MR. Frederick Snart (Disability Pension)

– in the House of Commons at 12:00 am on 13th December 1972.

Alert me about debates like this

10.16 p.m.

Photo of Mr David Marquand Mr David Marquand , Ashfield

I wish to raise the case of Mr. Frederick Snart—a case of extreme administrative and medical complexity. It is also a very moving case in human terms. Before getting involved in the administrative complexities I will say something about the human reality behind them. We are dealing here with a human being and not a statistic—a human being who has been treated very harshly.

Mr. Snart is a retired miner who is suffering from pneumoconiosis, and his disability was recently assessed at 100 per cent. I saw him recently. He could walk unaided only from his bed to his couch, which was a couple of feet away. He was fighting for breath, and when I talked to him I could hardly hear what he said because of the terrible rattle of his breathing.

Mr. Snart contracted the disease as the direct result of nearly 50 years' work as a miner—work which was essential to the British economy. It is a matter of elementary justice that the society in whose service Mr. Snart contracted the disease should now compensate him to the fullest possible extent—although no compensation can possibly be adequate. It is elementary that if rules and regulations stand in the way of justice for Mr. Snart those rules and regulations should be changed.

Mr. Snart first developed chest trouble over 10 years ago. He thought that he had pneumoconiosis, and on five occasions between 1960 and 1967 he applied for certification to that effect. Each time he was turned down by the pneumoconiosis board. In 1969, on the advice of Dr. Davies, his consultant, he appealed to the Central Pneumoconiosis Medical Panel. The panel decided that Mr. Snart's condition was due not to pneumoconiosis but to emphysema and bronchitis. In February 1971 Mr. Snart was again examined by a local pneumoconiosis board. This time the board diagnosed pneumoconiosis and assessed the disability at 20 per cent.

In August 1971 Dr. Davies, under whose care Mr. Snart was, wrote as follows: There is now good evidence that my interpretation of the X-rays in 1968 was correct and that the Central Pneumoconiosis Medical Board was wrong. In these circumstances to back-date his benefit only to August 1970 does not appear to be generous. There should be no real argument that pneumoconiosis was making a substantial contribution to his disability before 1968. That was the opinion of the consultant who was in charge of Mr. Snart's treatment and who, presumably, knew more about his treatment than did anybody else.

On the basis of Dr. Davies' opinion, Mr. Snart appealed to the medical appeal tribunal. The tribunal increased the pneumoconiosis board's assessment of his disability from 20 per cent. to 100 per cent. But although the tribunal has jurisdiction over the assessment of disability, it has no jurisdiction over the date of development. The tribunal was unable to backdate its award to a date before August 1970. I am confident that if the tribunal had possessed the power to backdate, it would have done so.

The key sentences in the decision read as follows: The X-rays available appear to date to 1969 and show a progressive disease…Although we have not the power in our view, to go behind the determination of 19.8.70 as to the development date, our decision is to vary the award of the Medical Board of 5.2.71 by substituting an assessment of 100 per cent. for life from 19.8.70. That form of words clearly indicates that the medical appeal tribunal believed that Mr. Snart's disease had begun to develop before August 1970, and that the only reason it did not say so explicitly was that it did not have the legal authority to decide that question.

Mr. Snart then appealed again to the Central Pneumoconiosis Board to change the previous decision on the date of development, but the board refused to do so. So what is the present position? First, the medical body, the Central Pneumoconiosis Board, says that Mr. Snart did not have pneumoconiosis at all until August 1970. Another equally eminent—perhaps more eminent—medical body, the medical appeal tribunal, said that Mr. Snart's pneumoconiosis was so serious that it should be assessed at 100 per cent. disability from August, 1970—in other words, no pneumoconiosis until August 1970, but 100 per cent. Disability for pneumoconiosis starting from August 1970.

In the nature of the illness, this is an obvious absurdity. It is inconceivable that Mr. Snart could have developed 100 per cent. disability for pneumoconiosis overnight. If the medical appeal tribunal is right in its assessment of 100 per cent. disability, the only possible conclusion is that the pneumoconiosis board was wrong in its decision on the date of development.

When I raised the case with the Minister, he replied as follows: I appreciate your concern about the case which is clearly one of some difficulty, but I can only say that I am unable to help. Responsibility for deciding whether a claimant is suffering from pneumoconiosis, including the date on which the disease developed, is a matter for the pneumoconiosis medical boards. Neither the Secretary of State nor I have power to intervene in their decisions. I entirely accept that under the present regulations pneumoconiosis boards have absolute and complete jurisdiction over questions of diagnosis. I also accept that the Minister cannot intervene in their decisions, and I am not suggesting that he should have the power so to intervene, administratively. But I do not accept that the present regulations should remain unchanged.

It seems abundantly clear from this case that the present regulations have led to a state of affairs which is absurd and grossly unjust. I am convinced that the right solution is to give the medical appeal tribunal powers to override the pneumoconiosis board not only on questions of assessment but on questions of diagnosis.

I found one passage of the Minister's letter to me a little disturbing. He seemed to be questioning the medical competence of the medical appeal tribunal. He seemed to be suggesting, obliquely at any rate, that the pneumoconiosis board was more likely to have made a correct diagnosis. He said: Mr. Snart successfully appealed to the medical appeal tribunal (comprising a legal chairman, a cardiologist and a surgeon, but not a consultant chest physician).…The application was referred to a central pneumoconiosis medical board, differently constituted from the 1969 central board but again including a chest physician. I can only assume that the reference to a chest physician was meant to suggest that the medical appeal tribunal was less competent medically than was the pneumoconiosis board, but that argument is totally irrelevant to the case that I am putting forward. I am not interested in whether the medical appeal tribunal which examined Mr. Snart's case was correctly constituted. It was not Mr. Snart's fault if it was not. If it had the wrong members that was not his fault, and he should not be penalised for it. The point at issue is simply whether the tribunal should have the power to override the board on questions of diagnosis. No one disputes that it has power to override the board on questions of assessment. If it is medically competent to decide questions of assessment, why is it not also medically competent to decide the question of diagnosis?

The tribunal which considered Mr. Snart's case consisted of three independent members. I understand that the pneumoconiosis medical board which considered his case consisted of one independent member and two DHSS doctors. I am not suggesting that the DHSS doctors were partial or biased, but I do not think there can be any doubt that a tribunal consisting of three independent members is likely to have greater moral authority than a board on which one independent member can be outvoted two-to-one.

I remind the Minister and the House that in most cases of industrial disease the medical appeal tribunal has complete jurisdiction over the question of diagnosis. Regulation 30 of the Prescribed Diseases Regulations says: Subject to the provisions of regulation 40 of these regulations, if a claimant is dissatisfied with the decision of the medical board on a diagnosis or recrudescence question he may appeal and the case shall be referred to a medical appeal tribunal. Regulation 40 creates a special exception to that general rule for pneumoconiosis. It seems to me abundantly clear that the effect of Regulation 40 in Mr. Snart's case has been to create an unjust and anomalous situation. I think that the powers of the medical appeal tribunal in questions of pneumoconiosis should be put on all fours with its powers over other industrial diseases, and I think that the case that I have raised this evening shows this quite clearly. I urge the Minister to take the necessary steps to bring that about. I hope that he will be able to do so soon enough for it to be of some benefit to my unfortunate constituent.

10.30 p.m.

Photo of Mr Don Concannon Mr Don Concannon , Mansfield

In this short debate of 30 minutes I should like, first, to thank my hon. Friend the Member for Ashfield (Mr. Marquand) for initiating it and then to welcome my hon. Friend the Member for Chesterfield (Mr. Varley) whose father, I understand, suffers from this terrible disease to the extent of 30 per cent. There are members of my family who have this disease to a degree of 100 per cent. When we talk about a 100 per cent. disability for pneumoconiosis we are talking about living corpses. Most people engaged in the mining industry acknowledge this fact.

As a young branch official I was responsible for sending to these medical boards in Sheffield people with pneumoconiosis, emphycema and bronchitis. My hon. Friend the Member for Chesterfield will probably agree that we were living too close to this disease, and have probably become somewhat complacent about it. Therefore, I especially thank my hon. Friend the Member for Ashfield who, as it were, comes from outside the mining industry and is not overwhelmed. We take it as a matter of course, and that is wrong.

I also thank my hon. Friend for his references to Dr. Davies, who is recognised by all in the East Midlands mining industry as the specialist. He is the East Midlands consultant for everyone suffering from chest diseases.

For many years miners have been fighting this underground war for the nation, and the casualties are more terrible than in any modern warfare. As a young branch secretary, along with others now in this House, I have seen my comrades almost disappear before my eyes because of this terrible disease.

I realise that this is a short debate, and I do not want to prolong it. It is probable that my hon. Friend the Member for Ashfield and I now have a larger concentration of mining and miners in our constituencies than exists anywhere else in the country. He and I, and my hon. Friend the Member for Chesterfield, are here to see and ask for fair play. I know that inquiries are going on into this terrible disease and others like it and that they are going on as fast as they can. However, my hon. Friends and I are seeking fair play for the people whom we send to these medical boards and who come back with what seem to them to be excuses for their not receiving compensation. I must stress again that we are seeking fair play for these people. Justice must be seen to be done in these cases.

10.33 p.m.

Photo of Mr Paul Dean Mr Paul Dean , Somerset North

I am grateful to the hon. Member for Ashfield (Mr. Marquand) for raising the case of Mr. Snart. As he said, we have corresponded about this matter. I should like to express my sympathy to Mr. Snart for the severe disability which he and his family suffer.

I do not accept that Mr. Snart has been dealt with harshly within the Industrial Injuries Act as it is. I am glad that the industrial injuries scheme has been able to help him. He is now getting a 100 per cent. disablement pension and a constant attendance allowance, both under the scheme, plus his retirement pension, and his wife is receiving a pension on his insurance.

As the hon. Members for Ashfield and Mansfield (Mr. Concannon) said, this is not a simple case. Indeed, it is difficult, as in so many other cases where emphysema and bronchitis are involved. These are what we call the English diseases.

The preferential rate of benefit and of conditions for benefit under the industrial injuries scheme, compared with the national insurance scheme, rest on the principle that the disease or injury must be caused or made worse by the condition of the man's work, but the scheme tries to give the benefit of the doubt in all cases. In view of the circumstances which the hon. Gentleman put to me, I asked our medical advisers to examine Mr. Snart's case, and they have pointed out to me that the apparent difference of medical opinion seems to relate not so much to the extent of Mr. Snart's disablement but to the extent to which it is due to pneumoconiosis. They consider that the major cause of his disablement is emphysema and bronchitis, which are, as I have said, common in the general population.

The main argument, therefore, is not about the severe disablement of Mr. Snart but whether he is entitled to the higher benefits of the industrial injuries scheme or the lower ones of the national insurance scheme. I freely admit—and, indeed, doctors will admit—that medical science is not an exact science. Particularly is this so in areas of this kind, where one is dealing with common diseases and diseases which are prescribed, as pneumoconiosis is, and as emphysema and bronchitis, in association with advanced pneumoconiosis, are.

Persons claiming benefit for pneumoconiosis are frequently found also to be suffering from bronchitis and emphysema. There is no evidence generally acceptable to the medical authorities on these diseases which establishes that they are predominantly occupational in origin and can be attributed to the nature of the employment in individual cases with reasonable certainty. Research, which is kept under constant review, suggests they have an association with factors such as smoking, geographical location and air pollution, and possibly genetic factors. Consequently, bronchitis and emphysema do not satisfy the conditions for prescription as industrial diseases in their own right. Special provision is, however, made for these conditions where they accompany pneumoconiosis.

The question of the definition of pneumoconiosis is one of the important issues currently under consideration by the Industrial Injuries Advisory Council in its major review of the provisions for pneumoconiosis. I hope that in due course we shall receive from that council valuable advice on which we shall be able to push the frontiers forward.

Mr. Snart first claimed disablement benefit for pneumoconiosis on 8th April 1960 and was seen by a pneumoconiosis medical board which made a full radiological and clinical examination. The board gave full and careful consideration to all the evidence but it decided that he was not suffering from pneumoconiosis. The hoard considered that Mr. Snart was suffering from emphysema and was fairly severely incapacitated.

Mr. Snart made four further unsuccessful claims between 1960 and 1967—in 1960. 1962, 1966 and 1967. Following his claim in 1966, he was given a radiological examination only by a member of the pneumoconiosis medical panel, but in connection with the other three claims in 1960, 1962 and 1967 he was examined radiologically and clinically by a pneumoconiosis medical board which on each occasion decided that he was not suffering from pneumoconiosis.

Then on 15th June 1968 Mr. Snart claimed for the sixth time and on this occasion his claim was referred to a central pneumoconiosis medical board which, in accordance with the general practice, included a chest consultant from outside the Department. The central board, which examined Mr. Snart on 16th April 1969, found evidence of some dust in his lungs but was of the opinion that this dust retention did not amount to pneumoconiosis. The board concluded that his condition was due to severe emphysema and bronchitis which are not prescribed diseases and so do not attract disablement benefit under the Industrial Injuries scheme.

Mr. Snart made a further claim on 28th December 1970 and was examined by a local pneumoconiosis medical board in the following February. The medical board called for the radiographs and hospital reports of the investigations which had been made at Ransom Hospital, Mansfield. After considering all the evidence, it eventually decided that he had suffered from a slight degree of pneumoconiosis which they assessed at 10 per cent. since August 1970. It also decided that the emphysema and bronchitis from which he suffered made the pneumoconiosis 10 per cent. more disabling than it would otherwise be and so Mr. Snart was awarded a pension at the 20 per cent. rate from August 1970. The board noted in its report that Mr. Snart's overall cardio-respiratory disablement was 70 per cent. but that only 20 per cent. of this disablement was attributable to pneumoconiosis.

Mr. Snart appealed against the board's assessment to a medical appeal tribunal which, in accordance with the usual practice, comprised a legal chairman and two medical practitioners. The medical members of the tribunal were a consultant cardiologist and surgeon. It was unfortunately not possible to include a chest consultant as a member. The tribunal increased the assessment of Mr. Snart's disablement from 20 per cent. to 100 per cent. from 19th August 1970 for life, but it had no power to make an assessment before August 1970, as this would have involved a question of diagnosis on which it had no jurisdiction.

Mr. Snart then contended that the disease should have been diagnosed from an earlier date—May 1967—and he applied for a review of the decision of the 1971 pneumoconiosis medical board who diagnosed the disease from August 1970. In view of the unusual circumstances his application was considered by a central pneumoconiosis medical board, which was differently constituted from the 1969 central board but again included an eminent chest consultant from outside the Department. The central board, after hearing the views of Mr. Snart's union representative and carefully examining all the documentary evidence including the hospital records and X-rays, said that it was unable to diagnose pneumoconiosis before August 1970.

The hon. Gentleman has asked me about the constitution of the central pneumoconiosis medical board, and made the point, without making any imputations, that there were two doctors from the Department. One of the doctors takes the chair. He takes no part in the proceedings whatsoever. The other is always an acknowledged expert who spends his time dealing with such matters, and it has been felt—and I think that it has been generally accepted over the years—that it is better for the constitution of the board to have on it someone who is an acknowledged expert and is dealing with these matters within the Department the whole time and therefore has access to all the latest research and the like. That is the reason for the constitution of the board.

The hon. Gentleman was good enough to say that he did not in any way wish to alter the procedures so that the Minister could interfere with what are semi-judicial and highly expert medical matters, on which we should properly trust the independent adjudication procedure, relying on the best medical advice available.

He was a little disturbed about some of the procedures involved. I would like to assure him and the hon. Member for Mansfield that I am at the moment having a look at the procedures. I will want to take account of what they have said. We are extremely anxious, particularly when dealing with bad disability and with men who feel a sense of injustice, that we should lean over backwards to see that that injustice is removed wherever possible.

Although I have not been able to say anything which will be of real help and encouragement in the sad case of Mr. Snart, I hope that the hon. Gentleman feels that we are always examining our procedures and our methods of diagnosis, in order to try to improve them. The point he has made about procedure is one which I have in hand. I cannot say what the outcome will be, but I assure the hon. Gentleman that I will give careful consideration to what he has said.

Question put and agreed to.

Adjourned accordingly at sixteen minutes to Eleven o'clock.