§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. E. Wakefield.]
§ 8.58 p.m.
§ Mr. Eric Johnson (Manchester, Blackley)
The topic to which I want to draw attention tonight—the welfare, treatment and education of spastics—really concerns three Government Departments, namely, the Ministries of Health, Education and Labour, but tonight I intend to confine my remarks to those aspects of the problem which are primarily the concern of the Ministry of Education.
In the recently published Report by the Chief Medical Officer of the Ministry of Education, upon the Health of the School Child, which covers 1952 and 1953,it is shown that out of a school population of 5,970,000 as many as 16,719 were known to be physically handicapped and, of those, 2,954–17¾ per cent.—were spastics.
I must say, however, that that figure seems to me to be very much on the low side, because, in a Ministry of Health report which deals with the special welfare needs of epileptics and spastics, we find that it stated in page 15 that the Committee considered that, for all practical purposes, the incidence figures of children of school age suffering from cerebral palsy lies between one and two per thousand of the school population. That would appear to mean that between 6,000 and 12,000 spastic children are to be found in a school population of just under six million.
The Report on the Health of the School Child further goes on to say that there were 4,042 children in day special schools for the physically handicapped and that another 470 had been recommended for admission and were waiting to get in. There were also 2,071 in boarding special schools, and in that case 913 were waiting for admission. It is reasonable to suppose that, out of the handicapped children either in special schools or waiting to go in, a large proportion must have been spastics.
Therefore, one conclusion which could be drawn from a comparison of the figures in those two Reports, which appear to 133 differ so widely, is that there is at the present time a very marked lack of accurate information about the size of this problem, and I think it may well be a good deal larger than is generally supposed.
These waiting lists may not, at first sight, appear to be large enough to cause any great concern, but I do not think it can be too strongly emphasised that, in treating the spastic, early action is essential. Indeed, I would say that the time lost in waiting for admission may never be recovered at all. If the figures which I have quoted are correct, rather than the ones given in the Report on the Health of the School Child, the position is obviously even more serious.
The case that I want to put forward tonight is based on two assumptions. They may not be universally accepted, but I think they are supported by the experience of those who have a good deal to do with the education and the treatment of spastics. The first assumption I wish to make is that it is more than doubtful whether schools for the physically handicapped provide sufficient facilities, such as physiotherapy and speech therapy, to make any marked difference in the development of the badly handicapped spastic child. Indeed, I believe that it is true to say that teachers in the schools for the physically handicapped themselves admit that only comparatively lightly handicapped spastics fit properly into the routine of these schools.
My second assumption is that residential schools are more suitable than day schools, although, of course, there may be much to be said for day schools in the larger towns. I admit that Chapter 8 of the Report on the Health of the School Child states, in page 69 thata child should never be removed from home unless it is quite certain that there is no practical alternative.It may seem presumptuous on my part, but I venture to disagree with the Chief Medical Officer, and I think that I get some support for my view in a circular issued by the Ministry of Health, entitled "Welfare of Handicapped Persons." In page 17, paragraph 28,of that circular, which deals with the special welfare needs of epileptics and spastics, we find the following sentence:As indicated above, the Committee appreciates that the assessment of educability in cases of cerebral palsy is extremely difficult, 134 but is convinced that, wherever possible, doubtful cases should be given a period of special study in, for example, a hospital school, or, if practicable, in a residential school.Out of these assumptions arises the question of the facilities actually available now for educating spastic children in special schools. The present position is not at all satisfactory. There are only five residential schools and one special day school for spastics in the whole of Eng and and Wales, providing for fewer than 250 children, which is not very much, even if the higher figure be accepted. Of these schools, four were set up, and are administered, by voluntary agencies.
Under Section 6 of the Education (Miscellaneous Provisions) Act, 1953, local authorities are empowered, with the approval of the Minister, to make special arrangements for the education of a pupil at a school not maintained by them or by another local authority, and, if necessary, to pay for that child's school fees and board and lodging. I do not know to what extent local authorities are making use of that power. I realise that it may put a burden on their rates to do so to a very large extent, but I hope that the Minister will encourage local authorities to make these grants. We all appreciate that it is not much to encourage them to make use of such facilities when there are not enough special schools. That is the case at present; there are just not enough of them.
Existing facilities, and those which are proposed, leave out a very large proportion of spastic children and cerebral-palsied spastics who are also educationally sub-normal. More has to be done for the child who is not mentally deficient but who has a low intelligence quotient, because no provision is made. Because many spastics are both physically handicapped and educationally sub-normal they get into difficulties in two respects. Such a child cannot go to a physically handicapped school because it is educationally sub-normal, and it is no good sending it to a school for educationally sub-normal because it will not get the special physical treatment there which is required and which is not provided in those schools.
There is another matter which seems serious and deplorable. Large numbers of spastic children are passed on from the local education authority to the mental health committee and are denied the 135 opportunity of any education at all. There is no school to which the low I.Q. spastic can go. Most of the special schools require either an average or a low average intelligence quotient. Some mental authorities provide for educational centres, but these are not designed to cater for the potentially intelligent but for the seriously retarded spastics, who need not institutional care but patient nursing.
Another serious gap in the education and training of spastic children is that there is no provision for the continuation of their education after the age of 16. The average spastic child in a special school—if it has been fortunate enough to get there—is still, at the age of 16, behind in education. That the Ministry of Labour can provide training for the lightly handicapped person after 16 years of age is no answer to our problem. It is surely wrong to plunge an intelligent spastic child into vocational training before it has had proper time to develop its mental abilities as much as it can.
I now venture to make one tentative suggestion. The first and most urgent thing for spastics with a low intelligence quotient is more residential schools. The fact that a spastic must be given an I.Q. below that for a physically normal but educationally sub-normal child should not be taken as clear evidence that it cannot be educated at all. That fact has been proved so often that there is a strong case for abandoning the rather rigid estimates of I.Q. and for giving all but the obviously mentally deficient cases the benefit of the doubt.
The education of the spastics is essentially a long-term problem. That fact should not deter local authorities from making the provision which is required. I quote again from the circular on the welfare needs of spastics, where it is said:It is known that in at least one school, some children who in the first instance had been rejected as in educable, subsequently proved to have a higher level of intelligence than was at first supposed.That shows that it is really a long-term policy.
My first suggestion is for residential schools. My second is for a special residential school to provide secondary education for spastics. My hon. Friend, who is no doubt familiar with the contents of Chapter 10 of the Departmental Report on the Health of the School Child which 136 deals with secondary education for physically handicapped pupils, will have noted what is said in the section on cerebral palsy in page 95 of the Report. Cases are there quoted. One is of a boy suffering from cerebral palsy who yet was able to pass the entrance examination of a well-known public school and who is reported to be doing very well. Another passed from a school for physically handicapped children to the various stages leading to a university degree in economics. This section of the Report concludes by saying that the problem of spastic children needs very special consideration in relation to grammar school provision. I think that there is every justification for an experiment to be made in providing, at any rate, secondary education for spastics in a special school.
I began by saying that the treatment and education of spastics concerned three Government Departments—Health, Education and Labour. In concluding, there is no need for me to stress the very great importance of those Departments working even more closely together than they are at present. The whole problem is really inter-related. One cannot separate the spastic into three different stages of its life. In the field of education in particular, I hope that everything possible is being done to encourage and help local authorities to set up, and make use of, additional facilities. I feel that many of them would send children to the special schools if more of those schools were available. Great interest has been shown by many local authorities in the two new schools for spastics, which I understand are to be opened this summer by the National Spastics Society. It may well be—although I do not know—that some local authorities are lagging behind, but I hope that my hon. Friend will look into this and, perhaps, give the local authorities a little encouragement.
I also hope that he will make sure—as I know he will—that his Department does recognise the very great contribution being made to the welfare of spastics by such voluntary societies as the National Spastics Society. I should like to take this opportunity of expressing how greatly I am indebted to that Society and to its Secretary, Mr. Pritchard, for the help and information I have been given. I am sure that we are all great believers in the immense value of voluntary social work. None the less, in dealing with 137 such a formidable problem, I think that my hon. Friend might do well to remember that it is rightly said that an ounce of help is worth a pound of sympathy. I trust that he will not only continue to cooperate with the voluntary societies, but will seek every opportunity of giving them some practical help to expand the invaluable work which they are already doing in such a worthy cause.
§ 9.16 p.m.
§ Mr. Somerville Hastings (Barking)
I am quite sure that all who are interested in these unfortunate children, including their parents, will be grateful to the hon. Member for Blackley (Mr. E.Johnson) for having brought forward this subject this evening. Perhaps I may be allowed to digress for a few seconds to deal with the natural history of this disease, in order that I may explain better what I want to say about the education of spastic children.
Spastic disease occurs at birth. It is due to some affection of the brain before birth or injury of the brain at birth. At any rate, it occurs at or before birth. As regards treatment, there is, so far as we know at present, little that can be done by means of drugs or operation in connection with this disease. It therefore follows that all that we can do at present—and it is a very great deal—is by way of education. Therefore, I want to stress that education and treatment cannot be separated. They are one and the same thing; they are a continuous process. I suggest that they have to be begun directly the disease is recognised.
Spastic disease is in most children a double handicap. Children are affected, not only spastically by the unco-ordination of muscles, but their intelligence is, in about 70 or 80 per cent. of cases, affected as well. That makes it very difficult for the teacher of these children to make clear to them the nature of their trouble, and how they can best co-operate in connection with its treatment.
There is another difficulty which arises from this double handicap. The people who are looking after and dealing with these children have very great difficulty in ascertaining to what extent the mind is affected. As most of us know, we are only able to express our feelings by means of our muscles—the muscles of the mouth and throat in talking, the muscles of the neck in nodding the head, and the muscles of the face to convey 138 expression. These children have muscular unco-ordination, and it is very difficult to say to what extent the mind is affected as well. Therefore, as already pointed out, some of these children find themselves in institutions for the mentally deficient, in which they really should not be.
There is a third difficulty in that many of these children are also deaf. I want to stress, first, that to get the best, and, indeed, the only satisfactory results, the educational treatment, or whatever we call it, has to be started as soon as the trouble is recognised, and the earlier the better. Sometimes spastic disease can be recognised at the fourth month, and all over the country, fortunately, diagnostic centres are being started where this disease is recognised, so that treatment can be commenced from the very beginning.
Remembering the mental condition of so many children, and their difficulty in expressing themselves, it will be easily understood that the teachers and those who treat these children have an exceedingly difficult task. They must be sympathetic and must secure the child's affection if they are to do their best for the child. Then they have to determine which muscles are at fault and try to get the muscles working again and their association with the brain connected once more.
I want to stress the difficulty of the task of teaching these children. People may ask whether it is worth it. I suggest that it is thoroughly well worth it. As has been pointed out, a good many such children are able to learn a trade or profession and earn their living. Even where no speech is possible owing to muscular paralysis, children can be taught to type and express themselves in that way.
Many of these children are able to take their place in industry of one sort and another after going through the schools, residential or otherwise. I suggest that even when that is not possible it is the duty of the country in which these children live to provide that training which will enable them to get the most out of life, considering their handicap.
There is another reason why we ought to do our best for the education of these children, and that is partly for the sake of the parents. Parents too often assume that, to some extent, the handicap of 139 their children is their fault. Of course, this is not so. It is their misfortune only. When these children get to institutions for their training and education, the parents meet together, and get mutual help and comfort, and are better able to understand the fact that it is not their fault. As a result, instead of hiding the child, parents are enabled to play their part aright in the child's education.
I agree with the hon. Member for Blackley that a great deal can be done with these children in residential schools, and I cannot help feeling that for some of them, at any rate, the hospital schools are the best. I have paid many visits to St. Mary's Hospital, Carshalton, where Mrs. Collis does such fine work in the training and education of these children. I know that some of her results surpass all expectations.
The education of such people must not cease when they reach the age of 16. They must not, so to speak, be thrown on the scrap-heap and merely given National Assistance. The care of these people must continue. Some of them, of course, are to be looked after quite well by their families, but there are others who need continued care and treatment.
When the London County Council was responsible for the hospitals of London, it used one of its hospitals as a convalescent home for young people and put into the hospital some chronic cases as well as ordinary cases which were merely convalescing. The mixing together of the young people helped these young, chronic patients. The convalescing cases soon understood that a few of their colleagues would probably never leave the hospital alive and, as a consequence, were especially kind to them. The chronic cases, such as spastics, enjoyed the life of the convalescent hospital and derived if not benefit, certainly much happiness from it.
I want to stress particularly the importance of the early recognition of spastic cases, the commencement of treatment and education from the very first, and its continuation, with modifications of course, throughout the life of these unfortunate people so that they may get the best out of life which is possible for them.
§ 9.27 p.m.
§ Mr. J. R. H. Hutchison (Glasgow, Scotstoun)
I approach this subject with a certain amount of diffidence, first, because it is a very poignant subject, 140 secondly, because it is extremely complicated—as has already been shown by my hon. Friend the Member for Blackley (Mr. E. Johnson) and the hon. Member for Barking (Mr. Hastings)—and, thirdly, because I must confess that to a certain extent I am fumbling, just as, I think, the whole nation is fumbling. Cerebral palsy is a new complaint only recently recognised and recognisable as a special form of both a physical and mental handicap.
My difficulty is further accentuated, as has been shown by the two previous speakers, by the fact that the responsibility for the situation is divided between three Government Departments. One finds oneself straying from one Department to another the whole time. If I fire questions at my hon. Friend the Parliamentary Secretary to the Ministry of Education which are not his responsibility, he will realise why.
The hon. Member for Barking put his finger on the kernel of the problem when he said that to make any progress with the education of a spastic child and with its treatment, with physiotherapy, the work must be continuous,and the first thing which emerges is that one of the Ministries must take a lead in the matter.
If I may, I should like to congratulate the Ministry of Education on appearing to be a step ahead of the other Ministries in recognising the proper method and, indeed, the gravity of the problem. This at once illustrates the difficulty with which I am faced of there being three Ministries: I understand that there is a shortage of physiotherapists, that such facilities as are already available, as my hon. Friend the Member for Blackley has shown, are not adequate, and that even those which are available need more physiotherapists than exist.
My hon. Friend the Parliamentary Secretary can with perfect justification say that that is not his responsibility, but if and when he does, I will go on to say to him that I understand, further, that there is a shortage of teachers for backward schoolchildren. I do not know the cause of that, but I think that their conditions of employment and the special course through which they go need further examination. It is no good setting up special schools or making further facilities available if there are not people there who can handle both the physical 141 and mental sides of these tricky and complicated cases.
I wish to ask my hon. Friend the Parliamentary Secretary about the method and conditions under which grants are made to special schools. My hon. Friend the Member for Blackley said that already there are a few special schools in existence. I think there is only one in Scotland. I saw it during the last Recess. I am not sure if I am right, but I understand that the attitude taken by the Ministry of Education is that it is not satisfied that there is a demand for more. It has said to the National Spastics Society, perhaps with a certain amount of logic, "Go on, set up another and, if you can show that there is a need for it, we will start paying grants to you such as those made to the schools already in existence."
That raises two or three problems. First, there is the original outlay, which has to be met out of voluntary funds. Then there is the time lag, because I do not think the grant is made retrospective. One might ask the Ministry of Health to take some financial interest in these schools. After all, the Ministry will be relieved of some financial responsibility. I may be talking nonsense and it may be that the Ministry is doing something like that, but I do not think that is so.
I ask my hon. Friend whether these grants are made direct by the Ministry of Education to the special schools or made by local authorities. Has the Minister any power over the local authorities if they do not agree to make such grants? My hon. Friend used the word "encourage" throughout his speech and I agree. I am afraid that I did not tell the Parliamentary Secretary that I would intervene in this debate and he cannot answer, so to speak, "off the cuff," but I should like to know whether the Minister of Education has any direct powers to make grants or to give help.
As the hon. Member for Barking so rightly emphasised, early diagnosis is important. This may reach the right ears in some sort of liaison system. Something ought to be done in the direction of instructing students and, perhaps, mid-wives to try to recognise cases which might turn out to be suffering from spasticity. As the hon. Member for Barking emphasised, it is then that the importance of treatment begins.
142 I was informed that a review is being made in Scotland and a report is being produced on all aspects of handicapped children and their education. I conclude by asking whether a similar review is being undertaken in England and whether my hon. Friend can tell us that anything is likely to emerge from it. Will he try to set up some sort of working liaison between his Ministry and the other two Ministries concerned? Since his Ministry has shown a degree of interest, perhaps he may go further and have the honour of taking the lead.
§ 9.34 p.m.
§ Miss Margaret Herbison (Lanarkshire, North)
I am sure all of us are most grateful to the hon. Member for Blackley (Mr. E. Johnson) for raising this matter tonight and for the very thorough way in which he dealt with it in a short time. It seems that almost until the present time it has been taken for granted that every spastic child is not only severely handicapped physically but also severely handicapped mentally.
My hon. Friend the Member for Barking (Mr. Hastings) said that the number of those not only physically handicapped but mentally handicapped is somewhere between 70 per cent. and 80 per cent. I am not at all sure that that figure is correct. It is very difficult to assess the intelligence quotient of a child who is a spastic. As far as I know, there is no intelligence test that one could apply to spastic children, and it seems to be just a matter of guesswork when one tries to put a figure to the percentage of spastic children who are not only physically but also mentally handicapped.
I realise that not only in England and Wales, but in Scotland, we have failed lamentably—I do not blame one Government as against another—in what so far we have attempted to do for the spastic child. It is indeed a tragedy for the spastic child who is mentally handicapped, but our neglect has been a far greater tragedy for the child who is a spastic but who is not in any way mentally handicapped. It is for that reason that we should from this point onwards do everything we possibly can, first to try to find the children who are not mentally handicapped, and in the first instance do everything we can to help them.
143 We then come to the question, which the hon. Member for Scotstoun (Mr. J. R. H. Hutchison) raised, of the training of teachers. There is special training after ordinary training, at least in Scotland, for those who are to teach in special schools for the physically or mentally handicapped. Even in those schools there is a shortage of teachers, just as there is a shortage of teachers in schools for normal children. But if there is to be any real improvement in what we hope to do for spastic children, a great deal of thought must be given by the Minister of Education and by the Secretary of State for Scotland to the training of teachers for spastic children.
I have at present an open mind about the suggestion by the hon. Member for Blackley, supported by my hon. Friend the Member for Barking, that residential schools or hospital institutions are the best places for these children. I have always felt, however, that whether a child was physically or mentally handicapped he should, if possible, be at home.
I know that the handicaps of the spastic are so severe that residential schools might be the best place, but a child who is afflicted in this way needs the love and care of his parents. It is because of the great need for special love and care that I feel that, where possible, the child should spend its time at home and should be educated in a special school.
From my knowledge of special schools for mentally handicapped children, I do not think that it would be possible at present to educate the spastic child in these schools, but I hope that eventually this will be done. One of the things to be guarded against is making the spastic child feel that he is isolated or is a child apart from the rest of the community. At present, because so little has been done for these children, the child feels that it is one apart, and the parents feel intensely that their child is one apart. My hon. Friend the Member for Barking dealt with the point admirably in speaking of the feeling of those parents who have spastic children. I am glad that the National Association is doing such good work.
I know that my hon. Friend the Member for Mother well (Mr. Lawson) wishes to speak. I do not want to touch on the points which he wishes to make, but it is 144 the case that in Scotland parents are becoming alive to this problem and are showing the initiative which we as legislators have failed to show up to the present. I hope that the fact that these parents are showing this initiative will ginger the Legislature into doing something worth while for these children.
I read a very interesting article dealing with this subject. I am not sure whether it was in "Picture Post" or in "Illustrated."
§ Miss Herbison
The article dealt with the life of a man who had been a spastic. It showed how this man had struggled since childhood, how once he had overcome one difficulty his determination led him to overcome another, and how he is now holding a good job and doing it admirably. Because of that article and because of the study I have given to this subject, I feel that we are too prone to take for granted that the majority of spastic children are also mentally handicapped.
The hon. Member for Scotstoun spoke of the difficulties caused by the fact that the care of these children was divided amongst three Ministers in England. We in Scotland are fortunate in that the Secretary of State for Scotland is responsible for both education and health. I am quite sure, therefore, that the Parliamentary Secretary to the Ministry of Education will bring points made by Scottish Members to the notice of Scottish Ministers. We shall then have the closest co-operation in Scotland between the two Ministries. I know that the Ministry of Labour is also involved in this matter.
At present, the majority of these spastic children are never able to work, because they have had no training or education. To their intense physical disability is added the feeling that they are of no use at all. They are becoming frustrated. In many instances this frustration leads to despair. Even if the child is living at home with brothers and sisters who are normal, the older the spastic child becomes the more he sees the difference between himself and his normal brothers and sisters.
We, as legislators, have a great responsibility towards these children. I plead, as others have been pleading tonight, that 145 the Minister of Education, the Minister of Health, and the Secretary of State for Scotland, should realise that there is at present a very strong and growing feeling that we have failed so far in our duties towards spastic children.
§ 9.45 p.m.
§ Mr. James Johnson (Rugby)
The whole House and the country are indebted to the hon. Member for Blackley (Mr. E. Johnson) for his sincere and moving speech. I wish to take up only a few moments to deal with four words which the hon. Member used and to ask the Minister a question about this subject in connection with the West Midlands. The hon. Member for Blackley said that local authorities were lagging behind in dealing with this matter. I wonder whether that situation is not somewhat similar to the situation in the matter of university awards and scholarships, where one finds that some county councils have been somewhat backward in the last few years. Would the Minister do what he was asked to do by the hon. Member for Scotstoun (Mr. J. R. H. Hutchison), namely, make a survey of England, to find out where we are lagging behind and where there is a connection between counties and county boroughs?
I used to be on an education committee in Coventry where there had been for some time a school for spastics. The work clone there was wonderful and one was moved by the thanks of the mothers for what was being done for their children who had gone to this school. It was a most moving experience to feel the changed atmosphere after these children had received tuition at that school.
A few days ago I asked the Minister of Health about the situation in the West Midlands, and I am sorry to say that he gave me an evasive answer, attempting to pass this question over to the Minister of Education, whose Parliamentary Secretary is now facing us on the Bench opposite. In my own county of Warwickshire there are at least 47 spastic children of school age, there are at least 100 in Staffordshire, where there is one school, I believe that there is no school in Shropshire, and Hereford is equally badly off.
I plead with the Minister, therefore, to have a word with the education authorities in the West Midlands because, although it is mainly a matter of spending 146 money, it is not quite as simple as that. If one talks to the hard-working and conscientious county officials, one is told that if money were voted and there were the buildings, it would still be necessary to find the staff to look after these children. It is not simple to obtain qualified staff.
As a past teacher, I believe that teachers in these schools should receive extra money because theirs is even more a vocation than teaching in the normal schools. It has a fascination for those who go in for it and they stay in, once they are in, because it is a calling. However, all too few are qualified for this work, so I am pleading for an additional allowance over and above what is almost a mere pittance. Again on the question of staff, attendants are needed, not nursing staff. In the Midlands potential staff are drawn away by the high wages paid in car factories and other industries. I ask the Minister to pay attention to the wages of the domestic side as well as on the teaching side.
The hon. Lady the Member for Lanarkshire, North (Miss Herbison) referred to intelligence. It is almost impossible accurately to measure the intelligence quotient of children who are spastics. This makes it all the more important to ensure that they live full and decent lives. I ask the Minister to survey England, particularly the West Midlands, and to give all the financial help he can to the local authorities and local education committees.
§ 9.49 p.m.
§ Mr. A. Hargreaves (Carlisle)
I want to refer to the opening sentences of the hon. Member for Blackley (Mr. E. Johnson). When, a little over two years ago, I tried to find out the incidence of spasticity amongst children of school age in the counties of Cumberland and Westmorland, the local education committees had no firm figures to go on, and that was also the case in the City of Carlisle. The parents formed themselves into a small association in Carlisle, and the longer their work proceeded the more members they found. It is true—and I have no doubt that the Ministry now has evidence of the fact from those two counties—that there was a great deal of what might be called hidden spasticity among children of school age. That is certainly true in my personal experience.
147 A small group was formed in Carlisle a little over two years ago. They went into the County of Cumberland because there was need for a linking up of parents who have spastic children. They also went into North and South Westmorland and found children not attending school who scarcely saw the light of day. These people are now in voluntary associations in Cumberland and Westmorland and they and their children meet together. I am sure that if the Minister follows the lines adopted by these voluntary associations he will be made aware of the position.
I know that a survey is being made which will teach us that the incidence of spasticity is very. much greater than was shown by the figures available to us at the time when I made my inquiries from the Ministries two years ago. I reinforce the statement made by the hon. Member for Blackley that the statistics available were not reliable and that the incidence was much greater than we had known at the beginning of these endeavours.
My hon. Friend the Member for Lanarkshire, North (Miss Herbison) mentioned the intelligence quotient of spastic children. I do not believe that 70 or 80 per cent. are affected mentally. I suppose that on the face of it the medical profession would take it for granted that damage to the brain which leads to lack of co-ordination of muscle must lead to some loss of mental faculty. I would say, too, that diagnosis at an early age is impossible. We need only state the fact that no baby has any co-ordination at all to realise that we must wait a little while before diagnosis of lack of co-ordination of the muscles is possible.
However, it is certainly true that very early treatment offers hope. That is my firm conviction. It is often true that a keen, vital intelligence is the enemy of treatment. The physiotherapist endeavours to inculcate a pattern of muscle working, but the keen intelligence takes short cuts to induce a limb to behave in a certain way. That keen intelligence is the enemy of the muscle pattern-building in many cases. That is another reason why very early treatment offers more hope than can be expected when a child is handled at a later stage. I hope that the Minister can continue the work embarked upon and that we can 148 look forward to a happy co-operation between the Ministry of Education and the Ministry of Health in dealing with these children before they reach school age. I pay tribute to the hon. Member for Blackley and impress upon the Ministry how strong our feelings are on this subject.
§ 9.55 p.m.
§ Mr. George Lawson (Mother well)
I am delighted to follow my hon. Friend the Member for Carlisle (Mr. Hargreaves). When he referred to the problem caused by keen intelligence I wondered whether the phenomenon was not sometimes seen in the case of the very bright child who suddenly develops a stutter or stammer for no apparent reason. That is not what I originally wanted to say, but it came to my mind and I thought I might bring it out.
I wanted to give an account of what is happening in Lanarkshire. First, I want to describe a little incident which seems to me to be peculiarly tragic. In my constituency a man and his wife who found that they could not have a child decided to adopt one. They adopted what appeared to them to be a perfect child, only to discover, later, that it was a spastic. That is the tragedy of the case. This couple did not decide to part with the child, but to rear it; and they could show no more affection for it if it had been their own.
This man and his wife were with 40 or 50 parents whom I met at a meeting which was held about three months ago in Motherwell. Those parents, with a number of sympathisers, have been working together and have set up a temporary association—the Lanarkshire Spastics Association—covering the whole of Lanarkshire and having its centre at Motherwell. Through the good offices of the Motherwell Town Council they have been granted, at a nominal rent, a large house which they have been engaged in furnishing, not in the ordinary way, but with the various forms of specialist furniture which the spastic child requires, such as the desk where the child sits in the middle, and cannot possibly fall. They have all kinds of devices to meet the needs of spastic children.
These children may be their own, but they are prepared to bring in others. Their efforts were directed towards providing a 149 school for about a dozen children, but they found themselves very badly off for money, and approached the Lanarkshire education authority. I raised this question in the House and discovered that the Scottish Office knew nothing of it, which indicates that we are not particularly well informed upon the question of spastics and what is being done for them.
Since these parents have made their effort to set up this school in Motherwell the Lanarkshire Education Authority has become interested, and I was recently informed that it is taking the school under its wing; that the centre in Motherwell will become an ascertainment and occupational centre, and also that it will give a measure of training as a day school for future children. Very soon, the Lanarkshire education authority hopes to open a day school in Hamilton, which will cover the Lanarkshire area, and it now takes the view that this day school should be developed into a residential school covering the West of Scotland.
I raise this matter not because of giving publicity to what is happening but because a special appeal was made to me—and, I have no doubt, to other hon. Members representing Lanarkshire constituencies—to do all that we could to influence the Scottish Department of Education and the Secretary of State for Scotland to accept every possible form of assistance from the centre. I would ask the Parliamentary Secretary to pass this information on to his right hon. Friend. We are very much concerned that this venture in Lanarkshire should be followed up and made a real success, thereby providing means for the same type of development in other areas.
§ It being Ten o'clock, the Motion for the Adjournment of the House lapsed, without Question put.
§ Motion made, and Question proposed. That this House do now adjourn.—[Mr. Kaberry.]
§ 10.0 p.m.
§ Mr. F. H. Hayman (Falmouth and Camborne)
I wish to endorse the tribute which my hon. Friend the Member for Carlisle (Mr. Hargreaves) paid to the hon. Member for Blackley (Mr. E. Johnson), who initiated this debate, because this is a subject which is brought forcibly before us all at times. I think that there is no class of person in the community more 150 to be pitied than the spastic child or the mother of the spastic child.
The Parliamentary Secretary will probably recall that twice in the last week I sent him particulars of a case of a spastic child which was crippled and dumb, and in which the mother's health is breaking up entirely. I have had other cases of a similar nature brought to my notice within recent months. We are grateful for what has been done for many of these children, but I would especially support the plea made by my hon. Friend the Member for Rugby (Mr. J. Johnson) for adequate salaries, and, perhaps, additional payments to be made to teachers and other workers who have been looking after these children. They are relieving the parents of a terrible burden, but they are undertaking a big burden themselves. It is really a vocation, not just a profession, and, for that reason, I support all that has been said, and hope that something more can be done for this profession.
§ 10.2 p.m.
§ The Parliamentary Secretary to the Ministry of Education (Mr. Dennis Vosper)
As my hon. Friend the Member for Blackley (Mr. E. Johnson) knows I very much welcome this debate tonight. I am indeed very glad that it has taken place, and that so much time has been available in which to discuss this subject. I very much welcome many of the contributions that have been made, particularly that of the hon. Member for Barking (Mr. Hastings),who has great experience of this matter and who is, as many hon. Members know, a patron of one of the voluntary societies involved.
I think the number of hon. Members who have taken part in this debate is evidence of the success of the publicity that has recently been given to these unfortunate children. Like the hon. Lady the Member for Lanarkshire, North (Miss Herbison), I read the article to which she referred—I think it was in "Picture Post" and not "John Bull"—and I think it may be partly responsible for the widespread belief that there are some 10,000 spastic children in England and Wales for whom little or nothing is being done by the State.
I am not going to disagree with the figure of 10,000 spastic children, but I disagree with the implication—which I do not think has been reiterated tonight— 151 that a great proportion of these children should be placed in special schools for spastics only and that they are being neglected today. As many hon. Members have mentioned, this debate tonight concerns three Departments in England and Wales, and, particularly tonight, one in Scotland. As far as individual points about Scotland are concerned, hon. Members will not expect me to reply to them, but I will ensure that they are passed on to my right hon. Friend the Secretary of State for Scotland.
One cannot, of course, separate education from the health and welfare of spastics, but if we take the figure of 10,000, with which I do not disagree—I think that there are probably about 10,000 children under the age of 16 who suffer from this terrible affliction—about 3,000 are under school age; that is, under the age of five. In the main, these children are not my Department's responsibility; although I agree with my hon. Friend the Member for Blackley that they need early treatment, this is mainly the responsibility of the National Health Service. My right hon. Friend the Minister of Health is aware that treatment should start early, and he is, at the moment, on the look-out for improvement, and I will certainly see that a copy of this debate is placed before him at an early date.
Again, my hon. Friend, and I think also the hon. Lady the Member for Lanarkshire, North, referred to the Ministry of Labour. I agree that continued treatment is an important problem, but I do not propose to deal with it on this occasion, but to refer it to the Ministry of Labour.
I mentioned earlier that there were perhaps 10,000 children affected by cerebral palsy, of whom 3,000 are under school age. Of the remaining 7,000, some 1,500 are not capable of receiving education, even in a special school. I will say a word about them in a moment, but they are not the responsibility of my Department. Of the remainder, about 3,000 are very lightly handicapped and are in ordinary schools. Some of the rest are in hospital or getting home tuition, and 1,800 are in special schools for physically handicapped children.
Some hon. Members have said that a survey should take place of children awaiting places: I am able to tell them 152 that a survey of all physically handicapped children in England and Wales, not only spastics, was completed the week before last. My Department asked all local authorities to advise it of the physically handicapped children who, on 1st October last, were awaiting admission to a special school. With the exception of seven, all local authorities have now replied.
The figures revealed are interesting. We have not only the numbers but the names and details of every child who, in the opinion of the local authority, requires admission to a special school. The figure is not the 10,000 which may be in some people's minds but is, in fact, approximately 450, of whom 400 require admission to a boarding school.
I admit that these children are not getting proper education at the moment but the Government, prior to the survey, had already taken action to put that right. The number of schools for physically handicapped children under construction is more than sufficient to cope with the number awaiting admission. It must be remembered, as one hon. Member mentioned, that it is sometimes difficult to persuade parents to let children go to a boarding special school: on this basis the accommodation scheduled at the moment is more than sufficient to cope with the waiting list of 450.
§ Mr. E. Johnson
I am sorry to interrupt my hon. Friend, but, on the question of schools under construction, could he say what schools these are and who is making them?
§ Mr. Vosper
I am advised that 10 schools are under construction in England, seven of them by various voluntary bodies and three, if my calculations are correct, by local authorities. Some are for spastic children only and others for physically handicapped children of all categories, which will include spastics. Some of these 10 will be completed this year and, according to our plans, all will be completed by 1958. There is, I think, no hon. Member for the Principality here now, but I should also mention that there is one very important and large school being provided in Wales.
The hon. Member for Rugby (Mr. J. Johnson) mentioned the West Midlands. I do not want to anticipate my reply to a Question that he is going to ask. My 153 information is—I have not the individual figures for the local authorities with me—that the waiting list for the three areas of Staffordshire, Worcestershire and Warwickshire is 41,and that one of the 10 schools to which I have referred is a school being constructed by the Staffordshire authority which will accommodate more than that number.
§ Mr. J. Johnson
In my own county of Warwickshire, the chairman of the county council education committee has informed me that there are at least 47 there—in that one county.
§ Mr. Vosper
I think that the answer to the survey which we sent out for October showed a number very much less than that, but we will go into that when the hon. Member asks his Question. I am satisfied that there will be sufficient accommodation available within two or, at the most, three years for all children needing accommodation.
The second point raised was about the type of accommodation, and I think that my hon. Friend the Member for Blackley takes the view, as many hon. Members probably do, that the majority of these children should be in special schools for spastics only, whereas, at the moment, the majority of the children are in special schools for physically handicapped children of all kinds. I do not think it is sufficiently realised that the term "spastic" covers a very wide range of physical and mental disability. Almost all the 3,000 children I have mentioned as being in ordinary schools are, in fact, much better off there, because they are receiving the treatment which they need through the Health Service. As to the remainder, there is, perhaps, a difference of view as to whether the children should be in special schools for spastics or in special schools for the physically handicapped, as most are at the moment.
The number of special schools for spastics only is, in fact, seven at the moment, of which four are run by voluntary bodies and three by local education authorities. All these seven schools have received, or have been promised, substantial Government grants, and these schools, as hon. Members will realise, concentrate on those children with the most severe handicaps. Our experience—and I think that the hon. Member for Lanarkshire, North (Miss Herbison) supports me in this—shows that the 154 children with less severe physical handicaps and normal intelligence do well in the ordinary special schools for the physically handicapped.
There is much to be said for widening the range of these children's experience and placing them among children suffering from handicaps different from their own. The "Health of the School Children" Report, to which my hon. Friend referred, bears out that this is the right approach. While it is a matter of opinion, those teachers and experts to whom I have put this question in recent weeks—and I have seen some of the children in these special schools—bear out that their preference is for these children being in special schools for the physically handicapped and not in schools for spastics only.
There are 24 boarding schools and 82 day schools for physically handicapped children, all of which, I am advised, take a number of spastic children, and there are some spastics in the schools for delicate children. The hon. Member suggested that facilities in the ordinary schools for the physically handicapped are often inadequate for spastic children. We are aware that increased facilities for physiotherapy and speech therapy are required in some of these schools where there is no spastics unit.
We shall soon be advising the school authorities about the special facilities which spastics need, and we shall encourage them to make sure that they are in fact provided. This was the point made by the hon. Member for Scotstoun and by other hon. Members. This is not the responsibility of my Department, but I believe there is, in fact, a shortage of physiotherapists, and a slight shortage of teachers for special schools, although I do not think it has been significant up to the present.
Referring to the training and pay of these teachers, teachers in these special schools do, of course, get two extra increments of pay at the moment, and my hon. Friend may have read, or be about to read, the Report recently published by the National Advisory Council on the Training and Supply of Teachers, which deals with teachers for handicapped children. That Report does not deal with pay, but it does deal with conditions of training which must, in due course, involve pay considerations. That Report was published 155 only just before Christmas and is now under consideration.
One or two hon. Members spoke about boarding schools versus day schools. Again, the present trend, both here and in other countries—and this again is borne out by the Report on "The Health of the School Child "—is that we should experiment more in favour of day schools than of boarding schools—unless, may be, home conditions make this inadvisable, or where the child is so severely handicapped that a day school is quite out of the question.
This is a matter of opinion, but I am giving what I believe to be the majority view of the moment, and it is the direction in which my Department is thinking at present. It is important to keep children as much as possible in the normal world so that when they leave school they may be in a better position to take their place as normal citizens. In particular, I think that the very young should not be taken from their homes without very great consideration having been given to that course.
As I have mentioned earlier, many parents desire to keep their children at home, and in view of what has been said by the hon. Member for Falmouth and Camborne (Mr. Hayman), they deserve credit for taking on the task and bearing the burden when they are able. Nevertheless there are some children who, if the parents could be persuaded to agree, would be better in boarding schools, though the parents of some of 400 we hope to place in boarding schools are reluctant to see them go. In this connection, such bodies as the National Spastics Society, with their contacts with the parents, could, I think, give us some assistance.
The hon. Member for Barking spoke of those children who are doubly handicapped—the problem of those who are educationally subnormal and those who are in educable. It is a fact that the voluntary schools—the special schools for spastics only—do not take children who are educationally subnormal. This is not the case in the ordinary schools for physically handicaped pupils, and there is no reason why the child with the double handicap of cerebral palsy and educational sub normality should not be educated—as some are—in these schools. 156 There has been some difficulty up to now, but with the extra accommodation becoming available it should be much more easy to get these doubly handicapped children into schools.
A greater difficulty is that of accommodation for those who are in educable. Much of the public concern about spastics at the moment may be due to the fact that there are many parents who are very reluctant to accept the fact that their children can never be educated in a special school as those schools are now conceived.
The hon. Member for Blackley suggested that the facilities provided for the in educable are inadequate. In this debate I should not want to comment on that, because the occupation centres are the responsibility of my right hon. Friend the Minister of Health, but both he and the Minister of Education are agreed that where there are marginal cases, and where there is uncertainty, children should not be classified as in educable until there has been a trial period in a special school—day or boarding—even, sometimes, a prolonged trial.
I realise that in the past this has not always been possible, and there maybe cases in the future where it will be difficult, but the increased number of schools should make it much more possible. I know that this is a matter of much concern to the parents of spastics and to the societies concerned.
One point made, I think, only by my hon. Friend the Member for Blackley, was the question, as he put it, of secondary education. There are several schools which are providing secondary education for physically handicapped children at the moment. What I think he had in mind was grammar school education. Here our survey leads us to believe that there are very few spastic children indeed who are capable of receiving a grammar school education. However, our survey covered all physically handicapped children, and I think that there will be sufficient physically handicapped children of all types to make a grammar school a possibility. We are looking further into that.
I should like to conclude by saying a word about voluntary effort, and to suggest the direction in which we should go. I hope I have not given the impression, and that hon. Members have not expected me to give it, that in this field the State 157 should do everything. Here, as in most social services, voluntary effort can do, and has done, great pioneer work. I quite agree that independent schools have been providing, and are continuing to provide, places which are not available elsewhere.
I should like to draw the attention of the hon. Member for Blackley, however, not only to Section 6 of the 1953 Education Act, which he mentioned, but to Section 33 of the 1944 Act. That Section requiresThat local education authorities shall, so far as is practicable, provide for the education of pupils whose handicap is serious in Special Schools";that is to say, in grant-aided schools. Undoubtedly, from the information that I have outlined, during the next three or four years local education authorities will find that more places are available in grant-aided special schools. Therefore, it is important to see that the large amount of money which has been so very generously subscribed by the public, in recent months particularly, should not be wasted by duplicating facilities which already exist or which are now being provided by the State.
Voluntary bodies of various kinds have done a great deal to help these unfortunate children by starting schools, by research, and by giving advice and information to the parents. The British Council for the Welfare of Spastics, the older body, has organised a number of very useful courses, and the National Spastics Society, formed as a parents' association, has recently raised a very large sum of money for spastics' welfare. The Government are most anxious that there should be the fullest co-operation with such bodies. I say this in answer to the several questions which my hon. Friend the Member for Glasgow, Scotstoun (Mr. J. R. H. Hutchison) asked me.
In answer to another question asked by my hon. Friend, I would say that local education authorities can contribute towards the maintenance of children whom they send to a voluntary school. They can also contribute to the funds of the societies for services rendered to education. What they cannot do, but what the Government can do, is to make capital 158 grants towards the establishment of voluntary special schools, provided that they conform to the Ministry standards and—and I emphasise these last words—meet a genuine need. The provision of capital grants is the responsibility of the Minister of Education and presumably of my right hon. Friend the Secretary of State for Scotland in Scotland—not of local authorities.
Summing up, it seems that we have nearly, if not completely, reached the position in which the present proposals will provide adequate boarding places for spastics, if my argument that, on the whole, physically handicapped children should be treated as one category, is accepted. We shall not, of course, have provided sufficient accommodation on the argument that they should all be put in special schools for spastics.
If this is to be the case, it does not mean that large sums collected from a sympathetic public cannot be used for another purpose, because there is an immense amount to be done in this field, but I would stress that when a voluntary society intends to embark upon a project which may duplicate State provision—and I have reason to think that that might be so at the moment—it should consult Government Departments, as societies have been doing, as well as local education authorities concerned, as fully as possible.
Everything that has been said tonight will be studied by my Department and by other Departments concerned. I should like to go one stage further. I see that the hon. Member for Barking is now back in his seat. We are anxious to give all possible help to voluntary bodies. This problem, as my hon. Friend knows, has exercised my mind since I assumed this office some 3½ months ago. If he or any other hon. Member, or those whom they represent, disagree with what I have said, or feel dissatisfied, or feel that they can make a further contribution, I hope they will see me and my advisers at the Ministry. We shall then make further progress in what I consider to be a most important task.
§ Question put and agreed to.
§ Adjourned accordingly at twenty-four minutes past Ten o'clock.