Auditory Verbal Therapy

Helen Morgan Excerpts

Tuesday 21st January 2025 Westminster Hall

[Helen Morgan (North Shropshire) (LD)]

It is a pleasure to serve with you in the Chair, Mr Western. I thank the hon. Member for Washington and Gateshead South (Mrs Hodgson) for introducing the debate, as well as Sam, his family and Auditory Verbal UK for campaigning on this important issue. I confess that I am quite new to auditory verbal therapy, and it has been fascinating to research the issue more for the debate and to listen to hon. Members’ contributions.

The hon. Member for Washington and Gateshead South made a hugely compelling argument for improving access to auditory verbal therapy, setting out not only the benefits for the children who would be able to improve their ability to listen and speak, but the economic benefit that would derive from what I think we can all agree is a small investment—as an accountant, I can confirm that £2 million is probably a rounding error in most instances. I also thank other Members for their useful speeches today, not least the hon. Member for Bury North (Mr Frith), who highlighted the importance of early intervention, and the hon. Member for Derby South (Baggy Shanker), who highlighted the educational impact that early access to appropriate therapy can have.

There are more than 50,000 deaf children in the UK. Around 7,200 of them are under the age of five. Some 90% of deaf children are born to hearing parents, who do not have the experience of dealing with hearing impairment. Although deafness is not a learning disability, deaf children face a significant attainment gap during their time at school, and their educational outcomes are poorer. There is also a higher risk of poor mental health. In addition, deaf people are less likely to have decent employment, and suffer generally from inequality as a result of being hearing impaired.

It is important to say up front that all deaf and hearing-impaired people have the right to participate fully and independently in society. Too often at the moment, those rights are not being fully realised. Liberal Democrats believe, as I am sure hon. Members from all parties do, that every deaf child deserves the best possible start in life, the opportunity to flourish and for their families to be supported, so that they can express themselves and communicate with ease, in the way that is most comfortable for them.

The hon. Member for Bolton North East (Kirith Entwistle) highlighted that offering a range of therapies is the best way to support families who have a child who is deaf, and that they should be able to exercise choice when deciding which therapy is most suitable for them. Under section 17 of the Children Act 1989, local authorities in England have a duty

“to safeguard and promote the welfare of children within their area who are in need”

by providing

“a range and level of services appropriate to those children’s needs.”

A child is defined as being in need if they are disabled, and the Act says that a child is considered disabled if they are deaf. We are therefore in a position where it seems that local authorities must be compelled to provide appropriate support for deaf children and their families. The National Deaf Children’s Society notes that

“in some cases, local authorities do provide funding to help”

a child “access AVT”.

The problem is that the Government have confirmed that audiology services are commissioned locally and that

“the responsibility for meeting the needs of non-hearing children lies with…National Health Service commissioners.”

That leaves us with the dreaded postcode lottery. It would be helpful if the Government provided guidance to local authorities on the level of support they should be providing, particularly, in the context of this debate, for AVT.

Locally in Shropshire, headteachers report an inability to access basic speech and language therapy for hearing children. The strain on local government finances will clearly have a significant impact on what is available to children in each area. Will the Minister confirm whether provision of AVT will be a responsibility of the Department of Health and Social Care or local government? Therapies such as this might sometimes fall into the gap between the two, and it would be useful to understand how it can best be delivered.

As I mentioned, I am slightly new to this topic but Liberal Democrats have long campaigned for better support for people who are deaf, and particularly for those who communicate through British Sign Language. We would like BSL to have official, equal status to the UK’s other languages, and would like free access to sign language lessons for parents and guardians of deaf children. We welcome all the developments in improving outcomes for deaf children, including technology such as cued speech visual systems, for which there is a major centre in the constituency of my hon. Friend the Member for South Devon (Caroline Voaden).

I echo the call of the hon. Member for Washington and Gateshead South for a pilot scheme—that seems a sensible way forward. The existing research on AVT is promising but the evidence base is still narrow and a pilot scheme seems the best way to broaden that evidence base and convince those who have not yet been convinced by meeting children who have benefited profoundly from the therapy. More broadly, the Government should strengthen the availability of basic speech and language therapy training for people working with children to ensure that children who are struggling with hearing impairment can be identified, that their progress is monitored and supported, and that an equal outcome is found for them.

In conclusion, will the Minister confirm whether the provision of AVT is the responsibility of the Department of Health and Social Care or a local government issue, bearing in mind that the provision of such assistance comes through local government? Will he also confirm that the 10-year plan will address services such as AVT for deaf children and adults? Finally, will he consider a pilot scheme to broaden our understanding of the benefits of AVT?

--- Later in debate ---

[Stephen Kinnock]

The hon. Gentleman will know that NICE has a prioritisation board, and ultimately that is the decision-making process for prioritising guidelines and the entire operating framework for what falls under NICE’s remit. This is something that absolutely should be on the radar, and of course we are constantly in conversation with NICE about its prioritisation, but it is important that it takes an objective clinical stance on the question.

We have committed to develop a 10-year plan to deliver a national health service that is fit for the future. The engagement process has been launched. As we work to develop and finalise the plan, I encourage those concerned about the availability of services to support children with hearing loss, including auditory verbal therapy, to engage with that process to allow us to fully understand what is not working, as well as what should be working better and the potential solutions. I encourage all hon. Members present to go to change.nhs.uk to make their voice heard.

This summer, we will publish a refreshed long-term workforce plan to deliver the transformed health service we will need to build over the next decade to treat patients on time and deliver far better patient outcomes. We are also in the process of commissioning research to understand the gaps between the supply and demand of different therapy types for children and young people with special educational needs and disabilities. That will help us to understand the demand for speech and language therapists and inform effective workforce planning.

[Helen Morgan]

I am pleased to hear that the Government have increased the number of speech and language therapists, which is so important for young people who are struggling to achieve their potential in an educational setting, but will the Minister address the specific point on commissioning by local authorities? Often, they are so strapped for cash that they are effectively trying to limit demand.

[Stephen Kinnock]

Commissioning is led by ICBs. It is important that ICBs have open channels of communication with local government. We in the Department of Health and Social Care have close contact and engagement with colleagues in the Ministry of Housing, Communities and Local Government, and it is important that that relationship and interaction feeds down through the entire system, but the leading organisations on commissioning are the ICBs.

A number of colleagues raised the question of a pilot scheme to identify how our existing workforce can work differently. The early language and support for every child programme is an excellent example of different professions coming together to support children and young people—local authorities, schools, and the health and care system working together in the community to support our children and young people. The ELSEC workforce model focuses on recruiting pre-qualification speech and language therapy support workers into the workforce to improve the capacity and knowledge of staff who support children with emerging or mild to moderate speech, language and communication needs in early years and school settings.

Nine regional pathfinder partnerships are trialling new ways of working to better identify and support children in early years settings and primary schools. We have asked pathfinders to consider how to make the model sustainable after the project period. The therapy assistant roles have the potential to attract individuals to train to become speech and language therapists through the apprenticeship route. I understand that Auditory Verbal UK is progressing a National Institute for Health and Care Research grant application to support a pilot, and I would welcome an update from AVUK about how that is going when we get the chance to meet.

We welcome the work that AVUK is doing to upskill health professionals to deliver auditory verbal therapy. On the point made by the shadow Minister, the hon. Member for Hinckley and Bosworth, there are as yet no NICE guidelines on hearing loss in children, and NICE has not made any recommendations on AVT specifically. Decisions on the need for guidelines on new topics and updates to existing guidance are made by NICE’s prioritisation board, in line with NICE’s published common prioritisation framework. I understand that NHS England met with AVUK and discussed the need for more high-level research evidence for the intervention and the need to develop evaluations of impact. I am pleased that AVUK has been invited to join the chief scientific officer’s audiology stakeholder group, where it will contribute to decision making.

We recognise the impact on the lives of children of timely access to high-quality services, including different therapies to help children to develop the right skills to engage with education. The Government’s ambition is that all children and young people with SEND or in alternative provision receive the right support to succeed in their education and as they move into adult life. We will strengthen accountability on mainstream settings to be inclusive, including through the work of Ofsted, by supporting the mainstream workforce to increase their SEND expertise and by encouraging schools to set up resourced provision or SEN units to increase capacity in mainstream schools. That work forms part of the Government’s opportunity mission, which will break the unfair link between background and opportunity, starting with giving every child, including those with SEND, the best possible start in life. We will work with the sector, as essential and valued partners, to deliver our shared mission and restore parents’ trust.

I again thank my hon. Friend the Member for Washington and Gateshead South for securing this debate and sharing her insight on the vital issue of early interventions for non-hearing children. We recognise the importance of such services and the life-changing impact they can have on the lives of children. We are committed to ensuring that all children receive the support they need to live healthy, fulfilling lives. I will continue to work closely with NHS England and the Department for Education as we strain every sinew to deliver on those commitments.