Speech Therapy Services (Children)

Pat Glass Excerpts

Wednesday 3rd November 2010 Westminster Hall

[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.

[Mr Gary Streeter (in the Chair)]

We have 14 minutes until wind-ups begin, and six colleagues are trying to catch my eye, so contributions of around seven or eight minutes would be most welcome.

--- Later in debate ---

[Pat Glass]

The Minister spoke about early intervention, which has huge support. However, we are hearing fairly reliable but worrying reports that the much-trumpeted pupil premium will not be paid for children under the age of five. Will the Minister confirm that it will be paid for all children in education from the age of two, and not be restricted to those over the age of five?

[Sarah Teather]

The hon. Lady will be aware that the consultation closed just before the comprehensive spending review. We will be making a much more detailed announcement on the pupil premium shortly, but we want to ensure that local authorities know much more about the scheme when they get their settlement.

I was about to speak about some of the issues raised by the hon. Lady in her speech. Early identification is vital for the child and the family; as she said, it will reduce costly interventions later. It is essential that more timely referrals are made to specialist services. That is why I asked Dame Claire Tickell, who is leading a review on the early years foundation stage, to look specifically at how to improve early identification of such problems by the EYFS. She is leading the process at the moment, and she will soon be reporting her findings to the Government.

For the same reason, we have extended the two-year-old offer to significantly more disadvantaged young children. About 130,000 disadvantaged two-year-olds will benefit from 15 hours of early education a week. That point was raised by a number of Members. Indeed, the hon. Member for Gedling (Vernon Coaker) said that children often arrive at nursery without the required language skills because they have not been exposed to language in the usual way. Offering high-quality early education is vital in giving those children the chance to pick up those skills.

The hon. Member for Gillingham and Rainham (Rehman Chishti) spoke about Sure Start centres. Many already provide speech and language therapy, but more use of such evidence-based programmes is definitely part of the reform programme that the Government want to institute. The Under-Secretary of State for Health, my hon. Friend the Member for Guildford (Anne Milton), who is responsible for public health, recently confirmed the Government’s intention during this Parliament to recruit and train 4,200 health visitors. Health visitors will be key in picking up on speech delay in very young children, ensuring that they are referred to the appropriate services, including Sure Start centres.