Speech Therapy Services (Children)

Nick Smith Excerpts

Wednesday 3rd November 2010 Westminster Hall

[Paul Maynard]

I thank the hon. Gentleman for an interesting contribution, which highlights a problem that covers so many areas of medical training: what comes in at the beginning does not always come out at the end. We have to support those who are making a commitment to public service.

It is worth noting that speech and language therapists play an immensely important role across a wide range of areas. In the youth justice system, for example, the offenders are children, although we often do not think of them as such. The work that speech and language therapists do within young offender institutions is vital in reducing reoffending rates and crucial for improving life chances. The Children’s Communication Coalition made an interesting comment in its June 2010 report:

“The true costs of not supporting children with speech, language and communication needs—above and beyond those that are measurable in direct financial terms—are very great indeed. The personal and familial costs of poor educational attainment, descent into criminality and long-term exclusion from the mainstream are hugely significant and potentially corrosive to society at large. Poor educational outcomes often lead to poorly paid jobs or unemployment. In turn, this can lead to a perpetuation of the poverty trap and a vicious cycle of health problems and health inequalities”.

In a sense, that could sum up the entire debate in 30 seconds, and I could just sit down. It covers everything we need to be concerned about.

[Nick Smith (Blaenau Gwent) (Lab)]

I congratulate the hon. Gentleman on securing the debate. Does he agree that communication competency needs to be a key performance indicator, along with literacy and numeracy, in our schools?

[Paul Maynard]

I agree entirely. The hon. Gentleman has anticipated my next point. Speech and language therapists are there not just to help children, but to help the entire children’s work force understand that communication needs to be the golden thread running through everything they do. They need to be equipped to train staff, teachers and others who work with children, as well as the children themselves. I ask the Minister to confirm that she will do all she can to ensure that we recruit more speech and language therapists to meet the unmet needs that are out there.

The better communication action plan made a specific commitment to universal screening as part of the healthy child programme. Many major bodies, including the Royal College of Speech and Language Therapists, which I suspect has managed to get many supporters to attend the debate, wants to see that occur at age two and five, in advance of the reading assessment. What steps will the Minister take to ensure that that aspect of the action plan is taken into account?

Another important aspect that is often overlooked is that when we discuss children’s speech therapy we often think of those aspects that are what I describe as being high incidence, but low need. In other words, many children face communication difficulties, such as language delay, but their support needs are actually quite low. There is a much smaller group, which has much more complex needs, but the incidence of that need is relatively low. That poses a particular problem in commissioning. I wonder what the Minister’s views are on how we balance those two competing aspects, because where there is low incidence but high need, it is often more of a health intervention, rather than an educational intervention, that is required.

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[Pat Glass (North West Durham) (Lab)]

I congratulate the hon. Member for Blackpool North and Cleveleys (Paul Maynard) on securing this important debate, which is really important to me and to thousands of children and their families across the country.

The ability to communicate effectively is a key life skill. It underpins our ability to learn and to understand, to express our views and knowledge to others, and to understand their views and knowledge in return. Without good communication skills, we are not able to take our place alongside our peers in an increasingly complex world, in which good interpersonal communication skills are now as important—sometimes more so—than good qualifications.

I apologise for stating the obvious: communication is not just about being able to speak properly. It includes receptive language skills, which is the ability to understand and make sense of what is said to us, expressive language skills, which is the ability to speak clearly and make ourselves understood, and higher-order language skills, which is the ability to use and interpret humour, inference, scepticism, irony and other non-direct language.

There are many reasons why a child might fail to develop age-appropriate communication and language. For some children, there might be a link to a neurological or physiological problem, for instance oral dyspraxia, cerebral palsy or autism, but many more of them simply do not have access to the good language and stimulation that they need from an early age, and therefore enter our schools and nurseries with few, if any, information-carrying words.

In many children, communication disorders are complex and largely hidden. The child can speak, albeit with a limited vocabulary. He—it usually is a he—can go on to learn mechanically and by rote. On any crude measure of progress, such as reading age, the child might seem to be making good progress, but careful and specialist assessment by people such as speech therapists can identify that their grasp and understanding of what they have learned by rote is limited. They might appear to read well, but that reading is mechanical, with little or no understanding. As they have limited language and vocabulary, and their reading is mechanical rather than conscious and creative, their language-into-literacy skills do not develop as they should. That is largely why we have so many children failing to get good reading skills and go on to gain good skills in other areas. They do not have the basic understanding that they need to learn more complex concepts. That can lead to frustration in the classroom, and as a result a child can either become withdrawn, which can be misdiagnosed as a learning difficulty, or have tantrums and difficult behaviour, which can be misdiagnosed as a conduct or a behavioural disorder.

There are more than a million children in this country with speech, language and communication needs that are not the result of language neglect, lack of stimulation or other external factors. That means that in the average classroom there can be two or three children with such communication difficulties. Of that group, a large cohort has specific language impairment, meaning that their difficulty is not related to other general issues such as learning difficulties, hearing impairment, autism or cerebral palsy.

A child with a specific language impairment might well be cognitively able, which is a point made by the hon. Member for Blackpool North and Cleveleys. They will struggle, however, to understand the vocabulary used in the average classroom. A significantly greater number of children have speech, language and communication needs that could be classified as caused by language neglect and lack of stimulation in their early years. Those children need early and appropriate intervention. They and their needs cannot be ignored, nor can they be treated as less deserving simply because their needs are, in a sense, acquired rather than organic. Without appropriate intervention, those children will be diagnosed as conduct disordered or delinquent and will go on into a self-fulfilling prophecy, which will cost this country millions and millions of pounds.

We know from very clear evidence what happens to children with speech, language and communication disorders who do not get appropriate intervention and support. Youth offending services identify that 70% of young offenders have an underlying speech, language or communication disorder. The chief inspector of prisons tells us that more than 60% of prisoners have an underlying speech, language or communication disorder, as do a significant proportion of adults accessing our mental health services.

[Nick Smith]

Is it not astonishing that 70% of people in our criminal justice system have a communication disability or disorder? Should not the Government invest in specific speech and language therapy support, particularly for the young people in our criminal justice system, so that they have a chance to get back into proper life?

[Pat Glass]

I absolutely agree, and I can go on from that.

The National Autistic Society has identified that 70% of young people with autism, the vast majority of whom have an underlying language and/or communication disorder even if that is restricted to higher-order language difficulties, also have a mental health difficulty. Shelter tells us that a significant proportion of people classified as homeless have an underlying language and communication disorder. I could go on and on.

However, those issues are not limited to language and communication disorders; they are seen across many areas of children’s health, such as physiotherapy, occupational health and, one of the huge ones for me, child and adolescent mental health services. Review after review has identified that, to address the issues, diagnosis needs to be timely and carefully carried out by specialists—speech and language therapists—and services need to be appropriate to need and easily accessible, a point made by the hon. Member for Blackpool North and Cleveleys. Specialists in education and health need to work in partnership with the child and the family at the centre, not separately, and not, in the case of health, in a clinic far removed from the day-to-day life of the child in the classroom.

Unlike, I suspect, many other Members here, I do not see more and more speech and language therapists as the only answer. Although I want to add my thanks to specialist speech therapists for the incredible work that they do, and although I consider them part of the way forward, they are not the only answer. In my view and experience, early intervention and appropriate provision include four fundamental necessities. The first is better training for all early years education staff—teachers and support staff. Given that we know that in some cases there will be up to five children with a significant speech, language and communication disorder in an early years classroom, it seems reasonable that every such classroom should have within it one adult—a teacher or a specialist support assistant—who has additional experience or qualifications in this area. I was an assistant director of education in the constituency of my hon. Friend the Member for Washington and Sunderland West (Mrs Hodgson) a number of years ago, and we made that a requirement of our accessibility strategy. As a result, we saw a shift in the language-into-literacy issues—in the communication difficulties that were preventing children from learning to read and to progress in other areas.

Secondly, language development needs to be an integral part of the whole curriculum. The hon. Member for Blackpool North and Cleveleys talked about pulling children out of lessons and classrooms for one-to-one speech therapy sessions. Such sessions are isolated from what is going on in the child’s classroom, lessons and life, and are much less valuable than ensuring that the child is surrounded by a rich and appropriate vocabulary each and every day, and that lessons are planned and delivered to include language development as key steps.

Thirdly, specialist speech and language therapists need to be actively involved in curriculum design and delivery and in-service training for staff in schools. Finally, we need an accountability framework that understands the importance of language development in learning, and holds not only head teachers and governors, but those who commission children’s health services, to account for the training of staff and the outcomes of children with speech and language difficulties. By not intervening in an appropriate, timely and systemic manner we stand aside and allow generations of children to be labelled behaviourally disordered, conduct-disordered or odd and difficult, or as having learning difficulties. That is wrong and unnecessary, and too often it blights the lives of those children and their families.

As the Minister is here, I want to make a further plea to her to consider transferring the funding for children’s heath services to local authorities alongside funding for public health. It will not be sufficient funding, but at least it and the bulk of the responsibility will be in the same place, which will give parents a little more to hang their hats on when arguing for services.

Again, I congratulate the hon. Member for Blackpool North and Cleveleys on securing this important debate. I will work positively with anyone, on either side of the Chamber, who highlights these matters and is prepared to work with me to address them.

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[Mr Andrew Smith (Oxford East) (Lab)]

I join other Members in warmly congratulating the hon. Member for Blackpool North and Cleveleys (Paul Maynard) on securing this important debate. He spoke passionately, clearly from unrivalled personal experience and knowledge, about this important area. I agree with the high-quality contributions we have heard from all parts of the Chamber and I hope that the debate sends a powerful message to the Government about the importance of services in this area.

I want to speak in particular about the special value of the ACE—Aiding Communication in Education—centre to which the hon. Gentleman referred and which is based in my constituency, and of ACE North, which is based in Oldham. The centres provide a unique service for parents and professionals, with joint health and education-based approaches, combining whatever it takes to give children with severe communication difficulties access to communication, education and, thereby, independence.

I have seen at first hand the remarkable—often moving—difference the centres make in children’s lives. I took former Labour leader John Smith to the centre once and we were moved almost to tears watching a young girl learning to communicate using assistive technology, opening a world that would otherwise have been closed to her.

The centres provide a level of clinical expertise far beyond what is provided by the statutory services for children with such complex disabilities. Their intervention not only changes lives but saves money in later life. They also save money by preventing cases from reaching tribunals, which may be one of the reasons why some local authorities ask them for assistance.

The centres have a huge loan library of specialist equipment that children and their parents can try before they buy. That saves authorities buying unsuitable, expensive communication devices, which can cost many thousands of pounds and which would, if inappropriately purchased, end up in the school cupboard. The centres also work with the IT sector in a rapidly changing area to develop more effective aids to communication. At the point of use, advice to parents is free and independent, which is a lifeline for families learning to live with and support a child with severe communication difficulties.

The future of the centres and the services they provide is under pressure and under threat, and there are two main reasons for that. One is that the provision of direct funding, which central Government made available through grants and project support, is being shifted to local authorities. We should sound a note of caution to those who, under the mantra of localism, would shift all funding in the direction of local authorities, because highly specialist services can be marginalised and lose out in the process.

The other problem is that although the centres charge local authorities to recoup operation costs, the money is not always forthcoming at the necessary level. Furthermore, charitable donations, which the centres also attract, have decreased considerably due to the tougher competition facing all areas of the third sector in this difficult financial climate.

We therefore face a threat to a vital service. Were that service to go, we would lose something that, since 1984, has given thousands of severely disabled young people a voice and a chance in life. To run down these vital services in the national year of speech, language and communication would clearly be perverse and unacceptable.

[Nick Smith]

I do not want to make a partisan point, but the previous Government showed great leadership on this topic. They set up the Bercow review, and the then Secretary of State for Children, Schools and Families established the communication champion. Does my right hon. Friend, like me, hope that the new Government will show the same energy, dedication and enthusiasm as the previous Government in pursuing change on this important topic?

[Mr Smith]

Yes, I certainly endorse that, although I was not making a party political point, because the shift towards the presumption of local authority funding clearly did not start with the current Administration.

It would be disastrous and a tragedy if we removed the centres, losing their specialist experience and their huge loan library of communication equipment, in a climate where there is technology to help children, but the understanding, guidance and expertise to help them use it is often in desperately short supply. The same is true of the loss of specialist training for teachers and therapists in how to use the technology to support and motivate children in learning and moving towards independence.

The centres therefore face a serious situation, and I ask the Minister for an assurance that central Government sustainability funding for the ACE centres will continue for the full three years, until April 2012. On the centres’ service-level agreements with local authorities, what assurances can she give that councils will have, or will be guided to make available, the resources to ensure that the appropriate assessment and help is available in their area to children who need it? Will she look at providing immediate additional support from the sustainability services fund and the transition fund to ensure the future of the ACE centres? I should also be grateful if she could give an assurance that she will meet representatives of the centres to discuss the way forward so that we can save these valuable services.

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[Mr Robert Buckland (South Swindon) (Con)]

rose—

[Nick Smith]

rose—

[Sarah Teather]

I shall give way first to my hon. Friend the Member for South Swindon (Mr Buckland).

[Sarah Teather]

Health visitors are the key to picking up problems in the early years and making appropriate referrals. Some really interesting projects have been undertaken in Manchester, using community-based budgets; they linked health and education, realising that many children who fall behind when they get to nursery school have often missed health checks. Ways of sharing that data are important.

[Nick Smith]

I thank the Minister for giving way. I thank her also for confirming that the Government will not rip up plans introduced by the previous Government to take forward this important agenda. However, some of us are concerned that the new commissioning agenda for the national health service might mean that specialist services for speech and language therapy will not be commissioned by GP consortiums. Will the Minister confirm that special efforts will be made to ensure that GP consortiums are fully aware of this important service and that they continue to make it available?

[Sarah Teather]

I shall turn to commissioning in a moment. First, I want to say something about the school work force, a theme that was developed during the debate. It is vital that teachers and other members of the children’s work force have access to information, and that they have the opportunity for professional development in supporting children with special educational needs. Those on the front line are often the first to pick up problems, and they are vital in implementing whatever is suggested by the specialists.

One Member—I noted the point but not who raised it—spoke about the need for speech and language therapy to be well integrated into what happens in school. There are some good examples of that. Indeed, it is the kind of good practice that we want to build on through the Green Paper, with speech and language therapists training teachers to ensure that the therapists’ work continues in the classroom once the specialist help is over. That is vital. Progress has been made in recent years with the development of dedicated resources for teacher trainers and trainees, with specialist professional development for special educational needs co-ordinators and with online training material for school staff on a range of special educational needs, including specific materials on speech, language and communication needs for teachers and other staff.