Young Offender Institutions (Speech and Language Therapy)
(Limited Text - Ministerial Extracts only)
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The Minister of State, Department of Health (Paul Burstow)
I congratulate the hon. Member for Feltham and Heston (Seema Malhotra) on securing the debate and on setting out the issues so clearly. I note that, curiously, my noble Friend Lord Addington is debating this matter with Ministers in the other place. It is clearly of importance to parliamentarians in both Houses. The work of the all-party parliamentary group on speech and language difficulties underscores that point.
It is important to recognise that speech, language and communication difficulties are part of a complex and multi-layered range of needs that young people between the ages of 15 and 21 may have, particularly those within our criminal justice system. I understand the concerns about speech and language therapy that the hon. Lady has raised and will try to address them.
There have been a number of studies, mostly small-scale studies, on the prevalence of speech, language and communication needs. They place the prevalence of such needs in custodial settings at anything between 60% and 90%. One recent study found the 60% of young offenders screened on entry to custody had speech, language or communication needs. As has been said, among the general population the figure stands at 1%, although there are regional and local variations.
Much attention has been given to these issues over recent years. The hon. Lady made reference to Mr Speaker’s work on behalf of the last Government. The coalition Government are taking forward a number of the actions in the Bercow review. First, we had the Green Paper on special educational needs and disability, and the follow-up report that was published recently. Secondly, there have been pathfinder pilots to develop unified plans covering health, education and care needs, supported by the use of personal budgets. Thirdly, we have had the review of the early years foundation stage. The Department of Health is working closely with the Department for Education to join up health and care, sorting out one of the oft-stated criticisms of SEN provision for so many years.
I assure the House that speech and language therapy is available to young people, and in particular to those in the custodial estate. Currently, it is commissioned in the custodial estate through primary care trusts. It is meant to be commissioned according to local need. That means that in-house services are provided in some larger young offender institutions—not just in Feltham, but in Wetherby and Hindley. I urge the hon. Lady to look at the provision in those two other institutions.
From next April, the responsibility for commissioning prisoner health will move from primary care trusts, as they are abolished, to the new NHS Commissioning Board. That will help to ensure that people with health needs in custodial settings receive care comparable with that received by those in the wider NHS. Offender health lead commissioners will act for the board and determine the right level of service to be provided to meet the identified needs within the prisoner population. They will work at local level with health and wellbeing boards, children’s services, and police and crime commissioners.
Nick Smith
May I press the Minister? How many young people’s custodial settings have speech and language therapists working at them? Do some or all settings have them?
Paul Burstow
The hon. Gentleman will have heard me say that there is specific in-house provision at three settings, but there will also be referrals through NHS pathways for speech and language services, meaning that any young person in need of speech and language therapy should have access to it. That is one of the requirements of the commission—its responsibility is commissioning appropriate services to meet identified needs. I shall come to the identification of needs in a moment.
Speech, language and communications needs are just one part of an often complex picture. It is important that we acknowledge that there are complex interactions with, for example, mental health problems, learning disabilities, substance misuse and alcohol problems. Therefore, psychiatry, psychology, community psychiatric nursing, psychotherapy, and occupational and creative therapy can all play a valuable part—a bigger part in some cases—in treating and meeting the needs of young offenders.
The hon. Lady was right to highlight the contribution that speech and language therapies make not just in direct services, but in supporting colleagues in a multi-disciplinary team to ensure they have the necessary skills to provide the right communications support and so on.
Adopting a personalised approach is at the core of that. The hon. Member for Blackpool North and Cleveleys (Paul Maynard) rightly said that we need to ensure that people have the communications skills and understanding both when they are in prison or youth offending services and when they are released. That was an important point.
The hon. Lady spoke powerfully of her visit to Feltham and the conversations she had with the 15-year-old lad about his experience of speech and language therapy—he said it gave him more confidence. That is another reason why such therapy is an important component of the right health interventions to meet identified needs.
The hon. Member for Blaenau Gwent (Nick Smith) said in an intervention that early intervention is relevant as well as the change in commissioning responsibilities. Early intervention is a key part of the Government’s approach. Continuity of care and treatment is key. The average period of detention for a young offender is very short—80 days, often including remand. Custody therefore provides opportunities for health assessment and for identifying problems and needs, after which referrals can be made. It is therefore important that we have systems that allow those follow-ups to take place. It was right that the previous Government decided that the commissioning of prison health services should be an NHS responsibility, enabling those systems to be properly joined up, and this Government have maintained that.
We need to look right across the whole criminal justice pathway to provide health interventions that are appropriate to the individual presenting needs. In 2010-11 there were 2,040 10 to 17-year-olds in the secure estate at any one time on average. Sometimes, four times as many were on remand or awaiting sentence to custody, and 85,300 were being supervised by youth offending teams. There is a similar pattern in the 18 to 20 age group.
Seema Malhotra
It is important to talk about action across the justice system and recording and assessing, but where will that information be held, so that the records are kept and maintained as a person passes through the justice system?
Paul Burstow
That allows me to talk about Asset and what we are dong. Asset is a tool used by the criminal justice system to risk-assess reoffending, whereas we are introducing a comprehensive health assessment tool that incorporates questions on speech, language and communication needs and is designed better to meet the complex range of needs of children and young people in the secure estate. I will send further details about that to the hon. Lady, but in a way the role of the NHS in our prison service is better supported through the second tool and the information systems that support an individual on their journey through the criminal justice system.
We also need to go further back up the criminal justice pathway. The Department is expanding the liaison and diversion services for all ages, and that includes tailored support for children and young people and appropriate referrals for those with speech, language and communications needs. Even further back up the criminal justice pathway is our programme to support troubled families, which tries to break the very cycles that the hon. Lady talked about—of school absenteeism, crime and antisocial behaviour—and which can exacerbate other presenting problems and lead to greater communications difficulties.
In conclusion, this has been an important debate. Speech and language therapy is a highly valued intervention, and the Government recognise the contribution it can make to the quality of life of young people and the potential for reduced reoffending as a consequence. It is clearly necessary that people in the custodial service and in contact with the criminal justice system can be referred and have access to those services. However, speech, language and communications difficulties are just one part of a complex picture of needs, which is why we are ensuring that a more holistic approach is taken that assesses the range of needs that an individual presents when they enter the custodial estate.
As a consequence, we have threaded right through the criminal justice pathway a more personalised mix of treatment and therapy that meets those individual needs. That is our goal. These changes build on the important reform of commissioning, using the strength of a national commissioning board leading on commissioning prisoner health services and working with local partners to make the necessary connections with local services. That is how we will improve the quality of life, care and treatment for young people in our custodial estate. I shall write to the hon. Lady with the details she requested.
Question put and agreed to.