Education of Children with Cerebral Palsy

Debate between Philip Hollobone and Mark Hoban

Tuesday 9th December 2014 Westminster Hall

[Mr Mark Hoban (Fareham) (Con)]

I thank my hon. Friend the Member for Blackpool North and Cleveleys (Paul Maynard) for securing this debate and generously asking me to open it. My first event as a Member of Parliament was a fundraising evening for the Rainbow Centre, a charity set up by parents to enable their children with cerebral palsy to benefit from conductive education, a therapy pioneered at the Peto Institute in Hungary. At that point, the Rainbow Centre was above a carpet shop in the centre of Fareham; they were not the most salubrious premises, but it demonstrated the parents’ commitment. They were prepared to go there during the week and on weekends, often carrying their children upstairs so that they could benefit from the education provided there. Children came from as far afield as Hampshire, Sussex, Dorset, Wiltshire and the Isle of Wight.

Now the Rainbow Centre is in a purpose-built building in Fareham, and can offer support to more parents and their children. It also uses the techniques of conductive education to help adults with multiple sclerosis and Parkinson’s disease and those who have had strokes. My engagement with the Rainbow Centre led me to become involved in a parliamentary inquiry supported by Action Cerebral Palsy, an umbrella organisation for charities across the country supporting children with cerebral palsy. My hon. Friend the Member for Blackpool North and Cleveleys led the inquiry, and a final report will be published next month.

I will say a little about cerebral palsy to set the context for my later remarks. It is a motor disorder caused by damage to the immature or developing brain that occurs before, during or immediately after birth. In the UK, 1,800 children a year, or about one in 400 born, develop cerebral palsy. The condition can affect those from all social backgrounds and ethnic groups. At some point very early in life, either while a baby is growing in the womb, during birth or shortly afterward, something happens to interfere with the normal development of the brain or to injure the brain tissues. That abnormal development or injury disrupts the nerve signals sent along neural pathways between the brain and the muscles, leading to problems with movement, posture and co-ordination as the child develops. This is called cerebral palsy.

As cerebral palsy is a condition of very early childhood, the implications for the developing child cannot be ignored. During the formative years, the central nervous system develops rapidly, enabling the child to learn, explore and connect with their social environment. It is during those crucial early years that the ability to learn develops. Children with cerebral palsy are hindered to varying degrees during that process as they battle to learn fundamental skills related to their symptoms. Therefore, cerebral palsy should to a significant extent be considered as a problem of learning, rather than a problem of functioning or communicating.

Early identification of cerebral palsy and early intervention can help tackle problems of movement, posture and co-ordination. Between the ages of nought and two, a child has a high degree of neural plasticity, which can be harnessed with appropriate programmes in order to remap the neural pathways between brain and muscle, enabling children to overcome problems of movement, posture and communication.

I have seen for myself the huge progress that children have made at the Rainbow Centre through early intervention. Children whose parents were told that they would not walk now can; children said to have high degrees of dependency are now independent. Everyone who has been to the Rainbow Centre or similar centres around the country comes away moved by the sight of children, parents and educators working together through an educational programme that helps children improve their motor skills and rebuild those neural pathways. We can make adaptations to accommodate the physical symptoms of cerebral palsy—for example, we can provide ramps for wheelchairs—but it is so much more powerful and rewarding to work with children to rebuild their neural pathways so that those ramps are not needed.

There were several recurring themes in the inquiry, including problems with early identification. Also, once CP has been identified, parents are more likely to have to fight to get the right support for their children than to find it easy to obtain. There is poor signposting to centres offering appropriate programmes, a reluctance among some local authorities—including Hampshire county council—to support the work of specialist providers, and reduced access to specialist services as children get older. In many respects, those issues are not unique to cerebral palsy, and I commend the Government for their reforms relating to special educational needs and disability.

Those giving evidence in our inquiry warmly welcomed the intentions behind the Government’s reforms, which are widely believed to have the potential—I emphasise the word “potential”—to transform the lives of people with cerebral palsy. The introduction of education, health and care plans, which will provide statutory protection, comparable to that provided by statements of special educational needs, to young people who are in education or training up to the age of 25—as compared with 16 now—was seen as a particularly encouraging development by respondents to the inquiry. If services for children and young people with cerebral palsy are to complement each other, the plans should facilitate that by ensuring that services are jointly commissioned and provision is decided in dialogue with parents.

The stipulation that provision in plans is set on the basis of the expected outcomes for the child or young person, as agreed between professionals and parents, has been welcomed. It is believed that if the measures are followed through on, they should create the promised cultural shift that will lead to assessments for special educational provision being based on a continuing assessment of a child’s needs and expected progress, rather than being simply a fight over short-term solutions to long-term issues.

I want to emphasise some particular concerns of parents and other participants in the inquiry. The first regards the local offer, which is hugely important because of its potential to give families access to specialist cerebral palsy services offered by third-sector organisations. However, the challenge is what will be included in the local offer. Let me illustrate that challenge with reference to the Rainbow Centre. The centre has applied to be included in the offer for Hampshire, Portsmouth and Southampton, but councils in other areas served by the centre, such as Wiltshire and Dorset, have said that they will only include the centre if there is space available. That means that parents of children with CP in those areas will not know that the provision is available and will miss out on the support that the centre offers, and therefore on an education that could transform their children’s lives. Given the nature of centres dealing with CP, there will not be one in every county or unitary authority, so it is important that the local offer looks beyond council and area boundaries to ensure that all children with CP are signposted towards the right specialist services for them.

The issue of the local offer speaks to a broader point about the tension between tailoring services to local needs and a postcode lottery that results from a lack of national consistency. I suggest to my hon. Friend the Minister that Ofsted, in its inspection of children’s services, should examine the local offer and how comprehensive it is. Best practice guidelines should be produced for education and health professionals who work with children and young people with cerebral palsy, to accompany the special educational needs and disability code of practice. The guidelines should explain how the lives of children with cerebral palsy can be improved within the framework of the new system. Although there are the best intentions behind the reforms, parents and practitioners told the inquiry that many years of battling with education and health authorities over support for children with cerebral palsy have left them doubtful as to whether the reforms will make a difference.

The negativity about the reforms’ potential is the legacy of an adversarial SEND system in which parents and practitioners have been left battle-weary and sceptical that change can be achieved. There remains the fear that while the reforms could slightly improve the situation for children and young people with cerebral palsy, they will not address the widespread lack of understanding of the needs of those children and young people, which contributes to a systemic antagonism whereby parents have to fight too hard to prove what support their children need.

Perhaps one of the biggest recurring issues that emerged from the inquiry was the striking lack of awareness among health and education professionals, even among those responsible for carrying out assessments for SEN statements, or for making plans about cerebral palsy that establish what support children and young people who have CP require. This results in late diagnosis, missed opportunities for early intervention and a general scepticism from professionals about forms of support that parents often say have transformed their children’s lives.

There is a need for an awareness-raising exercise, so that if cerebral palsy is diagnosed, parents are made aware by professionals of the options available to them immediately, rather than having to search for those options themselves. In addition, parents who spoke to the inquiry said that all too often they themselves were the experts on cerebral palsy, and the professionals they encountered not only provided little help but acted as obstacles to parents and their children, preventing them from accessing the best help available.

There is a particular concern about early intervention and about whether the reforms will do enough to help. The inquiry shows why more needs to be done to support children and young people with cerebral palsy, especially in the “golden years”—post-diagnosis, for those under the age of two—when intervention is at its most effective because of the plasticity in children’s brains at that age. However, this is often also the period when that type of intervention is most absent.

The inquiry found that children are not receiving the specialist invention they need during these golden years because there is not enough specialist educational intervention available for children under the age of two and, where it does exist, health professionals and parents are too often completely unaware of it. Moreover, even when they are aware of it, local authorities’ responsibilities for assessing the needs of those under the age of two are not spelled out very clearly in the SEND code of practice. That means that by the time an assessment is made and support is put in place, there is a risk that the opportunity to intervene in these golden years, and to improve significantly the early intervention services for children with complex needs, such as cerebral palsy, has been missed. More clarity is needed in the SEND code of practice. It is not clear how local authorities are involved in the assessment of children’s needs prior to the check at the age of two. Of course, as I have said, for many children, intervention after the age of two is of reduced effectiveness.

I would be keen to hear from the Minister how the Government intend to encourage local authorities to target early intervention, and how health and education services will be encouraged to work together in early years—for example, by ensuring that the requirement on health professionals to advise parents on not only the health support available to their child but the educational and developmental support that they may be able to access is followed through on.

I have discussed problems to do with the availability and quality of care for children with cerebral palsy in their earlier years, but we should not fool ourselves into thinking that if we tackle these problems, they will be solved. It is clear from my conversations with parents, and from feedback from centres across the country, that far too many children with cerebral palsy can be isolated when they reach secondary school. Primary schools are often well prepared. Staff are able to work with children who have cerebral palsy, primarily because these schools are often laid out on one floor and are therefore very accessible. Children with CP can get around such schools without any issues, and they can take part in all the normal school activities. However, when they get to secondary school, they can often fall through the gap.

By their nature, secondary schools have much larger buildings than primary schools, with multiple floors and large complexes. Children with CP can often struggle to get around them, leaving them isolated from their classmates and often from parts of the curriculum. Children with CP have been unable to take subjects they love because of problems with wheelchair access. Those problems may prevent them from taking part in courses on the first floor of a building that does not offer access through lifts or ramps.

However, the problem runs much deeper than just physical access. Many secondary schools do not have the specialist knowledge to help children with CP to integrate, and that problem is compounded by the nature of CP. During their adolescent years, young people with the condition can physically regress if they are unable to continue the programmes that help them to remap and maintain their neural pathways. Ensuring proper integration between schools—both primary and secondary—and specialist services can make a huge difference. We do not want the advances in independence that are made in early years to be eroded because insufficient thought has gone into the primary and secondary education of a child with CP.

In conclusion, I hope that I have set out where I believe the debate is at regarding support for children with CP, based on my experience with the Rainbow Centre and my participation with the parliamentary inquiry that is supported by Action Cerebral Palsy. As I said, that report will be published next month, and I hope that the Minister will meet my hon. Friend the Member for Blackpool North and Cleveleys and me, as well as representatives of Action Cerebral Palsy, to discuss it and find a way ahead, so that the Government can help to implement its recommendations and we can improve the lives of children with CP and their families.

If I think back on the remarks I have made, I must admit that my views are perhaps coloured by my experience of meeting parents of children with CP. They have often had to fight hard to get the help their children deserve and that can enable their children to lead more independent lives than was perhaps imagined when their condition was first diagnosed. These are difficult battles to fight, so parents welcome the Government’s reforms, which should enable their children to get the early intervention they need. However, because parents are battle-hardened, they are also sceptical. They want an end to the adversarial approach to educating their children; early intervention in practice, and not just in theory; and consistency in the local offer, so that every child with CP has access to specialist education, regardless of who provides it and where they live. These parents have clearly set the bar for success, and it may be high in comparison with what they have experienced, but the Government need to prove to them that these reforms mean that they no longer have to fight for the right education and health support for children with cerebral palsy.

[Mr Philip Hollobone (in the Chair)]

As this is an Adjournment debate nominated by the Backbench Business Committee, we will hear from the hon. Gentleman again at the close of the debate, because he is entitled to two or three minutes in which to wind up; this is one of those occasions when the Minister will not have the last word.

--- Later in debate ---

[Mr Hoban]

It is a surprise and a pleasure to be asked to wind up the debate; I was not quite prepared for that when I came here this morning. The contributions by my hon. Friend the Minister and the hon. Member for Birmingham, Selly Oak (Steve McCabe) are welcome. Given the time we have had available, they extended beyond the normal 10 minutes, which was hugely helpful in exploring some of the issues that children with CP face.

Despite having been involved with the Rainbow Centre for 13 years, I have learned so much from taking part in the inquiry, and it is a real tribute to my hon. Friend the Member for Blackpool North and Cleveleys (Paul Maynard) that he led the process. The inquiry demonstrated some of the complexities and challenges involved in helping children with CP, and that came out of today’s contributions in different ways.

The Minister and the shadow Minister talked about the golden years, and integrating health and education is pivotal. We heard from witnesses about some of the challenges involved in identification. We can help to identify children at a much earlier age, but there are barriers to that, and the more we can do on early identification, the easier it is to make a difference to children’s lives. In terms of the inquiry, we will want to talk with not only my hon. Friend the Minister but the Department of Health about those early years to ensure the right processes are in place.

Two big points came out of the debate. One is about integration, not only of health and education, but of the state and the private sector, or the state and the voluntary sector and charities. How can we maximise the resources that are available? One thing that strikes me is that we are in danger of operating in silos, to the detriment of children with cerebral palsy. There are great specialist services out there that are accessible, particularly in the early years, and a lot of centres are registered with Ofsted, are respected and benefit from Government funding. However, as a child grows up, the services seem almost to be teased apart. It is harder for a child at primary school to have time in their curriculum to go to a specialist centre to continue an educational programme that helps them with their motor skills, and the pressures become greater as children progress through the education system.

The more ways we can find for specialist support and mainstream schools to work together, the greater the advantages for the children and for society as a whole. We therefore need to make sure integration works, and that we see that through as part of the Government’s reforms, and it is clear from listening to the Minister what emphasis he places on the importance of successful integration.

The second point is about accountability. Accountability is important, because it is where the system will stand or fall. I am not often critical of the Government; as the Minister knows, I am a loyal supporter. His intentions are fantastic, and I know how committed he is on this issue, but we need to make sure that his intentions are followed through on the ground, and that local authorities and local health services respond, following not only the letter of the law, but the spirit of the reforms he has introduced. A lot of people will be looking carefully at the framework Ofsted will publish, to see how we can manage local accountability and national consistency. The framework should be a powerful tool to support parents, who, at the moment, feel they are working through an adversarial system.

The implementation of the reforms and the role of Ofsted are vital, but we must do everything we can to ensure proper integration between specialist services, education and health to improve the life chances of children born with cerebral palsy. There is much we need to learn about what causes cerebral palsy and about the best interventions, but I am confident that, by working together, we will improve the quality of children’s lives enormously, which will be a real testament to the success of the Government’s reforms.

[Mr Philip Hollobone (in the Chair)]

I thank all Members who have taken part in this important debate.

Oral Answers to Questions

Debate between Philip Hollobone and Mark Hoban

Monday 1st July 2013 Commons Chamber

[Mr Hoban]

It was the hon. Lady’s party, when it was in government, that established targets for sanctions on jobseekers—targets that the present Government scrapped.

A range of measures exist to support those who are leaving the Work programme and bring them closer to employment. However, we are also asking people to go into the jobcentre every day in order to receive one-to-one support, and I think we shall find that that is very effective.

[Mr Philip Hollobone (Kettering) (Con)]

A4e tells me that 38% of its Work programme clients in the east midlands are aged between 18 and 24, and that one of the biggest challenges that they face is the provision of inadequate or irregular transport services in rural areas, and bad bus services in particular. Is the Minister aware of that problem, and what work can he do with the Department for Transport to deal with it?

[Mr Hoban]

My hon. Friend has raised an issue that applies to a number of areas. Work programme providers, Jobcentre Plus, employers and transport companies have worked together well to improve transport links, and to ensure that as many people as possible can travel to a job that enables them to look after themselves and their families.

Oral Answers to Questions

Debate between Philip Hollobone and Mark Hoban

Monday 20th May 2013 Commons Chamber

[Mr Hoban]

I remind the right hon. Gentleman that he was in the Government who introduced the work capability assessment and the employment and support allowance. I have set out the improvements that we have made to the system that we inherited from the previous Government, which was not working. We are continuing to make reforms, and that is demonstrated by the fact that the proportion of people claiming employment and support allowance has tripled under this Government.

[Mr Philip Hollobone (Kettering) (Con)]

I am afraid that appeals to tribunals following refused ESA claims are taking far too long. The Leicester office, which deals with appeals from my constituents, now has a waiting list of 40 weeks. I know that this is not the responsibility of the Minister’s Department, but will he liaise with the Ministry of Justice to get this sorted out as quickly as possible?

[Mr Hoban]

I agree with my hon. Friend that the whole process is taking far too long. We are working closely with the Ministry of Justice to reform the system and ensure that appeals can be heard more quickly. We are also working with charities to see what additional support we can give to people claiming employment and support allowance, to ensure that the right information is made available as soon as possible to enable claims to be processed as quickly as possible.

Oral Answers to Questions

Debate between Philip Hollobone and Mark Hoban

Monday 11th March 2013 Commons Chamber

[Mr Hoban]

No one should be complacent about the challenge that young people are facing, but I should point out to the hon. Gentleman that, if full-time students are excluded, 66,000 more young people have been in work over the last quarter. We are seeing more progress, but we must not be complacent, and we must not forget that the problem started some time ago.

[Mr Philip Hollobone (Kettering) (Con)]

What progress is being made with sector-based work academies? Which sectors are being targeted, and in which parts of the country?

[Mr Hoban]

My hon. Friend is right to point out what an important part of our programme sector-based work academies represent. They provide a combination of work experience, training and a guaranteed job interview. Jobcentre Plus will work closely with employers throughout the country to organise the right type of sector-based work academies, but I encourage Members to work with jobcentres to identify good opportunities in that regard.

Oral Answers to Questions

Debate between Philip Hollobone and Mark Hoban

Monday 10th December 2012 Commons Chamber

[Mr Hoban]

The Work programme providers are responsible, and they are paid to get people into work. This is a much better value programme than its predecessors, but we need to get providers to raise their game. The figures released at the end of last month showed that job outcomes were rising and that the longer the programme had been functioning, the more people were getting into work. This is a good start, and it is a much more effective programme than the schemes introduced by the previous Labour Government.

[Mr Philip Hollobone (Kettering) (Con)]

7. How many people have come off benefits after joining the Work programme in (a) Kettering constituency, (b) Northamptonshire and (c) England to date.

[Mr David Amess (Southend West) (Con)]

15. How many people have come off benefits after joining the Work programme to date.

[The Minister of State, Department for Work and Pensions (Mr Mark Hoban)]

Last month, we published data showing that 57% of claimants who joined the Work programme in June 2011 had spent some time off benefits. The figures showed that the programme was moving people off benefits and that, as claimants spent longer on the programme, more of them came off benefits.

[Mr Hollobone]

I recently visited A4e, which is helping to provide the Work programme in Kettering, and I was impressed by its commitment to getting unemployed people back into work. Is the Minister aware, however, that the two biggest barriers to finding permanent employment in my constituency are travel costs and child care difficulties? What can Her Majesty’s Government do to solve those two problems?

[Mr Hoban]

There is a range of ways of helping people with their travel costs in order to get them back into work. Jobcentre Plus can provide money through the flexible support funds, and Work programme providers can provide support to help people to reduce the cost of their travel. There is also funding available to help people who want to work to get free child care.

Northern Rock

Debate between Philip Hollobone and Mark Hoban

Monday 21st November 2011 Commons Chamber

[Mr Hoban]

I recognise the importance of the Northern Rock Foundation and I think we all appreciate the excellent work it does in the north-east, but following the denationalisation of Northern Rock it needs to think about how it will continue its work and how it will work with Virgin Money and Virgin Money Giving to continue its activities across the north-east in the future.

[Mr Philip Hollobone (Kettering) (Con)]

What commitment has Virgin Money made to Her Majesty’s Treasury that it will increase lending to small businesses with its new asset in place?

[Mr Hoban]

At the moment, Virgin Money operates primarily in the retail financial services field. It offers a range of products to personal customers. However, it has said that it will look to provide a range of products to small businesses in the future and we would welcome that increased competition in that key area.

Eurozone (Contingency Plans)

Debate between Philip Hollobone and Mark Hoban

Monday 20th June 2011 Commons Chamber

[Mr Philip Hollobone (Kettering) (Con)]

Does the Minister believe that the eurozone will remain intact with all its present members?

[Mr Hoban]

I am not going to comment on whether the eurozone will remain intact. Clearly, this crisis demonstrates the huge strain that the eurozone is under. That is why it was right for us to stay out of the eurozone.

Regulatory and Banking Reform

Debate between Philip Hollobone and Mark Hoban

Thursday 16th June 2011 Commons Chamber

[Mr Hoban]

The package of proposals that the Independent Commission on Banking is developing is aimed at tackling that. It is one of the reasons why it proposed a retail ring-fence and increased capital so that the ring-fenced retail business will continue to be strong. But we need to make sure that we have the right resolution tools in place in the event of a bank failure. I commend the previous Government for their introduction of the special resolution regime, to which I referred in my statement in the context of Southsea Mortgage and Investment Company Ltd. We need to continue to work on tools that will help us resolve a bank failure without the taxpayer having to pick up the bill. That is the position that we ought to be in.

[Mr Philip Hollobone (Kettering) (Con)]

My constituents in Kettering want to know that the household savings that they have deposited in their local high street bank are safe from financial speculation and that never again will large banking groups imperil the UK economy through unsustainable banking practices. How far does the Minister’s statement today go to reassure my constituents?

[Mr Hoban]

My statement today has demonstrated the action that we have taken over the past year to create a more stable and sustainable banking system. That should give comfort to my hon. Friend’s constituents in respect of the safety of their savings. Savers and depositors should be mindful of the limits on deposits imposed through the financial services compensation scheme, but the range of interventions that we are making, through this statement and further reforms, will ensure that we have a safer, more sustainable banking sector in the future—one that does not impose a burden on the taxpayer, but makes sure that it continues to meet the needs of businesses and households across this country.

Finance Ministers’ Meeting (Ireland)

Debate between Philip Hollobone and Mark Hoban

Wednesday 17th November 2010 Commons Chamber

[Mr Hoban]

I reiterate that no request for assistance has been received from the Irish Government.

[Mr Philip Hollobone (Kettering) (Con)]

Will my hon. Friend confirm the extent of Britain’s liability under the non-eurozone mechanism? Has he considered the possibility of renegotiating the package that the previous Government left us?

[Mr Hoban]

My hon. Friend should be aware that under the mechanism there will be no liabilities if no request for assistance has been made.

Banking Reform

Debate between Philip Hollobone and Mark Hoban

Thursday 17th June 2010 Commons Chamber

[Mr Hoban]

It is important that the Financial Policy Committee is transparent in its dealings. It is a great strength of the Monetary Policy Committee that it is transparent and that it can be held to account by the public for its decisions. We need to ensure that similar arrangements are put in place for the FPC—while respecting, as my hon. Friend has pointed out, the confidentiality of individual firms.

[Mr Philip Hollobone (Kettering) (Con)]

Will one of the new organisations under the Bank of England, the Office for Budget Responsibility or someone else alert the Treasury if the housing market starts to get overheated again?

[Mr Hoban]

One of the roles of the Financial Policy Committee is to identify threats to financial stability as they emerge. I would expect the FPC, in its work of looking at overall trends in the economy, to identify that sort of risk and to make it known not just to the Treasury, but to the wider public through its regular reports.