§ 11.12 a.m.
§ Lord Plant
My Lords, I beg to move that this Bill be now read a second time. This Private Member's Bill was introduced and piloted through another place by the honourable Member for Newham South, Mr. Nigel Spearing. I am sure that the House would wish to congratulate Mr. Spearing on successfully seeing this Bill through all its stages so that it has finally reached your Lordships' House. I am very pleased indeed to see that Mr. Spearing is at the Bar of the House.
The reason for his deep concern and continuing interest is because he found, after dealing with cases of asbestosis among his constituents, that there were no clear rules laid down for defining industrial diseases, especially new ones. Some constituents had been rejected for benefit during their lifetime by the pneumoconiosis medical panel. In those cases, the death certificate simply said "asbestosis" and therefore the registrar did not forward the case to the coroner. Had he done so, a post mortem would have been performed, the lung tissue probably examined by electron miscroscope and connection with the persons' work established. The Bill is not concerned with definition, diagnosis or compensation. It deals with regulations for the notification and certification of death and the recording of information relating to industrial diseases. It permits the Secretary of State to make regulations in an area of notification of death from industrial diseases which, surprisingly, are not as embacing as one might think. When a death is thought to be due to untoward circumstances, the registrar must refer such cases to the coroner. The registrar has to rely on the death certificate provided by the medical practitioner.
The area between certification by the doctor, registration by the registrar and subsequent proceedings initiated by the coroner, such as post mortem 1460 and autopsies, was reviewed by the Brodrick Committee which reported in 1971. If some of the recommendations of Brodrick had been implemented, instead of gathering dust in the Department of Health and Social Security, we should have had better statistical classification of reasons for deaths, in particular among those workers who had worked with asbestos, in the mining industry, printing, dyeing and the rubber and chemical industries. The Brodrick Report said there should be a new type of classification of death, a reportable death. It said:A Registrar of Deaths is obliged to report a death to the coroner in cases where he has reason to believe, or when it appears to him that … the death has been caused by abortion, or … the death has occurred during an operation or before recovery from the effect of anaesthetic, or…the death was due to industrial disease or industrial poison.As the Brodrick Committee then pointed out:This obligation is only on the Registrarand the committee recommended that it should be applicable to doctors as well as registrars. The report went on:a doctor should be obliged to report any death which he has reasonable cause to believe falls within one of these categories. In the main, we envisage that the Secretary of State will prescribe categories of death in respect of which there is for the time being a particularly public interest.The Bill will give the Secretary of State, or, with his approval, the Registrar General, power to make by statutory instrument regulations concerning the notification and certification of death and for the recording of information relating to industrial diseases and matters related thereto.
Sir George Young, the Under-Secretary of State for Health and Social Security, on 30th January of this year in another place welcomed the Bill on behalf of the Government. That has given great satisfaction over a wide field, including the Society for the Prevention of Asbestosis and Industrial Diseases, whose secretary, Mrs. Nancy Tate, a 1976 Churchill Fellow, has done so much in this field. The noble Lord, Lord Avebury, and I have the privilege of being trustees of that society.
Sir George Young said the Bill provided a means for moving towards the implementation of a small but useful part of the Brodrick Report. The Bill is directed at improving recognition of possible cases of industrial diseases by the doctor who signs the death certificate so that they can be referred to a coroner, who can order a post mortem with electron microscope analysis, particularly in lung diseases, with subsequent help by way of industrial death benefits. The measure is welcomed by the medical profession and the TUC, which in recent years has done so much in the field of preventive medicine. The ILO, supported by the United Kingdom Government, has also been active in this area and gives support.
I recognise that the Bill might be overtaken by wider regulations or legislation if the Government, now stimulated by the Bill, are able to implement Brodrick or parts of it. We must have as much relevant information as possible on the death certificate in relation to occupational background. We should know if there is any connection between the number of people who die from a certain disease and work in a specific industry. The Bill will mean that the death certificate must be redesigned so that the medical practitioner must say that he is satisfied that the patient's death 1461 was not due to, or contributed to by, any employment followed at any time by the deceased. Where that is not done, the registrar will have to report the death to the coroner, or in Scotland to the procurator fiscal; strangely, in Northern Ireland a similar Act already exists and hence the Bill excludes Northern Ireland. Therefore, deaths due to industrial diseases will come under greater scrutiny.
It is to be hoped that the department will be able to bring forward regulations to implement the Bill and indeed to widen the regulations dealing with births, deaths and marriages generally, taking into account some of the Brodrick recommendations. Very few doctors even consider the possibility that work may have contributed to the disease. A change in the regulations and the death certificate will bring about an increased awareness of the problem. I should like to see all cases refused by the pneumoconiosis medical panel notified and investigated by post mortem. I believe that 70 per cent. or more are refused benefit.
Lung cancer, mesothelioma and heart diseases are among the main diseases that I should like to see made notifiable and investigated. I was for 25 years chairman of the Post Office and Civil Service Sanatorium Society, with its own hospital at Benenden, and I was struck by the thorough investigatory procedures into the occupational backgrounds of patients. The death certificates anticipated what are expected to be the results of this Bill. There should certainly be a post mortem. when those who have been exposed to asbestos or mining dust die of heart disease.
I need not here bring to your Lordships' attention the progress that has been made in linking certain diseases with various occupations. Research into, and investigation of, death statistics continues, and it is now being accepted that industrial asthma may result from occupational environment. People who work with polyurethane, some laboratory workers with animals, and workers using complex platinum salts in the photographic industry are particularly subject to asthma, which ought to be classified as an industrial disease. Statistics are needed, and more information is needed on the death certificate.
I hope that the Government will support the Bill which, when implemented, will bring among general practitioners a greater awareness that many deaths not now linked with occupational risks should be so recorded. I hope the House will support the Bill. I regret having spoken for so long and for having kept your Lordships from dealing with the next Bill, which might be of greater interest. My Lords, I beg to move that the Bill be read a second time.
§ Moved, That the Bill be now read 2a.—(Lord Plant).
§ 11.22 a.m.
Lord Wallace of Coslany
My Lords, first, I wish to congratulate my noble friend Lord Plant on his speech and on his presentation of the Bill in your Lordships' House. Naturally enough, I also wish to congratulate my honourable friend Mr. Nigel Spearing on bringing forward the Bill. I wish to welcome the Bill on behalf of these Benches. Although the Bill is merely permissive, it gives the Minister powers that do not at present exist, and it plugs a gap in the existing legislation on industrial diseases.
1462 The progress of the Bill is an excellent story of all-party co-operation. My noble friend Lord Plant has clearly outlined the purpose of the Bill, which has cleared the scrutiny of another place, and I am sure that my noble friend Lord Hale, who is the next noble Lord to speak in the debate, will plug any gaps that might exist. I understand that the Bill has Government approval, and I trust that this House will give it a speedy passage, with the minimum possible delay. I shall not take up the time of the House any further—though not because of another Bill that is to follow, since this Bill is far more important than that. I hope that the House will give this Bill the maximum support and not delay its progress in any way.
§ 11.24 a.m.
§ Lord Hale
My Lords, I do not think it is necessary to add very much to what has been said. I am grateful to the noble Lord, Lord Wallace of Coslany, for his personal reference. This is a very remarkable Bill; it is almost an experiment in legislation. It has attracted the support of the entire membership of an all-party committee in the other place. No voice was raised against it, save the criticism from time to time from the box to the Minister, who was wholeheartedly in support of the Bill. Naturally, there were some hesitations and postponements. Yet the Bill has proceeded, despite those hesitations and postponements and despite the fact that in order to make one adjustment the committee had to be adjourned and finally sat under a new chairman, so as to find a little more time to ensure the Bill's progress.
This simple and very remarkable Bill imposes no obligation on anybody except the Minister. In the first case it leaves the judgment entirely to the Minister. It calls upon the Minister to act, no doubt with the advice of the special committee that is constantly dealing with industrial matters and monitoring very many diseases. There is nothing to prevent anyone drawing the Minister's attention to the desirability of an investigation of a death in the kind of circumstances with which this Bill is concerned.
The whole attitude towards industrial diseases has changed to a considerable degree. One reason for this lies in the advance of science and technology. In many cases, in particular those involving people who work underground, these advances have in the main eliminated the cause of the disease. Dust has been reduced in both the mine and the mill. The appearance of 2 million chemicals and so on presents some likelihood of special problems, which are being dealt with. However, a Bill such as this provides quite an answer to those who criticise all the processes of parliamentary government. The Bill, sandwiched in the middle of 30 or 40 other Private Member's Bills, each attracting a paternal interest from some Member or other, has been given special facilities—we might hear of another one this morning—in order to get through the maze of difficulties which tend to frustrate the passing of Private Member's Bills in another place, or for that matter Bills going from this House to another place. I am not sure whether I am entitled to name the Minister, but in view of the circumstances that I have outlined, I would say that Mr. Rossi, who was in charge, went to infinite trouble to secure the passing of this apparently small measure, which I believe brings into 1463 operation a different aspect and a different spirit in the making of legislation. Mr. Spearing deserves every possible compliment. I hope that the House will take the view that a Bill which attracted so much consent and such a warm welcome in the other place should be treated in the same way in this House, so that we shall be able to congratulate ourselves on seeing it go on to the statute book within the shortest practicable period.
§ 11.30 a.m.
§ Lord Bishopston
My Lords, I will detain your Lordships for only a few moments. As one engaged in industry and with trade unions, like many other noble Lords here, over the years, I welcome the Bill as a significant step forward in the reduction and indeed the prevention of industrial diseases. It is not always realised, of course, just how much suffering, and indeed death and grief, are caused by the occupational environment, and knowledge of the reasons for this situation, and other factors concerning it, is indeed essential if we are to reduce the causes of injury and death which often ensue.
Another factor, apart from the human aspect, has been the considerable amount of working time lost. I should emphasise—I think it is worth doing so—that we often hear a lot about the time lost through industrial disputes (which, of course, are regrettable in many cases) when far more time, often running into hundreds of thousands of manpower hours per day, is lost through industrial illness and disease, which is often preventable. I think this Bill, which will enable us to have far more information about the causes of the illnesses, and often death, which ensue as a result will be for the benefit of our industrial health, too, as well as for the human health involved. I am sure we owe a debt to Mr. Spearing and to all those involved in the passage of the Bill so far, and I am also sure we shall give it a speedy passage through this House.
§ Lord Drumalbyn
My Lords, may I first of all say a word of congratulation to the noble Lord, Lord Plant, on introducing this Bill, and express certainly my support, and I am sure the support of all my noble friends on this side of the House, for the purposes of the Bill. I rise to make just one comment on it. This Bill is admirably short, but I am not quite sure that it is desirable to introduce Bills of this kind, giving a Minister power to make regulations, without, so far as I can see, any possibility for Parliament to discuss the regulations at any time. Parliament is here, after all, to try to improve on what the Civil Service may do and on what Ministers may do, and it is not impossible that in a case of this sort, with the experience of Members of this House, for example, it might well be able to improve on what the Minister might put into regulations.
I was attracted to this subject partly because, in the past, I have been involved in such legislation from a ministerial point of view—and from the point of view of more than one Ministry—and have taken a great interest in it for a long time; but also because of the fact that a Bill of this character, that is so short, does not really give very much opportunity for full discussion in this House. It would have been desirable, 1464 perhaps, to have had a debate in the House on this report, which, as the noble Lord, Lord Plant, said, has been gathering dust meantime. Nevertheless, I certainly give it my very full-hearted support, and should any difficulty arise in the future over the fact that the Bill is bound to be highly technical in character as it works out—and certainly the regulations will be so—I suggest that it might possibly be necessary to legislate further on the subject so as to give Parliament a fuller opportunity to discuss.
But I do not want at all to give any impression that I think the Bill should be in any way delayed for this reason. Undoubtedly it will be possible for steps to be taken to improve the situation, to identify industries where the incidence of any particular industrial disease is strong, and to give a basis for further research and improvement. I think this is the purpose that the noble Lord, Lord Plant, has in mind. I would also thank him for his explanation of the Bill, because I am bound to say that without that explanation I found the Bill somewhat lacking in clarity of purpose. But now that he has given it I would welcome the Bill very much, and I hope there will be no delay in passing it.
§ Lord Segal
My Lords, I, too, should like to add my own few words of welcome to this Bill. It is a very important little Bill. Indeed, it is of such crucial importance that it may be the means of saving hundreds of valuable lives in this country in the future. It involves a complete redrafting of the wording and the form of the death certificate, and here I feel quite sure that the Minister will see that he enters into consultation with the representative bodies of the medical profession in this country before the final form of the death certificate is agreed upon. It is most important, not only that the cause of death should be certified but also what other diseases are present at the time of death, preferably certified in the order of their importance as having been the cause of death.
Here I would say that this involves the future of perhaps one of the most valuable sections of our community—that section of the working population who may be cut down in the prime of life through being engaged in industrial occupations which are a potential cause of early death. I can only say that this Bill is of such importance that I hope the Minister will give careful consideration to all the different factors and all the different professional bodies involved in it. Having said that, I should like to extend the warmest possible welcome to this Bill.
§ 11.38 a.m.
§ Lord Cullen of Ashbourne
My Lords, I should like to add my congratulations to the noble Lord, Lord Plant, for the careful way in which he described the Bill, including the background of the Brodrick Report, which I think gave us all a very good idea of what the Bill is all about. I should also like to congratulate Mr. Spearing on having initiated this Bill in another place.
The Bill is welcomed by the Government. It will enable regulations to be made by the Secretary of State, or with his approval by the Registrar General, to require doctors to identify those deaths where there may be some reason to believe that the employment 1465 followed by the deceased person might have been a contributory factor. These deaths would then be brought to the attention of the coroner.
I should like shortly to explain how this differs from the existing system. It is already open to a doctor to report a death to the coroner; for example, in cases of accidental or violent death, or if the cause of death is unknown, or if the death is clearly due to a known industrial disease. There is also a long-stop, so to speak. At the time when the death is registered by the relatives, the registrar will check whether the cause of death is one of those on the official list of industrial diseases. If it is, he will report the death to the coroner if the doctor has not already done so.
The present Bill will not stop any of these procedures, which will continue as before, but it is hoped that regulations under the Bill may help to identify a few more cases. They may do this because they will oblige the doctor to consider when he is filling out the medical certificate for the cause of death whether it is possible that the death was due to the deceased person's employment or whether his employment might have been a contributory factor. The form of the existing medical certificate of cause of death is prescribed by regulations made by the Registrar General under powers in the Births and Deaths Registration Act 1953. Under that part referring to the cause of death the Act provides for the doctor to show the disease or condition directly leading to death; the antecedent causes—that is, the morbid conditions, if any, giving rise to the disease; and other significant conditions contributing to the death but not related to the disease or condition causing it.
The certificate is in the form recommended by the World Health Organisation for international use. It has been proposed that a further box should be added to the certificate which the doctor would tick if he had no reason to believe that the death was due to any employment followed by the deceased, or contributed to by that employment. Where this box was not completed by the doctor the registrar would be required to report the case to the coroner.
It is, of course, very much a matter for discussion with the medical profession as to whether a negative statement of this nature is to be preferred to a positive statement, but the mechanics of bringing about this change in certification would essentially remain the same. We will, of course, ensure that all proper consultations take place before any action is taken. The duty of reporting these deaths to the coroner will be placed on the registrar of births and deaths.
We shall, however, need to have very careful consultations with the medical profession about the form of words to be used on the death certificate. We do not want coroners to be overwhelmed with cases. For example, there is a widespread belief that heart attacks may be contributed to by stress at work, but the epidemiological evidence in support of this belief is slender and still controversial. We would hardly want all heart attacks to be reported to the coroner. We shall, therefore, embark on consultations with the medical profession. The provision for Scotland in the Bill would enable the Secretary of State—or with his approval, the Registrar General of Births, Deaths and Marriages for Scotland—to make regulations for Scotland under the powers in the Bill.
1466 My noble friend Lord Drumalbyn did raise a technical point, and I am sure it will be looked at carefully by my right honourable friend. I do not feel that I should comment on it, except to say that these regulations will be subject to the scrutiny of the joint committee as to their technical correctness. No doubt the technical committee will examine the extent of the powers under which the regulations are made, so that the regulations will not be allowed to enforce anything beyond the scope of the Bill.
Finally, may I say that this is enabling legislation which will be followed by appropriate consultations. When the regulations are made by statutory instrument, due publicity will be provided to the medical profession, and it is intended that the regulations will be made during the lifetime of this Parliament.
§ 11.43 a.m.
§ Lord Plant
My Lords, may I thank the noble Lord the Minister for his most helpful and encouraging reply in relation to the Government's intentions. I should also like to thank noble Lords for their interest in this Bill, which I hope will be continued.
On Question, Bill read 2a and committed to a Committee of the Whole House.