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Pneumoconiosis: Support for Former Miners

Volume 637: debated on Tuesday 13 March 2018

I beg to move,

That this House has considered support for former miners with pneumoconiosis.

It is a great pleasure to serve under your chairmanship, Mr Bailey. I thank the Minister for being here to respond to the debate and colleagues for their attendance.

It is a privilege to have secured my first Westminster Hall debate on a subject of interest to many of my constituents and many in former coalmining communities across the UK. Mansfield has a proud coalmining history, which ended very recently—just a few years ago—when the nearby Thoresby colliery closed. For decades, the community was built around the industry, and we still feel many of its effects.

I applied for this debate because, although coalminers’ pneumoconiosis is not a terribly widely known illness, it is prevalent within mining communities and should receive greater attention. I have been contacted by a number of constituents and unions about this issue, which I am keen to raise directly with Ministers. I am asking the Department for Work and Pensions to work with the Department of Health and Social Care to review the diagnostic tools that are used to assess miners for signs for pneumoconiosis.

Coalminers’ pneumoconiosis is an occupational lung disease caused by the inhalation of dust from coalmines. It is often known as “black lung” and it causes thousands of death each year worldwide. Inhaled coal dust progressively builds up in the lungs over long periods, leading to inflammation of the lungs, fibrosis and even necrosis. The most common symptoms of pneumoconiosis are coughing and shortness of breath. The risk is generally higher when people have been exposed to mineral dust in high concentrations and if they have been exposed to coal dust for long periods.

Coughing and shortness of breath can, of course, be symptoms of a wide range of illnesses, which is partly why pneumoconiosis is often overlooked by health professionals and others. Even when a former miner presents to their GP with those symptoms, it is not always picked up straightaway. Most miners would recognise that a cough is inherent—part of the territory of working in those conditions—and many would not consider it a symptom of anything more than their career underground. Many therefore do not come forward early enough, and this is where the problem lies. We need to do more to encourage this conversation.

Many former miners who present with such symptoms are simply referred as out-patients to their local hospitals for standard chest X-rays. They will have had these X-rays regularly throughout their time in the industry and most will have been told that they have a clean bill of health on that basis. The trouble is that traditional two-dimensional X-ray films often do not show enough detail to diagnose pneumoconiosis, especially when the patient is in the early stages of the disease. The tell-tale sign of the disease is nodules in the lungs, which can be as small as l mm or 2 mm in diameter. When using X-rays for diagnosis, it is usually possible to pick up on pneumoconiosis only at a later stage, when large masses of dense fibrosis have developed in the lungs. By that stage, there is usually a notable decrease in lung function—in effect, it is too late.

A successful diagnosis is also less likely because of the time that has passed since the pits closed. The doctor they see now, who examines the X-ray, is less likely to have specialist knowledge of the industry and related illnesses. They are also less likely to have seen this disease before, so are perhaps less likely to spot it.

For the best results and the quickest analysis, a CT scan is the most effective diagnostic tool. CT scans show the lungs in three dimensions, which provides far greater detail and allows for a more accurate diagnosis. For many of us, it is surprising to learn that there is not a regular screening programme in place for former coalminers to pick up cases of pneumoconiosis and other lung conditions. Many former miners received their last X-ray at work. When miners retire or are made redundant, their access to regular X-rays simply stops. Former miners then tend not to receive another until they present to their GP with symptoms such as breathing difficulties or a persistent cough. Many fear that they have cancer, and are given a CT scan only to find that it is in fact pneumoconiosis.

It is important to note that the latency period for pneumoconiosis is about 10 years, but can be as long as 15 to 20 years. The lack of regular screening once a miner leaves that environment and retires is clearly a problem. I am aware of several cases in my constituency of miners who received the all-clear for pneumoconiosis after getting old-fashioned X-rays at work, but were subsequently diagnosed with pneumoconiosis after CT scans revealed evidence of the disease.

My hon. Friend is making an excellent point. I have personal experience of lung disease in the family. Both of my grandfathers were miners, and some of their lung issues did not come to the fore until at least a decade after they left the pit. I want to emphasise the importance of what he says: we need to ensure that there is support throughout the process and throughout people’s lives.

My hon. Friend is absolutely right. That is a prime example of why it is important that assessment is ongoing and people who used to work down the mines have access to diagnosis and treatment throughout the rest of their lives.

A few years ago, the Union of Democratic Mineworkers decided to run a test case. The UDM paid for five former miners who had recently been made redundant to have CT scans. The men had all received recent occupational X-rays at the colliery, and each had received the all-clear from those scans, but when the five men went for CT scans, two were diagnosed with pneumoconiosis. Interestingly, two of the other three men were diagnosed with other health issues, which had previously been unseen in the X-rays. Four out of five had conditions that required a CT scan to get a diagnosis. Surely it is clear that former mineworkers are at high risk of many different respiratory health problems, and that a CT scan is the most effective tool for diagnosis.

At present, the reality is that without post-retirement screening for pneumoconiosis, and with standard guidance from the DWP and the Department of Health promoting X-rays for testing, many cases are not picked up until it is too late. It is a sad truth that pneumoconiosis is often noted in a patient’s file for the first time when they receive a diagnosis of lung cancer or other advanced respiratory illness. That is clearly unacceptable.

I agree with much of what the hon. Gentleman is saying. I just want to mention the compensation scheme. When people are deceased, if somebody other than the widow claims for compensation, it is incredibly onerous and expensive and there are many hurdles in the way. Does he agree that that process needs to be simplified and expensive hurdles scrapped?

I agree that it is important that people have access to the compensation that they rightly deserve, and that that should be as simple a process as possible. Key to that is diagnosing the condition in the first place. To get access to that compensation, they have to prove that they have the condition, which has to be diagnosed.

The issue of pneumoconiosis testing has been batted about between the Department for Work and Pensions, the Department of Health and regional clinical commissioning groups for too long. Miners are rightly entitled to compensation and access to benefits as a result of work-related illnesses including pneumoconiosis. The compensation provides lump-sum payments to sufferers and their dependants. The Government have a duty to look after those who suffer from diseases caused by their working environment. Hard-working coalminers deserve their rightful compensation and disability benefits when their working environment has left them with an incurable illness. If individuals are not diagnosed at an early stage, they miss out on not only vital healthcare but the welfare support that they deserve.

To successfully claim compensation, miners must prove that they have pneumoconiosis. Again, this is where we run into issues. The DWP also relies on X-rays to provide evidence of pneumoconiosis for compensation claims. The compensation assessments are problematic. Former miners are frequently tested with digital X-rays, but even the newer technology struggles to pick up on the true condition of the lungs. Often the image is not clear enough to confidently diagnose pneumoconiosis. In such instances, if their claim is denied by the DWP, the miner will lodge an appeal. That takes considerable time and effort, and it will draw on DWP staff time and resources as applications are processed for a second time. In order to appeal the decision, miners may undergo further diagnostic testing, including the all-important CT scan, which is an additional expense and carries an additional exposure to radiation.

The argument against the use of CT scans usually focuses on two elements. One is the cost of the scans compared to that of X-rays, and the other is increased exposure to radiation. In reality, if coalminers with suspected pneumoconiosis do not receive a scan the first time, they are often exposed to repeated X-rays over a long period and then eventually a CT scan anyway—often when their condition has deteriorated. That is more time- consuming in the long run, ultimately costs more and can involve increased exposure to harmful radiation.

In this debate, I am asking not for a radical change to the testing programme for all lung-related compensation and disability claims, but simply an acknowledgment that former coalminers are at high risk of lung conditions and that the diagnosis of pneumoconiosis, particularly in the early stages, inevitably requires a CT scan rather than an X-ray. There is a clear argument that the Department should consider CT scans as the definitive gold standard for the investigation process in pneumoconiosis claims.

There is a real possibility that thousands of former mineworkers are living with pneumoconiosis, but have no idea that they have the disease. Their occupational X-rays may have showed nothing and, even if they raise health concerns with their GP years later, there is every possibility that they will again receive only an X-ray, which does not show enough detail to diagnose the condition.

The UDM is based in my constituency. I recently met Jeff Wood, the national president, and Ian Gill, the social insurance officer, who work on pneumoconiosis claims. They explained to me in great detail a number of cases that they have personally seen where miners suffered for years without an official diagnosis. It is easy to sit in Parliament and look at issues on paper, but it is important to remember that there are real people behind those studies, and real families who would benefit from a relatively small and easy policy change.

Any former miners who have had unnecessary delays in receiving their diagnosis should receive the compensation and benefits that they are entitled to. I ask the Minister to work with the Department of Health and Social Care to bring about change and to ensure that people who are entitled to support for pneumoconiosis can access it at the earliest opportunity.

There are several clear benefits to the DWP working with the Department of Health and Social Care to replace standard X-rays with CT scans. Earlier diagnosis for patients will allow them to make the necessary lifestyle changes to improve their overall health.

The hon. Gentleman is right to say that when producing new proposals, policies or guidelines, Ministers should consult with the trade unions—not only the Union of Democratic Mineworkers but the National Union of Mineworkers.

Of course, it is important that everyone involved is encouraged to talk to GPs and to the Government. I am sure that we can do more with that. I mention the UDM simply because it brought the issue to my attention.

We can achieve earlier access to compensation and benefit support from the DWP. There are potential cost savings for the NHS, because an initial CT scan will help to avoid repeated X-rays, GP appointments and out-patient visits, as well as helping the patient to be healthier and less reliant on those services. There will also be a reduction in the number of appeals to the DWP for compensation claims, because the evidence will be provided in the first instance, and a potential reduction in future disability claims, because sufferers will be able to take action sooner to improve their lung function and overall health before it deteriorates.

The DWP needs to take the lead on what is, of course, a work-related disease. In an ideal world, former mineworkers would be offered additional testing at their GP and local health clinics. We need national action because, once again, we face a postcode lottery in terms of the support offered to miners. Some areas fare considerably better than others.

In Mansfield, we are lucky that the unions offer support to former miners. There are also other areas of the country where former miners receive brilliant help and support. In Rotherham, the BreathingSpace community service helps people with a wide range of respiratory conditions. It provides a number of health services but, importantly, also helps individuals and families to access welfare and benefits advice. That is an example of unified working across departments, with benefits advice available in a healthcare setting. As ever, the most successful programmes are those that offer a joined-up approach.

I urge the DWP to support that joined-up approach. Ideally, the DWP and the Department of Health and Social Care will agree that a CT scan is the most effective way to diagnose pneumoconiosis. I ask the Minister to commit to a review into whether her Department’s assessments for pneumoconiosis compensation can use CT scans as the default diagnostic tool. I hope the DWP will work with the Department of Health and Social Care to make that happen. It is a relatively simple change, which should not be too hard to implement but could make a real difference to thousands of former mineworkers and their families.

I understand that the UDM recently met my right hon. Friend the Member for Portsmouth North (Penny Mordaunt) when she was a Minister at the DWP, and she expressed sympathy with its campaign. I hope the new Minister will also be inclined to give the issue the immediate attention it deserves.

It is appalling that former miners are suffering unnecessarily and missing out on the compensation and access to benefits that they deserve. There is a postcode lottery and inconsistent access to CT scans. A national system led by the DWP in co-operation with the Department of Health and Social Care could deliver more effective testing and better results. That could help to cut costs, reduce waiting times and most importantly, provide the best support to individuals at the earliest opportunity.

This is not an abstract discussion. The disease affects large numbers of former miners, including people in my constituency, daily, and their families suffer too. It is a progressive disease, but if sufferers are diagnosed at an early stage, they can receive care and support quickly, and access the compensation and benefits that they deserve. We must not let our former coalminers down.

It is a pleasure to serve under your chairmanship, Mr Bailey. I congratulate my hon. Friend the Member for Mansfield (Ben Bradley) on securing this important debate. In his short time in the House, he has proven to be an extremely effective constituency MP. I also acknowledge the contribution of his neighbour, my hon. Friend the Member for Sherwood (Mark Spencer), who has focused continually on pneumoconiosis and its impact on former miners in his constituency. I am pleased to see my right hon. Friend the Member for Derbyshire Dales (Sir Patrick McLoughlin) and my hon. Friend the Member for North East Derbyshire (Lee Rowley) in the Chamber, and I thank all hon. Members who have contributed to the debate.

As my hon. Friend the Member for Mansfield said, pneumoconiosis is a serious disease that is common—too common—among former miners. It is a sad legacy of their exposure to dust, particularly coal dust, while working in the mines. I reassure him that the Government are committed to supporting former miners who have developed pneumoconiosis. Through the industrial injuries scheme, we spend £900 million a year on weekly benefits to support around 300,000 people for injuries arising from industrial accidents or from specific occupationally caused diseases..

In addition, lump sum payments are available through the Pneumoconiosis etc. (Workers’ Compensation) Act 1979. In 2016-17, more than 3,000 people received payments under the scheme totalling almost £42 million. Last month, I was pleased to demonstrate our ongoing commitment to that support by proposing measures to increase the value of lump sum awards by 3% from April. The coal industry pneumoconiosis compensation scheme—sometimes referred to as the coal workers pneumoconiosis scheme—is also available and has received 91,000 claims from mineworkers and their families since it was set up.

The hon. Member for Ashfield (Gloria De Piero) raised the issue of processing applications. I would be pleased to receive details of her concerns, because the devil is always in the detail. By reviewing those constituency cases, I can consider what more we can do to improve the process. We want to ensure that people get the compensation that they richly deserve and are entitled to.

I acknowledge the suffering of individuals with the disease. Coal workers’ pneumoconiosis, which arises from the inhalation of coal dust, is one of the most commonly occurring types of pneumoconiosis. Thankfully, many ex-miners with pneumoconiosis will have the simple type, which may not be associated with any disabling effects.

If miners continued to work underground and inhale coal dust, however, they have a higher risk of developing severe disabling effects from progressive massive fibrosis, which affects lung function and causes coughs, wheezing and shortness of breath. That is why working miners are regularly screened by X-ray to identify simple pneumoconiosis early and to remove the person from further dust exposure to prevent progressive massive fibrosis.

My hon. Friend the Member for Sherwood and UDM members met my predecessor, my right hon. Friend the Member for Portsmouth North (Penny Mordaunt), to discuss a screening programme for ex-miners using CT scanning or chest X-rays to detect pneumoconiosis. At the end of last year, I consulted with national experts and the deputy chief medical officer on all the issues raised at that meeting.

Importantly, there is a big difference between carrying out medical tests on a person with symptoms and carrying out tests on a healthy person. The symptomatic person needs to know what is wrong with them to get an accurate diagnosis so they can receive the right treatment. A healthy person undergoing a screening test believes that they are healthy, and would continue to do so, facing no risks from health interventions. Because a screening programme risks harming people’s health, we demand a high level of evidence to ensure that any screening does no harm and is of genuine overall benefit to people. We have looked at all the evidence, and the view was clearly expressed by medical experts that introducing a screening process in the UK would not meet those evidential thresholds and would not be beneficial. When pneumoconiosis is identified, often no treatment is required, and when it is severe, no specific treatment is available. There is no health benefit to identifying pneumoconiosis at an early stage once a miner has left mining.

The advice that I have been given is that the potential harms from screening for pneumoconiosis by X-ray or CT scans vastly outweigh any gains. However, I am mindful of the information that has been shared in this debate, so I think it is important that I set up a follow-up meeting to explore the matter further with my hon. Friends the Members for Mansfield and for Sherwood, with the Department of Health and Social Care, and with the national health service. Other hon. Members will be welcome to come along, because I am sure they want to know that we are leaving no stone unturned and doing the best we can for former miners.

I am aware that the Industrial Injuries Advisory Council—an independent scientific advisory body that looks at how industrial injuries disablement benefit is administered and provides advice to the Department for Work and Pensions—has discussed the use of CT scans for diagnosing pneumoconiosis, including the risks of increased radiation exposure. However, in the light of the issues raised in this debate, I will approach the council anew and ask it to reconsider the use of CT scans and give me further advice, which I will be happy to share with hon. Members.

My hon. Friend the Member for Mansfield rightly spoke about raising awareness among former miners, who too often do not come forward because they assume that having coughs and colds is just part of being a miner or former miner. There is much more that we can do to raise awareness among former miners and their families and communities, and to encourage them to come forward and speak to a GP. Much work has been done in the last couple of years on improving the care pathways, and a lot more information and training has been given to GPs, so former miners who come forward now will experience a much better quality of care and a rapid assessment, either by X-ray or by CT scan, of whether they have pneumoconiosis.

I am very grateful to hon. Members present, particularly my hon. Friend the Member for Mansfield, for raising the issue. I assure them that the Government will continue to support former miners who have pneumoconiosis—not just financially, through all the schemes I have described, but by really looking at their diagnosis and health needs.

Very helpfully and constructively, the Minister says that she is planning a meeting with hon. Members. Would she be content for the National Union of Mineworkers, which is based in my constituency, to be represented at that meeting? The NUM would have a constructive contribution to make to the process.

Of course. I am happy to work with anyone who makes a constructive contribution to ensuring that former miners are aware of the risks to their health and seek help at the earliest possible stage. We need to support them in getting not only diagnosis and treatment, but compensation, which we are proudly giving to people who suffer in this way. We must remember that miners contracted pneumoconiosis while making a vital contribution to the growth and prosperity of this country. It is only right that they receive our support when they need it most.

Question put and agreed to.

Sitting suspended.