Auditory Verbal Therapy

Luke Evans Excerpts

Tuesday 21st January 2025 Westminster Hall

[Dr Luke Evans (Hinckley and Bosworth) (Con)]

It is a pleasure to serve under your chairmanship, Mr Western. I congratulate the hon. Member for Washington and Gateshead South (Mrs Hodgson) on leading this debate and pay tribute to Auditory Verbal UK for its tireless advocacy in this area. I know that, to obey parliamentary protocol, I should never direct comments to the audience but I would like to say thank you to Sam for his advocacy and for being here to watch this debate. Maybe one day he will be on these green Benches, advocating for further changes, although I hope the Government will have served that purpose by then. If Sam is listening, I hope it is okay, Mr Western, to put those comments to him through you.

As Members have noted, the provision of auditory verbal therapy was previously discussed in the House in December 2023. In the aftermath of that debate, I understand that AVUK held discussions with the Department of Health and Social Care and received support from two Ministers in the last Government: Maria Caulfield, the former Member for Lewes, and Dame Andrea Leadsom, the former Member for South Northamptonshire. I also understand from the charity that, before the election, the last Government were considering how to roll out training for auditory verbal therapy and to upskill the existing speech and language therapist workforce. That is part of the workforce plan for the NHS and I am pleased to see that the current Government are continuing in that vein.

Helen Keller said that the only thing worse than being blind is having sight but no vision. Since the election, it appears that the Government are possibly stepping back from this area. Recent responses to written questions have indicated that the Government have no plans to review the adequacy of the provision of AVT and have stated doubts about the strength of the current evidence supporting its effectiveness, but today we have heard arguments made about a range of studies that suggest AVT really can support deaf children to develop age-appropriate spoken language and attain educational outcomes on par with hearing children. It is not for us, at this point, to make a decision but it is for this House to raise this topic. As a first step, will the Minister commit today to meeting Auditory Verbal UK so that it can present the latest evidence and research from the UK and abroad?

We know that integrated care boards are responsible for commissioning services for their local communities, including the provision of auditory verbal therapy. Thanks to charitable funding and efforts from AVUK, there are now 33 certified AV therapists across the UK. However, as other Members have noticed, there are still major gaps in provision, particularly in the public sector. Will the Minister therefore commission a review about the impact and effectiveness of the AVT that is currently taking place in the NHS? Although there are five AV therapists in Manchester, there is just one for the whole of the west midlands, and, as the hon. Member for Washington and Gateshead South mentioned, there are currently no AV therapists in the north-east. The hon. Member for Bolton North East (Kirith Entwistle) also said that there are none in the north-west. That highlights the postcode lottery, which needs to be addressed—especially when, as we have heard, there are 50,000 deaf children in the UK.

AVUK has argued that national guidance to ICBs could help to improve provision across England. Although the National Institute for Health and Care Excellence has guidance on hearing loss for adults, there is no such guidance for children. We know we need an evidence base for guidance, and, given that NICE is the organisation responsible for that, it seems reasonable to focus our attention on it. Can the Minister commit to speaking to NHS England and NICE about current guidance for hearing loss and whether it needs to be updated in the light of the emerging evidence around AVT?

Much has been said by Members today about the return on investment we can see from putting more money into AVT. AVUK has said that for every £1 invested in therapy, there could be as much as a £4 return. We have seen in other areas—for example, the children’s hospice grant—how a small amount of national funding can go a long way in supporting community services across England. Therefore, as decisions are made on the allocation of NHS funding announced in the autumn Budget, will the Minister consider AVUK’s ask to provide funding to train more public sector workers in AVT? I think it was also Helen Keller who said, “I cannot do everything, but I can do something. I must not fail to do something that I can do.”

I congratulate the hon. Member for Washington and Gateshead South on securing this important debate and raising these issues. Deaf children across the land are lucky to have an advocate in her—she is doing her part. I thank the hon. Members for Strangford (Jim Shannon), for Bolton North East, for Bury North (Mr Frith), for Bolton South and Walkden (Yasmin Qureshi), for Derby South (Baggy Shanker) and for North Shropshire (Helen Morgan); they too, are doing their part by raising the issue in this debate. I thank AVUK for all it does; it is doing its part. I hope, in raising constructive questions as His Majesty’s Opposition, I am doing my part, too. In turn, I hope that the Minister will answer my questions and others raised today, meet AVUK and assess its evidence, and make appropriate recommendations and changes with the Department of Health and Social Care and the NHS so that deaf children can reach their full potential—in doing so, he will fulfil his part.

--- Later in debate ---

[Stephen Kinnock]

I can certainly tell my hon. Friend that this is a very dynamic situation. A system never stands still. For a system to work, we have to be constantly reviewing its performance and whether it is delivering to its objectives. I believe that the 10-year plan that we are producing will absolutely lead to a radical rewiring of the way our health and care system works. It will be driven by three big shifts: from hospital to community, from sickness to prevention, and from analogue to digital.

There is no doubt at all that where there are therapies and treatments that are working—that are clearly delivering big results, and value for money for the taxpayer—it is right that we give those priority in the way that we deliver. It is clear that AVT has huge potential, and it appears to have unexplored potential. I cannot pre-empt today how this is all going to pan out in terms of the system and the reforms that we are looking to push forward, but I can assure my hon. Friend that we are committed to innovating and to building a system that is fit for the future.

In 2019, with input from the National Deaf Children’s Society, NHS England produced a guide for commissioners and providers who support children and young people with hearing loss. The guide provides practical advice on ensuring that non-hearing children receive the support they need. Auditory verbal therapy is one type of therapy to support children with hearing loss, and it is important that local commissioners know their population and have the discretion to decide how best to meet its needs. When it comes to commissioning and providing services for children with hearing loss, we have been crystal clear with ICBs and NHS trusts that they must take the relevant guidelines into account.

We recognise the real need to improve access to therapies for all children who need them, including children with hearing loss. In recent years, in very difficult circumstances, the NHS has increased the number of speech and language therapists working in the service, but we know that more needs to be done. That is why the Government are committed to fixing the NHS and building a service that is fit for the future, with the workforce it needs to get patients seen on time.

[Dr Luke Evans]

The Minister rightly points out the need to try to deal with the postcode lottery and to ensure that there are reviews and sharing of best practice, but may I draw him back to my comments about guidelines? One thing he could do is ask NICE to look at the current evidence and consider what national guidance should be in place. ICBs have the right to choose what kind of treatment they think works best, and they will be driven by the clinical evidence and clinical guidelines; if there are no clinical guidelines, they will simply make their own decisions. Will the Minister commit to doing that?

[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.