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Mr. Deputy Speaker (Mr. Michael Lord): Order. I gently remind the hon. Lady that she should address the Chair.
Ms King: Thank you for that instruction, Mr. Deputy Speaker.
I should be most grateful to the Department of Health if it would look at the problems that exist between its provision for children and the provision made available by LEAs so that children in areas such as Tower Hamlets, where there are multiple indices of deprivation, can receive the speech and language therapy that will give them a fair chance in life.
2.10 pm
The Minister of State, Department of Health (Mr. John Denham): I congratulate my hon. Friend the Member for Bethnal Green and Bow (Ms King) on securing this debate on the important issue of speech and language therapy services.
More than 1 million children in this country have speech and language difficulties, and adults who had no difficulties at an early age may encounter problems later in life, after strokes or other accidents. We think of speech and language therapists as working mainly with children, and it is important that intervention occurs as soon as a problem is identified, but we should not forget that older people may also need help.
Speech and language therapists work with people of all ages who have communication difficulties, and children and adults with eating and drinking problems. Children make up more than 70 per cent. of their work load, as there are about 1.2 million children with speech and language difficulties in the United Kingdom.
There are many reasons why children need speech and language therapy. Speech and language delay is one of the commonest forms of developmental delay. Some children need help because of the limited opportunities in their home environment. The links between deprivation and delayed development are well documented. Some children are born with difficulties that require the attention of a speech and language therapist, such as cerebral palsy, a hearing impairment, learning disability or cleft palate.
The therapists also work with disabled babies and children who have difficulties in sucking, chewing and swallowing and those who, through accident or illness, have acquired communication or eating and drinking problems. Children with autistic spectrum disorder and specific speech and language disorder require intensive help. Other children need assistance because of delayed or disordered articulation or speech patterns, or problems with fluency, such as stammering.
The demand for speech and language therapy has grown because of a combination of factors. The therapists educate and train other professionals working with children and adults who may have speech and language difficulties, and public awareness of their skills is also
greater than it once was, so referrals to them have increased and are often made earlier in the child's life or, in the case of adults, sooner after the onset of their illness or condition.Speech and language therapists increasingly work in a preventive capacity in new inter-agency initiatives, such as sure start and on track, and their role in the school setting has expanded in both mainstream and specialist schools. My hon. Friend referred to the report of the working group set up as a joint initiative by my Department and the Department for Education and Employment. The group has recommended some constructive ways of developing the links between education and health services, to improve provision for the children who need it. She will know that Tower Hamlets is among the local education authorities already receiving direct support from the DFEE's standards fund. All English LEAs will be able to use their standards fund allocation next year to enhance speech and language therapy.
A research project was carried out under the aegis of the working group, under the direction of Dr. James Law. It provided a comprehensive overview of the nature and extent of speech and language therapy in England and Wales, identifying the factors that promote effective provision. The key messages were that there was a relatively healthy level of collaboration between local education authorities and speech and language therapy services in NHS trusts and that about 60 per cent. of the children receiving the services in primary and secondary schools have a statement of special educational needs.
The research also uncovered significant variations in the provision across England and Wales, in the first instance attributable to issues within the speech and language therapy service, including problems with recruiting and retaining staff and variations in case load. I shall come in a moment to the measures that can be taken to tackle the shortage of therapists.
The effectiveness of the therapy has been demonstrated in various ways, which has led to the professional input of the therapists being more valued, again adding to the pressure on the service. Some children also now present with more complex health needs, as a consequence of improvements and changes in medical technology that have substantially improved the life chances of premature and low-birthweight babies. Many of those children experience a degree of functional impairment in childhood and beyond, and some are severely disabled with very complex health needs. It is thus likely that a speech and language therapist will be a member of the multidisciplinary team that those children require.
In Tower Hamlets--a borough with high levels of deprivation--we would anticipate a high incidence of children with speech and language difficulties. There is also a large black and minority ethnic community, which poses additional challenges to the speech and language therapists working in the borough. Speech and language therapy with bilingual children must involve interpreters and, where possible, co-workers fluent in the children's languages and familiar with their culture. At best, the speech and language therapist would be competent in their first language.
The number of therapists currently from black and ethnic minority communities is small, so the Royal College of Speech and Language Therapists will draw up a recruitment and retention strategy to tackle the issue. Work with bilingual children is, of necessity, consuming of time and resources.
I want to discuss some of the measures that can be taken locally and nationally to deal with some of the issues that my hon. Friend has raised. It is fair for me to point out that the problems that she described did not begin in the past two or three years. The failure of the previous Administration to invest sufficiently in training places led to the shortage of speech and language therapists. Although we are expanding the training capacity, it is a skilled and professional job. I am afraid that it will take time to put right the years of under-investment in this part of the national health service, as in others.
It is right and proper that decisions on local services are taken locally. We want to encourage everyone who has an interest in improving health--patients and carers, organisations representing them and the local community in general--to have an input at local level to make the changes that make a real difference to people's lives. Vulnerable people are less likely to demand provision of services. We ask all with an interest in the subject to make sure that there are programmes to improve the health of the local population.
As a Government, we have placed a requirement on every health authority to lead the local development of a health improvement programme--HIMP. The first HIMPs came into effect in April 1999. They have developed to cover a three-year rolling time frame, with part of the programme reviewed in depth each year. They articulate national priorities in a local context.
I understand that the HIMP for the East London and the City health authority deals with learning disabilities and better services for vulnerable people. There may be scope to add more about speech and language therapy specifically. We would expect HIMPs to refer to investment in speech and language therapy services if there is a local need.
I reassure my hon. Friend about her constituents' fears. Not all local priorities are set by general practitioners. It is true that we have devolved considerable responsibility for commissioning the detail of services to primary care groups and primary care trusts, but the commissioning of services must be carried out in line with the HIMP set locally. That is a process in which all the stakeholders participate and to which they must be signed up. The partners involved in drawing up a HIMP include the NHS trust, the primary care trust and the local authority--and not just its social services department. The process also involves the voluntary sector and local communities.
I expect the focus of the development of a local strategy to improve learning disability services, including speech and language therapy, to be the HIMP process. I am sure that my hon. Friend will take a close interest in that strategic process, which creates the ability to tackle local needs for services such as speech therapy if they are judged to be a priority locally. With such services, it is not possible to prescribe uniform provision nationally, because the extent and nature of local needs and existing local provision can vary widely.
When there is a health action zone, it should act as a catalyst for organisations and the local community to work together in cutting across geographical and structural barriers to speed up the process of improving health. I know that in east London the HIMP draws heavily on the work of the health action zone partnership. Improving access to services is an important priority for the health action zone and one of its early achievements can be seen in Newham where, working with Newham community trust and social services, a speech and language service is now up and running at the Shrewsbury family resource centre. That includes a drop-in service to provide direct access to speech therapy staff.
We are committed to sensible and, I hope, more dynamic ways of working for people who are more vulnerable than most. The successful development and implementation of HIMPs is critical if the goals of reducing inequality, improving health and delivering better health and social care are to be achieved. We want to secure equal opportunity of access for people who are at risk. We have made it clear that the health care needs of populations, including the impact of deprivation, will be a driving force in determining where cash goes. For example, the East London and the City health authority has received one of the best financial allocations for 1999-2000 and for 2000-01--in percentage terms, the second highest increase in England.
Although there are many pressures on the NHS, the unprecedented increase in investment that it is enjoying enables us to be more confident that, as the staff are trained and become available, we will be able to address the issues raised by my hon. Friend. Reducing inequalities will be a key criterion for allocating NHS resources to different parts of the country by 2003-04. The NHS reiterates our commitment to that.
The White Paper "Saving Lives: Our Healthier Nation" required local targets to be set for reducing health inequalities. The NHS plan makes it clear that for the first time local targets will be reinforced by the creation of national health inequalities targets to narrow the health gap in childhood and throughout life between socio-economic groups and between the most deprived groups and the rest of the country.
We need to ensure that trained staff are available to fill funded posts. The problem in many parts of the health service is increasingly not so much the lack of funding for those posts but the lack of people to fill them. The Department of Health and the NHS are now responsible
for determining the number of training places in speech therapy. Responsibility and funding for that was transferred from the Department for Education and Employment in 1998. Since then, there has been an increase of 15 per cent. in training commissions. A further £21 million will be spent in the current financial year to provide additional training places for up to 490 key professionals. That figure includes funding to commission extra speech and language therapist training places. This year, we have already increased and funded 50 places over and above the NHS's commissions.Increases in therapy and other key health professionals' training places have recently been announced in the NHS plan and there will be 4,450 more places by 2004. Work is in hand to determine how many additional speech and language therapy training places will be commissioned as a result, taking account of increased demand arising from national service frameworks and other Government initiatives. Consultants have been commissioned to carry out a labour market analysis of speech and language therapists. The results of that project will be used to inform recommendations on future commissioning numbers.
We do not want children or older people to wait to receive the services that they need. My hon. Friend will be aware of the targets on waiting times that we have set in the NHS plan. Our ultimate objective, provided we can recruit the extra staff and the NHS makes the necessary reforms, is to have a maximum three-month wait for any stage of treatment by the end of 2008. My hon. Friend will know that the NHS plan sets interim targets across the service that will lead to improvements. We have enabled people to influence the provision of local services and it is important that they exercise that capacity. We are determined to make the new systems for improving health care work in practice.
My hon. Friend made specific points about the relationship between health funding and school standards funding. I will draw them to the attention of appropriate colleagues to see whether more needs to be done. I hope she will recognise that we acknowledge the issues that she and her constituents face, but we have set in place the resources, extra training and new investment that is needed to enable us to deliver the NHS plan.
- Adjourned accordingly at twenty-four minutes past Two o'clock.
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