Westminster Hall
Tuesday 28 November 2006
[Miss Anne Begg in the Chair]
Speech and Language Difficulties (Education)
Motion made, and Question proposed, That the sitting be now adjourned.—[Liz Blackman.]
9.30 am
John Bercow (Buckingham) (Con): I welcome the opportunity to initiate this debate on the education of children with speech and language difficulties. I begin by declaring an interest as the father of Oliver, three years old next week, who earlier this year was diagnosed as suffering from severe verbal dyspraxia.
Last week, at its inaugural meeting, I had the privilege of being elected chairman of the all-party group on speech and language difficulties. It will be immeasurably boosted by the involvement as officers of the noble Lord Ramsbotham, the former chief inspector of prisons, the right hon. Member for Rother Valley (Mr. Barron), the Chairman of the Health Committee, and the hon. Member for Stourbridge (Lynda Waltho).
It is peculiarly fortuitous for me to have the chance this week to air the issues involved in seeking effectively to educate children with speech and language difficulties. It may benefit right hon. and hon. Members if I set the scene or establish the background of what we are, properly, to debate today.
What is the situation as far as children with speech, language and communication difficulties are concerned? Somewhere between 5 and 8 per cent. of pre-school children suffer from such difficulties; it is estimated that the figure is nearer 10 per cent. among children of primary school age. It is noteworthy that there is something of a continuum of people suffering from speech, language and communication disorders. At one end, there are those who suffer only from mild speech or language delay; at the other, there are children, best described as non-verbal, who depend on augmentative communication and the use of symbols to be able to communicate at all.
Something in the order of one in 500 children suffers from an impairment so severe that it is likely to be not transient but enduring, significant and potentially insuperable. It is the responsibility, among others, of the speech and language therapist to deal with all those different conditions. No one in this Chamber should underestimate the significance, extent or effectiveness of the potential role of the speech and language therapist. That person is responsible for screening children, for assessing children, for the planning of services for children, for the delivery of services for children and for the management of individual children’s cases. That person is responsible for consultation with external providers and other agencies, which requires him or her to develop a certain political sophistication in addition to his or her other
qualities. At his or her best, that person should be responsible for communicating with parents—talking to them, listening to them, respecting their views and treating them genuinely, sincerely, meaningfully, practically and enduringly as partners.
The Minister and other right hon. and hon. Members with an interest in this debate will be acutely aware of the significance of early intervention in addressing the impairments from which children suffer. That can make a crucial difference to whether the child’s problems are overcome or minimised. If intervention takes place early in a child’s life, the impact of their impairment on their learning, attainment and subsequent employability can be minimised. In that desirable scenario, there is a great saving to the public purse of the spending that would have been made necessary by subsequent, delayed and inevitably much more expensive interventions.
The thrust of the research shows that if such intervention starts at an early age—certainly at pre-school level—it has a discernible impact on the child’s other skills. Put simply, if a child’s speech, language or communication impairments have been effectively addressed by the time they are five and a half, the chances are that they will be able to read and spell normally, communicate relatively effectively and avoid suffering some of the disadvantages that would otherwise flow. If, on the other hand, meaningful intervention takes place only when they are eight, or if it has not taken place by then, there is a real danger that the problems will become endemic, that the interventions required will be more numerous or intense and that the cost will be greater.
Unquestionably, learning intervention can be effective, but we have to be clear that it should be intensive. It is not possible—or even, in this debate, desirable—precisely to specify what constitutes “intensive”. Suffice it to say that it can mean specialist help in very small settings, or even a one-to-one environment, with a specialist providing help, nurture, encouragement and assistance. That might have to take place for hours a day, several days a week. There is a short-term cost; I do not in any sense seek to burke the reality that if one proposes intervention and wants to be effective, there is no point in half measures. One has to go the whole hog and make substantial investment at the outset on the basis that it will yield a benefit and avoid other costs later.
The corollary of the benefits of early intervention is that there are real dangers to late intervention. If intervention takes place only very late, the dangers are manifold and real. There is a danger of emotional and psychological difficulties, of behavioural problems, of lower educational attainment, of persistent communication handicap, of poorer employment prospects, of significant challenges to mental health and even of a regrettable descent into criminality. Those are the consequences with which we will have to reckon if, as a society, we make the judgment that we are not prepared to invest significantly up front because the issue does not have the political attractiveness to warrant it. We shall then have to bear consequences that people of good will in all parties will come to rue almost as much as the direct victims themselves.
There is another danger or downside to a failure to intervene early and a belated judgment—sometimes, even then, only half-heartedly—to intervene. There is a real economic cost to this country. As right hon. and hon. Members, we have to open our eyes to the reality that is staring us in the face. Research by the charity I CAN calculates that £26 billion is lost to this nation’s economy as a consequence of late intervention.
In Milton Keynes, Buckinghamshire and Oxfordshire alone, an area that incorporates my Buckingham constituency, it is calculated that there are currently no fewer than 2,063 16 to 18-year-olds who are designated as NEETs—not in education, employment or training. It is postulated by those who have undertaken research that approximately 1,000 of those 16 to 18-year-olds are NEET predominantly or exclusively as a consequence of speech, language and communication impairments that society has failed to address. There is a cost as a result of each individual so affected of £97,000.
Yes, there is a short-term cost in getting involved, in making judgments, in plumping for specialist expertise, in making resources available, and in applying one’s set of values but also one’s intellect to the challenge, but there is a far greater cost to the individual, to families and to society as a whole if we make a judgment, whether by commission, omission, deliberate will or simply a sort of moral carelessness that we are not prepared to deal with such matters because they are insufficiently important or salient in electoral terminology.
I would like to discuss some of the issues with which people who are interested in this field across political parties and in the wider public are presently concerned. Let me give an illustration of some of the things that come on to my agenda as a parent grappling with such matters or by virtue of direct representation from my constituents in Buckingham.
I hope that the Minister will take this in the spirit in which I intend it—I mean it most sincerely. First, there is a lottery in the public provision of services for children with speech, language and communication impairments. Services very much depend on where one lives, with which local education authority they deal, whether a personal relationship is established, and whether the people in charge are genuinely interested in the views, anxieties, concerns and recommendations of parents, or whether they pay lip service, if that, to the concept.
To those who endlessly preach the mantra of localism—there are people in that category in all parties—I offer a rider, or valid caveat, that it is not good enough simply to offload responsibility to the local level. Still less is it good enough to say that if people do not like the services that are provided, if they feel that they are unsatisfactory and there has been a failure to perform, they can make a conscious judgment to remove the offending local education authority at the subsequent municipal election. With great respect, that is a politically convenient ruse, but it represents a triumph of theory over the evidence of demonstrable practice.
The truth is that, although such matters are immensely important, the political purchasing power of the speech, language and communication difficulty
class of voters is very limited indeed. Most people are not aware of their day-to-day concerns because they are not affected. They would probably be sympathetic to the affected class if they knew more about it, but they do not. The idea that, in the main, such issues will influence the result of a local authority election across a whole borough or district—still less across a county—is, frankly, fanciful.
The lottery of provision is a serious problem. I invite the Minister, who is an immensely capable but also an enormously reasonable man, to reflect carefully on the verdict in the recent report of the Education and Skills Committee, which called for a national lead on a central strategy, and for a sense of purpose and direction.
Many hon. Members who took part in the debate on 26 October, which was ably contributed to by the hon. Member for Mid-Dorset and North Poole (Annette Brooke), felt that the Government’s response was, to put it mildly, operating below the level of events. As I believe I said at the time, the document was poorly composed. Clearly, it was put together by one of those clever officials who knows everything and nothing, and who thought it slightly impolite and cheeky of mere amateur, uninformed, interfering politicians to second-guess the wise judgments at which he or she had arrived.
Please, Minister, think again. The document was badly written. It suffered from statisticitis. It was all about inputs and it was highly defensive. It said that there was not much of a problem, and that where there was one, it was being dealt with anyway. It simply did not reflect the preponderance of opinion across the piece among my constituents and those of other right hon. and hon. Members. Their experience is that there is something rotten in the state of Denmark. That does not mean that good work is not being done by professionals, but there are real problems. I appeal to this high-flying, widely popular Minister to take account of those representations and to seek effectively and constructively to respond to them.
A second relevant concern in respect of speech and language therapists is that we are discussing a shortage profession. At present, some 7,000 therapists are on the books. It is estimated that there is a shortfall of 2,283, which, on current work force planning assumptions, will be met only by 2013. Many commentators believe, in the light of current widespread and savage PCT cuts across the country, that that prognosis is likely to err on the side of optimism rather than of pessimism. The shortfall is serious indeed.
The evidence is reinforced and compounded by a recent survey by the Royal College of Speech and Language Therapists, which found that 78 per cent. of managers questioned said that their budgets were being frozen. Fifty per cent. said that they would be obliged to provide an inferior service or to conclude that the service was altogether non-viable. Perhaps most damning of all, 80 per cent. of those who had come out of college and qualified as speech and language therapists could not get jobs. Out of 700, only 140 were able to get jobs. This nation must be mad—literally berserk—to contemplate with anything other than horror a situation in which there is a demonstrable, growing, intense and urgent demand for the provision of speech, language and communication services, yet
people go through the colleges, get qualifications and demonstrate their commitment to serve, but are denied the opportunity to do so. Something is seriously wrong.
A related concern in respect of speech and language services is an example upon which I confess I have zealously focused over the past seven months. I make no apology for that, as it is a practical, identifiable and factual case. The Nuffield speech and language unit is a renowned centre of excellence for the treatment of children with severe verbal dyspraxia. There is nothing like it anywhere in the country. It happens to be based in Ealing, but, for historically anomalous reasons with which I will not trouble right hon. and hon. Members, it falls within the auspices of the Royal Free Hampstead NHS trust. “Every Child Matters” contains 32 references to the importance of specialist provision, and “Removing Barriers to Achievement”, which was published in 2004, contains 68 such references.
The Government are on the record as saying that special schools should not be closed nor the number of places in such institutions reduced unless and until high-quality, local alternative provision is available. I have to say to the Minister that that simply is not the case in respect of the children who will be turfed out of the Nuffield speech and language unit. I have been disgusted to the point of virtual sickness—I use strong language, but I do so advisedly—by the attitude of the Royal Free Hampstead NHS trust. The part-time chair and full-time chief executive of that trust have conducted the phoney consultation process in respect of that valued facility with an arrogance, incompetence and insensitivity of a kind to which I have seen no equal in the 20 years since I entered public life. It appals me that, simply in the name of fobbing it off on to someone else and getting on with the important business of cutting their deficit and seeking foundation status, they are prepared knowingly and probably irrevocably to damage the educational prospects and life chances of some of the most vulnerable children in our community.
I would welcome it if, in addition to the discussions that I have had with the Department of Health and the Secretary of State for Health on the subject, there was some indication from the Department for Education and Skills that it was prepared to engage with the issue. I have not yet seen it. That leads me to the related concern of joint commissioning of services, which was provided for in the Health Act 1999 and talked about in the Children Act 2004. It was supposed to happen, and it was very much the established orthodoxy and favoured buzz word on the lips of Ministers, but the commitment seems always to founder on the rock of financial shortfall.
I want simply to put a series of propositions to the Minister and to colleagues about the sorts of things that ought to happen and the types of problems that require to be addressed. First, there should be a speech and language therapist as a matter of course in every multidisciplinary team assessing the feeding and swallowing needs of disabled children. Secondly, there should be a speech and language therapist in interdisciplinary teams that are responsible for the provision of family services, notably those of Sure Start. Thirdly, there should be a speech and language therapist attached to every mainstream school that is
committed to an inclusive environment and the best possible provision for children with speech, language and communication difficulties.
I believe that we need far more explicitly to tackle the problems that arise from the failure to deliver joint commissioning. We have an opportunity to confirm a commitment to that with the advent of the new children’s trusts. There is a great opportunity to say that it will happen, the obstacles will be removed, the financial rows will not continue and the services will be delivered. I find it extraordinary that a scoping study into desirable practice in speech and language provision, the responsibility of Canterbury Christ Church university, has still not appeared. In a written answer on 27 February, the then Under-Secretary of State for Education and Skills, the hon. Member for Liverpool, Garston (Maria Eagle), told a parliamentary colleague that the findings should be available to the Department in August 2006. On 13 September, the Under-Secretary of State for Education and Skills, the hon. Member for Corby (Phil Hope), told another parliamentary colleague that the report from that university study should be available in January. What is happening? If this were operational in the private sector, heads would roll, people would be dismissed, individuals would be called to account and there would be a significant public scandal, yet it simply is not happening.
I believe that these matters need to be dealt with urgently and firmly. I believe, too, that we need to attach the greatest possible importance and urgency to delivering more specialist provision within the field. I find it quite disappointing and not a little alarming that on pages 18 and 19 of the “National Audit of Support, Services and Provision for Children with Low Incidence Needs”, undertaken on behalf of the Department for Education and Skills, categories are listed for the project specification—multi-sensory impairments, severe visual impairments, severe/profound hearing impairment, profound and multiple learning difficulties, severe autistic spectrum disorders and severe behavioural, emotional and social difficulties—and nowhere in that list do we find reference to speech, language and communication difficulties or disorders. There is something wrong there, even if the authors—clever chaps and chappesses, without doubt—argue that it is in the ether and implicit in the work undertaken. It is not up front or explicit, and it is not acknowledged. There are people out there—I have met a good many of them over the past six months—who, as parents, providers or charitable representatives, are at the end of their tether.
We need, as Ofsted has said and the Audit Commission has periodically acknowledged, greater focus on the provision of specialists. We need data to be kept by local education authorities. It beggars belief that a lot of them do not even know how many people suffer, the extent of the suffering or the nature of the provision, its extent or its outcome. People are treated simply as features of a production process that is mechanistic and the quality output of which is a secondary consideration if it is a consideration at all.
We need major investment in this field, we have to be prepared to commit to it, and we need a different mindset. We have to relegate the old bureaucratic arrogance to the back seat of the room or, better still,
to kick that attitude out of the room altogether. If I can put that graphically, we need to bring from the front of Ministers’ minds on to the table the best thoughts that they have about how to improve services.
I am incredibly grateful to the Royal College of Speech and Language Therapists, to I CAN and, perhaps above all, to my friend Linda Lascelles, who runs the charity AFASIC—the Association for All Speech Impaired Children—for the briefings that they have provided for this debate. There could hardly be a more important subject related to the needs of vulnerable children than this. As I say, I both like and respect the Minister and look forward to his response. I hope he will recognise that I have raised this matter conscientiously in a public-spirited fashion and not for the pursuit of party advantage. I want my party to get it right, and I have a hunch that my right hon. Friend the Member for Witney (Mr. Cameron) and my hon. Friends the Members for South Holland and The Deepings (Mr. Hayes) and for Bognor Regis and Littlehampton (Mr. Gibb) will do just that. Above all, what I am interested in is providing the best service to children, and I think that that is a characteristic that unites every hon. Member in this Chamber.
Miss Anne Begg (in the Chair): I want to move to the Front-Bench speakers at 10.30 am, which means that there are now 32 minutes for Back-Bench speakers.
9.58 am
Andrew Selous (South-West Bedfordshire) (Con): I am mindful of your injunction about the time, Miss Begg, and I shall try to let all my colleagues in.
It is a great pleasure to follow my hon. Friend the Member for Buckingham (John Bercow), who is also my constituency neighbour. He spoke with great passion and knowledge and, if he will forgive me, it was not least an oratorical tour de force to speak for that long without a single note.
I heard Lord Ramsbotham speak many years ago at a conference, and he made the point that if he had to sack every single member of staff in a prison at which he was governor, the last person that he would want to go through the prison gate would be the speech and language therapist. That remark struck me forcefully. As my hon. Friend has already mentioned, we must wonder how many people are languishing at Her Majesty’s pleasure for want of having speech and language difficulties addressed earlier.
In my constituency, I have been aware of the general difficulty in speech and language provision for some time. In particular, it seems that there is a gap between the provision made by the Department of Health and that made by the Department for Education and Skills and the local education authority. I am not a great fan of local area agreements as I think that they are just another quango imposition on local authorities. I have said to my own local authorities that I will set them a simple test. If they can show me that the local area agreement in Bedfordshire can actually close the gap and get health services and education services working together to meet children’s needs, the agreement will be worth while. However, we will have to wait and see what happens.
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