HC Deb 10 December 1968 vol 775 cc381-92

Motion made, and Question proposed, That this House do now adjourn.—[Mr. Harper.]

12.14 a.m.

Mr. Edwin Brooks (Bebington)

The recent controversy and distress which were caused by an inept and sensational film are proof of the ignorance which still surrounds the subject of mental illness. And nowhere can foolish words—such as the glib term "ineducable"—cause more anxiety and pain than in the family tragedies provoked by the mentally afflicted child.

I feel obliged, therefore, to preface my remarks with a brief definition of terms, particularly as there is still widespread public confusion over an illness, or group of related illnesses, which was first defined in the medical literature at least as long ago as 1912. The two essential symptoms of the autistic child are lack of responsiveness to people—including parents—and insistence on the preservation of sameness. The child seems to be switched off, to inhabit a perpetual dreamworld.

As Dr. Gerald O'Gorman wrote in 1967: There is much debate and not a little confusion about the delineation of autism, mostly because nobody has yet been able to produce, an acceptable analysis of the nature of the condition. Some authorities, he states, regard it as an organic disease of the central nervous system. In their report "Innocents at Risk" published by the National Society for Autistic Children on the 26th November last, we read that the theory now most commonly held by specialists in the subject is that the development of some parts of the brain is very severely delayed". But whatever the causal factors, which only further research can clarify, it is clear, as Dr. O'Gorman says, that autistic children are exceedingly difficult to treat or to educate; they arouse severe anxieties and emotional strain in their families and in those who care for them. Perhaps the most poignant aspect of this illness, is that the child's dissociation from the real world—in terms of speech and communication notably—is bound to inhibit brain development at critical stages of growth. Nevertheless, it has been proved that a significant proportion of autistic children can be saved from a lifetime of dependency and institutional existence; there are well attested cases of such children succeeding at "O" levels, and even entering university. The essential condition of success lies in the speed and efficacy of the assessment and subsequent educational provision, and here the picture is far from satisftactory, particularly outside the south-east of the country.

It might be useful at this stage to stress the scale of the problem, which is seldom appreciated by the public, or perhaps even by Members of this House. From results obtained in a careful survey by the Medical Research Council, it seems that the incidence of autism is as much as 4 per 10,000 of the school population, which would mean that there are about 3,050 autistic children in England and Wales alone. This is more than twice the number of blind children, and almost the same as the 3,356 deaf children of school age in England and Wales. As Dr. O'Gorman states, childhood autism is no longer thought to be an excessively rare condition. Against this background, may I turn to the North-west and Wirral, where my constituency lies. According to figures supplied to me in a Written Answer answered on 14th October, there are 15 autistic children under the age of 16 living in the peninsula, of whom 13 are of school age, and of these 10 are receiving special education. I cannot vouch for the accuracy of these figures, but I am sure all official figures need refining. For example, it is surely surprising that in Wirral, with a total population of under half a million, there are 15 autistic children, yet in Liverpool near by, with a population more than half as big again, I understand from an article in the Liverpool Daily Post of 27th last month, there is only one child so designated.

I suspect—and I speak with some nine years experience as a member of the Birkenhead Education Committee—that as far as mental illness is concerned, we often see no more than the tip of the iceberg. Parents are naturally torn by feelings of guilt and fear, and many teachers who are bravely coping with oversize primary classes are ill-equipped to distinguish the truly mentally sick child from the naughty and inadequately disciplined one.

We need far more effective child guidance facilities in general, and if tonight I concentrate solely on one of the more extreme forms of mental disorder, I hope that this will not expose me to any accusations of complacency about the wider situation. However, it is by highlighting the inadequacies, as I see them, in dealing with the particular problem of autism, that one can indicate the varied responsibilities which are shortly to devolve upon my hon. Friend's Department of State in the forthcoming and long overdue reallocation of responsibility for the education of mentally handicapped children in England and Wales.

In passing, I hope my hon. Friend will look into the present arrangements under the Education Act, 1944, whereby local authorities are asked, and have a statutory requirement, to undertake responsibilities towards certain categories of disability.

The case of Shaun Brady, an eleven-year-old boy who lives in Wirral, deserves far more time and attention than I have available in this brief debate, but I shall try to summarise his experiences, first related to me by his father more than two years ago. At the age of five he attended a primary school in Wallasey, but had to leave after a few weeks because of his difficult behaviour.

He was then to attend, for about a year, child guidance clinics in Wallasey and Liverpool, and also saw a specialist at nearby Southport. The growing sus- picion that he was autistic was finally confirmed when he concluded twelve months' further treatment with a child consultant at Clatterbridge Hospital in my constituency. He also spent some time at Alder Hay Children's Hospital, Liverpool, for observation and treatment.

It would be unfair therefore, to say that he was not provided with expert assessment, and I know of the interest and deep concern which Shaun's illness has aroused among the medical experts on Merseyside. Nevertheless, from the age of seven onwards, he has had no specialist education appropriate to his particular disability; true, he spent 18 months at a Spastic School in Birkenhead—a place provided for him, incidentally, as a result of the generosity of the Spastic Society—but the autistic child is not suffering from the same disorder as the spastic child, and, perhaps, understandably, this experiment prove unsatisfactory.

Mr. and Mrs. Brady, who have three other younger children, all of whom are perfectly normal, now found themselves with the distressing situation that their boy could not be found any suitable place locally. Following reassessment in 1967, the local education authority, Wallasey were clear that Shaun should be admitted to a class or centre for autistic children", yet, despite application having been made to all neighbouring local authorities, and despite the help of the Department of Education and Science having been sought, it was found impossible to place him locally.

As Wallasey rightly said, in a statement issued on the 31st October last, Shaun requires full assessment and treatment in either a hospital with appropriate educational facilities or in a small teaching unit with other similar children and with a generous staffing of specialist teachers. But this could not be done, and eventually Mr. and Mrs. Brady decided to draw attention to their son's plight by refusing to pay rates to the local authority. Personally, I would like to think that I would have the guts to do the same in a similar situation. Mr. Brady, who is a building labourer, endured distraint upon his furniture and effects, and had much of his furniture eventually removed by bailiffs.

I can only say that I find this sort of passive resistance in a good cause far more inspiring than the mindless hooliganism which afflicts some of those who started life with all the educational advantages, and if ever we do have an adequate assessment and teaching unit in Wirral it should be called the Shaun Brady centre.

Following my intervention this summer in the matter, I heard from my right hon. Friend, the then Minister of Health, on 31st July, but, in response to my inquiries about Shaun's admission to the Cranage Hall Hospital in Cheshire for a three month period of assessment, I was told that, in view of the long waiting list for admission the Minister could hold out little hope for Shaun in the near future. Today, half a year later, Shaun has still not been able to enter Cranage Hall.

The pressure on available resources is also illustrated by the normal four-year waiting period for admission to the Rudolf Steiner School at Aberdeen, and this possibility—which was referred to in a letter from my right hon. Friend the Secretary of State for Education dated 4th October—seems unlikely to materialise for Shaun in less than two years.

This then, is the history of Shaun Brady, but I could easily have mentioned the names of other children in Wirral and in the North-West, whose parents have discussed their problem with me. Indeed, as a result of the concern felt by these parents, the past few weeks have seen the formation of the Wirral Society for Autistic Children, and it is proposed to start a class led by a qualified teacher and member, which will cater for three children at present receiving no help. I very much hope that my hon. Friend will use his good offices to see if any assistance can be given, notably in terms of finding suitable accommodation for these classes, and I would like to suggest that the Department might well earmark an annual grant to give launching aid to such examples of voluntary initiative in general.

Despite the heart-warming examples of parental initiative, the House and the Government must surely recognise their responsibilities, and I come to some specific proposals for helping autistic children which have been made by the various local authorities.

Indeed, all three major authorities—Birkenhead, Wallasey and Cheshire—have shown in recent months, and longer, a commendable interest in the problem of the autistic child, and if my hon. Friend will only agree to look seriously into their detailed proposals, I feel confident that he will see the merits of their case, not least on financial grounds. If, by neglect, we allow a single child to succumb to the autistic condition throughout adulthood, the cost to the State will prove far greater than the cost of suitable help applied in those crucial early years.

Cheshire and Wallasey have both kindly written to me today, despite extremely short notice, with up-to-date accounts of their views and plans, and I shall be sending these letters to my hon. Friend for his more leisured consideration. To pick out the main points, Cheshire has already submitted a proposal to the Department to build a residential diagnostic and educational unit for 30 autistic and non-communicating children as part of its 1970–71 building programme. However, this proposal has not been agreed by the Department, and I can only hope that better sense will be shown when the project is resubmitted for the 1971–72 programme. The Director informs me: In the meantime, Cheshire have been looking for existing premises which might prove suitable for conversion … at least on a day-to-day basis. The former Civil Defence premises at Hinderton Road, Neston, have been examined and it is felt that they could be converted as a Minor Works project. The present use of these premises will lapse at the end of the spring term 1969, and £4,000 has been allocated for 1969–70 to effect the conversion. If work can begin, as is hoped, immediately after Easter next year, the premises … could possibly be taken into use as a day centre for autistic children in the Wirral by September next year. About 30 children could be accommodated there, and there is likely to be room for Wallasey and Birkenhead children in addition to Cheshire children, which is clearly sensible since the consultants work in regional hospital areas.

The Director stresses, however, that such welcome provision of day facilities would in no way reduce the urgent need for a residential unit, and I hope that my hon. Friend will affirm that this is his view, too. An alternative and valuable proposal, which I have earlier supported in correspondence with the Ministry of Health, was put forward some time ago by Dr. David Zausmer, consultant child psychiastrist at Clatter-bridge Hospital. He planned a two-class, two-teacher day unit with an under-five play group in charge of a supervisor for 16 children between the ages of two and 11.

This was later proposed in the form of a £5,000 prefabricated building, but I was informed in July that although the Liverpool Regional Hospital Board had accepted this proposal in principle, it had so far been unable to find a place for it in its capital programme. I hope that my hon. Friend will take a searching look at this scheme, perhaps in its latest variant, which would mean a demountable structure at the Pensby Children's wing.

Facilities for expert assessment from the age of two onwards might mean a saving of tens of thousands of £s by enabling youngsters to surmount the autistic hurdle in childhood—and £5,000 is equivalent to an hour's expenditure on the Concorde project, and in terms of human suffering and human values I have no doubt where my priorities would lie.

I would not wish to close without praising the enlightened approach of the Birkenhead Director of Education to the needs of the mentally handicapped, and it is most welcome news that a teacher at Pilgrim Street School in Birkenhead is receiving encouragement to use her classroom in the evenings and on Saturdays to help autistics. The Director of Education at Wallasey has also shown great interest in the work of the newly formed Wirral Parents' Society, and has pledged full support. In fact, the tide is flowing at last in the right direction and I hope my hon. Friend will ensure that his Department functions as a surf rider, and not as King Canute.

We are dealing with a national problem, for it is estimated that only 150 children out of a total of over 3,000 autistics are receiving the facilities they need. Only three units exist outside the south-east—where 17 of the 20 specialist units in the country are found—and time is not on the side of the children lacking such facilities.

Childhood is either a time of growth, or it becomes endless, and if the Department will only give a lead we can enable many hundreds of children to come out of that secret world of solitary confinement to which they are unnecessarily sentenced by the indifference of those born more fortunate.

12.30 a.m.

The Under-Secretary of State for Education and Science (Mr. Denis Howell)

I am sure the House is very grateful to my hon. Friend the Member for Bebington (Mr. Brooks) for raising this matter. I think this is the first time that there has been an Adjournment debate on this subject. We in the Department of Education, especially since the Prime Minister announced only the other day that we were to take over responsibility for the education of all handicapped children, which previously had been the responsibility of the Ministry of Health, are glad of the opportunity which this debate creates to focus attention upon these extremely unfortunate children.

The term "autistic children" is fairly new in educational jargon. I am delighted, as I am sure that my hon. Friend is, that there has been more activity in Cheshire in this field than in most other places in the country. This is to the credit of Cheshire. It is also to the credit of Mr. Brady that he took steps to focus attention on the child for whom he had parental responsibility and great devotion. Dr. Kanner of Illinois started to call attention to these unfortunate children in the mid-forties and continued a dialogue about them in the fifties.

In 1961 a working party of psychiatrists, chaired by Dr. Mildred Creak, drew up a list of nine symptoms of autism. These were: gross and sustained impairment of mental relationships with people; apparent unawareness of his own personal identity to a degree inappropriate to his age; pathological preoccupation with objects without regard to their normal functions; sustained resistance to change in environment; abnormal perceptual experience—sometimes mani fested as apparent deafness and some times as excessive sensitivity to sounds; excessive and seemingly illogical anxiety; no acquisition of speech or loss of speech or failure to develop beyond a certain stage; distorted patterns of movement—sometimes over-active, sometimes immobile—and with bizarre movements such as rocking or head banging; serious mental retardation—but with isolated areas of normal or even exceptional skill.

It is worth outlining this condition in great detail because it shows the difficulty of diagnosis in these cases. Most of these children have normally been regarded with numbers of other children as psychotics. After all these developments, in 1964 my Department convened a conference which was attended by psychiatrists, psychologists and others concerned with special education to discuss the educational needs of pschotic children.

The main conclusions of the conference were that a good knowledge of the development of normal children was in the teacher, that additional training at that stage could be obtained only by working with these children, and that the personality of the teacher was probably more important than paper qualifications. There are difficulties in diagnosis and also in finding teachers of the right bent and aptitude to take on this work. A staffing ratio approaching one adult—whether teacher, child care worker or therapist—to two or three children was desirable to facilitate the establishment of communication with them. Such was the weight of the problem involved in the responsibility for these children and their education.

I agree entirely with what my hon. Friend said about the numbers of autistic children in this country. Investigations in Aberdeen and Middlesex, which we used to reach conclusions, show that there is about one in 3,000 who may be autistic, which would give the number my hon. Friend mentioned of about 2,500 to 3,000 children. Of these, about half would be severely subnormal.

There are 32 units, catering mainly for psychotic and autistic children. I will not go into details about where these are, except to say that most of them are in the Greater London Area, which is another matter of concern.

It is obvious from what I have said that we feel that much more research is needed into the problem. Not the least part of my gratitude to my hon. Friend arises because this debate enables me to say that we are co-operating with a study made by Dr. Rutter of the Maudsley Hospital Institute of Psychiatry on the special educational treatment of autistic children, and we are paying 75 per cent. of the cost of this piece of research, so important do we believe it to be. The project started in the autumn of 1966 and will run for five years, but we hope that after three years it will be possible to draw some preliminary conclusions which will be useful in the application of our new duties.

I turn from that general position to provision in the Wirral area and to the case of Shaun Brady. I shall be obliged if my hon. Friend will send me the correspondence to which he referred from the local authorities in his constituency. I do not dispute anything that my hon. Friend said the case history of Shaun Brady, and therefore I do not have to go over it again. However, I can give my hon. Friend more satisfactory news than he has known hitherto, which I am sure he will be delighted to relay to Mr. Brady.

The Cranage Hall Autistic Unit, which already provides residential and some teaching facilities for ten autistic children, is in the process of creating new buildings to take more children. I am informed today that the up-to-date position, which I sought for the benefit of my hon. Friend and the House, is that new wards already furnished, I believe, which will provide an additional 10 or 12 beds in Wirral in Cheshire, should be ready early in the New Year. I am confident that there is every hope of getting Shaun Brady into that unit within the next few months, early in the New Year. I am sure that my hon. Friend will be delighted with this information.

Although we found it not possible to proceed with the Cheshire project, for 30 children in the 1970–71 building programme, the Cheshire local authority is proposing to create a unit for 12 children at Neston in former Civil Defence premises at present being used for ordinary school classes. Obviously this will have a significant effect. The reason we were not able to include the project of Cheshire for a unit of 30 children was two-fold. There was the difficulty all the time of the schoolbuilding programme, with which the House will be familiar. This consideration weighed even more heavily in this case because of our doubt as to whether we should proceed with large units of 30, in view of the high staffing-child ratio I have mentioned and the belief among the professional advisers in my Department that children with such severe handicaps as these should be treated in much smaller units. Therefore, my professional advisers and I are delighted to know that the new project going forward for Neston is for a unit for 12 children, which we think would probably be more satisfactory.

We would not want to draw hard and fast lines in our thinking until the results of the research in which we are involved become apparent to the educational world and to my Department.

Mr. Brooks

I am grateful for this very welcome news, but do not some of the children involved need to have residential facilities rather than simply day facilities as is proposed in the Neston project?

Mr. Howell

There has to be a combination of day and residential provi sion. One accepts that without hesitation, but I think that the over-riding consideration here, once that point is conceded, is the attempt to keep numbers down to manageable proportions so that something really significant can be achieved in the life of the individual pupil.

I am obliged to my hon. Friend for raising the question of the Education Act, 1944, and pointing out that it was drawn far too narrowly. It lays down specific cases of handicap to which local education authorities have to have regard, but, because we knew so little about this problem at that time, autistic children are not included.

As the House knows, we are at present engaged in rethinking the whole of our education policy with a view to a new Education Act. I give an undertaking to my hon. Friend that we shall look at this point closely. It may well be that we ought not to define handicaps too specifically in the next Act lest there be a danger that the results of further developments hereafter, as happened with autistic children, are excluded. I hope that it will be possible to define or refer to handicaps in relation to education in that sense.

As regards the numbers in the Wirral, although my hon. Friend was a little sceptical about the answer which we gave, I confirm that there are, in fact, 15 children under the age of 16 who are known as autistic. My hon. Friend makes a fair point about Liverpool having only one. I think that that shows that some people take their diagnostic duties rather more enthusiastically than others do. We hope that there will be an improvement over the whole field.

I understand that Shaun Brady is the only one of the 15 in the Wirral not at present receiving education in a school or a hospital where educational facilities are available. I think that there is one child receiving home tuition and awaiting a place at Rudolf Steiner school. I have nothing to add on that matter.

I reiterate what I said at the outset, that we are grateful to my hon. Friend for raising this matter in debate. It is important that there should be public light and discussion on handicaps of this sort. Those of us who are engaged in the education service feel passionately about our responsibilities for the education of handicapped children, probably more passionately than we do about most other sections of education, because we know not only that the children will face a very difficult life but the burdens and responsibilities of their parents must always be borne very much in mind. It was for that reason about all that we were delighted in the Department of Education and Science that the Government, as the Prime Minister announced, decided that no child in the future should be written off as incapable of receiving education—"ineducable" is the awful jargon expression. As soon as we can pass the legislation through the House therefore, and responsibility passes from the Department of Health and Social Security to the Department of Education and Science, we shall have done something which, I believe, will have the support of educationists throughout the whole country.

Question put and agreed to.

Adjourned accordingly at sixteen minutes to One o'clock.