SPASTIC CHILDREN (Hansard, 28 June 1954)

§ Dr. Horace King (Southampton, Test)

I am grateful that the Minister is here tonight, and I am glad for his sake that the debate is not taking place as late as it was feared it might. The presence of the Minister is an indication of the keen interest which he takes in all problems affecting the physically or mentally handicapped.

The first Labour Minister of Health had the vision to appoint an advisory committee and the good fortune to appoint my hon. Friend the Member for Lowestoft (Mr. Edward Evans) as its chairman. The committee continues to do excellent work thanks to the initiative 1062 of the Minister and his full support. I should like to begin by paying tribute to my hon. Friend the Member for Lowestoft, who has devoted many years of his life to the care of deaf children and has widened his interest through the advisory committee to other health problems.

I would urge every socially-conscious citizen and every member of every local authority to read the Report on the Special Welfare Needs of Spastics. published as a result of the inspiration and initiation of the Minister. The chairman, Dr. Evans, and other distinguished people have made the Report a first-class document which is nearly as good as the excellent work which the individual members of the committee have themselves done for spastic children. What we want now is the carrying out of the Report.

I want to talk about some 6,000 to 10,000 children called spastics. The public are beginning to know the word and the sad stories behind it. A disease called cerebral palsy causes a kind of paralysis which makes control of the muscles irregular and difficult. It varies in intensity. Some children are mildly affected, some become crippled, and the most serious cases are unable ever to get out of bed at all.

Those of us who know intimately some spastic children realise how they have to use tremendous efforts to do, or try to do, any simple action. The things that ordinary children do naturally and easily spastics do only by using intense nervous energy, For example, we often first discover that a child is spastic when, unlike other babies, it is at a certain stage of babyhood, unable to sit up and look around. The first handicap of the spastic is failure to widen its experience by sitting up and taking notice.

Very often, the spastic child not only suffers that way, but is defective in eyesight—may be mirror-sighted, may be deaf, may be tone deaf—and we used to think that all spastic children were mentally defective, because they could not respond to the simple intelligence tests that we give tiny children when we are trying to measure whether they are intelligent or not. We are now beginning to realise this is far from the truth.

1063 If intelligence has to make itself known through movement, and the roadway between the brain and muscles is blocked, if, to do a simple thing, the spastic child has to use a hundred times the effort a normal child has to use, the normal test of intelligence may break down with the spastic child and we may dismiss as an an unintelligent child, a child whose intelligence has to cope with so many handicaps that it cannot surmount them.

Spastic children need every help medical science can give—education suited to their ability and aptitude, preparation for earning their living as best they can and protection if they cannot earn their living. Their parents need help, too. One of the problems is that the spastic child or, the spastic person needs different help at different ages and is deal with by different organs of the Welfare State.

Before the age of five, the youngster's well-being is largely a health matter. There is the local health service—maternity and child welfare department, the health visitor, perhaps some home help, certainly the ambulance service—on the one hand, and the hospital and the medical services on the other hand. The disease is a specialist problem and there is physiotherapy to be provided. Even at the earlier stage there may also be matters for the welfare authority to be interested in—assistance for the parents, provision of special equipment, for example, special chairs to enable the children who cannot sit to sit up.

After the age of five—and really, for spastics, it ought to be before the age of five—there is the question of education, which brings in the local education authority and the Ministry of Education. When the child completes its education at 16, or needs to be transferred for vocational training, we bring in the question of the Ministry of Labour, the Youth Employment Service, training centres and the like.

The most important point I wish to make is that we want to co-ordinate and bring together all the departments concerned with the well-being of spastics and see that the job of looking after spastics is treated as a whole at local and national level, to find some means of unifying this work—and there is so much can so easily go wrong if someone untrained 1064 handles a spastic, or even if excellent work at a young age has not been followed up throughout.

There ought to be somebody, a department, linking up all the Government offices dealing with spastics. I believe that spasticity is so definitely a matter for expert knowledge, so much harm can be done by ignorance, so definitely a matter for medical science, that we ought to make the medical authorities—the medical officer of health locally and the Minister of Health nationally—the linking factor. This is why I am glad that the Minister's committee, in making their Report, did not isolate the health aspect from the education and welfare aspects of the question of spastics.

What do we need? First, early diagnosis. We want to be able to recognise spasticity as soon as possible, not only for the treatment of the disease but because the sooner we help the parents of the spastic child the better. They will need all the skilled guidance medical science can provide them and from the earliest possible moment.

There is the vital question of testing the intelligence of the spastic child. It is an expert's job and one of supreme importance. Local authorities should help by seeing that every spastic is properly tested by specialists, so that no child is put down as being mentally defective when the trouble is not lack of intelligence but failure of the intelligence to cope with the physical handicaps of spasticity. The Minister can help by providing research into devising intelligence tests for spastic children and into early diagnosis of spasticity.

We also want to be sure that the local education authority takes an interest in the spastic child, from an educational point of view, before the age of five. This is an example of what I mean by coordination. We do not want the local education authority to say, "We do not come in until the child is five years old." When being assessed for educability the spastic child should be given the benefit of the doubt. Before being written off as ineducable the spastic child ought to be sent to a residential school or clinic for a period of careful study and observation. In the report there is evidence that children who had been classed as 1065 ineducable were discovered to be not really so at all.

We need at once more special schools for these children—and more spastic centres. Not every spastic child needs to go to a special residential school, though many do. The national provision is pitifully inadequate. I have said that there are between 6,000 and 12,000 spastic children of school age. There are places at special schools for 169—and even some of those owe their existence to the initiative and generosity of private citizens. Incidentally, the National Health Service should not mean the drying up of the wellsprings of private charity and if any rich man or woman is seeking to help a good cause this is such a cause. Marvellous work is being done at Croydon. Birmingham, Ivy-bridge, Devon, Harrogate, Newcastle and Bristol, and three more, I believe, are coming into being at Glossop, West Ham and Huddersfield.

It would be unfair to say that 169 places cover the whole provision, because other special schools for handicapped children provide for some spastics. My hon. Friend the Member for Stoke-on-Trent, North (Mrs. Slater) tells me that excellent work is being done for some spastics at an open air school in Stoke. Special spastic schools need not all be residential. Though more residential schools are wanted we also want spastic centres to which children can be taken daily for treatment, diagnosis and education—and if ineducable, for pleasurable activity—and returned to their homes in the evening. That means provision of transport day by day, but anyone who has seen the benefit such visits to such centres confers upon spastic children realises how worth while that transport is.

We also want an adequate number of home teachers for those whose disability makes it impossible for them to do more than sit up—who sometimes cannot do even that—but who can be educated. Then there is a tendency to leave the spastic at the age of 16 and to write him off, except as a welfare case if financial help is needed. We must widen the responsibility of welfare work. Indeed, all we ask is implicit in the welfare acts. We want to help the spastic to earn his own living if it is possible. That 1066 may mean further training after 16 in a training centre. It may mean the creation of special jobs for spastics and for other disabled people.

We do not appreciate sufficiently the wonderful work of Remploy, and how Remploy and similar undertakings can expand if we will give them the backing we ought to give. We ought to break down the nation's work, isolate those jobs which disabled people can do, and see that only disabled people are allowed to do them. If a disabled person works to the best of his ability he is a good citizen, and he gets a joy out of feeling that he is making his contribution, to the best of his ability, to the country. I know this from my experience in visiting Remploy. So we want suitable work for adult spastics. This links with the first point I made, namely, that we want a co-ordinated effort for spastics from babyhood through their schooldays and through youth into adult life.

The parents of spastic children are about the most wonderful in the country. That is saying a lot, because although we have some feckless parents, most British parents are willing to make tremendous sacrifices for their children. The parents of spastic children are trying to help themselves. Throughout the country there are parents of spastics associations. Most large towns have an association. The two or three Ministries concerned and the local authorities can help these associations by providing expert lecturers, meeting places for educational and social purposes, and by giving financial aid. I should like to see in every large town, near the physiotherapy unit, a spastic centre.

Spastic children could be brought to the centre. That would be work for the ambulance service. Work by the expert at the physiotherapy unit could be followed by personal contact between parents and consultant, and parent and physiotherapist, in the centre. There could be talks to the parents by experts, especially in the early days, and pooling of their problems and experiences. There could be education of children who could be educated together; and even for the ineducable children, if there are such, opportunities for pleasure and purposive 1067 activity, and a sharing of the burden borne for 24 hours daily by the mother. Parents of spastic children have a full-time job. They need assistance and relief. That is where voluntary effort can supplement the work which a good welfare service ought even now to be doing. The mothers of these children ought to be able to get a holiday at some time during the year. They ought to be able to get a break in the week's routine.

Good neighbours can help in this if they will help to bear the burden which fate has imposed upon some 5,000 to 10,000 British parents. I understand, though I may be wrong in this, my only guide being the Report, that at present no financial aid can be given local authorities for special work for spastics. If so, I hope the Government will remedy that. To do so would require legislation, so I cannot talk about that tonight. I would, however, ask the Minister what he proposes to do to implement his own Report in the matter of research into the causes, diagnosis and testing of spastics: in co-ordinating the jobs to be done, in providing clinics, and in urging the Minister of Education to provide schools: in tidying up the financial arrangements, and getting the Government to say to local authorities that it is behind anything they do for spastic children.

I know a married couple who, 11 years ago, adopted a baby. The child turned out to be spastic. They have slaved for ten years to give the child a chance in life. They have achieved wonderful things for him, particularly in the later years as knowledge and treatment have improved, showing what can be done for these children. I regard this couple as two of the grandest people in the country today. If they are typical of parents who are faced with the problem of having on their hands a child who, throughout life, will need protection and guidance, then such parents are people of whom the country ought to be proud and whom the country ought to be willing to help.

I end by sincerely congratulating the right hon. Gentleman on the initiative which has produced this Report on spastics. I hope he will carry out many of its recommendations.

§ The Minister of Health (Mr. Iain Macleod)

It not infrequently happens that in the last half-hour of the time of the House, when most hon. Members have gone home and matters of Divisions and pairs are no longer of consequence, we discuss subjects at least as important as those which have occupied the House earlier in the day. I am sure that this is true about this brief debate, because, although the number of spastic children may be small, they represent a challenge both to our humanity and our ingenuity, and I very much welcome what was said, and particularly the tone in which he said it, by the hon. Member for Southampton, Test (Dr. King).

The Report on which he founded most of his remarks was published in December by a special sub-committee of the Advisory Council on the Welfare of Handicapped Persons, and I willingly join in the tribute paid to the Chairman of the Advisory Council, a Member of this House, the hon. Member for Lowestoft (Mr. Edward Evans). This Report was approved by the Central Health Services Council and by the Standing Medical Advisory Committee, and it therefore has a considerable body of opinion behind it. More important, I am glad to say that the Committee interpreted its remit in the widest possible way, and the document covers the needs of spastics from their infancy until and after they are grown up. The document is of great significance and value.

I commended it to local authorities and told them that I thought they would find it particularly valuable in the functions which they have to carry out under Part III of the National Assistance Act. What the hon. Member mainly wants to know—and rightly—is how I intend to follow up this admirable initiative which the Committee has given.

I have already taken the first step—some time ago. In January—and the Report was not published until the previous December—I asked medical officers of health to include certain information in their annual reports for 1953 which will be of great value as the reports begin to come in during the next few months. I asked them to tell me what they could about the incidence of these cases in their 1069 areas. As the hon. Member said, the evidence is a little conflicting. It seems that there may be one or two children per 1,000 of the school population who are spastics, and about half that figure for adults. We do not know and we shall have much better information as these reports begin to come in.

Secondly, I asked them to review the facilities for these handicapped persons in their areas and, thirdly, to tell me what is being done about co-ordinating all the various bodies which have a share in this work. It is fair to say that although that initiative has been taken—and I have no doubt that it was the right thing to do—clearly the reports which we shall get this year will not be complete because the Report itself did not come out until the end of last year. Nevertheless, we shall be able to see from these reports what is the preliminary picture, at least, and we shall be able to judge a good deal more clearly where we should go from that position.

The hon. Gentleman said he thought it was the duty of the Minister to carry out research in this field. I do not want to quibble about words, but I do not think it is the Minister's or the Ministry's job to provide that research. It is our job to see that that research is done, and that is the main difference. Through the Medical Research Council, with whom I have been in touch about this debate, I am satisfied that in many areas research is, in fact, being done, and that it is reaching down into the hospitals—which is as it should be—and I have no doubt that the new Clinical Research Board will help a great deal in this field.

To come to the point about co-ordination which the hon. Gentleman stressed so well, and which the Report itself rightly puts in the forefront of its consideration, this has been at all times the theme song with me in all the speeches of any importance I have made about the National Health Service. It is something in which I believe profoundly. The Report talks about hospital and welfare provision, the educational service and the local authorities—and that is obvious enough—but it is a good deal less obvious—and I am delighted that the Committee point this out in paragraph 12—that a fully comprehensive scheme should include an arrangement under which, at the right time, the youth employment officer 1070 joins the team, and, if necessary, the disablement resettlement officer of the Ministry of Labour and National Service. So there are at least three major ministries—my own, the Ministry of Education, and the Ministry of Labour and National Service—concerned in this problem.

I should also emphasise the importance in this field of the general practitioner. Here perhaps I can quote a line or two from Sir Henry Cohen's Report on General Practice. This quotation is remarkably up to date because it was only released at midnight, and I am quoting from it seven minutes later: The general practitioner, by the exercise of this responsibility for his patient, can link preventive, social and curative medicine. Thus, the general practitioner service is an essential, not a subordinate service; indeed, in a sense, the general practitioner must hold the key position in the Health Service. That is true. I believe that to be the true key and link to all co-ordination. It is also appropriate that I should quote from that document because if I remember rightly the wife of the hon. Gentleman was a co-opted member of the committee.

One more matter in the field of cooperation and co-ordination to which I attach the greatest importance is the formation of parents' associations for these diseases and for people afflicted in this way. If properly guided—and nearly all are—they can do an immense amount of good. I very much welcome the formation of bodies of people, whose children or families are afflicted that can come together for comfort because it is a very comforting thing to have an association of people whose children are similarly afflicted to discuss common problems and to press on the Minister—and this I do not mind—from their experience the sort of action that they think he ought to take.

I should like to say a word about the problem of spastics in the mental deficiency hospitals, a problem which I regard as of great importance. There is a problem here, as there may be of deaf children in the mental deficiency hospitals, and for more or less the same reason. It is true many patients can be both mentally deficient and spastics—the underlying brain damage being responsible for both conditions—but it is very 1071 hard to estimate the intelligence of persons who cannot speak intelligently or co-ordinate their limb movements. We must try to break these barriers and it may well be that we will find in a few cases that there is not a mind as distorted or as troubled as we believe.

The key here must be individual treatment, and I think that that is the matter on which I would like to close. In the 1072 follow-up we should watch this of all points most closely so that not only with children in mental deficiency institutions but with all spastic children we should try to see that they get the individual attention which, in my opinion, is the only final answer to this problem.