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Mr. Bruce : The hon. Gentleman, from his known anti-European position--
Mr. Bruce : Oh, anti-EEC. Never mind ; from his anti-Labour party policy--currently, at the moment, position--
Mr. Cryer : The leadership has changed ; I have not.
Mr. Bruce : That is true ; I give the hon. Gentleman credit for that.
One would have assumed that British Rail might have had some idea of the forthcoming regulations when it ordered the trains.
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11 pmMr. Spearing : Has the hon. Gentleman heard the accusation by Mr. Peter Rayner that, alas--contrary to what had happened with previous sorts of stock--there was not sufficient testing, and that the design of the train that the hon. Gentleman mentioned, and other trains, was forced on British Rail, via the engineers, by people who perhaps did not have the right sort of experience? Is not that a possible reason for the problem?
Mr. Bruce : It is a possible reason for the problem, but the thrust of my argument is that I suspect that it was budgetary constraints that forced British Rail to design the trains to a budget specification that did not really meet the operating requirements. Basically, we have rolling stock on the cheap which, ultimately, may cost us very much more than it would have cost to design rolling stock equipped to do the job. That is the fundamental point which I am anxious to convey to the Minister.
We seek a commitment from British Rail and the Government. The argument between the two is not an edifying spectacle, and it is certainly not one which makes Conservative candidates in the north of Scotland comfortable. I do not really care whether British Rail can find an 8 per cent. rate of return, or whether the Government come up with a direct grant to make that happen. What I do care about is that given the contribution that the north of Scotland makes to exports in the United Kingdom, and from the United Kingdom, it deserves a decent rail service and it is not getting one. There is no evidence whatever that the extra money that is to be voted through tonight is likely to make the slightest bit of difference. That is my fundamental concern.
I make no apology for saying that Scotland has a unique export record. The north of Scotland in particular has an export-led economy. A substantial proportion of the output of our industries in the north of Scotland goes direct to the European Community markets. I believe that people who serve those markets are entitled to be connected properly to the European rail network. They are not being given that opportunity at present, and they are well aware of that fact. I can assure the Minister that the campaign will not abate or go away.
I have in my constituency the line from Aberdeen to Inverness, which I accept, in the simple narrow determinants of British Rail policy, is not a profitable line. But I must tell the Minister that it is an absolutely essential line, and I am absolutely sure that any economist would be able to prove conclusively that, in terms of the broad benefit to the community, that line is an economic asset. After all, we also have a road network in the north of Scotland which does not benefit from the investment offered elsewhere in the United Kingdom. As statistics that I managed to squeeze out of the Scottish Office proved, the A96 between Aberdeen and Inverness has the worst accident record per vehicle mile of any road in Scotland, and an investment commitment that is not comparable. This is not a debate about roads, but my point is that the competition between road and rail has to be seen in the light of where the investment is going. In our area, it is not going into either sector to any significant extent.
Under pressure, the director of ScotRail admitted to me that, in terms of demand, he could operate more trains between Aberdeen and Inverness. The trouble is that putting on an extra train costs money, and that is an
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investment which the director is not prepared to make because it is a step : he has to guarantee a full train. Suppose that he has one and half train loads of people. If he decides to put an extra train on and gets only 1.6 train loads, he may not make enough money to justify the investment. The fact that he is leaving 60 per cent. of the people at the station, or driving on the roads, may not be a matter of concern to him, but it is a matter of concern to the local community.People in my constituency have informed me of instances of British Rail staff going along the platform at certain stations at certain times, saying, "We advise you not to board this train as we do not consider the load is safe." Whether or not the staff had the power to do that, they were obviously genuinely concerned about the level of overcrowding.
I raised that matter with the junior Minister some time ago and his written answer was breathtaking. It boiled down to the fact that there was no evidence. The Clapham junction crash was cited in support of the argument that one was less likely to suffer serious injury when a train crashed if one was standing than if one was sitting. That is impossible to believe. We have only this month introduced the compulsory wearing of seat belts in cars. If it is not safe to sit in the rear of a car without a seat belt, how can it be safe to stand in an overcrowded train? That kind of argument does not stand up to analysis.
Far from getting extra trains, BR has decided that the way to get out of the bind is to increase fares to deter people from using its trains so that overcrowding can be reduced. Instead of adding to the service, BR has decided to deter passengers in an attempt to eliminate the overcrowding problem. There is no evidence that the Government are addressing that problem.
This is the Government's responsibility. It is no good the Minister saying that management is a matter for BR. The evidence that I have quoted shows that BR's management may be perfectly reasonable in terms of BR's objectives of solving a problem or reducing liability, but the Government must determine whether the service is being provided, whether the demand is being met and whether the wider community needs have been considered.
I regret to say that all the correspondence and contacts that I have had with Ministers show that they have washed their hands of the matter and passed the buck straight back to BR which effectively passed it back to the Government, saying that the level of support that it receives does not allow it to deal with the problem and that the criteria and operating circumstances are such that it cannot provide a viable service.
The hon. Member for Bradford, South (Mr. Cryer) referred to the Speedlink service. The implications of that closure are particularly critical for areas like the north of Scotland. I accept what the Minister says about a service with a turnover of £45 million that is losing at least £30 million or £40 million. That is an unconscionable amount of money in proportion to the total turnover. Clearly such losses cannot be sustained indefinitely. I do not have a problem with that. However, as the hon. Member for Newham, South (Mr. Spearing) said, simply to terminate the service gives the wrong signals, but it does more than that in areas like the north of Scotland. The opportunities for securing train loads is somewhat limited. It is not impossible and some operators are trying to put train
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loads together. However, they are being quoted prices that in some cases are 110 or 115 per cent. more than they were before. That is a substantial additional charge to absorb.An operator in my part of the world said that the consequence of being kicked off Speedlink would be an extra 20,000 lorries a year on the road between Durham and Aberdeen. That is not BR's responsibility, but it is a matter of considerable concern in terms of safety and efficiency of transport and travel to those who will be stuck behind those lorries.
There are some meetings of minds with the Government about whether there should be a role for the private sector. My party and I have no difficulty in being prepared to discuss with Ministers how we might expand that role to improve the service and increase efficiency. I would go further : it takes an unconscionable talent to lose the amount of money to which I have referred on that degree of turnover. No one could do worse. However, we must explore ways of attracting traffic back on to the railways instead of giving it up. Clearly, that course is not being pursued.
I am somewhat sceptical about supporting clause 1. If I can be literally boorish and speak in terms of pigs and troughs, we in the north of Scotland are pretty fed up with not getting the degree of investment that is in accordance with the economic contribution that we make to the United Kingdom economy, to our exports, and to the importance of the industries that we sustain, among which are the oil and gas industries, and the paper and whisky industries. Both the Government and British Rail have shown an utter inflexibility in accepting that we are entitled to a constructive response. People in the north of Scotland are looking, first, for the continuation of the existing rail network ; secondly, for an investment in rolling stock, in terms of both quality and quantity, that will meet the genuine demand and, thirdly, for full integrated access to the European rail network that will be opened up by the channel tunnel. We are not getting any of those things. My regret is that tonight we shall be supporting a clause that substantially increases British Rail's borrowing, but which leaves our part of Scotland continuing to be deprived of anything like the investment that we need if we are to make the contribution that we can make and are making to the national economy.
Mr. Cryer : On Second Reading, I asked the Minister whether the expenditure that is listed in clause 1 contains sufficient provision for the amount of money that British Rail will need to contribute to the Bradford electrification scheme. I am not asking, "How much?" because that has not yet been negotiated, but I should like the confirmation that the Minister probably forgot to give when he replied earlier.
I am extremely disappointed that we have to wait until the November Treasury round. As lawyers say, that shows "beyond peradventure" that the Department of Transport is tied hand and foot by the Treasury. The scheme is all ready to go ; £200,000 has been spent on the design work, but nothing can happen because of the Treasury restrictions that it must be included in the general round of expenditure. Given the proximity of a general election, the Government will be more likely to approve than to reject it.
I hope that the Minister will answer my next points because I should like them to be on the record. I refer first to his closing comments on Second Reading when he said
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that Speedlink divides the Conservative and Labour parties, as though he were proud of closing Speedlink. I shall remind him what that means. First, it means that some freight that is now carried by rail will have to be carried by road on lorries. The claim that the Conservative Government are seeking to move freight from road to rail is belied by the closure of Speedlink. Secondly, the Minister said that single wagon loads would be moving along the railways, through marshalling yards on to sidings. That is absolutely right. With the closure of Speedlink, that infrastructure will almost certainly go too. Although points, signalling equipment and rails seem perfunctory items, they have a value and, because of the financial pressures on British Rail, it will rip them out and realise their scrap value or perhaps even their transfer value for other sections of track. That will mean more costs in the future when whichever party is in government will have to come here to obtain a similar authorisation in its determination to move freight from road to rail. Single wagon traffic cannot be eliminated from British Rail, even if we have to accept that there is a cost in that over and above the bare minimum cost of transferring freight to rail.But what about the people who live in hamlets and who want to stop the 38- tonne gross vehicle weight lorries thundering through their narrow lanes? What about the children who, to get to school, have to cross the roads down which those lorries thunder? What about the town or village traffic lights where the lorries bunch up? What about the people who are trying to sleep early in the morning as the lorries start off in first gear and rev up through the gear box, with their great weights or, if they are empty, with banging rear axles that produce a cacophony? What about the growl of the diesels, the dirt, the noise and the intrusion? Everyone realises that under the Conservatives there has been an increase in heavy lorry traffic on the roads to an unconscionable and, in many places, unacceptable degree.
In some, but not all, areas, we could reduce the amount of lorry traffic by pushing that traffic from the road on to rail. The ending of Speedlink is a move away from that desirable aim. As I said, if Speedlink is removed it will become more costly and difficult to restore the service. Many of the facilities will be sold off, again under financial pressure. British Rail will be under pressure to sell the land on which the sidings stand.
11.15 pm
It is almost certain that to close down Speedlink will be a waste of public expenditure. Grants have been provided by the Government for private sidings. They were introduced by Labour, of course, because we were genuinely committed to moving freight from the road on to rail. Those grants are now wasted. The sidings will be pulled out because there will be no traffic. In some cases, the sidings will not take whole train loads because they will not be long enough to accommodate them.
If the Minister wants to go into the next general election on a transport policy of standing by the closure of Speedlink, we shall be happy to fight on it. We are committed genuinely to move freight from road to rail and to make it succeed.
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Mr. Freeman : I know that the House will want me to answer hon. Members' points extremely briefly.
The hon. Member for Newham, South (Mr. Spearing) referred to Speedlink, as did the hon. Member for Bradford, South (Mr. Cryer). British Rail expects half a million tonnes of freight to move from rail to the roads. That is equivalent to only 80 heavy lorries a day. The hon. Gentlemen can do the maths. I calculate that, at £30 million, that is a subsidy of £1,000 per lorry journey. That is not sensible. I am sure that the hon. Gentlemen would join me in wanting that money to be spent on moving the traffic that should not be thundering down the M1, M25 and M20 to the channel tunnel and, through proper investment, moving more freight via combined transport terminals.
Mr. Malcolm Bruce : This is a serious point. The transport users in my area have complained, first, that their costs have been increased by over 100 per cent. and, secondly, that the transitional arrangements are offered only for a year. Can the Minister assure us that the figures that he quoted will still be applicable at the end of that year ? Or will a lot more traffic go in after a year when no one is looking ?
Mr. Freeman : If the hon. Gentleman will write to me about a specific customer or issue, I shall look into it. I am glad that Tigerail is now shipping for west country customers. I gather that there is good news in prospect for the grain merchants and the whisky distillers in Scotland. If the hon. Gentleman will write to me with a specific example of traffic that is not being taken up by either British Rail or the private sector running freight trains on British Rail track, I shall certainly pursue it.
My hon. Friend the Member for York (Mr. Gregory) referred to property receipts. It is true that they have fallen. That is one reason why we increased the external financing limit by £400 million. We certainly want more property receipts in future years when the property market recovers.
The hon. Member for Gordon (Mr. Bruce) talked about
Edinburgh-Aberdeen electrification. We are well aware of the arguments. For InterCity we have an investment appraisal test of 8 per cent. He is right in saying that it is the same for the TGV investment in France. Exactly the same financial rate of return is required, so I am not ashamed of 8 per cent. However, for the supporting railways--I am not familiar with the line between Aberdeen and Inverness, but I imagine that it is a regional railway --as the hon. Gentleman will know, appraisal of new investment is on a cost -benefit basis. If there are non-user benefits, we shall take them into account when approving new investment.
I apologise to the hon. Member for Bradford, South for not answering his point about British Rail's contribution to West Yorkshire's electrification. I can confirm that there are unlikely to be problems. It is a relatively small direct contribution for track and vehicles, and I see no reason why British Rail would not be able to honour its commitment to a scheme which I hope will proceed in the next financial year.
Question put and agreed to .
Clause 1 ordered to stand part of the Bill .
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Clause 2
Increased limit relating to compensation
Question proposed , That the clause stand part of the Bill.
Mr. Prescott : The Minister will know that money has been used from the PSO grant for safety measures at level crossings. The Health and Safety Executive is undertaking an inquiry into problems with the doors on some inter-city trains. The Government have always said that money will be provided if that is necessary for safety reasons, so if the inquiry finds that work must be done on the doors for safety reasons, will the money be forthcoming?
Mr. Freeman : In the past financial year British Rail spent about £140 million on safety, and it is likely to spend more than £200 million on it in this financial year. When we receive the results of the HSE's investigations into the various tragic accidents, I can confirm on behalf of British Rail that if expenditure is needed to save lives, it will be given a very high priority. The Secretary of State is on his sleeper en route to Edinburgh now, and I apologise on his behalf for his absence from the final stages of the debate, but, on his behalf, I assure the hon. Gentleman that my right hon. and learned Friend will certainly look supportively on any such investment.
Mr. Gregory : There are international agreements in respect of compensation for air and sea travel, but not for rail travel. The Government have been in the forefront of extending the Athens and Warsaw conventions--
The Chairman of Ways and Means (Mr. Harold Walker) : Order. I must ask the hon. Gentleman to confine his remarks to the clause stand part debate.
Mr. Gregory : I was under the impression, Sir, that clause 2 deals with compensation. I wanted to ask my hon. Friend whether he was thinking of following the aviation and maritime examples rather than resorting to civil litigation methods. Might we have a code of practice or guidance under the clause to assist those who lose loved ones or who are injured on the railways?
Mr. Freeman : I shall certainly look into that and write to my hon. Friend.
Mr. Beith : I apologise for having had to leave the Chamber to deal with a query from an hon. Member who occupies a position of great power and influence in the building--he deals with accommodation matters.
Will the Minister look again at the public service obligation covered by the clause and at the extraordinarily illogical position in which the Government and British Rail find themselves? The Government say that they are not concerned about the service on any particular part of the network covered by the PSO ; they are concerned about whether the aggregate of service overall corresponds with the total service provided in 1988, now the base year for the public service obligation. If the only issue is how many miles are run by trains on the regional railway network, why do we have to pay this money at all? What is the point of the PSO as set out in the clause?
If the invitation is thus extended to railway managers to attract as many people as they can by putting the trains where the largest number of people are, and reducing the mileage that they have to travel and thereby reducing the costs by running twice the number of trains between close
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urban points, rather than providing, at greater expense, a service to rural areas, why should the taxpayer subsidise that? Why should we pay for that? Why should it not be subject to the same requirements of breaking even as other parts of the railway network, or be subsidised only so far as it is a means of making the infrastructure costs correspond to the level of those borne by road services? Surely the purpose of the public service obligation is to ensure that the railway system continues to provide services over a wide area of the country, particularly rural railways. The Minister must take account of what the Central Transport Consultative Committee told him, which is that in rural areas, 48 per cent. of the services were running on reduced services. That is 48 per cent. of services for which the grant under this clause will be paid. That is almost half the services. In some cases, as the committee pointed out, reductions were to the point at which closure was being avoided by the technicality of running a single train.What sense does that make? The Minister must tell BR that if it wants to close the line, it should come to him with closure proposals. It should not ask him to give it taxpayers' money so that it can spend it somewhere else, while pretending that it is running a service on one of the many lines covered by the network as it was in 1988. The Minister has not answered this question. He cannot regard the CTCC as a firebrand hooligan body that never makes sensible proposals. This is a serious criticism of the Government's attitude to the PSO.
I ask the Minister again. Why have a PSO if its purpose is not to maintain the broad totality of the rail network? Why not measure the money that he is handing out against some kind of performance indicator that examines whether the service is provided over the whole of the network? If it is his view that the 1988 network is no longer appropriate, and that some of the services should not be there at all, why is that issue not considered by closure proposals and the normal process of advice? Why does he allow BR to run services down to the point of one train in one direction a day? Ought not BR to be encouraged, where it has a network to run under a PSO, to run one that meets local needs and is marketed to maximise the support for it in that area? That is not happening. If the service were marketed, that might reduce the call on the PSO for the regional railways as a whole.
There is a crisis in regional railways, and the Minister cannot dismiss it by saying that the measure is the aggregate number of miles run. This process could go a lot further. It would not be difficult for the managements of regional railways further to concentrate all the existing rolling stock in a limited number of urban areas, where there are additional passengers to be obtained. By that means, they might attempt to meet the target to reduce the PSO money referred to in the clause. Is the Minister content to let that happen?
Mr. Freeman : There is clearly a difference between the hon. Member for Berwick-upon-Tweed (Mr. Beith) and the Government about how one fixes the PSO grant. I have made it plain that we disagree with the CTCC's view that there should be route or line specific PSO grant system. The hon. Member for Newham, South (Mr. Spearing) will remember that that was how the system was organised about 15 years ago. It was hopelessly bureaucratic and complicated. The hon. Gentleman must be saying that that is the way that he wishes to go, because that is the only
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alternative to the present system, in which the setting of the PSO is an iterative process. Perhaps I should briefly explain that. We do not set the PSO grant at the beginning of the year and say to British Rail, "Fix a service that suits that." British Rail has an obligation to run a system measured, broadly speaking, in train miles, as was provided on 1 April 1988. That gives BR the ability to change services and increase or decrease them on any particular line. 11.30 pmOn the question of marketing services and how we might change the PSO grant, I ask the hon. Gentleman to await our announcement on the way forward with privatisation, as we envisage it, and the way that it might affect regional railways. It is bound to involve a rediscussion of the whole issue of how the PSO grant--the social subsidy--is fixed and determined. I suspect that the hon. Gentleman wants a system not too dissimilar to the subsidising of rural bus services, where there is a specific subsidy to protect a specific service, including frequency. We have not reached that stage yet, but I hope that we will have an opportunity to debate that in greater detail on another occasion.
Mr. Beith : I must press the Minister. What is the point of paying millions of pounds to British Railway so that it can run X thousand train miles? What social purpose, what public good is served, by expending a subsidy on the achievement of a certain number of train miles? It is not a social purpose ; it is not an assessment that the community needs X thousand train miles.
The PSO grant was devised on the assumption that the country needed a rail network, providing trains between various places. When Fred Mulley first set out the provision, he did not say to the House, "What this country needs is for 50,000 train miles to be run every few months."
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His concept was for an overall network. It does not make sense to pay out money to BR simply to achieve a mileage target. It would make sense if it were to retain a network with a reasonable level of services. It might make sense to do it in a number of other ways. I can see logic in changing the system in various ways and I can see logic in the way that the system was being run, but I cannot see any logic in saying to the taxpayer, "We will spend your money so that a certain number of miles per year will be achieved by BR." I think that the Minister is a sensible enough economist and accountant--we both read economics in the same place at the same time--to realise that that is nonsense. It certainly does not meet the needs of those in rural areas whose services are being whittled away. I am confident of one thing--that the one train that now runs from Chatshill northwards will remain in the timetable.-- [Interruption.] It is the normal custom for an hon. Member to ask another hon. Member to give way, rather than to make the intervention first. The hon. Member for West Bromwich, East (Mr. Snape) must have pulled the signal levers early sometimes-- [Interruption.] If the hon. Gentleman is not careful, I shall recall his days with the railways at Macclesfield.That one train a day will remain in the timetable not because it is sensibly timed, not because anyone who uses it can get back from wherever he has gone, but because the only alternative is for BR to put forward closure plans. BR is dodging the requirement for closure proposals and using PSO money to run railway services where it can get the largest number of people on to them. That is not a sensible way to manage a public subsidy, and I cannot imagine that the Minister can, in any sincerity or seriousness, defend that. Question put and agreed to.
Clause 2 ordered to stand part of the Bill.
Clause 3 ordered to stand part of the Bill.
Bill reported, without amendment.
Bill read the Third time, and passed.
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Children (Deafness)
Motion made, and Question proposed, That this House do now adjourn.-- [Mr. Kirkhope.]
11.34 pm
Ms. Marjorie Mowlam (Redcar) : I am pleased to raise in this Adjournment debate the question of the early diagnosis of deaf children. It is important that there should be maximum public awareness of the problem. I hope that tonight's debate, in conjunction with last night's programme on BBC1 entitled "The Visit" by Desmond Wilcox, will help to highlight in the public mind the importance of the early diagnosis of deafness among children. First, I want to give to the House the apologies of my right hon. Friend the Member for Stoke-on-Trent, South (Mr. Ashley), a well-respected Member of the House who is also president of the Royal National Institute for the Deaf, who wishes to support my arguments tonight but is unable to be here to do so in person.
The early diagnosis of deaf children, the prescription of hearing aids, the immediate provision of education and speech training are essential if children with hearing loss are to develop communication skills and not be severely handicapped as a result of deafness. The central message of tonight's debate is the need to establish efficient screening, diagnostic and referral services and the publication of the outcome of the results. The provision of those services is an essential pre-condition for improvement in the education of deaf children.
Arguing and campaigning for the provision of those basic services is not new. The National Deaf Children's Society and the Health Visitors Association have been campaigning for years for an increase in screening and the publishing of the results. For example, in 1979, the society held a conference in association with the department of audiology at Manchester university on early diagnosis, and in 1980 it published a booklet entitled "The screening of hearing impaired children" setting out the problem and suggesting guidelines for improvement.
Later research, particularly a paper on the subject in the British Medical Journal in 1982 entitled "Auditory screening of schoolchildren--Fact or Fallacy" suggested that in one area the "school health service programme of auditory screening was ineffective and unreliable."
I know that there is some debate about that study because of the small sample involved, but the research emphasises the need for national screening and that the results should be published. I emphasise that the point of this Adjournment debate is to put high on the public agenda the need for parental awareness of the importance of the early diagnosis of deaf children. We are in no way trying to minimise the hard work and effort of the health visitors and the majority of local authorities who do all that they can to discover deafness at an early stage.
It is easy, as we have witnessed in many policy areas, particularly in the past decade, where a problem is defined and responsibility for the implementation of that policy is given--in this case to a regional health authority--for the adequate funds to perform that task not to be provided.
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The responsibility is delegated, but the funds needed to do the task properly are not available. Therefore, the attempt to achieve adequate diagnosis is left to a later stage.I make it clear that I make no criticism of health visitors or, for the main part, of the regional health authorities. I have raised the subject on the Adjournment at the wish of a family in Redcar, in my constituency. In that, there is no criticism of Cleveland county council, which has one of the best records in the United Kingdom for educational facilities for disadvantaged groups.
What primarily concerns me is that much of the research that I have read and my own experience with my constituents is that there are many problems relating to individual children which cannot be ignored. Despite the hard work carried out by many individuals, it is still clear that all is not well and that many hearing-impaired children are being diagnosed far later than they could be. The National Deaf Children's Society, as the only national charity specially concerned with deaf children and their families, knows better than anyone the extent of the problem. It warns of the far higher incidence of hearing loss in children than we are aware of which remains undetected and untreated. Figures are difficult to come by, but, based on the survey research available, a conservative estimate of more than 500,000 children is not unreasonable. As I am sure the Minister is aware, the main cause of the hearing problems is glue ear. The condition is thought to be caused by a malfunction of the Eustachian tubes which results in a build-up of fluid in the middle ear. In many children, the condition resolves itself, but if it is prolonged it can cause serious learning difficulties. About one in three children has glue ear, which is the equivalent of saying that for one in three children listening is experienced as if they have their head in a bucket of water. That is the impact of having glue ear. What concerns me is that late diagnosis means that those children are handicapped in terms of their learning ability and they work at a disadvantage that will put them back as their learning experience goes on in school. That concern makes early diagnosis essential.
The existence of a hearing problem should not, if awareness is high enough, be difficult for parents or teachers to detect. As we all know, if children have a hearing problem, they may appear listless, they may be inattentive in class, they may seem to be disobedient or wilfully misunderstand and their behaviour and responses may be erratic. Speech difficulties are another good indicator, as are reading problems, especially those associated with phonetics. General learning difficulties can arise from prolonged hearing loss. Asking for this Adjournment debate was the result of the hard work and persistent campaigning of one of my constituents in Redcar, Kathy Robinson. It is difficult to pay tribute to her work and she would not like it. She has worked hard for many years to publicise the plight of deaf children. She has especially campaigned for simple and straightforward improvements in the diagnosis of deafness among young children. I know from talking to her how frustrated she gets because what she asks for is so minor. However, in some senses, that is only one of the many frustrations that she has gone through in her life. The first frustration was the late diagnosis of Sarah, her first child, as deaf, followed 18 months later by the late diagnosis of her second child, Joanne. The learning difficulties compounded by late diagnosis are all too apparent to
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anyone who stops to think. The fact that months of learning have been stopped by people not being aware that the children were deaf has caused much frustration to Kathy Robinson and her husband Mick, and to other parents.The best way to put the matter is in Kathy Robinson's own words. She says :
"Sarah was diagnosed as deaf at 2 . She was almost 3 before she knew she had a name or that people had names. She was a nobody in a world of other nobodies. In time she began to recognise that the sounds she heard, Eh-Ah, meant her, Sarah. It was a long time to wait three years. And what was it like for her all that time, and afterwards as well--when she couldn't say she had a pain in her tummy because she didn't know it was a pain or that she had a tummy? Once she was smacked for not coming when she was called. Why didn't they know she couldn't hear? Because she was bright and alert-- and her record said hearing normal."
We must think not only of the frustrations experienced by parents but of that felt by the deaf children themselves. The Robinson family got through those early days, tough and traumatic though they were, by persuading one of the local schools, Sacred Heart--thanks to Cleveland health authority-- to accept Joanne and Sarah as pupils. That meant that they were part of the community from an early age. Kathy Robinson has also worked hard to publicise the plight of deaf children. Her book "Children of Silence" was published by Penguin. She says that it took her seven years to write, along with 16 rejections, but she was determined that others should know about the world of childhood deafness. The family's struggles were portrayed very well on the television last night.
The family have not given up, although Joanne and Sarah are now moving on to higher education and, in a sense, beginning to grow apart from them. Kathy is now campaigning to raise £9,700 to introduce a deaf tutor into a hearing school for five to seven-year-olds. She is also becoming something of a campaigner on behalf of sign language. I am sure that she will persuade me to take it up soon : I learnt the basics as a girl guide, and I think that the pressure is now on for us to learn much more than that. Yes, children's hearing is tested when they are approximately eight months old ; yes, it is tested again when they are at primary school. But the years lost in between are years in which a deaf child, through late diagnosis, may lose many years of educational advantage in the future. The voluntary sector is doing an excellent job in trying to make the public aware of the issues : The National Deaf Children's Society now provides postcards and offers a good deal of information, as does the General Practitioners Council for the benefit of doctors. Individuals such as Kathy Robinson and her family continue to campaign. Now, however, it is time for the Government to take some responsibility and to provide a greater chance of early diagnosis of deafness in young children.
We have two simple requests. First, we want a national policy, recognised in law, that would provide a standardised approach to screening. Records of screening should be available at national level, the results being monitored and published annually to show the percentage of children tested, referred for diagnostic assessment and shown to have a hearing loss needing medical and/or educational treatment. That would give us the picture
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nationally : it would show us what is being done, and would allow us to compare one authority or area with another.Secondly, we ask for the introduction of compulsory training for all GPs who undertake screening as part of child surveillance. As we all know, GPs work very hard, often under considerable strain, and the combination of work load and time constraints means that they do not always have the chance to listen to patients' worries, as they would like. We therefore ask for the option of standard procedures for referral or open referral for patients. The need for patients to self-refer, or have additional referral, is very great : tragically, 41 per cent. of deaf children pass their first hearing tests. That is what worries parents such as the Robinsons so much.
I have cited the Robinsons as an example of families who fight and conquer the problems of deafness. Now Sarah and Joanne are making their own way in the world, despite the handicap that no one can see. In a sense, that will become marginalised if the basic principles and approaches to the condition do not change. The changes that I have outlined are simple, the costs would be minimal, and the result of a correct early diagnosis of deafness is so crucial to a child's later ability to learn and participate in society that I hope that the Government will consider implementing my proposals.
11.49 pm
The Parliamentary Under-Secretary of State for Health (Mr. Stephen Dorrell) : The hon. Member for Redcar (Ms. Mowlam) follows her predecessor as Member of Parliament for Redcar in raising this matter on the Adjournment of the House. I think that Mr. Tinn raised it on three separate occasions. Members of Parliament for Redcar traditionally draw attention to a matter that undoubtedly should be an important national health service priority, in terms of its responsibility for child health.
Earlier today I heard about the experience of a grandmother whose grandchild had suffered a hearing loss that had not been diagnosed as quickly as it ought to have been, with the result that the child's mother thought that her child was, in her own words, being defiant and that she would have difficulty in handling the child. The fact was, however, that the child's hearing difficulty had not been diagnosed soon enough for the parents and those outside the immediate family to take remedial action. The hon. Lady was right to stress the importance of ensuring that there is effective screening for deafness in young children at the earliest possible time. That commitment is not disputed. We entirely endorse the hon. Lady's commitment to that objective and we have taken steps towards achieving it.
I hope that I shall not appear to be complacent if I refer to measures that we have taken, but that is not to suggest that everything that should be done has already been done. Further action can be taken in order to achieve that objective, but the earliest possible diagnosis of deafness in children is a shared objective. Allowance must be made for it and treatment must be offered that results in the child suffering no long-term effects. Delayed diagnosis can result in long-term damage to a child's hearing. There is a definite clinical reason for early diagnosis. The commitment, I repeat, is clear and is not in dispute.
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It is legitimate for me to draw attention to an element that we have included in the new general practitioner contract that has been in operation for 15 months. We took steps to extend the involvement of GPs in child health surveillance, in the belief that, through their regular contacts with the parents, they are particularly well placed to pick up concern about children's health. The new contract, introduced in April 1990, provides for a special payment to be made to eligible GPs to undertake child health surveillance work, in collaboration with health visitors. Eligibility is determined by training and by the experience of the GP in child health. That answers, at least in part, one of the hon. Lady's points. The involvement of GPs in child health surveillance does not come just like that ; GPs have to demonstrate competence before they are eligible for the specific payment for child health surveillance work. Therefore, it is a reflection of a GP's competence in child health surveillance. The new arrangements have led to the development of additional training opportunities for GPs to meet precisely the point that the hon. Lady has rightly identified.So far, some 70 per cent. of GPs within the NHS have been accepted as eligible to undertake child health surveillance because they have demonstrated the necessary competence. To become accredited, many of those doctors will have undertaken updating training, including training in screening for hearing impairments. As a result, many families will now have a choice between the child health clinic and their GP when arranging child health surveillance. Some may find the clinic more convenient, but others may prefer the continuity and familiarity that comes with the established contact between the family and its general practitioner. That is one thing that we have done which demonstrates our commitment to efficient screening. Another important idea, which perhaps goes some way to meet the hon. Member for Redcar's proper concern to ensure that the issue is constantly to the fore in not only the child's early years and at school but in the interim years, is the development of parent-held child health records. In that way, if the family or the child are seeing health professionals, there is a better chance that the complete health record and the results of every visit to a surveillance clinic or health professional are available. Record keeping is a vital part of child health surveillance. Often, physical or sensory impairments are revealed only through close monitoring of the child's development over a period of time. However, surveillance programmes are vulnerable to interruptions due to missed appointments or the family moving from one district to another and the records not moving as fast as the family. To underline the importance of records and, equally importantly, to involve the parents in the surveillance work and the preparation of records, there have been a number of local initiatives to introduce parent-held child health records. Recently, a working party led by the British Paediatric Association reviewed the local initiatives and produced a model personal child health record. The record requires the parents to record key events in the child's development--for example, when the child says its first understandable word--and any concerns that they may have about the child's health. The record also contains health promotion advice on subjects such as feeding, immunisation and accident prevention.
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The house visitor or doctor uses the record as a background to their examination of the child and enters the results of any tests they undertake as well as general observations about the child's development. The research shows that parents and health professionals welcome the use of those records and that they contribute to better co- operation and understanding of the diagnosis of various childhood disabilities. It uses the fact that parents have far more intense exposure to the child and may be aware of problems that they cannot link to a correct clinical diagnosis. However, those incidents can be entered into the child's record so that the health professional can make the necessary linkages.It is also important to recognise that early diagnosis of deafness is not necessarily as easy as it might sound. It is not simply a matter of attending a clinic and seeing whether the child responds to a particular noise or test. Hearing ability will not be the same from one day to another, particularly in the case of children suffering from glue ear, who, as the hon. Member for Redcar rightly said, make up the majority of children suffering from deafness. To some extent, it is a fluctuating condition. Therefore, parental involvement and surveillance over a long period should not be underestimated if we are to have an effective means of tackling the problem.
The hon. Member for Redcar also asked about the national commitment, which she said that we should write into law, to early diagnosis and giving practical effect to that and the collection of statistics. I recognise that on the collection of effective epidemiological information on a nationwide basis we have some way to go before we can produce figures with which we can all be happy and which record accurately and at the earliest possible moment the incidence of deafness in children. The purchaser obligation under the new management structures of the health service places on district managers the obligation that the hon. Lady sought to ensure that priorities are recognised and followed through.
One of the specific issues that must be addressed in all child surveillance work is the link between child surveillance teams in community health departments and in primary health care. I am prone to ask about the difference between community health and primary health. I have asked that question more often than I have received an answer that I found convincing. I am more convinced that it is a distinction without a difference. In future, one of the priorities of health service managers will be to ensure more effective delivery of the old aspiration of a seamless service between the primary health system, which is led by GPs, and the community system, which is the responsibility of the district health authority. By far the biggest difference between the systems is that they are run by two different bureaucracies.
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