Auditory Verbal Therapy

James Frith Excerpts

Tuesday 21st January 2025 Westminster Hall

[Mr James Frith (Bury North) (Lab)]

It is pleasure to speak under your chairmanship, Mr Western. I congratulate my hon. Friend the Member for Washington and Gateshead South (Mrs Hodgson) on securing this important debate and on her contribution to ensuring that this profound therapy is better heard, better known and more available to choose for a great many in our society.

When there is so much to resolve, so much to fix and sort out, it feels like smaller causes struggle to be heard or seen. Our politics seems too busy to care about even more causes; it is all just too much. Alternatively, it can be said that the last Parliament did good things for the deaf community, so to expect new money for new causes is a stretch too far, naive even. We must believe in better. Each Parliament has the opportunity to help the underserved, and there are always issues that, with the right political heat and weight, can be transformed. Such issues have long been on the roll of Government successes, whatever the political weather. Think of the long-standing injustices, new medicines on the NHS, or social equalities we have addressed.

The missions of this Government delivered their enormous parliamentary majority and a mandate to renew, reform and transform. Auditory verbal therapy takes the Government’s vital missions for health, for children, for the smashing of barriers to opportunity, and for growth, and it brings them to life. This cause gives the missions cause to blossom. There may not be a better example of a cause that, for such a fraction of an investment, can be transformational.

I know what we are asking for will not be green-lit today, but I know what we need. Former Health Secretaries I have met have spoken of the “whiteboard moment”, when we get the issue on to the whiteboard. That is the goal. It is the moment when the Minister asks their civil service teams to make something possible—to draft a plan to take us from where we are to where we need to be. It is a pilot, a tester, a starter for 10, where the Government do not just take our word for it, but see for themselves.

Should there be concern among our deaf community, let me say that this is not about undermining the celebrated protected status of British Sign Language. We celebrate BSL as a language—a unique cultural identity—and the last Parliament’s recognition of BSL in law was a landmark achievement. The argument for auditory verbal therapy is an argument for choice—choice for the child, their family and their future—and ensuring that families have the knowledge and support to choose the best path for them. It is not about competing choices, but having access to all of them. The demand is that these families’ cause is heard, and the majority of the country agrees. In a recent YouGov poll, 85% of UK adults believed that auditory verbal therapy should be available to all children via publicly funded services such as the NHS.

The first years of a child’s life are critical. It is when their brains are most receptive to language and communication. For deaf children, early intervention is essential. Auditory verbal therapy enables deaf children to develop listening and spoken language skills and equips them to thrive alongside their hearing peers. With AVT, 97% of deaf children without additional needs achieve age-appropriate spoken language within two years. That is the transformation we seek. It is not a big ask, but it has giant implications for the impact that AVT can have if we can reach that whiteboard moment and have civil service teams working with experts to bring this therapy into NHS early years programmes. It is preventive healthcare at its best: cost-effective, compassionate and life-changing.

For someone who learns that their child is deaf, navigating this new world is disorientating and complex, and they will feel unsure. It is also the moment where we should ensure that parents learn that there is a therapy that could help their child to communicate on a par with their hearing peers. The option of AVT should be as freely considered as learning to sign, and traditional or developing means.

Withholding this therapy after people have learned of its existence cannot remain the position, yet learning of AVT only to be told that it is unavailable, unaffordable or simply not an option where someone lives is the reality for far too many families. With only 33 certified auditory verbal therapists across the UK, access to AVT is exclusive and rare. Most families will never hear of it. By removing the barriers, we can give parents and their children the opportunity to decide for themselves. That means training more therapists—supported by Government bursaries—to meet growing demand, building regional hubs, expanding telepractice services so that no family is left behind, and raising public awareness to ensure that families know that AVT is an option.

If the heart of the argument does not move us, the head can. This therapy means economic growth and a sound investment in families’ futures and ours. This cause is transformational for not just them but the economy. For £2 million annually—a fraction, or a rounding error, when it comes to the NHS budget—we could ensure that thousands of deaf children access AVT. According to independent economic analysis, this investment would unlock £11.7 billion in benefits over 50 years, and here is how. We would reduce education costs, as early intervention means less reliance on one-to-one support, saving £3.4 billion. We would increase employment, with confident, independent deaf adults contributing £1 billion to economy. And we would improve quality of life, with thriving, independent individuals generate £4 billion in societal benefits. Without early intervention, the costs are far greater. Delayed support leads to unfulfilled promise or potential, higher unemployment, mental health challenges and long-term reliance on public services.

The new Government have wasted no time identifying waste to be cut from their spending. The Cabinet Office has pledged to reduce the £7 billion per year spent on consultants. Official analysis found that total spending on consultancy in 2022-23 was £1.2 billion, with the Department of Health and Social Care among the highest spenders, at £281 million. I share this Government’s instincts: the money saved must now transform the lives of those accessing AVT. Does the Minister agree?

For just £2 million a year, we can train more specialists in order to remove the barriers to opportunity, expand access through the NHS and ensure that every family makes informed decisions. We are not asking for those decisions today, but for a commitment to start this journey and to draft a plan that takes us from this underserved system to one that provides choice and opportunity for every deaf child and their family. With parents given every option to choose for them, their children are given the best chance to thrive. When all deaf children thrive, our society is stronger, more inclusive and more prosperous. This underserved issue can benefit from the Government’s mission to transform. As the campaign says, “Hear Us Now.”

--- Later in debate ---

[The Minister for Care (Stephen Kinnock)]

It is a great pleasure to serve under your chairship, Mr Western. I thank my hon. Friend the Member for Washington and Gateshead South (Mrs Hodgson) for securing this vitally important debate, and for her powerful and moving contribution to our discussion.

I would also like to break with protocol and welcome Sam to Parliament today. He is clearly a remarkable young man, and an inspiration to us all—thank you for being here, Sam. Like the shadow Minister, the hon. Member for Hinckley and Bosworth (Dr Evans), I thank hon. Members for their excellent contributions today. We have had a range of contributions, including from the shadow Minister, and from the hon. Members for North Shropshire (Helen Morgan) and for Strangford (Jim Shannon), and my hon. Friends the Members for Bury North (Mr Frith), for Bolton North East (Kirith Entwistle), for Derby South (Baggy Shanker) and for Bolton South and Walkden (Yasmin Qureshi). I think that may be all, but huge apologies if I have missed anybody. All their contributions were excellent and very well put.

My hon. Friend the Member for Washington and Gateshead South has done so much work to champion the interests of children with special educational needs and disabilities, including non-hearing children. I know that she also has an excellent partnership with Auditory Verbal UK, which I welcome to Parliament today. I would, of course, be happy to meet its representatives to follow up on all the points made in this debate.

This Government are committed to raising the healthiest generation of children ever. We will deliver on this ambition through the health and opportunity missions, and through the Government’s child poverty strategy. This is not about silos, with each Department delivering one part of a puzzle that does not fit together properly; this is about systemic, holistic change, and ensuring that we join up analysis, expertise and delivery across Government. Our mission-driven Government will drive long-lasting and sustainable change for children now and in the future. We will break down barriers to opportunity and ensure that every child has the best start in life. This includes all children and young people with special educational needs and disabilities, including non-hearing children.

We know that developing early communication skills is a key foundation for life, and there are serious knock-on consequences when that development is delayed. That is why we are committed to improving access to early interventions so that every child can find their voice. With the right support, children with hearing loss can develop effective communication skills, live fulfilling lives and enjoy the same opportunities as everyone else. The Government recognise the importance of the earliest days of an infant’s life. There is strong evidence that the 1,001 days from conception to the age of two set the foundations for our cognitive, emotional and physical development. That is why we are giving a £126 million boost for families to give every child the best start in life.

Thousands of families across England will be able to access family hubs, which will act as a one-stop shop for help with infant feeding advice, parenting classes and perinatal mental health support, among other things. Figures from the National Deaf Children’s Society show that there were more than 45,000 deaf children and young people in the UK in 2023. Between one and two babies in every 1,000 are born with permanent hearing loss in one or both ears. This number increases to about one in every 100 for babies who have spent more than 48 hours in intensive care. Early and effective support is crucial for these children and their families. Permanent hearing loss can significantly affect a baby’s development, so early and effective support is crucial for these children and their families.

It is vital that we intervene at birth. The NHS newborn hearing screening programme—the NHSP—aims to find babies who have hearing loss as early as possible so that the right support and advice can be offered right from the start. As we all know, language is linked to social, emotional and learning outcomes. From birth through to childhood, children and young people with hearing loss might need a range of therapies, such as speech, language and auditory verbal therapy. However, as we have heard today, those children are not always receiving the support that they need.

We recognise the important role of auditory verbal therapy as one of the therapies that can be useful for children with hearing loss. NHS audiology services, including the provision of therapies for children with hearing loss, are locally commissioned, and responsibility for meeting the needs of children with hearing loss lies with local NHS commissioners, because local systems are best placed to meet the needs of their own communities.

After 14 years of Tory neglect, incompetence and austerity, our NHS and care service are on their knees, but this Government are committed to properly funding the NHS, and we recently provided a £26 billion boost for health and social care in the autumn Budget. NHS England is responsible for determining allocations of financial resources. Each ICB will then commission the services they need for their local area, taking into account their annual budget, planning guidance and the wider needs of the population they cover. NHS England is supporting integrated care boards to make informed decisions about the provision of audiology services so they can provide consistent, high-quality and integrated care to non-hearing children.

In July 2016, NHS England published “Commissioning Services for People with Hearing Loss: A framework for clinical commissioning groups”. The framework supports NHS ICBs to make informed decisions to address inequalities in access and outcomes between hearing services.

[Mr Frith]

Does the Minister agree that, for all the good intentions of ICBs, our healthcare system is atomised, but that if they were to take instruction from guidance provided nationally, the pillar-to-post experience of a lot of families seeking auditory verbal therapy would end? Will he commit to updating the nine-year-old guidance to ICBs, or at least acknowledge that it needs updating, with a national pilot that proves the efficacy of AVT for families seeking that intervention?

[Stephen Kinnock]

My hon. Friend will know that one of the constant challenges in the system is getting the right balance between empowering those operating at the coalface—those who are close to the communities and know them best—to ensure they are delivering the best possible services, and ensuring consistency and coherence, both strategic and operational, across the entire system. It is safe to say that we are not always getting that balance right. One of the key objectives of the 10-year planning process that we are going through will be to address the so-called postcode lottery—variation between regions—across the whole range of health and care. Without that cross-cutting strategic look at the system, it will not be possible to get the balance right. I absolutely take the point, but one thing I will say is that we are crystal clear when we issue guidance to ICBs that they must take that guidance into account, and their performance is monitored on that basis.

NHS Backlog

James Frith Excerpts

Monday 6th January 2025 Commons Chamber

[Mr James Frith (Bury North) (Lab)]

A happy new year to you, Madam Deputy Speaker. If the House will indulge me briefly, may I begin by wishing my grandmother well? She had a fall last night and broke two of her ribs. She is doing okay, but at 98 she may need a little longer in hospital that I, her eldest grandson, might have needed—although that is not a given.

Tackling deep-rooted health inequalities in Bury North is my priority for this Parliament. The difference there of a mile between postcodes can mean a seven-year difference in life expectancy for men and a five-year difference for women. I wish to reach across the aisle and associate myself with the remarks of the good doctor, the hon. Member for Runnymede and Weybridge (Dr Spencer)—who spoke very well in the debate on assisted dying—on what I would call the democratic deficit for MPs in relation to ICBs and acting on health inequalities at a local level, well beyond what we might achieve through parliamentary questions or writing to and meeting Ministers. I am pleased that the Government will not allow the dire record and wasted years of Tory government to prevent Labour from doing what we do best in power: fixing and fast-forwarding the NHS.

In Bury North, a constituent I will call Jackie has rheumatoid arthritis. After a severe, debilitating flare-up she waited two days for a GP to call back. She spent eight hours waiting in two different hospitals before being admitted overnight, only to be discharged the next day and told to go to a third hospital, where no rheumatologists were in place. Her emergency appointment was 11 days later. She was left in tears and unable to speak, so her husband had to advocate for her to get the appointment she desperately needed.

NHS backlogs take a personal and punishing toll on people’s lives, including through lost income from lost jobs or, worse still, lost years with loved ones from late or missed cancer diagnoses. Today’s commitment from the Labour Government that 92% of NHS patients will wait no longer than 18 weeks for treatment by the end of this Parliament is an enormous, transformative ambition. If that figure, which is currently at 59%, improves to 65% by March next year, that will give comfort to those who rightly expect to feel the change that Labour will bring on their own doorsteps.

I also welcome the aim of ensuring that community diagnostic centres can operate 12 hours a day, seven days a week. Thanks to the Chancellor’s Budget, local doctors will be incentivised to consult specialists to explore alternatives to hospital treatment.

In Bury, where Fairfield general hospital has the second highest average wait times for elective surgery in the country, the new national standards for elective care are welcome. Incentives for trusts that improve wait times are welcome, but does the Minister agree that the focus should be on average wait times—affecting the maximum number of patients—rather than rewarding trusts that reduce the longest possible wait time for fewer patients? I understand the capacity demands that will come with that, but it is a hugely important distinction. Although reducing the longest wait times is important, focusing on that metric alone, and rewarding trusts for it, risks leaving many patients with painful and debilitating conditions and trusts ducking their responsibilities. This Government have made it clear that we will address that on our watch.

Access to Primary Healthcare

James Frith Excerpts

Wednesday 16th October 2024 Commons Chamber

[Mr James Frith (Bury North) (Lab)]

Some of us newly elected or returning MPs have only just got our accommodation and offices sorted out, so I commend the Government on the speed with which they have got surgeons back to work, resolved the doctors’ strike, reviewed and assessed the crisis and made announcements for a decade of national renewal. They have also affirmed the view that our NHS should be treated not as a shrine or beyond question, but as something that must be returned to deep service to our country and play its part as a health and economic public service.

Lord Darzi’s review for the Government highlights the critical issues in the NHS and the state we are in, and particularly the underfunding of primary care. It has been neglected in favour of a creeping trend towards hospital services, under the failed principle of leaving it late—the crisis mode setting that applied across our public services under the last Government. By design, people ended up in A&E because of a failure to plan for GP and primary care, with 16% fewer GPs than other high-income countries. The review also points out significant health inequalities, with deprived areas historically receiving insufficient resources. In Bury North, child poverty is up to 43%, densely concentrated in just three of our nine wards. Life expectancy for those living in Bury North ranges enormously: the difference in life expectancy between North Manor and East Ward is five years for women and nearly seven years for men.

[Dr Beccy Cooper (Worthing West) (Lab)]

Public health interventions cost only a quarter of the amount that clinical interventions do to add an extra year to life expectancy, so does my hon. Friend agree that the reduction of the public health grant was an appalling false economy and should be restored, as soon as finances allow, to at least 2015-16 levels of funding?

[Mr Frith]

My colleague makes a valid point; I defer to her knowledge of the public health system.

The distance of a mile or so has a huge impact for the men and women living in east Bury. I urge those carrying out the Government review to see how, in constituencies like mine, specific interventions could address those deep health inequalities and identify the work we need to do to resolve that impoverishment in densely populated areas and that ingrained health inequality. I urge the Government also to adopt multidisciplinary care models and shift care closer to home to address these issues—a sentiment that I know Ministers share.

Taking a wider view, the funding formulas are outdated and an update is long overdue. That update should take into account the weight of funding pressures for areas such as mine, with a mix of economic and demographic inequality, including the fact that so much of the revenue that our local authority raises is immediately swallowed up by adult care and the disastrous special educational needs system—a symptom of the crisis mode mentality under the previous Government.

The Government have wasted no time, investing £82 million to recruit a thousand newly qualified GPs and addressing the dental care crisis with 700,000 urgent dental appointments. The Government also aim to expand the role of pharmacies—a measure I hugely welcome—to reduce the burden on our GP and hospital care, and crucially also for those living with chronic illness or conditions. A boost to the engagement patients can have with health decision makers via the NHS app and an improved trusted status for healthcare professionals will boost this too and reduce the bureaucracy in our caring system.

There is a well known saying in good hospitals, “The best hospitals keep people out of them and get people out of them.” This principle strikes at the heart of what has gone wrong in recent years. The problems in A&E, emergency services and waiting times stem from a failure over the past 14 years to design by this doctrine. The key to resolving those issues lies in primary care—preventing people from needing hospital services in the first place and enabling faster discharges when they do. That is where the focus must be.