Auditory Verbal Therapy

Stephen Kinnock Excerpts

Tuesday 21st January 2025 Westminster Hall

[The Minister for Care (Stephen Kinnock)]

It is a great pleasure to serve under your chairship, Mr Western. I thank my hon. Friend the Member for Washington and Gateshead South (Mrs Hodgson) for securing this vitally important debate, and for her powerful and moving contribution to our discussion.

I would also like to break with protocol and welcome Sam to Parliament today. He is clearly a remarkable young man, and an inspiration to us all—thank you for being here, Sam. Like the shadow Minister, the hon. Member for Hinckley and Bosworth (Dr Evans), I thank hon. Members for their excellent contributions today. We have had a range of contributions, including from the shadow Minister, and from the hon. Members for North Shropshire (Helen Morgan) and for Strangford (Jim Shannon), and my hon. Friends the Members for Bury North (Mr Frith), for Bolton North East (Kirith Entwistle), for Derby South (Baggy Shanker) and for Bolton South and Walkden (Yasmin Qureshi). I think that may be all, but huge apologies if I have missed anybody. All their contributions were excellent and very well put.

My hon. Friend the Member for Washington and Gateshead South has done so much work to champion the interests of children with special educational needs and disabilities, including non-hearing children. I know that she also has an excellent partnership with Auditory Verbal UK, which I welcome to Parliament today. I would, of course, be happy to meet its representatives to follow up on all the points made in this debate.

This Government are committed to raising the healthiest generation of children ever. We will deliver on this ambition through the health and opportunity missions, and through the Government’s child poverty strategy. This is not about silos, with each Department delivering one part of a puzzle that does not fit together properly; this is about systemic, holistic change, and ensuring that we join up analysis, expertise and delivery across Government. Our mission-driven Government will drive long-lasting and sustainable change for children now and in the future. We will break down barriers to opportunity and ensure that every child has the best start in life. This includes all children and young people with special educational needs and disabilities, including non-hearing children.

We know that developing early communication skills is a key foundation for life, and there are serious knock-on consequences when that development is delayed. That is why we are committed to improving access to early interventions so that every child can find their voice. With the right support, children with hearing loss can develop effective communication skills, live fulfilling lives and enjoy the same opportunities as everyone else. The Government recognise the importance of the earliest days of an infant’s life. There is strong evidence that the 1,001 days from conception to the age of two set the foundations for our cognitive, emotional and physical development. That is why we are giving a £126 million boost for families to give every child the best start in life.

Thousands of families across England will be able to access family hubs, which will act as a one-stop shop for help with infant feeding advice, parenting classes and perinatal mental health support, among other things. Figures from the National Deaf Children’s Society show that there were more than 45,000 deaf children and young people in the UK in 2023. Between one and two babies in every 1,000 are born with permanent hearing loss in one or both ears. This number increases to about one in every 100 for babies who have spent more than 48 hours in intensive care. Early and effective support is crucial for these children and their families. Permanent hearing loss can significantly affect a baby’s development, so early and effective support is crucial for these children and their families.

It is vital that we intervene at birth. The NHS newborn hearing screening programme—the NHSP—aims to find babies who have hearing loss as early as possible so that the right support and advice can be offered right from the start. As we all know, language is linked to social, emotional and learning outcomes. From birth through to childhood, children and young people with hearing loss might need a range of therapies, such as speech, language and auditory verbal therapy. However, as we have heard today, those children are not always receiving the support that they need.

We recognise the important role of auditory verbal therapy as one of the therapies that can be useful for children with hearing loss. NHS audiology services, including the provision of therapies for children with hearing loss, are locally commissioned, and responsibility for meeting the needs of children with hearing loss lies with local NHS commissioners, because local systems are best placed to meet the needs of their own communities.

After 14 years of Tory neglect, incompetence and austerity, our NHS and care service are on their knees, but this Government are committed to properly funding the NHS, and we recently provided a £26 billion boost for health and social care in the autumn Budget. NHS England is responsible for determining allocations of financial resources. Each ICB will then commission the services they need for their local area, taking into account their annual budget, planning guidance and the wider needs of the population they cover. NHS England is supporting integrated care boards to make informed decisions about the provision of audiology services so they can provide consistent, high-quality and integrated care to non-hearing children.

In July 2016, NHS England published “Commissioning Services for People with Hearing Loss: A framework for clinical commissioning groups”. The framework supports NHS ICBs to make informed decisions to address inequalities in access and outcomes between hearing services.

[Mr Frith]

Does the Minister agree that, for all the good intentions of ICBs, our healthcare system is atomised, but that if they were to take instruction from guidance provided nationally, the pillar-to-post experience of a lot of families seeking auditory verbal therapy would end? Will he commit to updating the nine-year-old guidance to ICBs, or at least acknowledge that it needs updating, with a national pilot that proves the efficacy of AVT for families seeking that intervention?

[Stephen Kinnock]

My hon. Friend will know that one of the constant challenges in the system is getting the right balance between empowering those operating at the coalface—those who are close to the communities and know them best—to ensure they are delivering the best possible services, and ensuring consistency and coherence, both strategic and operational, across the entire system. It is safe to say that we are not always getting that balance right. One of the key objectives of the 10-year planning process that we are going through will be to address the so-called postcode lottery—variation between regions—across the whole range of health and care. Without that cross-cutting strategic look at the system, it will not be possible to get the balance right. I absolutely take the point, but one thing I will say is that we are crystal clear when we issue guidance to ICBs that they must take that guidance into account, and their performance is monitored on that basis.

[Mrs Hodgson]

Am I right in thinking, from what the Minister has just said, that he will issue revised guidance following today’s debate? Am I right that the Government, having given an extra £26 billion to local areas, will give them guidance that they should be looking to commission these services on a much bigger scale, so that we have more than 33 AVT therapists?

[Stephen Kinnock]

I can certainly tell my hon. Friend that this is a very dynamic situation. A system never stands still. For a system to work, we have to be constantly reviewing its performance and whether it is delivering to its objectives. I believe that the 10-year plan that we are producing will absolutely lead to a radical rewiring of the way our health and care system works. It will be driven by three big shifts: from hospital to community, from sickness to prevention, and from analogue to digital.

There is no doubt at all that where there are therapies and treatments that are working—that are clearly delivering big results, and value for money for the taxpayer—it is right that we give those priority in the way that we deliver. It is clear that AVT has huge potential, and it appears to have unexplored potential. I cannot pre-empt today how this is all going to pan out in terms of the system and the reforms that we are looking to push forward, but I can assure my hon. Friend that we are committed to innovating and to building a system that is fit for the future.

In 2019, with input from the National Deaf Children’s Society, NHS England produced a guide for commissioners and providers who support children and young people with hearing loss. The guide provides practical advice on ensuring that non-hearing children receive the support they need. Auditory verbal therapy is one type of therapy to support children with hearing loss, and it is important that local commissioners know their population and have the discretion to decide how best to meet its needs. When it comes to commissioning and providing services for children with hearing loss, we have been crystal clear with ICBs and NHS trusts that they must take the relevant guidelines into account.

We recognise the real need to improve access to therapies for all children who need them, including children with hearing loss. In recent years, in very difficult circumstances, the NHS has increased the number of speech and language therapists working in the service, but we know that more needs to be done. That is why the Government are committed to fixing the NHS and building a service that is fit for the future, with the workforce it needs to get patients seen on time.

[Dr Luke Evans]

The Minister rightly points out the need to try to deal with the postcode lottery and to ensure that there are reviews and sharing of best practice, but may I draw him back to my comments about guidelines? One thing he could do is ask NICE to look at the current evidence and consider what national guidance should be in place. ICBs have the right to choose what kind of treatment they think works best, and they will be driven by the clinical evidence and clinical guidelines; if there are no clinical guidelines, they will simply make their own decisions. Will the Minister commit to doing that?

[Stephen Kinnock]

The hon. Gentleman will know that NICE has a prioritisation board, and ultimately that is the decision-making process for prioritising guidelines and the entire operating framework for what falls under NICE’s remit. This is something that absolutely should be on the radar, and of course we are constantly in conversation with NICE about its prioritisation, but it is important that it takes an objective clinical stance on the question.

We have committed to develop a 10-year plan to deliver a national health service that is fit for the future. The engagement process has been launched. As we work to develop and finalise the plan, I encourage those concerned about the availability of services to support children with hearing loss, including auditory verbal therapy, to engage with that process to allow us to fully understand what is not working, as well as what should be working better and the potential solutions. I encourage all hon. Members present to go to change.nhs.uk to make their voice heard.

This summer, we will publish a refreshed long-term workforce plan to deliver the transformed health service we will need to build over the next decade to treat patients on time and deliver far better patient outcomes. We are also in the process of commissioning research to understand the gaps between the supply and demand of different therapy types for children and young people with special educational needs and disabilities. That will help us to understand the demand for speech and language therapists and inform effective workforce planning.

[Helen Morgan]

I am pleased to hear that the Government have increased the number of speech and language therapists, which is so important for young people who are struggling to achieve their potential in an educational setting, but will the Minister address the specific point on commissioning by local authorities? Often, they are so strapped for cash that they are effectively trying to limit demand.

[Stephen Kinnock]

Commissioning is led by ICBs. It is important that ICBs have open channels of communication with local government. We in the Department of Health and Social Care have close contact and engagement with colleagues in the Ministry of Housing, Communities and Local Government, and it is important that that relationship and interaction feeds down through the entire system, but the leading organisations on commissioning are the ICBs.

A number of colleagues raised the question of a pilot scheme to identify how our existing workforce can work differently. The early language and support for every child programme is an excellent example of different professions coming together to support children and young people—local authorities, schools, and the health and care system working together in the community to support our children and young people. The ELSEC workforce model focuses on recruiting pre-qualification speech and language therapy support workers into the workforce to improve the capacity and knowledge of staff who support children with emerging or mild to moderate speech, language and communication needs in early years and school settings.

Nine regional pathfinder partnerships are trialling new ways of working to better identify and support children in early years settings and primary schools. We have asked pathfinders to consider how to make the model sustainable after the project period. The therapy assistant roles have the potential to attract individuals to train to become speech and language therapists through the apprenticeship route. I understand that Auditory Verbal UK is progressing a National Institute for Health and Care Research grant application to support a pilot, and I would welcome an update from AVUK about how that is going when we get the chance to meet.

We welcome the work that AVUK is doing to upskill health professionals to deliver auditory verbal therapy. On the point made by the shadow Minister, the hon. Member for Hinckley and Bosworth, there are as yet no NICE guidelines on hearing loss in children, and NICE has not made any recommendations on AVT specifically. Decisions on the need for guidelines on new topics and updates to existing guidance are made by NICE’s prioritisation board, in line with NICE’s published common prioritisation framework. I understand that NHS England met with AVUK and discussed the need for more high-level research evidence for the intervention and the need to develop evaluations of impact. I am pleased that AVUK has been invited to join the chief scientific officer’s audiology stakeholder group, where it will contribute to decision making.

We recognise the impact on the lives of children of timely access to high-quality services, including different therapies to help children to develop the right skills to engage with education. The Government’s ambition is that all children and young people with SEND or in alternative provision receive the right support to succeed in their education and as they move into adult life. We will strengthen accountability on mainstream settings to be inclusive, including through the work of Ofsted, by supporting the mainstream workforce to increase their SEND expertise and by encouraging schools to set up resourced provision or SEN units to increase capacity in mainstream schools. That work forms part of the Government’s opportunity mission, which will break the unfair link between background and opportunity, starting with giving every child, including those with SEND, the best possible start in life. We will work with the sector, as essential and valued partners, to deliver our shared mission and restore parents’ trust.

I again thank my hon. Friend the Member for Washington and Gateshead South for securing this debate and sharing her insight on the vital issue of early interventions for non-hearing children. We recognise the importance of such services and the life-changing impact they can have on the lives of children. We are committed to ensuring that all children receive the support they need to live healthy, fulfilling lives. I will continue to work closely with NHS England and the Department for Education as we strain every sinew to deliver on those commitments.