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Dame Elaine Kellett-Bowman (Lancaster): Will my right hon. Friend give way?
Mr. Alison: I am afraid that I have very little speaking time left so I must ask my hon. Friend to forgive me. I will give way to her later if there is any time left.
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The situation with the 5,000 schools in the secondary sector is very different. Ofsted has reported that there is basic compliance with the law in 60 per cent. of secondary schools but that even those schools are not perfect.On that point, I wish to raise one particular issue with my hon. Friend the Minister. Inspection reports tend bluntly to state whether a school complies with the law. That information is far too limited. Some schools may be almost complying, others might be nowhere near it. One school might be holding assembly on four days a week, another on only one day.
Some schools are being criticised by inspectors for holding Christian assemblies. One school was told that its assemblies should be more multicultural. In another large urban secondary school, staff are determined to meet the law's requirements. Assemblies are held in the assembly hall for three days a week and in form classes for two days a week, yet the school was told that it had failed to comply with the law on a technicality. That inner-city school should be commended rather slated on a minor technicality.
Let us be clear about the issue. Do we want a secular education system? We should take careful note of what happened in the United States. The Supreme Court banned school prayers and religious teaching in 1963. Since then, teachers have been dismissed for allowing prayer in school and parents have had to resort to legal action so that bible clubs or Christian Union groups can meet on school premises.
There have been 25 bleak years of secular dominance, but in the past few years things have been changing. One recent Gallup poll found that the Supreme Court ruling banning prayer is being flagrantly broken in 75 per cent. of high school graduation ceremonies. Three states have passed laws guaranteeing the right to have religious teaching and worship in schools. In the recent congressional elections, the Republicans stood firmly on the school prayer ticket and everybody knows with what results. Even President Clinton has now declared his support.
The Christian Action Research and Education organisation, representing 100,000 church members, recently concluded that in the matter of school worship:
"We judge that the alternative to the present position, with all its imperfections and ambiguities, would lead inevitably to a thoroughly secularised system.".
If we should ignore the secular voices, we should also ignore those teacher trainers who call for cultural anarchy. In his recent lecture at the Royal Society of Arts on 12 December 1994, Professor John Hull of Birmingham university called for the complete repeal of section 7 of the Education Reform Act and for the term "collective worship" to be abolished in favour of "collective spirituality". That new term is reminiscent of 1960s new-age hippy culture and has distinctly left-wing overtones. The suggestion that all religions are to be harmonised into "collective spirituality" is nothing less than a call for the restoration of the full-blown, multi-faith mish-mash that was so vigorously criticised when the 1988 Act was put on the statute book.
I know that my hon. Friend the Minister will resist the call for collectivisation, as he so ably resists all other calls of such character. I am grateful to my right hon. Friend the Secretary of State for making it clear that the Government stand firmly behind the present arrangements for school worship.
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I am also grateful to the Archbishop of Canterbury for his public comments in support of daily Christian worship and to my distinguished constituent the Archbishop of York for the admirable letter to The Times on 9 January outlining some clear, realistic and perfectly attainable aims for school worship in non-church schools. Other bishops and officials in the Church of England should take heart from the lead given by the two archbishops and march confidently behind them.In respect of teaching or leadership resources, my friend, Mr. Clive Calver, general secretary of the Evangelical Alliance, in a letter published in The Times on the same day as Archbishop John Hapgood's, referred to the resources lying potentially available from 5,000 evangelical churches and 700 member societies that are affiliated to the Evangelical Alliance.
Secondary schools need to be encouraged to establish closer links with local churches. In far too many cases, schools are refusing offers of help from the community.
Secondary schools would do well to learn from our primary schools, which have a superb track record in keeping the law on school worship and in securing the support of the local community. Undoubtedly, there should be more research on the issue. How is it that some secondary schools keep the law while others do not? It cannot be just a matter of accommodation, as some allege.
Dr. Carey recently said:
"There is a danger in giving the impression that secularism is all dominant in our society. Most people still have some links to the Church, however tenuous those may be."
The Archbishop pointed out that one quarter of the population went to church last Christmas. He went on to say that the
"establishment does not equate with privilege but with responsibility."
Churches need to be mobilised to offer support to schools. A major effort is needed here, particularly by the Church of England. Strenuous efforts should be made to make the law work in secondary schools as it already does in primary schools. Let us see the Church once again, in the words of the Anglican prayer book, as the Church militant rather than the Church hesitant. I have 30 seconds to give way to my hon. Friend.
Dame Elaine Kellett-Bowman: I wish simply to confirm that the standard of religious education in my local primary schools is excellent. It is also very good in my local secondary schools. Not long ago, I visited a school in my constituency where the headmistress gave the best exposition of the trinity I have ever heard from anyone, even from a church minister. Fortunately, we are not lacking in either of those sectors.
Mr. Alison: I am grateful to my hon. Friend for reinforcing the evident scope and capacity for building on what is already good and solid ground.
1.46 pm
The Minister of State, Department for Education (Mr. Eric Forth): I congratulate my right hon. Friend the Member for Selby (Mr. Alison) on obtaining this Adjournment debate and very much welcome his choice of subject. It is a matter in which the House knows he has sustained a great interest over a long period. We know
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that he plays a very distinguished part in Church matters and the important relationship between the Church and the House.I immediately welcome my right hon. Friend's support for collective worship in schools. As he reminded the House, the Education Reform Act 1988 requires the curriculum to address the
"spiritual, moral, cultural, mental and physical development" of pupils and, as such, in the Government's view collective worship has a vital role to play.
Her Majesty's chief inspector's report for 1993-94 confirms that collective worship and religious education make a powerful contribution to a pupil's spiritual development and the sharing of moral values. Surely all that must be central to a school's efforts to establish its own distinctive ethos that will underpin all its activities and, most important, will be seen in the relationships and expectations within the school community.
The wording of the 1988 Act and the words of HMCI reflect closely the basis and thrust of my right hon. Friend's argument in this short debate. I should also confirm that the Government have no plans to change the legal requirements for collective worship, which give schools considerable flexibility in their arrangements for worship, not least because I agree with my right hon. Friend in his estimation of parental expectations in that regard. It would be a foolish person indeed who, given the strength of evidence that my right hon. Friend has brought before the House today, would seek to make some case for a radical change in the legal requirements and arrangements that are in place. In my view, we can continue to build on them.
As my right hon. Friend pointed out, the legislation rightly has Christianity at its heart, but it recognises that worship in schools will necessarily be different from worship in a community with beliefs in common. It does that by referring to collective rather than corporate worship.
The overall aim of the legislation is to offer pupils from a variety of backgrounds the opportunity to worship together wherever possible. It then gives flexibility--rightly, in my view--in the organisation of worship. Acts of worship need not be first thing in the morning but can be organised at any time during the day. Nor is there a requirement that the school should worship as a single group. It is open to a school to provide worship in separate age or class groups. The content of the worship in county schools and the equivalent grant-maintained schools can reflect faiths other than Christianity as long as the majority of the acts of worship over a term are wholly or mainly of a broadly Christian character. That gives the right balance and sufficient flexibility to those in different communities.
My right hon. Friend mentioned 300 schools of an overwhelmingly non- Christian nature. I will not argue with that figure, but flexibility in the arrangements is necessary to give cognisance of such schools and allow them to arrange their collective worship in the most appropriate way, bearing in mind the fundamental requirements of the legislation.
The detailed requirements for collective worship are spelt out in the Department's circular 1/94, which was--logically--published in January 1994. It does not contain proposals for change, as some have suggested, but offers guidance on the existing requirements of the Education
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Reform Act and the Education Act 1993 for religious education and collective worship. It contains no new requirements beyond those of the Acts. The basic requirement for daily collective worship flows from the Education Act 1944, as does so much of our education system.I am gratified that my right hon. Friend chose to quote from the evidence in Her Majesty's chief inspector's report. That showed that the picture on compliance with legal requirements is not as bleak as is sometimes suggested. The evidence is worth repeating. As my right hon. Friend said, nearly all primary schools were found to provide a daily assembly and about 80 per cent. were judged to be complying with the detail of the law.
My hon. Friend the Member for Lancaster (Dame E. Kellett-Bowman) confirmed that in her constituency--to no one's surprise--her excellent schools are doing even better. Her view is that her primary schools and secondary schools are complying with the requirements. Regrettably, that is not necessarily so everywhere, as my right hon. Friend the Member for Selby said. The chief inspector's report stated that the majority of secondary schools did not provide daily collective worship for all pupils, but it said that worship, where it took place, was frequently of good quality and made a good contribution to pupils' spiritual and moral development.
It is right that Ofsted should monitor the provision of collective worship at school level. The new inspection regime ensures that arrangements in every school are inspected. Ofsted then comments on whether the statutory requirements are being met. That information is made available to parents and the public, as is the action plan, which schools are required to publish, showing how they intend to remedy any shortcomings. The schools are primarily answerable to parents on that matter and many parents, rightly and understandably, attach considerable importance to that sphere of school life. My right hon. Friend has quoted some highly relevant statistics from the British social attitude survey to bear that out. A poll conducted by The Independent in 1993 found that about 70 per cent. of parents wanted their children to say prayers at school. As in so many other sectors of education today, if parents are not satisfied with the arrangements made by the school their children attend, they have access to the local curriculum complaints machinery established by the 1988 Act or they can take up the matter through the school governors. Parents with pupils at county schools can take up the issue with county councillors. If parents cannot satisfy themselves in those ways, the matter can ultimately be referred to the Secretary of State. However, it should be possible to resolve problems well before that. I urge all parents who are not satisfied with that important part of the provision in their child's school to take up the matter vigorously with the head teacher, parent-governors or other governors to ensure that the opinions quoted by my right hon. Friend and borne out by The Independent survey are properly reflected in the arrangements made by primary and secondary schools. I note my right hon. Friend's remarks about the need for Ofsted reports to go beyond a simple statement of whether a school is complying with the law. Ofsted is aware of the importance of commenting, too, on the positive contribution that a school's collective worship provision makes to pupils' spiritual and moral
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development, even if it is not meeting the letter of the law. Her Majesty's chief inspector's latest annual report does just that. Many schools are doing valuable work in that sector and we should recognise and acknowledge their achievements. Ofsted's draft revised framework for inspection, published yesterday for consultation, proposes that, where inspectors find that a school is not meeting the law on collective worship, the report should give the head teacher's stated reasons for failing to do so.I support what my right hon. Friend said about the importance of establishing links with churches and other places of worship in the local community--an important element of the argument. Although teachers, including head teachers, have the right to elect not to participate in collective worship for reasons of conscience, it remains the responsibility of the head to ensure that the statutory requirements are met. It is open to head teachers to invite members of the community, including religious leaders, to help to conduct collective worship, if they are able and willing to do so. Many schools have built up worthwhile relationships of that sort--with local clergy regularly making stimulating contributions to the schools' programme of collective worship.
My hon. Friend the Member for Lancaster said that that was the case in her constituency. If it can be demonstrated that it is possible in Lancaster, one is forced to ask why it cannot be done more readily and systematically in other parts of the country. We must urge not only the schools but local churches to see what can be done--in co-operation with each other--to try to ensure that, where heads and teachers have a genuine difficulty in meeting the requirements of the law, they can call on the support of local religious communities and leaders to help schools to comply with the law.
Mr. Peter Bottomley (Eltham): My hon. Friend the Minister has made a point that is worth emphasising. It should not be just up to the school and those responsible for religious education and worship to take the initiative and contact churches. Churches must take the initiative and contact schools to offer them help and show interest in what they are doing. Does my hon. Friend agree that, as we have just passed education Sunday, February might be a good time for each church and parish to contact all their schools--secular as well as denominational--to ask what more they can do to help them in their important work?
Mr. Forth: That was a typically positive and helpful suggestion from my hon. Friend. There must be more scope in local communities for that sort of co-operation between schools and local churches. I hope that we shall see much more of that so that assistance can be given to those heads and teachers who, for a variety of reasons, have difficulty in meeting the requirements of the law. I am sure that that would be widely welcomed. Schools that experience difficulty in meeting the legal requirements can turn to their local standing advisory council on religious education for advice. That is a local permanent body with responsibility for supporting the provision of both religious education and collective worship in the area. There is no doubt that the subject is of the greatest importance. My right hon. Friend has expressed consistent views in the House over many years and has highlighted the importance of the subject. He has allowed us briefly
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today to demonstrate not only the importance of the subject but the ways in which schools can be helped to comply with the law, which is not going to be changed. We want greater compliance-- happier compliance--with the law so that we can ensure that the great religious tradition of this country can benefit pupils up and down the land, regardless of their personal, parental or family religion. Pupils must benefit from the core beliefs of the Christian religion, which is, and continues to be, so important to our society and our education system. I am grateful to my right hon. Friend and hope that the few words that I have been able to say today have given him the reassurance that he sought in bringing the subject before the House.Column 972
Prescribed Disease D4 Claimants
1.58 pm
Mr. Bill Etherington (Sunderland, North): Like many other Opposition Members, before the Christmas recess I voted against what were loosely called the Jopling proposals for the so-called modernisation of Parliament. However, I am pleased to take part in today's debate, because I regard these debates as perhaps the only positive thing that came out of the decision taken before Christmas. I notice that my hon. Friend the Member for Jarrow (Mr. Dixon) is present. I am pleased about that, because the subject about which I intend to speak affects many of his constituents as well as constituents in the whole of the former Tyne and Wear metropolitan authority area.
It does not give me any joy to have to raise this subject today. There are many disturbing aspects on which I hope the Minister can reassure me. Although the prescribed industrial disease, mucous membrane disease, has been with us for a long time, only in relatively recent years--from about 1990--has it become better known, as medical knowledge of it has improved.
There are various welfare rights agencies throughout Britain. I am sure that they do a good job in advising people on how to claim benefits and find their way through the maze of legislation. I imagine that there is none better than Sunderland centre for the unemployed, run by Dave Towler. I have the utmost admiration for him. He has done a tremendous job for the people whom he represents. He will always have my support whenever he requires it, because I am aware of the quality of his work.
There is a close relationship between the Liverpool centre for the unemployed and the one in Sunderland. In many ways, there is an interrelationship between the industrial backgrounds and heritages of Merseyside and Wearside and Tyneside. In April 1992, it was agreed that there would be a mass campaign to make claims in respect of prescribed disease D4, or mucous membrane disease.
After a few months, a total of 18,000 claims had been made, of which 5,000 were from Merseyside and 13,000 from the Tyne and Wear area. Early in the campaign, it became obvious that there was a tremendous disparity between the decisions made in Liverpool and those made in Sunderland. For example, we found that at the level of the adjudicating medical authority--which sounded much better when we called it a medical board--85 per cent. of those who claimed in Liverpool received satisfaction while in Tyne and Wear fewer than 1 per cent. did so. We are not talking about some inconsequential difference. There is a tremendous disparity. It begs a question that until now certainly has not been answered.
Many of those who underwent medicals for the adjudicating medical authority had received reports from ear, nose and throat consultants that they were suffering from the disease; yet the general practitioners employed by the DSS largely disregarded those reports. We found that somewhat unusual. I have always understood that a consultant's report should take precedence over what a GP might think on a subject of which he probably does not have so much knowledge. My hon. Friend the Member for Sunderland, South (Mr. Mullin) and I wrote joint letters to Mr. Tinnion, regional chairman of the independent tribunal service, Judge
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Thorpe, who was in charge of the national tribunal system, the Secretary of State for Social Security and the Lord Chancellor. We drew attention to the disparity. The replies that we received suggested that there was nothing to worry about; indeed, they appeared to deplore any parliamentary interference in their jealously guarded system of justice.Following that response, Sunderland centre for the unemployed commissioned a statistical survey by Dr. Peter Kelly who lectures in statistics at Newcastle university medical school. The aim was to find some pattern between what happened in Liverpool and in Tyne and Wear. We have all the information, which I shall be only too pleased to make available to the Minister should he require it in order to take some action.
The survey highlighted the fact that, following the refusal of either the industrial tribunal service or the Department of Social Security to take action on the matter, some of the medical appeal tribunal consultants in the Tyne and Wear area began to be more favourable to appellants, even though we were told that there was nothing wrong and nothing needed to be changed.
My hon. Friend the Member for Sunderland, South and I wrote again to the various authorities that I mentioned. We received much the same sort of response. The fact that things seemed to have improved was ignored. Eventually, the various advice centres and Sunderland centre for the unemployed decided that the only way ahead, in view of the response that we had had--to say that it was tardy would be to suggest that it was rather better than it was--was to make use of the proper procedures of the full majesty of the law.
Between 150 and 180 appeals made from various offices were sent to the social security commissioner. The commissioner considered two cases. They are known as the Greer decision and the Blackwell decision. The decision was almost unprecedented for the commission. I shall read it out in full. It said:
"The medical appeal tribunals who re-hear the cases should be composed of a different Chairman and different members all of whom have never sat on a medical appeal tribunal in Tyne and Wear in relation to the prescribed disease D4."
It is fair to say that, despite all the reassurances that my hon. Friend and I received from the various bodies, the commissioner most certainly thought that there was something wrong which needed to be put right.
Mr. Chris Mullin (Sunderland, South): Does my hon. Friend agree that one of the odd things about the case is the way in which the decisions made by medical people, who are presumably there as scientists rather than politicians, appear to reflect the political needs of the hour rather than the actual condition of the people whom they are supposed to examine?
Mr. Etherington: My hon. Friend makes a fair point. I am afraid that I am too cynical an individual to give him the answer that he requires. It should be surprising. Unfortunately, I do not find it surprising. The point that he makes is one of which the Minister should certainly take note.
The commissioner was saying that there was something sadly wrong with the system in the north-east. The decision dealt with both adjudicating medical authorities and the medical appeal tribunals--two bodies which are
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supposed to be completely independent in every way--yet it would appear that the commissioner was not prepared to accept that they were independent.I am sorry, Mr. Deputy Speaker, that I must use so many terms in the debate. It must be perplexing for people who are trying to follow the debate. It is easy enough for the likes of me, the Minister or other hon. Members who know the system well. There are so many sets of initials. It is sometimes difficult to keep up. It had been stated consistently in writing by the Benefits Agency medical service that no research had been done into mucous membrane disease, except the research that involved chromate-related damage to the mucous membrane. That is not true. A great deal seems to have been overlooked by the Benefits Agency medical service, certainly in the north-east of England.
Consultants acting on behalf of appellants throughout the sorry saga were so worried about the matter that a symposium was held on 20 June 1994 in York. It was attended by many ear, nose and throat consultants from Britain. They were addressed by eminent colleagues from Scandinavia and the United States who had carried out in-depth research into mucous membrane disease.
The symposium concluded that there was a condition called industrial rhinitis. I was pleased to have the privilege of attending that symposium. I do not pretend that it is a subject about which I know very much. I found the symposium enlightening but disturbing in some ways in view of what had happened before it took place. In attendance at the symposium was a representative from the Industrial Injuries Advisory Council who later advised the Secretary of State on the list of prescribed diseases. Following the symposium and as a result of information that had been sent to the council by consultants, trade unions, and so on, in September 1994 the IIAC recommended to the Secretary of State that mucous membrane disease, prescribed disease D4, should be broadened to include industrial rhinitis. Out of this whole sorry saga, that is the one consolation. I should be pleased to give the Minister all the information that I have in my possession--much of which came from his Department. A number of questions need to be answered. Those with the disease in the north-east have suffered an injustice and we want that to be put right along the lines set out by the commissioner. That has not yet happened and it shows no sign of happening.
My first point is how do the Government explain the difference between Liverpool and Tyne and Wear when the industrial backgrounds are the same? Secondly, we have proof that the full-time medical adviser gave misleading information to the Wearside adjudicating officer's department. I am pleased that one of my constituents, Brenda Jackson, has given me permission to use her name. Obviously, I will not name the doctor concerned. That is not for me to do; it is for the Department to find out and do something about him. I would never say anything in this place that I was not prepared to say outside it. However, the information is available if the Minister wants it. There has been a similar occurrence with a constituent of my hon. Friend the Member for Houghton and Washington (Mr. Boyes), with which I have no doubt he will deal in due course. I have appraised him of the situation. It is believed that my hon. Friend's constituent lost his case because of misleading information.
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Thirdly, the adjudicating medical authority is still not complying with the commission's written directions. When can we expect some progress on that? Fourthly, how can an organisation such as the DSS, with all its resources, not fund research, yet advice centres and independent consultants--sometimes even charitable bodies--seem able to do some research and produce tangible, worldwide evidence on the disease?Fifthly, in some agreed minutes between the DSS and the advice centre in Sunderland about a meeting held on 3 August 1994, it was recognised that there was a need for uniformity in decision making. It was said that training was required, through the Benefits Agency, of the Department's general practitioners--the majority of whom are either part time or retired. Why has that not been done?
Sixthly, why are consultants' reports treated with such disregard--I might almost call it disdain--by those general practitioners? If they were in the mainstream of medicine and referring their patients to consultants, they would abide by the consultants' opinions. Why are there different standards?
Seventhly, because of fresh evidence supplied to the DSS and because of the threat of advice centres pursuing the matter to judicial review, has the DSS now agreed to review all prescribed disease D4 cases?
Eighthly, after the re-boarding of medicals there is documented evidence that appellants were deemed by the adjudicating medical authority to be suffering from various forms of rhinitis at their original medicals two years ago. As those decisions would now be brought within the commissioner's interpretation of prescribed disease D4, the review medicals by the same general practitioners show that those people are suddenly not suffering from any form of rhinitis.
Ninthly, boarding doctors are refusing to abide by even DSS policy division directives on how they are to proceed at review medicals. Doctors are refusing to examine appellants on review.
The impression that I get--I say this with some sadness--is that there is a force of opinion within the medical section of the Benefits Agency medical service in Tyne and Wear that has taken it upon itself to ensure that, come what may, appellants suffering from distressing conditions do not get their rightful entitlement. We can reach no other conclusion.
Mr. Ronnie Campbell (Blyth Valley): Is there a case for sending the evidence to the ombudsman? It appears that there is some malpractice which should be investigated.
Mr. Etherington: I have to give my hon. Friend a somewhat cautious reply. So many things are wrong that I can honestly say that I do not know what is the best way forward. I hope that today's debate is the best way. I am just sorry that it has had to come to this. I want to refer to the proceedings of a social security appeal tribunal held on 31 January, which involved my constituent to whom I referred earlier. I shall read out the relevant passage about misinformation from a doctor employed by the Benefits Agency. It states:
"Mr. Towler invited clarification about document 28"--
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which is the misleading document. It continues:"He submits that Mrs. Jackson has clearly not been examined by Department of Social Security consultants, only doctors of GP status. To this extent the document carries a wholly false (not just misleading) impression."
Miss Guthrie, the adjudication officer, conceded that point. It is a sorry state of affairs when I have to come to the House and report something that is basically the equivalent of perjury.
I know that the Minister is a sympathetic person, because of his involvement with bronchitis and emphysema. I hope that he will ensure that my constituent and the other 13,000 people in the north-east who are claiming in respect of the disease will have their claims reheard and that they will receive the same sort of justice as that received by the people on Merseyside.
2.16 pm
The Minister for Social Security and Disabled People (Mr. William Hague): I congratulate the hon. Member for Sunderland, North (Mr. Etherington) on securing the Adjournment debate. From the presence of several of his hon. Friends, I recognise that there is widespread concern that goes beyond his constituency alone. I appreciate his concerns and I am aware of his active interest in this matter over a considerable time.
The prescribed disease in question, known as prescribed disease D4, has a long history and raises some difficult issues. I should like briefly to explain the background. The origins of the present prescription are to be found in the Workmen's Compensation Act 1906. It provided, from 1907 onwards, for compensation for ulceration of the mucous membranes of the nose and mouth. The original occurrence which led to the condition being added to the list of diseases at that time was the adverse effect--bleeding from the gums--found to be experienced by men unloading a certain type of iron ore.
It was recognised even then that because the condition prescribed was common among the general population, a clear link with a particular job could not be assumed in the individual case. The burden of proof that the disease arose as a result of work was, therefore, always left with the worker.
When the industrial injuries scheme was introduced in 1948, the present PD D4 was included as part of the adoption of the prescribed list of occupational diseases used by the Workmen's Compensation Acts, which the new scheme replaced. The disease is presently defined as:
"inflammation or ulceration of the mucous membrane of the upper respiratory passages or mouth produced by dust, liquid or vapour". The occupational requirements are:
"any occupation involving exposure to dust, liquid or vapour". It can be readily appreciated from what I have just said that both the disease and the occupational cover are in very general and wide terms.
One of the major problems with the present prescription of PD D4 is that the signs of the disease, such as running nose, feeling of nasal obstruction, occasional bleeding and loss of smell, are extremely common among the general population and have a multitude of possible causes. The disease is usually short-lived and generally causes very little disability of any serious or lasting nature. Furthermore, it can be extremely difficult to identify the specific cause of the condition. There are many different causes and other general factors, such as smoking or the
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drying effects of central heating, which can worsen it. It is not surprising, therefore, that consistent diagnosis of the condition is very difficult; making a clear link with an occupational cause is even more difficult.Until fairly recently, as the hon. Gentleman said, there were in fact very few claims made each year for PD D4. Then, in the spring of 1992, local trade unions and unemployment centres in the north-east of England mounted a campaign to encourage people to claim for the prescribed disease. The campaign subsequently spread to the north-west.
It was the increased number of claims received as a result of the campaign which highlighted the very general nature of the prescription and the difficulty that it presents in deciding claims. This, in turn, raised questions about the precise nature, causes and effects of the disease, since, if they could be laid down more precisely, much of the confusion to which the hon. Gentleman referred could perhaps be avoided.
My predecessor, my right hon. Friend the Member for Chelsea (Sir N. Scott), looked into the problem in 1993 and rightly decided in September 1993 to ask the Industrial Injuries Advisory Council to consider and advise on the question of whether the present prescription of PD D4 should be changed and, if the council concluded that it should, to ask it for recommendations on revised terms of prescription. The council is the independent, expert body which has the statutory role to provide such advice; Ministers rely on it for advice. It has examined all the relevant scientific evidence that was available--the hon. Gentleman referred to members of the council taking an interest in these matters. The council completed its report towards the end of last year.
My officials are considering the implications of the council's findings. I expect to receive the report shortly and will respond in due course. However, any changes proposed by the council will not have retrospective effect and current claims must be decided on the basis of current legislation.
I should like at this point to explain the decision-making process for industrial injuries claims, because the hon. Gentleman asked several questions about that matter. The first question, which is decided by an independent lay adjudication officer, is whether the claimant satisfies the prescribed occupational requirements. Because the present prescription covers any occupation involving exposure to dust, liquid or vapour, few claims for PD D4 fail at this stage. Claims which satisfy the occupational requirements are then referred for medical examination. In the north-east, these examinations have been carried out by medical practitioners with higher qualifications in the specialty of ear, nose and throat surgery.
If the examining medical practitioner considers that the claimant is suffering from PD D4, he then acts as an independent adjudicating medical authority and assesses the degree and likely duration of any resulting disability. Where a prescribed disease has been diagnosed, adjudicating medical authorities also give advice to the lay adjudication officer on whether they consider the prescribed disease is due to the nature of the claimant's occupation. For most prescribed diseases, if the claimant satisfies the occupational test and is diagnosed as suffering from the disease, it is presumed that the disease was caused by the relevant occupation, if the claimant worked in it shortly before developing the disease. But as
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I explained earlier, there is no such presumption for PD D4, because of its very common nature, and the link between the occupation and disease needs to be proved on the balance of probability in each case.The claimant has a right of appeal to a medical appeal tribunal against the decision of an adjudicating medical authority, and to the social security commissioner--but only on a point of law. The adjudicating medical authority may review the decision if it is satisfied by fresh evidence that the original decision was given in ignorance of a material fact or was based on a mistake as to a material fact. I shall say a little more about that later. I should make it absolutely clear to the House, especially in view of the intervention by the hon. Member for Sunderland, South (Mr. Mullin), that the adjudicating authorities, both lay and medical, are entirely independent. Neither Ministers nor officials can intervene in their decisions.
As I have already said, the characteristic features of PD D4 are very common indeed among the general population. Sometimes, it is not an easy task to determine whether these symptoms are due to a specific agent when they occur so commonly and widely. In these circumstances, diagnosis and clinical assessment are not an exact science; it is a matter of clinical judgment by the experienced independent doctors dealing with the cases who take account of the facts in each individual case.
Comprehensive training and continuing medical education programmes are pursued by Benefits Agency medical services to ensure that their doctors are expert both in the legal aspects and in the disablement assessment issues of all prescribed diseases. The training received for assessing PD D4 is part of that.
Doctors who serve as members of the adjudicating medical authorities are also trained by senior Benefits Agency doctors according to a well- established programme. Senior managers in Benefits Agency medical services regularly undertake quality assurance of the work of adjudicating medical authorities and set standards of performance.
Since 1992, as far as I know, there have been more than 8,000 claims for PD D4 in the north-east. In the vast majority of cases, the adjudicating medical authority has not found the claimant to be suffering from PD D4. Even where the disease has been diagnosed, in most cases the degree of disablement assessed has been below the 14 per cent. threshold which qualifies for payment of disablement benefit. On the latest figures available, less than 0.5 per cent. of the north-east claims have attracted an assessment of 14 per cent. or more.
The hon. Gentleman asked about differences between the north-east and the north-west, mentioning Liverpool in particular. Even in the north-west, fewer than 1.5 per cent. have had an assessment of 14 per cent. or more. In both cases, the proportions are very small. This low success rate reflects the fact that the disease is not generally very disabling. It is true that there is some difference between the level of diagnosis of PD D4 in the north-east and that in the north-west. This is a sign of the difficulty that medical authorities have had in deciding claims, for all the reasons that I described. That is why we asked the Industrial Injuries Advisory Council to review the present prescription.
I mentioned earlier that reviews of medical authorities' decisions may be sought on the basis of fresh evidence. Last April, the Sunderland branch of the Trades Union
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