mixer on a building site. Some of the concrete mixture which contained lime splashed into his right eye on 15th February, 1957. The affected eye was washed out as soon as possible and the man put some castor oil in it This eased his pain, but the eye continued to run and he was taken to hospital for treatment. On 8th October, 1957, he was examined by the medical board who came to the decision that a loss of faculty had resulted from the accident and the extent of the disablement resulting from loss of faculty was assessed at 30 per cent. from 16th August, 1957, for life.

The man had lost the vision of the affected eye and he was awarded a pension of £1 0s. 3d. for life. But not only had he lost the vision of his right eye, he had also suffered disfigurement, and because there was no mention of this in the medical board's report he thought that it had been overlooked by the board. Therefore, unfortunately— and I emphasise "unfortunately"—he decided to appeal. One fact that is obvious is that he had had concrete mixture in his eye and, despite treatment, had lost his vision. To an intelligent layman the question was whether there should be a further pension for disfigurement. He made the fatal mistake of appealing to the medical appeal tribunal.

On 14th January, 1958, his appeal was considered. He never thought for one moment, nor did his advisers, that the question of loss of vision through accident was in doubt. But the decision came as a shock, and was an equally shocking decision. This is what it was: Upon perusing the hospital notes, the report of Mr. E. Brock, and hearing the claimant, the tribunal are not satisfied that the claimant's loss of vision is the result of the relevant accident. The decision of the medical board is accordingly set aside. Here is a man who had lost the vision of one eye, had suffered disfigurement, and had also lost his pension of £1 0s. 3d. a week for life. Is it any wonder that the Industrial Injuries Fund is hundreds of millions of pounds in surplus?

Hon. Members should note the negative aspect of the decision. The members of the appeal tribunal were not satisfied that the loss of vision was due to the relevant accident. Were they satisfied about the true cause of the loss of vision? If not, should not this man have had the benefit of the doubt?

Let us see what other cause there might have been. I have examined the hospital record. It says: This patient first attended on 11th March, 1957, with an inflamed eye following an attack of influenza.

Photo of Mr James Jones Mr James Jones , Wrexham

This is an extraordinary record for two reasons. So far as I know, there is no record in the hospital report that the man had had a splash of concrete mixture in his eye, but there is a record of his having suffered from influenza. However, the fact is that he had not suffered from influenza, nor had he lost a day's work between the date of the accident and that of his admission to hospital. This may have been a clerical error or an oversight, but there has obviously been a muddle somewhere.

This man had had some concrete mixture in his eye; about that there is no dispute. Then there is a record of influenza, and that is in dispute. Yet the medical appeal tribunal decides that the accident, about which there is no dispute, is not relevant to the loss of vision. Cases such as this weaken public confidence in the medical appeal tribunal. We cannot afford this, and that is why I ask the Minister to make further and searching inquiries into these cases.

Photo of Mr Leslie Spriggs Mr Leslie Spriggs , St Helens

Before my hon. Friend sits down, will he tell me whether it has been established that his constituent had not suffered from influenza even though it had been recorded that he lost his sight through influenza?

Photo of Mr James Jones Mr James Jones , Wrexham

My information from the gentleman himself is that he had the accident on a certain day and from that day on until the date of his admission to hospital he did not lose a single day from work. I suggest that anyone who had had influenza could not have carried on with his daily work in that way.

10.14 p.m.

Photo of Bernard Braine Bernard Braine , Essex South East

I think that the whole House will have been impressed by the sincerity with which the hon. Member for Wrexham (Mr. Idwal Jones) has spoken about two of his constituents who are suffering from grievous ill-health. Certainly, I personally am very grateful to him for raising this subject. We spend a great deal of time here discussing the abstract principles and structure of our social services, but it is very easy to forget the individual cases, every one of them different, which make up the whole.

Moreover, as my right hon. Friend the Minister said the other day when we were debating an earlier stage of the Bill to which the House has just given a Third Reading, individual cases can be very instructive upon general matters. I take it that that was part of the purpose which the hon. Member for Wrexham had in mind in raising these cases tonight.

The hon. Gentleman was good enough to give me some particulars of the cases that he proposed to mention, and that has enabled me to examine them personally. I appreciate his kindness. At this point I should say, however, that I am prepared to do the same with any cases which hon. Members may draw to my attention for any reason. If I can do nothing else, I can at least provide a clear and, I hope, informed explanation of the case and point out any rights of appeal and review for which the law makes provision. I hope to enlarge on that point later.

I should, however, be completely out of order if I sought to discuss particular cases tonight. I think that that is well understood in the House. We have in the Industrial Injuries Scheme an independent system of adjudication set up by the principal Act of 1946. Ministers have never been abl to interfere in the decisions on claims in respect of industrial injuries. The cases mentioned by the hon. Member for Wrexham are examples, and I shall treat them as such, though I will certainly do anything that I can do in respect of them on the lines that I have indicated.

These two cases have been before the medical appeal tribunals established under the Industrial Injuries Act. These tribunals are the highest adjudicating authorities on medical questions that we have under the Act. To get the matter into perspective, I should explain that the 13 tribunals which exist in Great Britain heard 20,490 cases during the twelve months up to 30th September last. This figure shows the magnitude of the work—

Photo of Bernard Braine Bernard Braine , Essex South East

I will give way in a moment.

This figure indicates the magnitude of the work which these tribunals carry out with, as I hope to show, great efficiency and with complete absence of friction.

Photo of Mr Leslie Spriggs Mr Leslie Spriggs , St Helens

My hon. Friend said that the cause, put forward for the loss of sight, by the appeal tribunal, was influenza, yet there was no evidence of influenza. Why has the Ministry made such a mistake?

Photo of Bernard Braine Bernard Braine , Essex South East

The Ministry has made no mistake whatsoever. If the hon. Member will permit me to develop my answer in the somewhat limited time which I have, he will understand the position more clearly. I am prevented by the rules of order and custom of the House from going into details of these particular cases. That does not, however, prevent certain action from being taken, nor prevent me giving some help to the hon. Member for Wrexham. If the hon. Member for St. Helens (Mr. Spriggs) will permit me to develop my argument, he will see that that is so.

The hon. Member for Wrexham mentioned the Welsh tribunal, with which he is particularly concerned, as are other hon. Members whom I see present, approximately one-third of the claimants before this tribunal have secured a more favourable assessment as a result of their appeal.

The hon. Member for Wrexham seemed to imply that he would have expected a higher proportion of successful appeals. I think that he was just a little less than fair here, because the results of the Welsh tribunal approximate very closely to those of other tribunals in Great Britain, considered as a whole. If decisions of appeal tribunals showed a very high proportion of successful appeals, the obvious inference would be that the tribunals in the first instance—in this case, the medical boards which examine claimants—were severe or unduly harsh in their standards.

If we examine the results of other appellate bodies under the National Insurance Scheme we find very much the same proportion of one-third, which indicates a fairly healthy balance between these decisions and those made in the first instance.

Photo of Bernard Braine Bernard Braine , Essex South East

I am endeavouring to answer points raised by the hon. Member for Wrexham and not by the hon. Member for St. Helens. I hope that the hon. Member for St. Helens will allow me, on this very important subject, to give as full and frank an answer as I can in the short time at my disposal.

Photo of Bernard Braine Bernard Braine , Essex South East

I shall not give way. The hon. Member has perhaps not been here long enough to understand how important an Adjournment debate is to an hon. Member who initiates it, and I want to give the hon. Member for Wrexham as full and frank a reply as I can.

For example, I refer to the table on page 48 of my Ministry's most recent Annual Report, which shows the results of appeals to the Commissioner under the National Insurance and Industrial Injuries Acts. It will be seen that, under National Insurance, out of 2,160 appeals dealt with there were 731 decisions in the claimant's favour, and under industrial injuries there were 794 appeals, of which 240 were decided in the claimant's favour.

A medical appeal tribunal consists of a chairman, whose appointment is in the hands of the Lord Chancellor, or, in Scotland, in the hands of the Lord President of the Court of Session, and two medical members who are invariably of consultant status and who are nominated by the Royal Colleges, or by medical faculties of the universities. For the Welsh tribunal, members are nominated by the University of Wales and the two chairmen, who share the duty of presiding over the sittings of the Welsh tribunal, are eminent Welsh barristers of very high reputation.

A tribunal's duty, placed on it by the Statute, is to weigh up the medical evidence and to decide whether the medical board's assessment was correct, in the light of its experience and expert knowledge. The tribunals have before them all the evidence which was before the medical board, including records of what the boards themselves found on examination, and any specialist reports and X-rays. The claimant has the right to appear before the tribunal and to be represented by anyone he may choose. He may produce evidence and witnesses and if the tribunal wish for more evidence, such as a further medical opinion, they may adjourn for it to be obtained. I want to emphasise that, although the tribunals are independent bodies, the Minister's representatives are on the spot and always do their best to bring out every shred of evidence favourable to the applicant.

Sometimes, as in the two cases which have been mentioned tonight, a case before the tribunal will turn on the connection between the claimant's condition and the accepted accident. There may be, and there very often is in such cases, a clash of medical evidence. In such cases, it is particularly necessary to have an independent and highly qualified tribunal of this kind which will bring its collective experience impartially to bear on the evidence and reach a decision. That is a long-standing tradition of adjudication under our social insurance scheme—and I do not think that hon. Members on either side of the House would wish it otherwise.

So far as my Department is concerned, and the work of these tribunals, I need only refer to what was said in the House yesterday in our debates on the National Insurance Bill, when the hon. Member for Coatbridge and Airdrie (Mr. Dempsey) said: I must give credit to the Ministry of Pensions and National Insurance. It takes great pains to give an appellant every opportunity to appeal. Indeed, the Ministry bends backwards to try to accommodate working people seeking to further their interests. On the other hand, the Ministry goes to considerable pains, by engaging medical advisers and medical adjudicators to guide it as to the extent of loss of faculties and to protect itself against abuses."—[OFFICIAL, REPORT, 23rd November, 1960; Vol. 630, c. 1225.] As I have said, under industrial injuries legislation we have an independent system of adjudication which is outside the scope of Ministerial interference. I am sure that such interference would be wrong, and with bodies of the standing which I have been describing, it would in any case be impossible to have a satisfactory system of adjudication, in which the public had confidence, on any other basis.

I entirely accept that there have been and there are bound to be cases in which claimants are, naturally, disappointed. When we consider the vast number of cases that come before these appellant bodies, and which have been dealt with over the past twelve years, I think that it can be safely said that the record of these highly expert tribunals for impartial and humane decisions compares very favourably with the record of other bodies of similar standing. It should be a matter of the greatest satisfaction to us all that the Franks Committee, which included these tribunals in its recent review of tribunals in general, was able to say, in paragraph 171 of its Report: The impression we have gained of the working of the system of adjudication for national insurance and industrial injuries claims is most favourable. The system is generally considered to have operated smoothly for many years, and we are satisfied that no structural changes are called for. The House might like to know that following the recommendations of the Franks Committee on specific points, there is now in operation a right of appeal from these tribunals to the Commissioner on points of law. There have been comparatively few appeals so far, but that avenue is open to appellants.

Having tried, in the time at my disposal, to bring out the salient features of these tribunals for the benefit of the House, I would like to conclude by making two points in respect of the speech made by the hon. Gentleman.

First, the hon. Gentleman referred to the Wrexham tribunal. There is no Wrexham tribunal as such. The Welsh tribunal holds some of its sittings at Wrexham during the year for the convenience of claimants who live in North Wales. It is, so to speak, an assize town of the Welsh tribunal. It has the same chairman on the Tribunal when it sits at Cardiff or Swansea. The only difference is that sometimes the medical members include specialists practising in Liverpool, but with professional interests in North Wales, as well as specialists from purely Welsh centres. During the twelve months to 30th September last, 17 of the 215 sittings of the tribunal were at Wrexham.

The second point is about appeals and reviews. I have already mentioned the appeal on a point of law from the tribunal to the Commissioner. It is also provided, under Section 40 of the 1946 Act, first, that a decision may be reviewed by a medical board if it is satisfied by fresh evidence that the decision was given in consequence of non-disclosure or misrepresentation of a material fact; and, secondly, if the board is satisfied that there has been unforeseen aggravation of the relevant injury.

In one of the cases referred to by the hon. Gentleman, the review procedure has, in fact, already been invoked. In the other case, there has so far been no application for a review on these grounds. I will gladly discuss with the hon. Gentleman these procedures in the context of these two cases. It may well be that I can give him some advice which will be helpful to him in these circumstances.

I hope that I have made it clear to the House that we have here independent tribunals staffed by people of the highest professional standing with whose decisions neither I, nor my right hon. Friend, can interfere. I am sure that it is the general view of this House, and of the nation, that Ministers should not have the power to interfere with such bodies. I venture to suggest that such complete independence is the only and the best safeguard for the public confidence in these tribunals which, as the hon. Gentleman said, is essential for the proper working of this important scheme.

I repeat that I will gladly undertake to have a private talk with the hon. Gentleman to try to advise him how best these procedures can be used to help him in these two difficult cases that he has brought before us tonight.

Photo of Mr Leslie Spriggs Mr Leslie Spriggs , St Helens

In view of the fact that there is a doubt about whether influenza was ever diagnosed correctly, I ask the Joint Parliamentary Secretary to take into account in the final deliberation which he will make on behalf of the Minister the fact that a mistake has been made. In the courts, where there is a doubt in any case, the doubt is always resolved in favour of the person concerned.

Photo of Bernard Braine Bernard Braine , Essex South East

I cannot comment on the details of cases. What I have said is that if there is a doubt on medical grounds it is possible for an appeal to be made to the Commissioner on a point of law. I have undertaken, and I say it now for the third time—

The Question having been proposed at Ten o'clock and the debate having continued for half an hour, Mr. SPEAKER adjourned the House without Question put, pursuant to the Standing Order.

Adjourned at half-past Ten o'clock.