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As the Minister knows, this is not the first, the second, or, indeed, the third time I have raised this point. I know that it is conventional not to sound passionate about issues when raised in the House and I hope that your Lordships will forgive me if, instead, a small sense of irritation and frustration comes through as I outline how I came to the conclusion that I have just enunciated and why I have posed the Question today.
This journey began in Scotland when I went to the young offender establishment at Polmont. I was walking with the governor, who told me that if, by some mischance, he had to get rid of all his staff, the last one out of the gate would be his speech and language therapist. When I asked why, he explained that young offenders were quite incapable of communicating what was wrong with them and where they had come from in a way which could help healthcare, education and disciplinary staff to reason with them properly, and that when he appointed a speech and language therapist, all this was unzipped, as it were. Therefore, he regarded investment in speech and language therapy not as an optional extra but as an integral part of helping young people, thereby reducing the risk that they presented to themselves, their families and friends and, above all, to their communities and neighbourhoods, and as an essential component of an effective rehabilitation strategy.
Having met the speech and language therapist and seen some of her work, I asked who the best speech and language therapist in England was. I was told that it was Professor Karen Bryan, now of Surrey University, so I contacted her and asked whether she would come with me to a young offender establishment in England and put 10 per cent of the boys there through the sort of tests that a speech and language therapist would do to see whether the work was as realistic and valuable as it seemed in Scotland. She came on an inspection and confirmed that a significant number of young offenders had speech, language and communication problems. She said that such difficulties might affect behaviour—for example, hitting someone rather than having a conversation—and might reduce the chances of a prisoner benefiting from education provision and from what she described as verbally mediated interventions such as anger management and drug rehabilitation programmes.
Professor Bryan proved from her examination that 50 per cent of those young offenders had substance abuse-induced memory loss, with all the implications that has for education. It turned out that the substance most blamed for that was cannabis. Forty-seven per cent reported that their talking was poor; 37 per cent of them had literary problems; 30 per cent had difficulty in speaking with others; 23 per cent scored less than an 11 year-old in comprehension tests; 20 per cent had
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I was sufficiently impressed by this information to recommend immediately to the Prison Service and to Ministers that the matter should be looked at seriously, and that speech and language therapists should be appointed preferably to every young offender establishment. Unfortunately, as with so many policy recommendations, it was greeted with a deafening silence, and nothing had happened by the time I retired from the post.
Lord Renton of Mount Harry: My Lords, can the noble Lord give us any idea of the cost of appointing a speech and language therapist at any individual prison?
Lord Ramsbotham: My Lords, I thank the noble Lord for that intervention. I shall mention figures in due course.
Fortunately, in 2002, Lady Helen Hamlyn, who had been left a trust by her husband, asked me to advise her on helping with young offenders and whether anything made a particularly significant difference. I told her that the only thing that I had come across in the whole of my experience which affected 100 per cent of an establishment was speech and language therapists. To cut a long story short, we went to the Home Secretary, Mr Blunkett, the prisons Minister, Mr Benn, and the Commissioner for Correctional Services, Mr Narey, and agreed that Lady Hamlyn would fund a two-year trial of two speech and language therapists in young offender establishments. It would be overseen by Professor Bryan and therefore evaluated academically. We chose Staffordshire as a location because of the excellence of its director of social services, under whom speech and language therapists came. The two therapists were appointed to Brinsford and Werrington young offender establishments in July 2003, at a cost of £150,000, which Lady Hamlyn had made available.
The role of the therapists was to diagnose young persons’ speech, language and communication difficulties through initial assessments and interpretation of other assessment data and to use those diagnoses to plan interventions which they would devise and deliver. They were responsible also for liaising with all the staff of the prison, youth offender teams and other external agencies, and to support and advise the staff in the managing of young people with such difficulties to enable them to access education and other treatment designed to address offending behaviour. It was fascinating to note that the governors of the prison, the education and healthcare staff and the discipline officers immediately realised that they had been given a tool without price which they had never had previously. This was reflected most clearly in a discussion that I had with a hard-bitten prison officer in Brinsford—they do not come more hard-bitten than that—who
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The reports of Professor Bryan were greeted also by the Director-General of the Prison Service and the chairman of the Youth Justice Board, who said that they would like to have speech and language therapists, but, unfortunately, that they could not afford them because, at the time, their budgets were effectively frozen to fund the introduction of the National Offender Management Service.
In January 2005, because Helen Hamlyn’s funding was coming to an end, I alerted Ministers to the fact that, unless something was done to bring speech and language therapists into the mainstream of provision, the trial would come to an end. The case study’s figures and outcomes showed conclusively that 100 per cent of an establishment would benefit from speech and language therapy, and that, unless, a therapist were made available, it would all come to nothing.
Our other conclusion was that the speech and language service falls between the jurisdictions of the Home Office, the Department of Health, the Department for Education, children’s services, the Prison Service and the Youth Justice Board. The trouble with so many people being involved is that it falls through the gap.
I now turn to the question of the noble Lord, Lord Renton, about funding. Nationally, speech and language therapy provision is expected to be funded by primary care trusts local to an establishment. This has to compete with other priorities for health funding, although this therapy, as I have explained, is not only to do with health.
So what are we talking about in terms of costs? It costs £33,000 a year to provide one speech and language therapist who is sufficiently experienced to run a working establishment. When I think of that figure, I am bound to think that Mr Blair, in removing £30 million from the Home Office budget for his respect agenda, might perhaps have considered leaving a little bit behind for speech and language therapists—and perhaps some of the 1,647 civil servants in the National Offender Management Service might similarly be dispensed with for something of that value.
The debate between the Home Office and the Department of Health continues. It was going on when the general election in May 2005 resulted in another clean sweep in the Home Office, so the person then dealing with the matter moved on. Since then, I have tried on a number of occasions to raise it with the Minister, verbally and in writing, as she knows. Now we have other people playing in the field: I have alerted the Minister responsible for social exclusion, Hilary Armstrong, that this is a matter of social exclusion because of what is happening to people deprived of the ability to communicate.
The Royal College of Speech and Language Therapists is now in close contact with the National
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Noble Lords may think that what I am saying refers only to young offenders. However, there has been a report by the Learning and Skills Research Centre for the Prison Service that refers to adults, in which it is pointed out that 74 per cent of all those taking part in enhanced thinking skills programmes, on which so much emphasis is put by the Government, do not have the listening and speaking skills of level 2 or 3 that those programmes demand. Indeed, 35 per cent have listening and speaking skills below level 1—but those skills can be enhanced by therapy. The report concluded that oral communication should be seen as an essential part of the learning journey for prisoners, and not an add-on.
Those figures relate to adults. But I am sure that noble Lords will agree that the earlier help can be given to young people to help them to communicate, the better. A report called Cost to the Nation of Children’s Poor Communication by the I Can organisation, in its “I Can Talk” series issued in 2006, points out that about 10 per cent of all children have persistent communication difficulties and that the upwards of 50 per cent who have transient difficulties can, with the right support, catch up. There is a direct correlation between children with a communications disability and low attainment, behavioural and emotional difficulties, mental health issues, poor employment or training prospects and youth crime. Again, there is a need to do something about these communication difficulties, which is at the start point of the very basis of what we want to do.
The Parliamentary Resources Unit, in producing evidence for this question, showed that 60 per cent of young people entering prison do not have sufficient verbal skills to cope with the regime or benefit from education and rehabilitation. If the issue of communication skills is not addressed, those young people are not likely to benefit from prison and will become repeat offenders.
I am sorry to have to go through all that at something of a gallop because of the time limit, but I hope that noble Lords will see that my frustration and irritation is that here is a matter that is so absolutely basic to understanding what needs to be and can be done with young people and which, considering who is going to pay for whatever it is that we do, makes all the White Papers, Green Papers, consultation documents, five-year plans and so on a dream land. Those things will just be dreams unless something actually happens. In posing my Question, therefore, I ask the Minister to accept the urgency of this. I ask that the Home Office show some leadership and say, “Damn the fact that we are having all these problems with primary care trusts not having the money; if necessary, let us find it and provide these therapists. Let’s give these young people the start in life that we have a responsibility to provide”.
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2.35 pm
Lord Avebury: My Lords, when the chairman of the Youth Justice Board, Rob Morgan, the Chief Inspector of Prisons, Anne Owers, and the Children’s Commissioner for England, Professor Al Aynsley-Green, visited Feltham Young Offender Institution last Tuesday, they jointly called for an honest debate about alternative ways of dealing with young offenders who commit low-level and less serious crime. They said that more than 3,350 children and young people are being held in custody today. The youth justice system has just a handful of bed spaces left. We simply cannot put up a sign saying “No Vacancies”. Action is urgently needed to stop custody for young people going into meltdown.
As with adults, but even more so with children, the courts ought to consider whether, by awarding custodial sentences, they may be increasing criminality by exposing vulnerable people to bad influences, particularly when they know that the places to which these offenders are sent are bursting at the seams. They also know that in those circumstances it becomes increasingly difficult for prison and YOI governors and staff to give adequate attention to those who get into trouble because they are suffering from a range of mental health, substance abuse and communications problems and disabilities.
In the case of speech, language and communication, they have not even got as far as systematically assessing the problem, six years after it was highlighted by the noble Lord, Lord Ramsbotham, when, as Chief Inspector of Prisons, as he described, he visited HM YOI Swinfen Hall in November 2000. He told your Lordships how he brought in Professor Karen Bryan of the University of Surrey to assist him, and her survey revealed alarming rates of disability in speech, language and communications among the young offenders in every test that was applied. The noble Lord—the Chief Inspector, as he was then—recommended that further research should be conducted to establish the extent of these problems more generally and their impact on prison careers and reoffending.
It stood to reason that prisoners with those impairments were more likely to leave prison with unresolved problems that could lead to reoffending. Professor Bryan suggested—and the noble Lord endorsed this—that appropriate screening should be developed, validated and included with educational entry tests throughout the prison system. The noble Lord then commended Dr Bryan’s analysis to the Director-General, and said that the DfES needed to think about remedial education for these disadvantaged young men.
In a debate on prisons in July the following year I asked whether the matter was being pursued. As the noble Lord, Lord Rooker, did not make any comment in his winding-up speech, I wrote to him the following day asking him about taking the recommendations further. Beverley Hughes MP, who was then Minister for Prisons, replied that there was no standard approach to screening for these impairments, but that Professor Bryan’s findings had been incorporated in something she called “the health needs assessment toolkit”. A principal education officer had been
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Four years on from the original recommendations, however, the noble Baroness, Lady Scotland, told me on 12 January 2005 that they had still to study Professor Bryan’s report, and would then consider any action that might be appropriate. The noble Lord, Lord Ramsbotham, and I had both tried to prompt the noble Lord, Lord Warner, in Questions on 27 March, but he then wrote to say that there was no money in the Prison Service health budget up to 2003 for speech and language posts, and that since then it was entirely a matter for PCTs, as the noble Lord, Lord Ramsbotham, has explained, to decide how the available money should be spent. There were no plans to fund these posts centrally.
As the noble Lord also explained, no provision had been made to replace the speech therapy funding provided by the Helen Hamlyn Trust, which ceased in July 2005. I wrote again to the noble Baroness, Lady Scotland, saying that we seemed to be back to square one, with every PCT deciding its own policy on speech and language problems, in spite of the evidence of the prevalence of these difficulties and the bearing they were likely to have on the propensity to reoffend. The noble Baroness replied that no screening was undertaken of young offenders for speech and communication difficulties per se, but that the Government preferred a general learning needs assessment to identify all learning difficulties or disabilities. This process, a key part of the learning and skills delivery arrangements for all offenders, would lead to referrals to appropriate health or education professionals.
I wrote again to the noble Baroness on 18 June asking her how, as part of the general assessment, speech and language difficulties would be assessed and by whom—bearing in mind that there was no funding for those posts, as the noble Lord explained—and how, if PCTs were unwilling to fund SLT services, as we heard, they would be provided for offenders identified by the general screening as needing them. I also sent her an account of research by David Moseley et al on behalf of the Learning and Skills Development Agency—mentioned by the noble Lord, Lord Ramsbotham—which showed that training in oral communication for prisoners in general cut reconviction rates within the first year after release from 44 per cent to 21 per cent. It is surely reasonable to suppose that for inmates with speech and language difficulties the benefits could be even more spectacular.
As the noble Lord said, unfortunately, while PCTs have to pay for SLT as part of health services, in the current climate of cuts and reorganisation it is bound to have a low priority. Werrington now has a part-time speech and language therapist and at Brinsford the local PCT has carried out a needs analysis but as yet it has no service. Managers are making out a business case for SLT in their local YOI, but I am not aware of any instances where this process has led to the delivery of a service. Why, in any case, should it be necessary to reinvent the wheel in each of the 15 PCTs which serve the 11 male and
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I simply do not understand why the Home Office, which, one would think, must be desperate to find effective ways of lowering reconviction rates, has dithered and procrastinated for the past five years over an approach which would certainly produce immediate and possibly very substantial benefits to the prisoners concerned and to society as a whole. Up to 90 per cent of juvenile offenders have below-average language skills and two-thirds are below level 1 literacy. These young people do not have the skills to cope with verbal interventions aimed at reducing reoffending. Therefore, all juvenile offenders should be assessed, using known techniques, and remedial SLT provided for those who need it, using ring-fenced money, as the noble Lord, Lord Ramsbotham, demanded. It is partly because of the failure to apply the lessons of six years ago, and of the other work reinforcing the pioneering study by Professor Bryan and the noble Lord, Lord Ramsbotham, that our adult prisons are overflowing today.
2.43 pm
Lord Dholakia: My Lords, I fully support the call of the noble Lord, Lord Ramsbotham, for the use of speech and language therapy in young offender institutions. It is one of the crucial elements in the process of rehabilitation of many young offenders. The experience of the noble Lord, Lord Ramsbotham, as HMI adds weight to this important subject. I thank him for this debate. I must make an admission. Having just returned from South Africa this morning, my speech may be in need of therapy, but I am sure that a little sleep will put it right.
If we look at the nature of speech and language problems, it rapidly becomes clear how these are linked to an increased likelihood of offending. Speech disorders cover a range of different problems. They include articulation disorders, such as difficulties in producing sounds in syllables or saying words incorrectly to the point at which other people cannot understand what is being said. They include fluency disorders such as stuttering, and voice disorders, including problems with the pitch, volume or quality of a young person’s voice that distract listeners from what is being said. Language disorders include difficulties in understanding or processing language, difficulty in putting words together and an inability to use language in a socially appropriate way.
The reasons why young offenders with speech or language disorders need therapy vary greatly. They can include hearing impairments, cognitive delays, weak oral muscles, birth defects, such as cleft lip or palate, autism, breathing disorders, swallowing disorders and brain injury. Each of these disorders would receive appropriate treatment and therapy to ensure that there is no impediment in the child’s development. But could we genuinely say that that equally applies to those in our penal institutions?
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Young people with such problems often have problems of non-verbal communication such as eye contact, gestures, facial expressions, body language, tone of voice and rate of speech. When young people cannot communicate effectively, this often leads to frustration which, in turn, can result in difficult and delinquent behaviour. It can also lead young people to remove themselves from situations that require communication, and into a vicious circle because then they have no opportunity to improve and develop their communication skills.
It is hardly surprising, therefore, that research has shown that if children with communication difficulties cannot access treatment, this can lead to behavioural problems. If these problems are not remedied, this can put serious obstacles in the way of successfully rehabilitating offenders.
There is a direct relationship between behavioural problems and rehabilitation. It can make it much harder for them to communicate with potential employers to get a job. We know that offenders who get and keep a job are between one-third and one-half less likely to reoffend than those who remain unemployed. It can make it more difficult for them to access education successfully, and we know that achieving educational qualifications significantly reduces the likelihood of a return to crime. It can make it harder for them to communicate with potential landlords, yet we know that offenders who go into stable housing are at least one-fifth less likely to reoffend. It can make it more difficult for them to cope in an offending behaviour programme or in group-based drug rehabilitation programmes.
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