Education of Children with Cerebral Palsy

Debate between Mark Hoban and Edward Timpson

Tuesday 9th December 2014 Westminster Hall

[The Parliamentary Under-Secretary of State for Education (Mr Edward Timpson)]

As ever, it is a pleasure to serve under your chairmanship, Mr Hollobone. It is also good to know that I will not have the last word, which I am sure is a relief to everyone who has taken part in the debate. I congratulate my hon. Friend the Member for Fareham (Mr Hoban) on securing this debate by proxy, if that is the right way to put it. Most importantly, he has brought to the attention of the House support for children with cerebral palsy, borne from his experience of going to the Rainbow Centre in Fareham, of which he is clearly a vocal and passionate champion. He was instrumental, along with my hon. Friend the Member for Blackpool North and Cleveleys (Paul Maynard), in establishing the recent parliamentary inquiry into cerebral palsy, to which officials from the Department for Education and the Department of Health gave evidence. We look forward to seeing the final report in the new year.

At this juncture, I will say a little more about the contribution of my hon. Friend the Member for Blackpool North and Cleveleys. First, having led the debate in the House for many years on how we better support children and young people with cerebral palsy with such expertise, candour and aplomb, he has, through being too good at that role, been recognised for his efforts, as well as his wider knowledge and skills. He now sits behind me as a valued Parliamentary Private Secretary in the Department for Education. He is therefore unable to speak in the debate, although I know he is champing at the bit to do so. Secondly, and more importantly, it is only thanks to his tenacity, passion and leadership that we are having the debate at all. I put on record my own appreciation, along with that of my hon. Friend the Member for Fareham and many others in Blackpool and beyond, for his continued efforts in raising awareness of cerebral palsy and challenging us all to think hard about what more we can do to support children and families living with CP.

The Government’s ambitions for disabled children and those with SEN, including those with cerebral palsy, are the same as for all other children: for them to achieve well in their early years, in school and in college; to find employment; to lead happy and fulfilled lives; and to have more choice and control over how they are supported. The reforms introduced by the Children and Families Act 2014, which came into effect in September, should work to the benefit of all children and young people, regardless of their type of need or impairment. We want to ensure that the reforms work well for all children and young people with cerebral palsy. We are keen to build our understanding of the evidence on what works, and we will be more than pleased to work with many of the excellent organisations out there with expertise in the area, including Action CP. Our national voluntary and community sector grants programme is another opportunity for us to support good proposals, including on early intervention and identification. I know that Action CP has submitted such proposals to us in its bid through that programme.

Our special educational needs reforms and early years policies are designed to improve how we identify and support children and young people with special educational needs. Getting the right start in life is so important for all children, but particularly for those who are disabled or have SEN. My hon. Friend the Member for Fareham is absolutely right that early identification and intervention for children with cerebral palsy is crucial if we are to put in place the right support at the earliest possible opportunity to help mitigate its physical, emotional and educational impact and ensure that we allow them to reach their potential.

A number of measures are in place to identify children’s needs as early as possible, including those with cerebral palsy. The key principle is that assessments have to be focused on the needs of the individual child and their particular circumstances. When they are between two and three years old, all children are offered a healthy child programme review, which is carried out by a health professional. That is a snapshot assessment on a given day looking at health and development outcomes. Where the child is in registered early years provision, the education practitioner, who is usually the child’s key worker, must carry out a progress check when a child is aged between two and three, and provide parents and/or carers with a short written summary of the child’s development in prime areas. I am also conscious that the golden years, as my hon. Friend the Member for Fareham puts it, fall before the age of two. We must carefully consider what more we can do to establish as early as possible whether cerebral palsy is playing a part in a young baby or toddler’s life and to put in place support that will have a discernable, positive effect on their future development.

The hon. Member for Birmingham, Selly Oak (Steve McCabe) mentioned some of the specific screening protocols for children who experience complications at birth, and I will pass on his views to my colleagues in the Department of Health. Decisions about conducting specific early screening protocols for conditions such as cerebral palsy are quite rightly made by specialist clinicians. Diagnosing cerebral palsy often takes time and no test confirms it or rules it out. In some cases when a baby requires special care in hospital after being born, it may be possible for a confident diagnosis to be made relatively quickly, which is good in order to ensure a quick response. In many cases, however, a clear diagnosis is possible only after a few months or years of screening. For those with milder symptoms, a diagnosis may not be rendered until the brain is fully developed at three to five years of age.

Under the healthy child programme, babies undergo screening, health checks or immunisations at birth, 72 hours, five to eight days, six to eight weeks, 12 weeks, 16 weeks, six to eight months, 12 months, two and a half years and at school entry. Each of those routine contacts with a health professional enables parents to discuss any concerns. They can then contact their health visitor or GP at any time should they have such a concern about their child’s development. As technology and science advance, we want to continue to push the boundaries of what is possible to ensure that we get that confident diagnosis at the earliest possible time. I am happy to work with my colleagues in the Department of Health to establish whether the national health service is doing all that is possible.

If significant concerns emerge or if a special educational need or disability is identified, practitioners should develop a targeted plan to support the child’s future learning and development, involving other professionals as appropriate. In doing so, to pick up on a point made by my hon. Friend the Member for Fareham and reinforced by the hon. Member for Birmingham, Selly Oak, it is right that as much understanding as possible is in place as to what learning is and how it can manifest itself in each individual child’s circumstances, so that no opportunity is lost to develop every aspect of their potential.

As my hon. Friend the Member for Fareham set out, the first few years of a child’s life are fundamentally important. They shape their future development and influence how well they do at school, their health and well-being and their achievements later in life. We fully recognise that, which is why, since September 2010, every three and four-year-old has been entitled to 570 hours a year of Government-funded early education over no fewer than 38 weeks of the year. Since September 2013, the most disadvantaged two-year-olds across England have been able to access a funded early learning place. By May 2014, more than 116,000 two-year-olds were already benefiting from early learning. That number has continued to grow since September 2014, when the number of children entitled to a place doubled to some 260,000.

Through the early years foundation stage, we seek to ensure quality and consistency in all early years settings, so that every child makes good progress, that no child gets left behind and that learning and development opportunities are planned around each child’s needs and interests. That is also at the heart of the reforms in moving towards to a birth to 25 single plan and assessment system to ensure consistency of approach from all professionals who come into contact with a child throughout their education. The EYFS currently calls for integrated working between health and education practitioners to assess a child’s development and needs at age two where possible, which is particularly important for children with cerebral palsy. We have asked for integrated reviews to be offered as standard practice from September 2015.

As ever, there are some excellent examples of effective integration of education, health and care services. I can point to ones in Cornwall and Wolverhampton that we have discovered through engagement with the relevant authorities, but we need to ensure a consistent approach to integrated working across health and education not only through legislation, but in practice on the ground. To follow that through, Ofsted will look for evidence of integrated working in all settings, from early years through to the compulsory school age, to seek assurances that early years providers and others are assessing children’s progress and needs appropriately and are doing all that they can to support each child’s development towards being ready for school and beyond.

A more holistic picture of a child’s needs is more likely to lead to the child getting the help that they need through early intervention. Supporting more timely and more accurate early intervention might be more effective, could lead to longer-term savings and could improve children’s life chances, especially those from disadvantaged backgrounds. That is why, for children of school age and beyond, we have ensured that the new special educational needs code of practice gives clear advice on identifying needs and providing support, based on effective practice from successful schools, including those in the achievement for all programme.

My hon. Friend the Member for Fareham welcomed the emphasis that the reforms rightly place on educational and life outcomes, both in early years settings, schools and colleges, and, for those with more complex needs, through co-ordinated assessment and a single education, health and care plan. As the hon. Member for Birmingham, Selly Oak reminded us, health bodies and local authorities now jointly plan and commission services for disabled children and young people and those with special educational needs. I have worked closely with my colleagues in the Department of Health throughout the development and implementation of the reforms, and will continue to do so, to ensure that health is an integral part of the drive to improve outcomes for children and young people, but where we could and should go further, we will look to do that. I had an extremely productive meeting with the Under-Secretary of State for Health, my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter), and we have a clear and joint commitment to ensure that the work being done throughout the national health service to implement the reforms is as much a priority in the NHS as it is in education and social care agencies.

Better information for parents and young people has been a theme throughout the development of the reforms. There should also be an opportunity for them to feed back, so that improvements can be made that reflect their observations of where services may be falling short. Through the local offer, parents will know what they can reasonably expect their local early years provision, school, college, local authority and local services to provide without having to battle for the information, which was so disparately spread in the past. From his observations about the Rainbow Centre in his constituency, my hon. Friend the Member for Fareham made the point well that the local offer in his local authority area makes it clear that the centre is available to parents, but that that is not reflected in the surrounding local authorities, which do not necessarily see it as a part of their own offer.

We made it clear throughout the passage of the legislation—I am happy to reiterate it now—that a local offer is not confined to services within a local authority area, in particular when it relates to specialist services. We tend to operate within what many would see as artificial boundaries, but many parents need to look beyond their local authority to find the service that best meets their children’s needs. Local authorities should therefore be thinking long and hard about services not only within their own local authority, but in surrounding areas, so that the local offer genuinely reflects what they would reasonably expect to be made available to parents for all conditions and for all children who have special educational needs and disabilities. Local authorities must consult parents of children with SEN and disabilities, and children and young people themselves, when developing and reviewing their local offer and must publish the action that they will take in response to comments about it. That will help to ensure that local services are responsive to local needs and will make it even more important that the offer reflects what parents say is required.

[Mr Hoban]

I appreciate that I will have a second bite of the cherry in a minute, but I just want to press the Minister on this point about what the local offer includes. He rightly places emphasis on consulting parents, but if the parents do not know that there is a specialist centre in the next county, or the next city in the case of Birmingham, they will not know how to feed that back. What steps will the Department take, either directly or through Ofsted, to monitor the composition of local offers?

[Mr Timpson]

I was going to come on to the issue of accountability, but will bring it forward in my contribution as my hon. Friend has raised it. The hon. Member for Birmingham, Selly Oak also made the point about how to ensure that implementation is taking place on the ground. A real difference for families would be if they had a different experience and a more coherent and cohesive response from each agency, involving them more in the process. That involves ensuring that the local offer sets out clearly for parents what the local authorities expect to make available. The regulations that underpin the Children and Families Act—not only the code of practice, but other delegated legislation—make it clear what local authorities should be doing to achieve just that.

In the early stages of implementation, we brought a network of SEN advisers into the Department to work with us, and they are out in the field the whole time, establishing with all 150-plus local authorities that they have complied with the legal requirements of the Act in the publication of the local offer—every single local authority has a published local offer—and that the offer reflects the spirit of the reforms. The SEN advisers have been working in the system for many years—they were hand-picked for that reason—and their knowledge means that they can establish where there is a shortfall in the local offer and in the information available.

Beyond the first year of implementation, we have been working closely with Ofsted. We have asked it to conduct a survey on local authority readiness for the reforms and whether there is a need for an inspection framework, so that parents may have confidence that education, health and social care services are genuinely working together with parents, families and children at the earliest possible opportunity, involving them not only in the development of their own plan, for their own child, but in the wider strategic plan for provision in the local area.

We will announce soon how the accountability framework will be shaped in future, but the Christmas present that I can offer to parents and families at this time of year is that we are clear with Ofsted about the need for a clear level of accountability that does not involve a direct relationship with the Department, instead relying on a local approach to accountability, which will help to provide consistency throughout the country. I hope that that will be a welcome development for many parents who were anxious to know how we intend to ensure that the reforms that we have set out and our vision will be translated into action on the ground.

The need to raise awareness among professionals is a key aspect of our reforms, as is the sufficiency of education and health care specialists with the skills to support children, including those with cerebral palsy, a point made by both my hon. Friend the Member for Fareham and the hon. Member for Birmingham, Selly Oak. Transition points can often be a stage in a child’s life where support can fall away, causing a period of uncertainty and or decisions to be delayed. That is the whole reason why we have moved towards a clear birth-to-25 system, for a much easier way to transcend movement through the education system that does not include different plans and different people, but gives parents and children consistency of support through what can be a difficult time.

The Government have established a clear, national statutory framework for identifying, assessing and providing for all children with SEN and disabilities. Detailed arrangements are, rightly, made locally, allowing local provision to be more responsive to local need, but the needs of children and young people with SEN vary greatly. Indeed, the needs of those with cerebral palsy can vary greatly, as we have heard, depending on the precise nature of the condition and other factors in their life. Education settings therefore need to ensure that they give their staff the training necessary to support the individual needs of the children and young people for whom they provide.

Early years providers, schools and colleges are responsible for deciding what specialist expertise is required to meet children and young people’s needs and for securing that expertise. That is explicit in the SEN code of practice. We have been at pains to drive the point home that it is the responsibility of all teachers within a school or an educational setting to have an understanding and awareness of special educational needs and disabilities, so that they can play their part and not see it simply as the role of the SEN co-ordinator or other specialists. Specialist organisations can play a key role in increasing awareness of particular disabilities. My Department has supported such organisations in the fields of autism, dyslexia, and speech, language and communication needs, which are the most prevalent types of SEN, to provide information, advice and support to schools, early years settings and local agencies.

The new SEN and disability code of practice makes it clear that local authority and health partners should ensure that a designated medical officer is in place to ensure that assessment planning and health support are carried out. I am interested in securing the further spread of DMOs. There are some excellent examples of where they are making a significant contribution, but there is still scope for them to become more embedded in more parts of the country. I will be looking at that closely in the coming weeks and months. The code recognises that the DMO role would usually be taken by a paediatrician. The person appointed should have appropriate expertise and links with other professionals. That helps to bind health in, not only with the clinical role of the DMOs but with the role that they can play within schools, so that there is a genuine partnership to ensure that assessment, planning, and implementation and review of the plan are done as a collective response to the child’s needs.

The Children and Families Act places the views, wishes, feelings and aspirations of children, parents and young people at the heart of the new system. That is what the Green Paper set out in 2011 and what we have seen through to the conclusion of the legislation. To make it happen we have an active young people’s national advisory group, EPIC, who have been involved in the development of the reforms from the start, and they are still with us. I meet the group regularly and I find their involvement hugely valuable. They share with me their real-life experiences, not only of the consequences when they get suitable, solid and constant support, but of when the system fails to deliver and the fallout that occurs. Such input has helped us to focus on the practical implications of our reforms and led to some important and significant changes. Several of the young people involved in the EPIC group have cerebral palsy and have proved to be some of our most articulate and persuasive ambassadors.

We are also doing a lot to improve advice and support for parents, including funding, through our reform partner, the Council for Disabled Children, and the recruitment and training of independent supporters in every local authority. When we asked parents what, under the old system, would make the biggest difference to them in battling it and in trying to get some of the basic provision necessary to getting on, they suggested independent supporters. Parents said that they would value some independent support from someone who was not from the local authority or the health service, but had expertise in SEN and disabilities, in particular in the areas most relevant to their own child. Independent supporters will provide advice and support for parents of children with SEN and for young people with SEN through the statutory assessment and the education, health and care plan—or EHCP—processes. Such supporters will help to build the resilience of families and to tailor support to their individual needs.

We are also providing funds for SEN and disability parent carer forums in each local authority. Forums play a central role in helping to shape local policies and provision and they have been effective in co-producing local authorities’ local offers. From their knowledge of the services available in the surrounding area, they have helped to draw out some of the gaps in some local authority offers. We wanted to continue supporting them in that, for the good reasons set out by my hon. Friend. I am sure that parents of children with cerebral palsy will want to be active in those forums, if they are not already, and I would certainly encourage their involvement.

The reforms we have set in train are still at the early stages of implementation. We have set out a transition of about three and a half years from the old system to the new. Throughout that period, however, our knowledge should not remain static, and we remain open to the suggestions, views and concerns of parents and those working in the SEN system to make sure that the work we are doing to bring about a change in culture across that system takes hold in the way we envisaged.

In that endeavour, the work my hon. Friend has undertaken in this parliamentary inquiry, together with my hon. Friend the Member for Blackpool North and Cleveleys, who is ably assisting me this morning, is most welcome. I hope—indeed, I am sure—they will continue their work in their constituencies and in Parliament. I look forward to seeing their final recommendations in the inquiry’s report in the new year.

I am more than happy to meet my hon. Friends and representatives from Action Cerebral Palsy to see what more we can do to support children with cerebral palsy and their families. There is growing awareness of the issue, but still far too little. Although we are all exercised by the many points that have been raised in the debate, it is incumbent on us all to make sure that understanding and awareness are much more widespread.

I thank my hon. Friend the Member for Fareham and the hon. Member for Birmingham, Selly Oak for their helpful, insightful contributions. If there is anything I have not covered, I will, in the usual way, endeavour to write to them to provide them with further details. The debate has been helpful in setting out some of the challenges that still lie ahead and the progress that has been made, although we recognise that there is still work to do.

Equitable Life (Payments) Bill

Debate between Mark Hoban and Edward Timpson

Tuesday 14th September 2010 Commons Chamber

[Mr Hoban]

I want to make progress because I am conscious that there is an eight-minute limit on Back Benchers’ speeches, and clearly many Members on both sides of the House are interested in the debate.

Once we receive the independent commission’s report, I plan to publish a document, early next year, showing clearly how the scheme will function. The ombudsman envisaged that any system of payments would need to be independent, simple and transparent. I agree with that thinking and I have tried to ensure that our approach meets those criteria. On independence, the Government have established the Independent Commission on Equitable Life Payments to advise on the design of the scheme; to ensure simplicity, we will ensure that the future system of payments is as straightforward as possible to avoid any undue burdens being placed on policyholders; and, on transparency, we have published Sir John Chadwick’s report, the actuarial advice from Towers Watson and representations made to Sir John. Interested parties therefore have access to information when making their representations.

In the spirit of transparency, I shall update the House on wider matters relating to Equitable Life and payments to its policyholders. It is worth reminding hon. Members that one outcome of Sir John’s work is that it enabled us to produce the first bottom-up assessment of relative loss, which we did by comparing the performance of Equitable’s policies against those of comparator companies. There are some reservations on the detail, but there appears to be some broad agreement on the general approach of comparing Equitable Life’s performance with that of a basket of comparator companies. I recognise that a number of Sir John’s recommendations were contentious, including his view that the majority of policyholders had to make the same investment decisions irrespective of maladministration, but I stress that Sir John’s review is just one of the tools at our disposal in looking to fix an incredibly complex problem.

[Mr Edward Timpson (Crewe and Nantwich) (Con)]

My hon. Friend mentioned the work of the actuary and the advice given to Sir John Chadwick to formulate his report, but, given the transparency that my hon. Friend is trying to bring to this matter, has he considered publishing the actuary’s calculations?

[Mr Hoban]

My hon. Friend makes an important point about transparency. The actuarial advice gives a clear demonstration of the methodology used by the actuaries, but 30 million premium transactions had to be compared with a basket of comparable companies from 1992 to the end of 2009. The publication of the model at that level of detail would not aid transparency. It would be more likely to confuse, given the complexity of the calculations. However, we have ensured that EMAG and ELTA—Equitable Life Trapped Annuitants—have had an opportunity to meet Towers Watson, the actuaries, to go through the calculations. Towers Watson has provided examples of its calculations so that the mechanics can be understood.