October 8, 2007

Speech, Language and Communication debate

John Bercow leads a debate focussing on training, co-operation in the delivery of services and the statementing process.

John Bercow (Buckingham) (Con): Good morning, Mr. Illsley. In welcoming you to the Chair for what is the first Adjournment debate in Westminster Hall since before the summer recess, I confidently look forward to your firm, fair and wise stewardship of our proceedings.

On 3 September this year, I was pleased to accept the invitation extended to me by the Secretary of State for Children, Schools and Families, supported by the Secretary of State for Health, to lead a review of services for children and young people with speech, language and communication needs. The review is charged with advising the Government of the day on the range and composition of the universal and specialist services that will be required to meet, in an affordable manner, the diversity of needs that exist. It will also consider how planning, performance management and effective co-operation nationally and locally can spur beneficial early intervention with the effect of securing improved services. Furthermore, it will look at those examples of best practice in the commissioning and delivery of services that could usefully be regarded as benchmarks for the wider development of services across the country.

That is quite a broad remit, and within it fall a large number of issues, on which I do not have the time, and I do not intend today, to focus, although I should like to address some of them. That, however, is the background to the events that are likely to unfold over a period of months. It is also probably as well to say that when this Adjournment debate was secured on 25 July, courtesy of the ballot undertaken in Mr. Speaker’ office, I had it in mind, as a result not least of discussions with a range of interested parties, to highlight a series of quite specific issues, and it is on those that I shall concentrate the thrust of my remarks.

It is probably a good idea to set out the background to our consideration of these important issues. In other words, what is the problem? Approximately, 5 to 8 per cent. of pre-school children suffer speech, language and communication problems, and the figure rises to 10 per cent. for children of school age. About one in 500 children suffers a severe and intractable communication impairment. That is the context that right hon. and hon. Members need to address in considering these issues.

I want to focus specifically on three main areas and then listen intently to the contributions from colleagues on both sides and the Minister’ response. I want to say something about training and co-operation in the delivery of services, and about the statementing process. I have agreed with the Secretary of State that the review is not intended to reopen the question of Government policy on statementing, although I confess that the Government have not quite got it right at the moment. The Secretary of State has agreed, however, that I certainly am entitled to look, and should look, if the review is to be complete and full functioning, at the impact of statementing on children with speech, language and communication impairments, because that is fundamental. I want to look at language units, which are often a proper source of provision for the affected category of children. There are a number of issues relating to language units on which we need to focus and which should be proper matters for consideration in the review.

What is to be said about training and co-operation? Good work is being done out there; there are some excellent professionals and there are examples of good practice. I say that at the outset for the avoidance of doubt, lest anybody think that I am seeking to create an impression of doom and gloom. I am not seeking to do that, because that would not be justified, but there are legitimate concerns about public policy and current practice, and the Government must take those into account if they are to build on the work that they have done in recent years.

I have been struck by the survey evidence that I have seen and by two pieces of evidence in particular. A YouGov survey undertaken for the Communication Trust showed that 73 per cent. of adults in contact with children in schools did not believe that they had had any training that would equip them adequately to cope with children who suffered speech, language and communication impairments. That is a significant deficit, which we need to address. The second piece of opinion polling evidence that struck me as relevant was the finding in the poll undertaken by the National Union of Teachers, which showed that only 32 per cent. of respondents felt confident in accommodating and dealing with children who suffered speech, language and communication impairments. A large number of professionals therefore say that they have not had the necessary training and only a small proportion of teachers—less than a third—feel comfortable enough to deal with the client group with which I am concerned.

That evidence seems to highlight the importance of the inclusion development programme. I am conscious that that programme is now to be unveiled and rolled out—relatively widely, I hope, across the country—but there are issues that the Government need to consider. First, there is the perennial issue of funding. Have we got the wherewithal to make this a meaningful commitment? Secondly, will the Government, in upskilling the entire work force, as the evidence that I have adduced demonstrates is necessary, take proper account of the need to make a greater priority of ensuring that there are sufficient specialists who will be able to address the needs of children with more severe impairments? In other words, we can upskill the general work force to deal with the relatively widespread but modest impairments from which children suffer—that is one issue—but we must also ensure that we have sufficient skilled specialists to provide the expertise and intensity of care that the more serious sufferer requires.

Finally, I ask the Minister not to discount the likelihood that, as a consequence of unveiling the programme and, as I hope right hon. and hon. Members will understand, raising expectations, he will generate an increase in demand for the very services on which my review must focus. It is a question, therefore, not only of whether there are sufficient resources today, but of whether the resources are likely to be adequate as events unfold in the months ahead.

Dr. Ian Gibson (Norwich, North) (Lab): I congratulate the hon. Gentleman on raising this subject and endeavouring to move things forward, and I am sure that we shall all play our part in supporting and helping him. I just wanted to point out that the title of the next debate suggests that health funding can lead to inequalities in the system. I am very interested, as I know the Government are, in inequity and inequalities in this country. Will the hon. Gentleman address that problem and realise that somebody such as Stephen Hawking, who is very creative, can access equipment that people in other parts of the country find difficult to access or to get support or continuing funding for? There is an inequity problem that I hope the hon. Gentleman will address in his review.

John Bercow: That is a fair point‚Äîthe short answer to the hon. Gentleman’ question is yes, I will. In the terms of reference agreed with the Department for Children, Schools and Families and the Department of Health, we have factored in the requirement to look at the circumstances of people from lower socio-economic backgrounds and those from areas of significant deprivation because problems in those communities can be intense. I accept the salience of the hon. Gentleman’ point. As in so many other walks of life, people who have means or who have contacts and therefore access to means are able better to cope with their significant difficulties than those who do not have such means or access to contacts who could provide means. I hope that, I have reassured the hon. Gentleman that although his concern will not be the only or prime focus of the review, it must be part of the equation.

I spoke about training and co-operation and I shall now say something about the need for that co-operation. In acknowledging that important work has been undertaken and that good examples of effective practice can and will be identified, we cannot shy away from the fact that there are significant challenges, to put it fairly and dispassionately, which are represented not least by some of the critical reports that have been issued in recent months. The Minister may recall that we last debated these matters on 28 November 2006. Since then, there have been no fewer than four reports that, in one form or another, posed a significant challenge or raised a pertinent question.

A report from the National Audit Office focused specifically on the subject of the Sure Start children’ centres. It perturbs me that the report said that, of 27 centres surveyed, only five demonstrated a close working relationship with a local primary care trust. That is not good enough. I accept that the children’ centres, which are a welcome development, are of recent origin, so I am not saying that they should be damned for ever or seriously lambasted, but there is a policy failure and the NAO properly drew attention to it. The Audit Commission has also produced a report, which lamented the lack of multidisciplinary support services at local level. An Ofsted report said that standards in communication in schools were lower than expected. Finally, a report from the Public Accounts Committee explicitly said that more had to be done to meet specific needs such as the requirement for speech and language therapy.

I hope that the Minister will take note of those reports in a constructive spirit and agree with the general proposition that they underline, perhaps most strikingly of all, the need for co-operation at all levels—among practitioners on the ground who are charged with the delivery of services, between schools and local authorities and, critically, between local authorities and PCTs. The issue of joint protocols or concordats from PCTs and local authorities would perhaps be a portent of better things to come. It would be a sign that they accepted a responsibility to translate the theory of joined-up working into demonstrable practice—demonstrable not only to service providers and those responsible for strategic management, but to the recipients of services. Such co-operation, joint working and a sense that we have an obligation to seek to provide so far as possible a seamless service is of the essence.

I should emphasise how incredibly important joint working and a seamless service are as far as children are concerned. Specialists in the field generally conclude that one of the best predictors of, or guides to, the outcome for the child is whether the agencies concerned come together early and meet as necessary relatively often, both to plan what to provide to the child and to monitor how those provisions work, and to improvise as necessary. I say that in the context of what I believe Members on both sides of the House will accept as the basic fact of the enormous benefit of early intervention and the huge danger of its absence. Simply stated, the benefit of early intervention is that children can have teething problems addressed, as it were, and they will then be in a position to access the national curriculum and to fulfil their potential.

The Government have signed up to the principle of early intervention. The downside of its absence is difficult to overstate. I do not in any sense seek to be melodramatic about it and I am working simply on the basis of what I understand, as an interested lay person, to be the evidence. If there is no early intervention, there is a risk of emotional and psychological difficulties, behavioural problems, lower educational attainment, poorer employment prospects, persistent communication handicap, challenges to mental health and, indeed, in the worst-case scenarios, a descent into criminality. If we are to avoid that grisly scenario, we must ensure that agencies come together early, regularly and effectively to translate the aspiration of good policy into practical effect at local level.

John Barrett (Edinburgh, West) (LD): Does the hon. Gentleman agree that another important aspect of agencies working together is that parents and other non-educational sector interested parties make maximum use of the time that the children affected spend outside their educational establishments? Co-ordination within the educational setting would mean that maximum use is made of the time that a child spends outside it.

John Bercow: That is certainly true, in which respect the hon. Gentleman prompts me to make an additional and, I hope, valid observation about the incredibly important role of parents. They must be a part of the delivery of the best possible care for their children, but information and support for parents is sometimes not what it might be. Parents ought to have some sort of toolkit, the better to enable them to play their part in helping children. That would require effective planning within an educational setting with a view not only to that environment, but to the time that a child spends outside school.

Hilary Armstrong (North-West Durham) (Lab): I apologise for being a few minutes late. I should like to invite the hon. Gentleman to follow up on the issue of early intervention. A lot of work has been done on early intervention concerning what does and does not work. Actually, we must be clear about the form that early intervention takes. Some programmes are successful. The incredible years programme—aficionados call it the Webster-Stratton programme—has been rolled out in all Sure Start centres in Wales, and their performance has outstripped that of centres in both Scotland and England. The programme is dedicated and committed and is centred around parents, but it does some important work with children. While looking at early intervention and working with parents, I hope that the hon. Gentleman takes on board work that has shown that we must be clear about which programme is being followed, and that we must monitor programmes carefully to produce particular outcomes.

John Bercow: The right hon. Lady makes the point that it is not good enough simply to sign up to the principle of early intervention, but that one must be clear about what form it should take. I do not claim to be an expert, or seek to prescribe a precise blueprint for application across the whole country. That said, she is right that there are examples of obviously good practice that follow a particular model and that could perhaps be benchmarks, as I mentioned at the beginning of my speech, for the development of services across the country. I am not sure that it is for me to invite myself to the project that the right hon. Lady describes, but if she, through her good offices, felt able to weed out an invitation, it is perfectly possible that my colleagues and I might find the time to go there to see for ourselves what good work it is doing.

That is exactly what we want to see—good practice. Actually, we should like to see some examples of bad practice, but not with a view to playing the blame game or because we want to point the finger or to apportion responsibility between one individual and another. At the risk of sounding pious, which I do not intend or want to do, the issue is bigger than that. We are trying to arrive at constructive solutions, so I am very happy to look at what the right hon. Lady suggested. There are of course examples of I CAN programmes, among others, that work very well, but there is a range of different provision, and we should be open-minded in looking at what is effective.

I said that I should like to say something about the statementing process, specifically as it relates to children with speech, language and communication impairments. I hope that the Minister will understand when I say that one of the difficulties that parents have is that there is not always that much material on paper that can be easily viewed and presented to Ministers. It is therefore necessary to some extent to work on the basis of examples heard from reputable pressure groups, and to reach a view about whether those are isolated instances of malpractice, inefficiency or lack of forethought, or whether they are emblematic of a wider trend about which we should be concerned. I am not saying that the statementing process misfires in every local authority in the country, but I believe that the evidence of inadequacy, poor practice and grounds for concern is sufficiently extensive—if not prevalent—for us to need to address the subject.

I have some specific considerations for the Minister and colleagues. I know from the contact that I have had with campaigning organisations and charities in the field‚Äîincluding AFASIC, I CAN, the Royal College of Speech and Language Therapists, the National Autistic Society, and Treehouse, which I had the privilege of visiting earlier this year, to name but a few‚Äîthat there are anxieties among parents. For example, a lot of parents are actively discouraged from pursuing a statement for their children, or are not even told of the existence of the statementing process. If they come to know about it they are told, “It is very unlikely that you would get a statement; it is not worth trying. There is a Government preference for their reduction and it simply is not the right route to follow. You should go about things in a different way.” That can happen justifiably, but it can happen when manifestly the child would benefit from a statement of special educational needs.

I think that we know—and the Minister can testify from personal experience, I am sure—that in a vast number of cases, if a child does not have a statement of special educational needs, he or she is unlikely to receive speech therapy on any sort of regular basis at all. The argument concerning such a child is that he or she is not the most seriously affected, and that school action—or school action plus a bit of monitoring, waiting for the developmental process to happen and an assessment in due course—will do. However, that is the danger; very often if the intervention does not take place, and if nothing is provided by way of speech and language therapy, the problems of those children will be significantly exacerbated, necessitating a greater investment, and more extensive intervention later, or, failing that, leading to the virtual certainty of seriously aggravated difficulties for the individual and probably for the economy and society as a whole.

Some children who do have statements of special educational needs—this is not a party political point; I found examples of good practice in authorities with different political labels around the country, and I found that some local authorities run by my own party were good, while others were very bad—get very little speech and language therapy. It might, for example, amount to a termly assessment and a brief session with a therapist. I put it to hon. Members that when someone has been deemed sufficiently needy to warrant a statement of special educational needs, to get simply a termly session, or a couple of sessions a term, is palpably insufficient.

There are examples of children having to wait a long time between agreement to the statement and implementation of the requirement to provide speech and language therapy. I know of a case‚Äîother hon. Members may be able to invoke still worse and more serious cases‚Äîin which a child’ parents had to wait seven months from the time when the statement was agreed to the time when provision was put on the table for the child in the educational setting. There are many instances in which the speech and language therapy is unquantified in the statement‚Äîvery likely in violation of the letter, and certainly of the spirit, of special educational needs legislation in general and the code of practice in particular‚Äîand in which that unquantified commitment is then undelivered. The requirement is unquantified and undelivered and, therefore, the need is unmet. That suggests to me that we should at least consider in the statementing process some sort of scrutiny by an external source of the content of statements, and monitoring of implementation of statements. That failsafe would guarantee to parents that what was in a statement was translated into practice. Parents need that safety valve or reassurance, which is I think lacking at the moment for many children. Let those issues be debated in the course of the review, the visits that we make and the evidence that we receive.

The final issue on which I want briefly to focus is language units. I mentioned that they are often very suitable sources of assistance to affected children. I have declared an interest in this matter before, Mr. Illsley, but for the avoidance of doubt may I declare that interest again, as the father of a child approaching the age of four? My son, Oliver, is in a language unit at a mainstream primary school in Pimlico, and he is getting fantastic help. It is a brilliant unit. He is very fortunate. The unit does not appear to be threatened. Although my interest in the subject of speech, language and communication was, as I have openly and honestly stated, initially founded on and driven by my personal experience, I am not complaining about what my child is getting. We have been very fortunate. Many people have not been as fortunate, and we all have a responsibility to try to do something to better their prospects and improve their care and provision.

What is it about language units that concerns me at the moment? In at least five cases—this is the only point at which I shall name names, of organisations, at any rate—it would be very difficult to ascertain that the local authority provided such units at all. In the cases of Bristol, Durham, Norfolk, Salford and Wandsworth, it is difficult to see from my research and from looking at websites that such a facility is available. The question that I want to ask is, how can parents ask for a place in a language unit if they are not aware of the existence of the unit? The truth is that they cannot.

It seems to me that the wider issue of data collection‚Äîhaving a store of information that is kept locally and perhaps transmitted to the national level‚Äîis worth considering in the months ahead. I know of several cases in which people have said, “There is a cut in the number of placements in the units, brought about by the drive to reduce the incidence of statements.” If the cut in the number of places were the consequence of a declining need objectively identified, I should not be wasting colleagues’ time and yours, Mr. Illsley, complaining about the situation. If, however, the reduction is the result of arbitrary and capricious decisions taken to meet some wider and separate but not necessarily justified public policy, it is a source of concern.

People have reported to me through pressure groups and parents’ organisations that a language unit may be gradually run down, and the authority will then say that there is no demand for it. Parents in such authorities have come to me or to colleagues and said, “We were told simply that we had to place our child in a mainstream class”‚Äînot in a language unit within a mainstream school‚Äî”and we were not informed of the unit’ existence as an option at all.” That seems to constitute an arbitrary run-down of provision.

I know of instances in which such units have come to house children who are on the autistic spectrum and who perhaps have behavioural, emotional and social difficulties. Although some units can cater to such children’ needs, if a child’ primary need is not speech and language therapy, one must at least ask whether a language unit is the proper or best place for that child. We must be careful not simply to push children into a particular facility without reference to their objectively identifiable primary need.

The challenges are considerable. The Government have at least three sources of guidance on the stocks, which I think have been publicly released, that are supposed to inform the consultation process on the future of such units. I have raised the matter with the Secretary of State for Children, Schools and Families, and I should like to be clear in my mind that authorities know clearly what those sources of guidance are, that we can establish what mechanism exists for monitoring their enforcement, and whether Ministers are satisfied that the rules are being followed in both letter and spirit.

I raise the issue in such terms because I am not saying categorically that there is a rampant or majority abuse of the procedures. I should not go so far as to suggest anything of the sort, but the evidence that has come to me is more than merely anecdotal. I hope that colleagues will forgive me if I say that the special needs community, although it is gradually becoming more demanding, articulate and vociferous, and rightly so—I am looking at the right hon. Member for North-West Durham (Hilary Armstrong), who had responsibility for social exclusion for a considerable period—is still not particularly powerful.

I have sometimes cavilled when Ministers, or representatives of any party, have said, “Well, of course these matters must all be determined locally. Local education authorities are elected bodies. They must make their dispositions in these matters, and if parents are dissatisfied they can kick out the authority at the ballot box.” To that piece of institutionalised cant, I tend to reply, “Get real.” For the most part, such parents are few and far between and thinly spread, and they often do not know each other. The idea that by objecting to a particular decision on a given institution in an individual locality they will be able to drive the local authority from office is for the birds. In dealing with vulnerable children, we need protective mechanisms. The Government have a special responsibility, which I am confident they will accept, to monitor what is occurring with a view to securing improvements and redressing bad practice wherever it proves necessary.

The House has indulged me so far, for which I am grateful. I do not think that the issues are ideological at heart. I have reflected on them long and hard. There are differences of emphasis—sometimes quite important ones—between the advocates of inclusion and those who are absolutely and indomitably opposed to it, but my sense, having mixed with a wide variety of people in the field during the past 18 months, is that most people do not subscribe to either position in its extreme form. Most are fairly pragmatic. They can see the benefit of an eclectic mix of provision tailored to the particular circumstances of individual children, and most are prepared to depend on and be guided by what the evidence proves.

In most cases, it is not an ideological matter or the source of a great philosophical tension between the political parties; it is a question of pragmatics and of trying to bring the big issues to the fore. If the Minister will forgive me—I would say this whomever the Government in power were—it is a question of ensuring that, while we are, very properly, preoccupied with our big battles about the future of the health service, education provision and social care, we do not forget those important services that are needed admittedly only by a minority, although a significant minority, and that require uplifting in political priority and public consciousness.

It is worth trying to co-operate across the parties. It is much easier to walk away into one’ hole and avoid any criticism by saying, “Never the twain shall meet; we can’t possibly work with people of another party.” That judgment probably makes for a quiet life, but it is the wrong judgment to make. I am proud to be a Conservative Member of Parliament. I happen to think that such issues are important, and I believe that this place is, on the whole, pretty tribal. Most politicians are too tribal, as are most commentators, but I think on the whole that the public are not very tribal. They rejoice in instances of politicians across the spectrum coming together and considering how to put aside our party differences and work together to better the public provision, especially when the beneficiaries are a group of children who are often very needy, frightened and vulnerable.

I remind colleagues that children with speech, language and communication impairments are disabled children. That is often not recognised. The hidden disability of an incapacity to communicate can be a source of great problems for the individual, for his or her wider social network and‚Äîultimately, if those problems are not tackled‚Äîfor the country. It would say something positive about this country’ political DNA if we came up during the next nine months with a set of constructive and practical proposals, the implementation of which would alleviate some of the difficulties, improve the quality of provision and raise the life chances of some concerned and frightened children who need our help sooner, rather than later.

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