Young Offender Institutions (Speech and Language Therapy)

Nick Smith Excerpts

Thursday 28th June 2012 Commons Chamber

[Seema Malhotra]

I thank the hon. Gentleman for his contribution. He makes an important point about the inability to understand what is going on in the justice system through an inability sometimes to read and, certainly, to understand what is being said. An important part of the argument is that we need better speech and language therapy services in order to reduce reoffending.

Statistics from the Royal College of Speech and Language Therapists show that 10% of school-aged children and 1% of adults in the general UK population have speech, language and communication needs, but that 55% of children in deprived areas are affected by such needs. They suffer from a “word gap” of an estimated 30 million words when compared with children in wealthier households, and that limits their ability to use language to communicate effectively.

It is estimated that more than 60% of young offenders have speech, language and communication needs, and there is evidence of a vicious circle—of deprivation leading to reduced language development, leading in turn to communication difficulties. Children with speech and language difficulties are more likely to become frustrated at school, to play truant and to get involved with crime. Once they are involved, they struggle with the formalities of courts and of police interviews, and they come out worse because of it.

[Nick Smith (Blaenau Gwent) (Lab)]

I, like my hon. Friend, have visited young people with communication disabilities in prison; I did so in Park prison, near Bridgend. Does she agree that it is essential to recognise as early as possible, at the point when young people enter the criminal justice system, whether they have communication difficulties? Does she agree further that the Asset tool should be updated so that needs can be identified without delay and the right help delivered?

[Seema Malhotra]

I thank my hon. Friend for his comment. He makes an important point about early identification within the justice system—particularly if somebody’s needs have been missed earlier in life—in order to help an individual to facilitate the rehabilitation that we hope is possible for them.

There is an important debate about the standards of provision in the education system, and I shall speak about that tomorrow at an excellent training conference on developing oracy and literacy, organised by Hounslow Language Service in my constituency.

My concern in this debate, however, is about the access to speech, language and communication needs assessment and services once young people have reached prison. When I visited Feltham young offenders institution recently, I met a 15-year-old boy who has been receiving speech and language therapy, and learning a few speech exercises had already made him more confident in speaking to his family on the phone—with a clear impact on his personal confidence.

The boy’s vocabulary was like that of a child, but this is not so surprising when we discover that 35% of offenders have speaking and listening skills below national curriculum level 1, equivalent to those of a five-year-old. A further 26% of offenders are estimated to have national curriculum level 2 speaking and language skills, which compare to those of an average seven-year-old.

I also heard the story of a young man who was recently at Feltham. He had a lisp, and when he was three his GP had told his parents that this was because he had a small tongue and nothing could be done. He proceeded to do poorly at school. He was laughed at, including by his own family; his mother would force him to speak when friends came round as a source of entertainment. When in prison, this young man came to accept some speech and language support, and within a matter of weeks he was becoming a more confident speaker, with an almost instant change in attitude to turning his life around. An ability to communicate better has been increasingly associated with reduced violent behaviour of young offenders, and that was indeed the case with this young man.

We know that it works to invest in communication skills and in the training of staff and officers in the justice system. The Royal College of Speech and Language Therapists’ briefing on youth crime of June 2012 quotes statistics from Red Bank secure children’s home in Liverpool. Five out of seven young offenders in one section had challenging behaviour. Staff were involved in physically restraining these young offenders on two to three occasions per day. After communication training and guidance from the speech and language therapist, staff were able to reduce the number of restraints to two per week. The Communication Trust has published in its booklet, “Sentence Trouble”, some useful suggestions about how youth justice professionals can positively interact with young people with speech, language and communication needs. It identifies an awareness and training gap in the youth justice work force, who are much better prepared to deal with mental health issues and substance abuse than with speech and language difficulties.

I am concerned that dealing with the speech, language and communications needs of young offenders is falling through the cracks between the Departments for Education, Health and Justice. It is probable that many young people in prison may not have been there had the education system or health system intervened effectively earlier in their life. In 2010, research with therapists conducted by the royal college in four areas of the country suggested that over 90% of young offenders with communication difficulties had not been known to speech and language therapy services prior to their contact with the criminal justice system. Yet the benefits of these services are clear in improving justice outcomes and reducing reoffending. It is feared that current education and rehabilitation measures in prison require a higher level of language comprehension than many young offenders possess. However, current provision of these services in young offender institutes is limited and patchy. Of the 21 young offender institutes, only Feltham has a full-time speech and language therapist, while four others—Hindley, Wetherby, Polmont and Cornton—provide some support on one to three days a week.

There have been moves to make this case and improve provision in the past. In 2006, Lord Ramsbotham, formerly Her Majesty’s chief inspector of prisons, said in a Lords debate:

“in all the years I have been looking at prisons and the treatment of offenders, I have never found anything so capable of doing so much for so many people at so little cost as the work that speech and language therapists carry out.”—[Official Report, House of Lords, 27 October 2006; Vol. 685, c. 1447.]

The Bercow report recommended that the youth crime action plan and work on young offenders’ health should consider how best to address the communication needs of young people in the criminal justice system, including those in custody. The youth crime action plan of 2008, produced under the previous Government, included recognition of the Bercow review’s recommendations. However, I am not certain whether any action has yet been taken by this Government, nor has the Under- Secretary of State for Justice, the hon. Member for Reigate (Mr Blunt), who is responsible for youth justice, commented on speech and language therapy.

The royal college has called for at least one full-time specialist in every young offender institute. The Prison Reform Trust supports this recommendation, and its report, “No One Knows”, recommended that

“prison healthcare should have ready access to”

learning disability expertise and

“speech and language therapy.”

Arguably, on the current evidence, there is a strong economic case for this. Secure children’s homes and training centres cost about £200,000 a year, while placement in a young offender institute costs £60,000 a year. This, the House may be interested to hear, is twice the cost of a year at Eton, which is £30,981. I thank the Minister for providing these up-to-date figures following my written question last week—excluding the Eton figure, of course, which were obtained from Eton’s website. In comparison, a full-time speech and language therapist employed under NHS “Agenda for Change” band 7 costs £30,460 a year—marginally less than a year at Eton. The funding of speech therapy is surely cost-effective, compassionate and necessary for an effective and intelligent youth justice system.

To conclude, I would be grateful if the Minister updated the House on a number of matters. First, what is the Government’s policy on the provision of speech and language therapy in young offender institutions, and on the call for there to be at least one full-time speech and language therapist at every institution? Secondly, will he clarify which Department is accountable for the provision of speech and language therapy in young offender institutions, and how the Department for Education, the Department of Health and the Ministry of Justice work together on this issue? Thirdly, is it true that Asset, the assessment tool used by police and the justice system, does not include a section that enables staff accurately to identify speech, language and communication needs? Fourthly, what assessment of speech, language and communication needs takes place when a young offender is sentenced to prison? Fifthly, is the existing funding secure and are there plans to increase the provision in young offender institutions? Finally, how do Ministers currently measure and review the effectiveness of such services?

I thank the House for the opportunity to speak on this topic today.

[The Minister of State, Department of Health (Paul Burstow)]

I congratulate the hon. Member for Feltham and Heston (Seema Malhotra) on securing the debate and on setting out the issues so clearly. I note that, curiously, my noble Friend Lord Addington is debating this matter with Ministers in the other place. It is clearly of importance to parliamentarians in both Houses. The work of the all-party parliamentary group on speech and language difficulties underscores that point.

It is important to recognise that speech, language and communication difficulties are part of a complex and multi-layered range of needs that young people between the ages of 15 and 21 may have, particularly those within our criminal justice system. I understand the concerns about speech and language therapy that the hon. Lady has raised and will try to address them.

There have been a number of studies, mostly small-scale studies, on the prevalence of speech, language and communication needs. They place the prevalence of such needs in custodial settings at anything between 60% and 90%. One recent study found the 60% of young offenders screened on entry to custody had speech, language or communication needs. As has been said, among the general population the figure stands at 1%, although there are regional and local variations.

Much attention has been given to these issues over recent years. The hon. Lady made reference to Mr Speaker’s work on behalf of the last Government. The coalition Government are taking forward a number of the actions in the Bercow review. First, we had the Green Paper on special educational needs and disability, and the follow-up report that was published recently. Secondly, there have been pathfinder pilots to develop unified plans covering health, education and care needs, supported by the use of personal budgets. Thirdly, we have had the review of the early years foundation stage. The Department of Health is working closely with the Department for Education to join up health and care, sorting out one of the oft-stated criticisms of SEN provision for so many years.

I assure the House that speech and language therapy is available to young people, and in particular to those in the custodial estate. Currently, it is commissioned in the custodial estate through primary care trusts. It is meant to be commissioned according to local need. That means that in-house services are provided in some larger young offender institutions—not just in Feltham, but in Wetherby and Hindley. I urge the hon. Lady to look at the provision in those two other institutions.

From next April, the responsibility for commissioning prisoner health will move from primary care trusts, as they are abolished, to the new NHS Commissioning Board. That will help to ensure that people with health needs in custodial settings receive care comparable with that received by those in the wider NHS. Offender health lead commissioners will act for the board and determine the right level of service to be provided to meet the identified needs within the prisoner population. They will work at local level with health and wellbeing boards, children’s services, and police and crime commissioners.

[Nick Smith]

May I press the Minister? How many young people’s custodial settings have speech and language therapists working at them? Do some or all settings have them?

[Paul Burstow]

The hon. Gentleman will have heard me say that there is specific in-house provision at three settings, but there will also be referrals through NHS pathways for speech and language services, meaning that any young person in need of speech and language therapy should have access to it. That is one of the requirements of the commission—its responsibility is commissioning appropriate services to meet identified needs. I shall come to the identification of needs in a moment.

Speech, language and communications needs are just one part of an often complex picture. It is important that we acknowledge that there are complex interactions with, for example, mental health problems, learning disabilities, substance misuse and alcohol problems. Therefore, psychiatry, psychology, community psychiatric nursing, psychotherapy, and occupational and creative therapy can all play a valuable part—a bigger part in some cases—in treating and meeting the needs of young offenders.

The hon. Lady was right to highlight the contribution that speech and language therapies make not just in direct services, but in supporting colleagues in a multi-disciplinary team to ensure they have the necessary skills to provide the right communications support and so on.

Adopting a personalised approach is at the core of that. The hon. Member for Blackpool North and Cleveleys (Paul Maynard) rightly said that we need to ensure that people have the communications skills and understanding both when they are in prison or youth offending services and when they are released. That was an important point.

The hon. Lady spoke powerfully of her visit to Feltham and the conversations she had with the 15-year-old lad about his experience of speech and language therapy—he said it gave him more confidence. That is another reason why such therapy is an important component of the right health interventions to meet identified needs.

The hon. Member for Blaenau Gwent (Nick Smith) said in an intervention that early intervention is relevant as well as the change in commissioning responsibilities. Early intervention is a key part of the Government’s approach. Continuity of care and treatment is key. The average period of detention for a young offender is very short—80 days, often including remand. Custody therefore provides opportunities for health assessment and for identifying problems and needs, after which referrals can be made. It is therefore important that we have systems that allow those follow-ups to take place. It was right that the previous Government decided that the commissioning of prison health services should be an NHS responsibility, enabling those systems to be properly joined up, and this Government have maintained that.

We need to look right across the whole criminal justice pathway to provide health interventions that are appropriate to the individual presenting needs. In 2010-11 there were 2,040 10 to 17-year-olds in the secure estate at any one time on average. Sometimes, four times as many were on remand or awaiting sentence to custody, and 85,300 were being supervised by youth offending teams. There is a similar pattern in the 18 to 20 age group.