Speech and Language Therapy

Dave Robertson Excerpts

Monday 27th January 2025 Westminster Hall

[Dave Robertson (Lichfield) (Lab)]

I beg to move,

That this House has considered e-petition 657935 relating to speech and language therapy.

May I say what a pleasure it is to lead this debate with you in the Chair, Mr Vickers? Before I turn to e-petition 657935, I beg your indulgence to mention that today is International Holocaust Memorial Day and the 80th anniversary of the liberation of Auschwitz-Birkenau. Given that it is possibly the last significant anniversary on which many of the survivors will be with us, it is really important that we mark today, because we must never, ever forget the crimes that were committed in the early part of the last century. I stand four-square behind the work of the International Holocaust Remembrance Alliance in making sure that we never forget and that we can turn darkness into light.

Today I am introducing a debate on a topic that we so often take for granted, particularly those of us who have the opportunity to contribute to the debate. Communication, and our ability to speak and to put our views on the record, is fundamental. It is fundamental to Members of Parliament because of the job that we do, but it is also fundamental to everybody across this country and, in fact, across the globe. The power of communication is in our ability to speak and to express our thoughts, our feelings, our hopes, our needs and our politics. In its simplest definition, it is how we connect with each other.

For some people, however, it is not so simple. The words, feelings and thoughts are there, but they cannot quite find how to get their words out. That is so difficult for many people, and we should never overlook it, because every single human being has the ability to communicate and a need to connect with people. Supporting people to make sure that they can always find the words, and that they can always communicate and reach out to others, is something that I am sure everybody would support.

That is where speech and language therapy steps in—not just as a treatment, but as a lifeline and a way to help people to find the words. It is about helping people to find their voice and to overcome the barriers that keep them from being heard. If we cannot communicate, we can feel invisible and alone, which is a huge challenge in itself. Speech and language therapy is more than just a clinical service; it is absolutely vital to a huge number of people across this great country. It is the bridge between silence and expression, and between isolation and inclusion. Speech and language therapists are the unsung heroes who help people to rediscover their ability to speak, to listen and to engage with the world, regardless of whether they are a child who struggles to form words, an adult recovering from a stroke, or someone with a lifelong condition that affects communication.

Last week, I had the great privilege of speaking to Mikey, who created this fantastic petition. One thing that struck me in that meeting was not just how thoughtful, well prepared, well read and on top of every single part of the issue he was, but his determination that this debate should not just be about him. It is not about Mikey’s treatment or his journey, although he is very able and willing to discuss them with people; it is about Mikey standing up for people who find themselves in a similar situation to him. When we meet somebody who is a true campaigner, and who is willing to spend their time and effort supporting people across their community, we should applaud them. I place on the record my thanks to him for his work.

When I spoke to Mikey, he told me that he is actually one of the lucky ones. A year and a half after he was diagnosed with apraxia, he was offered an hour of speech therapy a week. That was a huge boon to Mikey’s ability to take part, develop and just be part of the world. He feels lucky for that one hour, because the ability to access speech and language therapists is a postcode lottery, but it should not be a matter of luck. Getting help for something so important should be a minimum; in fact, the Royal College of Speech and Language Therapists recommends four sessions a week for Mikey’s condition. Mikey raised that not because he did not feel supported, but as an example of the fact that current provision and support do not meet the need, even for people like Mikey, who, in his own words, is lucky to have the support that he has had.

Just over 23,500 adults and more than 67,000 children and young people are on a waiting list for speech and language therapy. Every one of those lives can be touched and immeasurably improved by ensuring that they have the treatment they need to rebuild the confidence that they may have lost. Mikey told me that, after his treatment, his confidence has grown, he is less anxious, he is able to speak publicly with strangers and friends, and he has been able to get a job and catch up in education. That is all down to the speech and language therapists who have supported him to reach his goals. Not everything is down to the therapists, obviously—Mikey is responsible for a huge amount of what he has done—but his ability to express himself, and to show the world where he is coming from and what he does, is down to the language therapists who have supported him.

I met representatives of the Royal College of Speech and Language Therapists and Speech and Language UK last year, and the most striking thing that came out of those meetings was how important it is to look at this issue through the lens of social justice. The most striking piece of data that they shared is that 25% of all children, when they go to primary school, have some form of diagnosed or undiagnosed speech, language and communications need. If one looks at the most deprived areas of the country, that percentage rises to 50%.

On top of that, more than 60% of children in young offender institutions have communication difficulties. That information—that reality—is too stark to be an accident; something could be driving that. Reaching out and ensuring that people can express themselves and engage with the world at large, whether that is school, friends or family, can support them to access the world and prevent them from going down a path that could end with them making some difficult decisions and finding themselves incarcerated.

However, it is not just about young people; it is also about adults who develop conditions such as dementia, Parkinson’s, which is close to my heart, or long covid, which we will be talking about a lot over the coming years in the post-pandemic world. The speech and language difficulties that can come with long covid have driven demand since the pandemic, although there was significant demand for speech and language therapists before that.

I will touch briefly on Parkinson’s, because a close family member—my mum—suffers with it. Mam learned English to go to school, as her family spoke Welsh at home, and since she moved to England, where she brought up me and my brothers, she has spent her whole adult life communicating in her second language. Mam was also fluent in French. Seeing where she has gone with her Parkinson’s—just not being able to find the words—is a real challenge for all of us who know her. Helping her to find that word and communicate is something that I think everybody who knows her would support, and I am sure that anybody with a relative in a similar position would also be eager to support them with that.

Parkinson’s UK did an audit of its members in 2022 and, of the people it spoke to, just 40% had access to speech and language therapy. Only 15.5% were referred to therapists at the diagnosis stage and only 8% were seen. That is one example—I beg the House’s forgiveness for raising one of such significance to me; I picked it because that is where I have a lot of direct experience—but there are many, many conditions that can be supported through speech and language therapy.

Returning to the postcode lottery that I mentioned, there are areas of this country where integrated care boards are spending less than £1 per person receiving therapy—I think 58p was the smallest number that I saw. In the best-funded area for speech and language therapy, the ICB was spending £16.35 per child who was receiving therapy, which is a vast difference. Now, I am not going to say that ICBs are not doing their job; we are all aware that there are regional disparities and that ICBs have to cut their cloth according to the funding available. When we see such a significant disparity, however, with around 30 or 32 times the amount being spent in one area compared with another, it highlights that for far too many people, it is a real fight to get the support that they need because the funding is not there.

In the Minister’s response, I am interested to hear whether anything can be done in the long-term 10-year health plan for the NHS to set minimum standards or whether the Government intend to level the playing field between different areas. Many people, especially those from disadvantaged communities, live in areas where services are scarce and where waiting times are long. That can exacerbate some of the issues faced by those communities, as well as by the individuals affected.

We know that it is not always about just funding or putting more money into the system. Where money is needed, it should be there, but recruiting and retaining speech and language therapists is vital. No amount of funding in the world can replace a human being actually doing that role, or the skills, training and care that they provide for the people they are supporting.

There is a shortage of therapists in our system, and many are leaving the profession due to burnout, insufficient support and unsustainable workloads. When I spoke to the royal college, it was absolutely clear that recruitment is one side of the coin, but retention is the other. It is not just an operational necessity, but how we increase the number of speech and language therapists available and make sure that the more experienced people can train, support and mentor people who are less experienced to get through those grades, from grade 5 to grade 6 and so on.

A survey by the royal college found that 17% of speech and language therapy roles are currently vacant. That is a huge number: almost one in five. Ensuring that we have the right number of people to support the vital care that people need would have a profound effect across the country. The biggest shortages are in bands 6 and 7 in the NHS, which are the more specialist roles.

Across the board, therapists are saying that they want to do the job. Nobody goes into healthcare for the money, but because it is a vocation and they want to support their community and support people where they need it. To support them, however, we have to do something about caseloads to ensure that they can devote enough time to each person they see.

I am proud that the Government will bring forward a 10-year plan to offer a vision of a healthier, more resilient NHS. However, given how well supported this petition has been and how important speech and language therapy is for people who need it, I am very eager to hear that the Government are taking the issue seriously and making sure that speech and language therapy is fully integrated into that 10-year plan, so that we can look much more at preventive care, get community services to deliver support where it is most needed, and prevent those acute issues developing.

I am very glad to see so many hon. Members from both sides of the House in the Chamber. Ultimately, this debate is an opportunity for us to talk about speech and language therapy, and to make sure that it has the place that it deserves at the heart of our health system. I am sure that there is much more that other hon. Members will want to say, and I look forward to the contribution from the hon. Member for Meriden and Solihull East (Saqib Bhatti).

[Several hon. Members rose—]

--- Later in debate ---

[Dave Robertson]

I place on record my thanks to all the hon. Members who have contributed to the debate, starting with the hon. Member for Meriden and Solihull East (Saqib Bhatti), who made an excellent contribution, as I think we would all expect. I congratulate him on his campaigning on this important issue. I thank my hon. Friend the Member for Wolverhampton North East (Mrs Brackenridge) for raising the story of her constituent Samantha, who I am sure will be watching the debate closely.

I thank the hon. Member for Leicester South (Shockat Adam) and my hon. Friend the Member for Hyndburn (Sarah Smith) for reminding us of the importance of supporting the next generation and all those who come after. I thank my hon. Friend the Member for Altrincham and Sale West (Mr Rand) for raising the issue of unacceptably long wait times for speech and language therapy. I thank my hon. Friend the Member for Stoke-on-Trent North (David Williams) for highlighting the caseload faced by speech and language therapists in Stoke-on-Trent and the great county of Staffordshire. I also thank my hon. Friend the Member for Dulwich and West Norwood (Helen Hayes) for discussing the need for early intervention and the remarkable impact that it can have.

I thank my hon. Friend the Member for North Warwickshire and Bedworth (Rachel Taylor) for the story of her father’s experience in speech and language therapy. I thank the Liberal Democrat spokesperson, the hon. Member for Winchester (Dr Chambers), for his excellent contribution on the need to raise awareness around aphasia, which does not necessarily get spoken about enough in the community.

I thank the hon. Member for Sleaford and North Hykeham (Dr Johnson), on behalf of His Majesty’s official Opposition, for her considered remarks and for avoiding making the issue a political football. It is really important to highlight where we do agree, because there is often more agreement than people realise in this place. By working together, we can achieve those goals.

I especially thank the Minister for Care, my hon. Friend the Member for Aberafan Maesteg (Stephen Kinnock)—did I get that right?

[Stephen Kinnock]

Not bad.

[Dave Robertson]

Mam never quite got round to teaching me the Welsh that she speaks. I thank the Minister for his kind words about her and for outlining the complicated funding scenario that currently exists for speech and language therapy, along with the Government’s desires for the future of this therapy as an example of the three shifts that the Government will introduce in the NHS, and the need for people to engage thoroughly with the NHS 10-year plan consultation as a vehicle to securing those changes.

I thank the Petitions Committee for allowing me to lead the debate. It has been a real pleasure, not least because my constituency was the fourth most supportive of the petition. Finally, on behalf of all hon. Members who have been able to contribute today, I say an enormous thanks to Mikey, without whose campaigning we would not be here discussing this issue.

Question put and agreed to.

Resolved,

That this House has considered e-petition 657935 relating to speech and language therapy.

Hospice and Palliative Care

Dave Robertson Excerpts

Monday 13th January 2025 Commons Chamber

[Dave Robertson (Lichfield) (Lab)]

I thank the hon. Member for Wimbledon (Mr Kohler) for securing this debate. Like many Members here, I am here to talk about my local hospice. Just over the constituency border in Whittington, St Giles hospice has been doing its vital work for more than 40 years. However, 2024 was a challenging year for the hospice, with rising costs, plus the impact of the cost of living crisis making fundraising more difficult, leading it to make some impossibly hard decisions last summer. St Giles had to close one of its wings and make a number of redundancies among its clinical staff. That was due not to reduced need across Lichfield, Burntwood, the surrounding villages and further afield, but only to the financial situation that the hospice faced.

I commend my constituent Sean Collins, who is leading St Giles’s urgent funding appeal. The hospice supported Sean and his children following the loss of their mother and wife, Felicity, at just 38 years old. I am not sure I would be strong enough to turn that tragedy into something as positive as Sean has, but he has all my support.

The generous donors to St Giles do so much to care for people they have never met with their donations. In a recent meeting with Elinor Eustace, the CEO of the hospice, she mentioned how much she values all that they do, but said that she does not want to have a fully funded model, because of the value that fundraising brings to the entire community around the hospice. Having said that, Government support is essential to making sure that hospices across the country can continue to do everything they do for all our communities, so I welcome the £100 million of additional funding that the Government announced just before Christmas. However, we must find ways to ensure that all hospices remain sustainable in the long term.

St Giles receives just 18% of its funding from the NHS, which is less than £1 in every £5 when the national average is £1 in every £3. Levelling that playing field cannot come fast enough. In addition, St Giles has to deal with five different integrated care boards. That is five different NHS organisations for five different geographies, all with different funding formulas, different grant processes, different reporting mechanisms, different key performance indicators and different timescales. That is all for grants that add up to nothing more than an administrative nightmare. Simplifying and standardising that process will ensure that St Giles can spend less time securing grants from the NHS and more time on caring for the community in my constituency and further afield. I ask the Minister to look very closely at that point, because there is a real opportunity to secure significant benefit for hospices across the country.

Musculoskeletal Conditions

Dave Robertson Excerpts

Tuesday 17th December 2024 Westminster Hall

[Sonia Kumar]

I agree with the hon. Gentleman. I have worked in paediatrics where many patients get diagnosed late and suffer with late onset. That affects their whole life from the beginning, including their ability to get involved with physical activity and to build relationships, or their mental health and sleeping patterns. Getting an early diagnosis is one of the solutions I want to put forward. I would like the Minister to consider involving physiotherapists from early on, at nursery stage, to find out why we are not picking up MSK conditions from a really young age so that we can provide health and wellbeing from day one.

[Dave Robertson (Lichfield) (Lab)]

I hear my hon. Friend’s point about early intervention and making sure that we diagnose MSK conditions as soon as possible. A member of my extended family suffers from pregnancy-related osteoporosis, which needs to be picked up as soon as possible so that appropriate treatment can be put in place and mothers supported through it. A new charity has been set up specifically for pregnancy-associated osteoporosis, and it is pushing for the #MeasureThatMum campaign to make sure that midwives are trained to pick up the condition at that point, as early as is physically possible. Does my hon. Friend support that?

[Sonia Kumar]

Of course. One of the things MSK physiotherapists look at is spinal fractures, 70% of which happen in the thoracic spine, generally in older women who have had poor bone health. It is essential to look after bone health from a really early age, while women are in their 40s, so that when they are older, in their 50s, 60s, 70s and 80s, they are on the right medication and doing bone health exercises to help for the future. For MSK conditions and osteoporosis, physiotherapists are essential. Spinal fractures are very often undiagnosed, and those who suffer spinal fractures as they get older are more likely then to have a hip fracture, after which the mortality rate becomes really high. My hon. Friend makes a very good point.

Let me explain why MSK physiotherapists and MSK care are so important. By 2035, two thirds of the population are expected to have two or more long-term conditions, which include MSK conditions. Versus Arthritis reports:

“Arthritis and related musculoskeletal conditions affect 20.3 million people in the UK.”

That means that one in six people has arthritis, which is a staggering amount. MSK conditions cost the NHS £5 billion a year, accounting for one in five GP appointments, 1.6 million hospital admissions and 30 million prescriptions a year. People with low confidence who feel that they cannot manage their conditions are more likely to attend hospital, while those who are most confident with long-term conditions have 38% fewer hospital admissions.

That is what we can do for the economy, but this issue is also about first-contact practitioners, as I mentioned at the beginning. With first-contact practitioners, we can save so many GP appointments. It is part of the long-term plan, which has been created to improve the impact on GP care and allied health professions that work in general practice. Working adults with MSK conditions are twice as likely to be economically inactive compared with those with long-term conditions. Of the people who are economically inactive due to ill health, 21% report having MSK conditions. It is about not just health but the economy and the wellbeing of the society that we are hopefully building together now that we are in government.

It is really important that we look at this issue in a holistic way. MSK conditions affect not just affect somebody’s mental health but their relationships and how they build them. They affect whether they can get into bed and sleep well, as well as their sleep hygiene. Perhaps a person eats poorly because they cannot get out, so they put on lots of weight. A person’s emotions, self-esteem and ability to work can be affected. I do not believe there is a silver bullet or that if we manage MSK conditions it will just fix one part. It has to be effective in respect of all the facets of somebody’s general wellbeing. We cannot tackle waiting lists and return people to work without that, and we need a strong workforce to plough back into the economy. It is incredibly important for people to understand that it is about holistic management and how we can improve health literacy and self-efficacy for people with MSK conditions.

I came to this debate to talk about solutions, as I am a solution-led person. We need to recognise the allied health professions in the NHS and build a workforce for MSK physios. That includes not just MSK physios but paramedics, podiatrists and every single person in the 14 allied health professions, all of which help to build resilience in the NHS, reduce waiting lists and build a healthier society.

MSK assessments need to happen from day one in nursery. We cannot expect paediatrics or care to be delivered well if we wait until the future, look back and say, “We should have done a better job when that person was younger.” If we looked at MSK conditions from day one—early in a child’s development and in their early years of support—there would not be a massive impact on society later in that person’s life because of having to do delayed diagnosis with multiple appointments and to look after their general wellbeing.

We also need to embed into society notions of what good health looks like from day one. That includes keeping active, going to classes and going to rehabilitation. We need a bigger awareness campaign about what being well looks like. It should not just be that the person leaves school and that is it; it needs to be lifelong. In the same way that people do continuous professional development, they should learn what looking after their body entails, and that should be translated into health policy.

We also need to increase the scope of physiotherapists’ practice. At the moment, they do not do DEXA scans, but they look at bone health in every other way. We look at X-rays, and work in fracture clinics, rehabilitation and trauma orthopaedics, but we do not look at the full picture of bone health. Will the Minister consider inputting that in future?

We need to increase the roll-out of community appointment days. We must provide same-day services for patients, including assessments, advice, health promotion and rehabilitation, and the community and volunteer sectors should provide support in a non-medicalised environment. If somebody has shoulder, knee or back pain, there should be a one-stop shop where they can be assessed appropriately, and they can then move on and get the right care at the right time.

We also need to put community care services on high streets and in places of worship. There are people who are not getting access, and there are massive health inequalities, so how do we promote care and health in difficult-to-reach communities? I would love to see care being put into places of worship and other locations people do not normally think of. I very much welcome the fact that the Government are already moving away from hospital care.

We also need to increase the number of first-contact practitioner places. A consultation with an FCP physio is £30 cheaper than the traditional GP-led pathway. MSK issues are one of the most common reasons to visit GPs, accounting for about 20% to 30% of appointments. Will the Minister meet me to discuss more of the solutions that I think need to be put forward to manage MSK issues? Would he be happy to visit my constituency to look at our fracture liaison service? I hope we will continue to fund that and that the service will be rolled out nationally.

Access to Primary Healthcare

Dave Robertson Excerpts

Wednesday 16th October 2024 Commons Chamber

[Dave Robertson (Lichfield) (Lab)]

I congratulate the hon. Member for Newton Abbot (Martin Wrigley) on his excellent maiden speech. I am sure he will be a fierce advocate for the people of Newton Abbot and the surrounding area over the coming years. I look forward to working with him.

I am very glad to be able to speak in this debate, because primary care is an important issue that affects all our constituents. During the election campaign, it was absolutely the No. 1 issue that came up on the doorstep across Lichfield, Burntwood and the villages in my constituency.

We are effectively here to discuss the centralism and poor decision making that typified the last decade and a half of incompetence by the Conservative party on primary care. There can be fewer more obvious examples of that than the fate of Burntwood health and wellbeing centre in my constituency. The building was home to a GP surgery serving almost 5,000 residents in the town. The contract for the surgery expired in March last year, but no replacement facility was ready for that date. The surgery could not move, which meant it had to close. The building itself is still in use by the integrated care board and the practice was happy to seek an extension, but that was not allowed by NHS England.

As a result, more than one in eight people in the town have had to be redistributed to other surgeries because a process in London did not allow organisations in Staffordshire to deliver the best solution for my constituents. It is centralist and wrong. It was wrong then and it is wrong now, and it needs to change. Even worse still is that the proposed replacement facility, originally scheduled for completion in October 2023—last year—is nowhere near ready. We are expecting planning permission sometime in early 2025 and who knows when it will actually be completed.

This is such an important issue for my constituents in Burntwood, as we all know the potential knock-on effects that delays in accessing primary care can cause. The staff at the remaining surgeries are doing all they can to support the community, but at some point increased patient rolls like this cannot be mitigated. It is one example of the challenges people face in seeing a GP. It is not the only one in my constituency and very far from being the only one across the whole country. It cannot be fixed overnight; 14 years of it going wrong will take longer than 14 weeks to fix. However, I applaud the Health Secretary for going as far as he has so quickly: cutting red tape to allow 1,000 new GPs to be taken on and commissioning the Darzi review of the NHS so that this party, the one that created the NHS, can ensure that we build a health service that is fit for the 21st century.

[Madam Deputy Speaker (Caroline Nokes)]

I thank the hon. Gentleman for not using all his time. I call Tom Gordon to make his maiden speech.