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As I said, for all those reasons, speech and language problems have a direct impact on the prospects for resettlement and rehabilitation. They can increase the risk not only of offending but of mental health problems. Some of the dynamics involved were summed up in an article by Jennifer France, which is available on the website Speech Language & Therapy in Practice. I commend this work. Drawing on her experience as a speech therapist with mentally disordered offenders at Broadmoor hospital, Ms France writes:
“Is there a link between patients' histories of illness, crime and violence and their inability to communicate properly? I think that the answer to this must be yes. So many times we hear stories from patients saying ‘Nobody would listen to me’, ‘They wouldn't believe me—I told them what would happen’, ‘There was no one to talk to’, ‘I didn't know how to say it’, ‘I couldn't find the words to say what needed to be said’”—
There are many factors combining to produce a dysfunction in communication. When retracing histories, we find out about domestic disruption, broken families, physical and sexual abuse, alcohol and drug abuse, truancy, being taken into care and much else. It seems that discussion and sharing were seldom a part of everyday life, so the opportunities to express feelings and show care were minimal. We know that speech and language problems can be tackled and remedied by speech therapists, who are skilled in treating problems of articulation, fluency, oral-motor, speech and voice problems, and language disorders. They can help young people, either in a group setting or on a one-to-one basis, to develop, use and enjoy language; to be able to
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This, in turn, increases the ability of young people to lead fulfilled and law-abiding lives. I therefore fully support the call of the noble Lord, Lord Ramsbotham, for an increase in speech and language therapy for young offenders in custody. Enhancing their rehabilitation prospects in this way is in the interests not only of the young people themselves, but of the whole community.
I declare an interest in this subject, as president of NACRO: the National Association for the Care and Resettlement of Offenders. As part of our rehabilitation work, issues identified both by the noble Lord, Lord Ramsbotham, and NACRO must be taken seriously. I am aware that the Prison Service requires all programmes and courses designed to change prisoners’ attitudes and behaviour to comply with the quality assurance arrangements set out in Prison Service Order 4350—Effective Regimes Interventions. It would be helpful to know how often this order has been used to deal with behavioural problems arising from speech and language factors.
2.52 pm
Viscount Bridgeman: My Lords, I am sure that I speak for the whole House in assuring the noble Lord, Lord Dholakia, that he has no need for an SLT.
Once again, we have the benefit of the vast experience of the noble Lord, Lord Ramsbotham, in prison work, and we are grateful for this opportunity to debate the subject. One thing that really struck me was his experience with the hardened warder at the Staffordshire prison saying that he had mistreated young offenders simply because he was unaware of their speech problems. The illustration of the noble Lord, Lord Dholakia, of what we might call the technical problems was most impressive.
I am sure that the Minister needs no convincing of the value of SLTs. Cost has come up a number of times in this debate, and I shall return to it at the end. The noble Lord, Lord Ramsbotham, mentioned the Royal College of Speech and Language Therapists, which has articulated its concerns that SLTs are becoming a soft target for cuts in the health service. It is their simple and stark conclusion that the number of SLTs in youth offender institutions is currently inadequate. It is as simple as that.
The noble Lord, Lord Avebury, mentioned the study by the Learning and Skills Research Centre concluding that recidivism rates were reduced by as much as 50 per cent in the first year after release for prisoners who have been supported to improve their oral and language skills. The report by I Can, shows that 60 per cent of young people entering prison do not have the verbal skills to cope with their regime or benefit from education and rehabilitation. In other words, they do not have the basic tools to enable them to get on to the bottom rung of the education ladder: possibly tantamount to expecting a blind person to learn to read print.
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As always, we get back to prison overcrowding. Last year, some 98,000 prisoners transferred, many of them victims of churning. In previous debates in your Lordships’ House, we have highlighted the appalling effect this has on families, and particularly women. No less insidious, however, is the effect on young offenders’ education, including the SLTs we are debating today. With the logistical strain imposed on the authorities by coping with overcrowding, it is not difficult to see that education is one of the first things to go.
We have talked about the cure to a certain extent, so I shall go back to prevention. I hope that, in her reply, the Minister will be able to update us on the results of the youth inclusion programmes introduced in 2000 to target 13 to 16 year-olds and the youth inclusion and support panels that target eight to 13 year-olds, especially in the light of the Prime Minister’s comments in September that he would expand programmes that target prospective parents whose children seem destined to go wrong.
On the subject of costs, the noble Lord, Lord Ramsbotham, mentioned the many departments involved. However, the Department of Health comes most to mind. Several noble Lords referred to the fact that very often primary care trusts have the will to help with SLTs, but are constrained by their budgets. I note that the training budget of strategic health authorities has reputedly been cut back by £160 million.
It is easy to see why SLTs are less tangible in their impact than the availability of discrete forms of treatment in the health field. For that reason, it is all the more important that your Lordships are aware of their value and the need for them. As we have seen, they are all too often a soft target.
I invite the Minister to give us an example of how effective joined-up government can be in this Administration. Even with her versatile skills, we cannot expect her to speak for another department in this debate, but can she obtain some assurance in writing, particularly from the Department of Health, of awareness of the real concerns expressed in the House today about the need to provide proper funding for SLTs? As the noble Lord, Lord Ramsbotham, so elegantly pointed out, they are simple to institute, very embracing throughout the service and relatively cheap to put into effect.
As so often, the remarks of Her Majesty’s Chief Inspector of Prisons hit the nail. Only five days ago, Miss Anne Owers said:
“Every time I go into a custodial establishment, I see staff achieving amazing things in difficult circumstances with highly troubled young people. But I fear the system is approaching breaking point”.
I shall be very interested to hear the Minister’s reply.
2.58 pm
The Minister of State, Home Office (Baroness Scotland of Asthal): I, too, commend the noble Lord, Lord Ramsbotham, on securing today’s debate, during which there has been unanimity about the importance of speech and language therapy and learning. The House recognises, as do I, that speech and language therapy has rightly been a matter of
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Speech and language therapy services are already available for young people housed in young offender institutions and secure training centres. Even though the therapists themselves are not employed directly by or based in those institutions as speech and language therapists, they are available as specialist referral in all primary care trusts. I assure the noble Lord, Lord Ramsbotham, that in cases where the need for this service has been identified, a referral to speech and language therapists employed by primary care trusts will take place.
This is an issue on which the Department for Education and Skills, the Home Office and the Department of Health are working closely together. Indeed, I had the advantage of speaking to my right honourable friend Rosie Winterton yesterday and this morning about this interest, and I am pleased to be joined on the Front Bench by my noble friend Lord Adonis, who, as the House will know, has a keen interest in the education of young people and has worked diligently to deliver high-quality care for the children of our country.
We are together examining what more we can do to improve mental health assessments and services for young offenders in the Prison Service young people’s estate. Together we are looking, in terms of additional funding as part of a wider prioritisation work, at the scope and timing of further allocations to the National Health Service. I am pleased to be able to tell the House that we are by no means being slow or lacking energy on this issue. I understand the frustration and irritation of the noble Lord, Lord Ramsbotham, but I share with him that he is not on his own in that situation.
The House will recall the document Patient or Prisoner? which was published by the noble Lord, Lord Ramsbotham, when he was Her Majesty’s Chief Inspector of Prisons. It recognised the inequality between those health services provided in prison and those provided outside. Today, due to the changes in policy set in train by that document, we have a different situation in which the National Health Service extends into prisons. Since the budget for managing prison health services was transferred to the National Health Service from the Prison Service, the total amount invested has risen from £118 million in 2002-03 to nearly £200 million this year. No one can doubt the commitment of the Department of Health to this area, or that of the Government. It is not just the money that has been devolved to the National Health Service. Primary care trusts also bear the responsibility for commissioning health care for prisoners in their estate, and they do so on the basis of local need. It is not therefore a question of Ministers providing central funding for speech and language therapy in the young offenders’ estate. Instead, it is a matter for the local National Health Service providing for its prisoners and young offenders as local requirements dictate.
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It is right that the noble Lord, Lord Dholakia, reminded us that this is a through service. We have to identify need in children at the earliest possible moment, satisfy that need and thereby, perhaps, obviate the need of them falling into a situation where they will commit offences and be incarcerated. It is not just about looking after them when they are incarcerated, sometimes for relatively short periods; it is about the through care that takes place when they leave a young offenders’ institution and go back into the community. It is about having appropriate speech and language therapy available to them as they need it throughout the whole process. It is very important for us to put what happens in our YOIs in the context of children’s all-round needs. It is therefore important to remember that speech and language therapy is a specialist service, one of many such services, and that primary care trusts assess their local priorities before deciding how to use their entire annual allocation. In this regard, the House should be in no doubt that the local National Health Service is discharging its duties properly.
Speech and language therapy is not being overlooked by the National Health Service. The national toolkit, to which the noble Lord, Lord Avebury, referred, and which is used by primary care trusts to make assessments, specifically identifies speech and language difficulties as a particular need to be considered when determining spending priorities. That combination of extra investment and local determination is yielding results. The number of speech and language therapists employed in the National Health Service has increased by 38.8 per cent since 1997, with 6,759 employed at September of last year. The number of training places for speech and language therapists is also increasing; in 2005-06, they had increased to 797, up by 74 per cent since 1999-2000.
As the noble Lords, Lord Avebury and Lord Ramsbotham, mentioned earlier, Professor Karen Bryan’s research in this area produced some striking and valuable conclusions. She found that 60 per cent of young offenders who were screened on entering custody were identified as having difficulties with speech, language and communication—considerably more than the 1 per cent identified in the wider population. This research has produced a valuable evidence base which the Department of Health is now using to inform its forthcoming model for commissioning child and adolescent mental health services for those in custody.
This model will recommend to primary care trusts, prison governors, secure training centre directors and local child and adolescent mental health services that they give full consideration to the speech and language needs of young offenders. The model will help to provide also specialist assessment, care and treatment for children with more severe and complex mental health problems or disorders that can be associated, as the noble Lord, Lord Dholakia, said, with speech and language difficulties. The range of services to be provided will include child psychiatry, child psychology and community psychiatric nursing, speech and language therapy, psychotherapy and occupational and creative therapies. Although those
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As the noble Lord, Lord Dholakia, mentioned, many young people in custody had difficulties in school. Truancy is strongly associated with crime, and many of the young people who end up in custody have very low levels of educational attainment. Research has found that nearly half of school-age children in custody had literacy and numeracy levels below those of an average 11 year-old and over a quarter had levels no higher, and in some cases lower, than those of an average seven year-old. Those factors, low attainment and truancy, tend to reinforce one another and, consequently, children who go into custody have often had no education at all for a significant period.
Lack of educational attainment is only one of a number of problems that are likely to affect young people who go into custody. Many have a background of family disruption and conflict, and many are being, or have at some stage been, looked after by a local authority or in voluntary care. Much greater percentages than those identified in the rest of the under-18 population have reportedly suffered violence at home and/or sexual abuse.
Closely linked with the above problems is the high rate of mental illness among young people in custody. Research has found that a third of young people in custody have a moderate to severe mental health need and there were high levels of anxiety, depression and concentration problems. Drug and alcohol abuse is often a factor in youth crime and it is particularly marked in the case of those going to custody.
Serious problems of this sort, often deriving from family circumstances that are unlikely to change for the better, cannot be fully remedied during a short, or even a longer, period in custody, but we can begin to address them. For those serving longer terms, there is a chance to make up some lost ground, particularly as regards education. For example, in 2004-05 all trainees in secure training centres who were serving detention and training orders of six months or more—who, in other words, were serving three months or more in custody—improved their literacy and/or numeracy by one skill level or more.
If that good work is to bear much fruit, it needs to be followed up after the young person has left custody.
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The Youth Justice Board has been leading a multi-agency, interdepartmental steering group to take this work forward. In February, it published a framework action plan identifying seven resettlement pathways: case management and transitions; accommodation; education, training and employment; health; substance misuse; families; and finance, benefit and debt. Those are important changes.
It is also important that we recognise that resettlement is a four-stage process, with work starting pre-sentence and following the child through the custodial and then the community parts of the detention and training order and finally back into the community. It is crucial that, in this fourth phase, sustained support is provided both by mainstream community services, such as education and health providers, and by families and communities.
I commend to your Lordships the three new powerful alliances that I launched last year. The first is a corporate alliance to engage with employers so that a greater number of offenders will be able to get employment. The second is a civic-based alliance, encouraging those involved in the community, whether through arts, sport, local authorities or other activities, to come together to support the policy. The third is a faith-based and voluntary society alliance, which we hope will help to underpin better the work that we are doing. We believe that these new alliances will make a huge difference.
The noble Viscount, Lord Bridgeman, mentioned youth inclusion panels, and 122 are now being funded. We also now operate youth inclusion programmes in 110 of the most deprived or high-crime estates, and the arrest rate for those joining is down 65 per cent. I absolutely agree with what has been said about the importance of the work and the contribution that we can make with speech and language therapy, and we shall continue to commit to it, but I ask your Lordships to bear in mind that it has to be set within the context of all the other excellent work that is being undertaken at the moment.
- House adjourned at thirteen minutes past three o’clock.
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