SPEECH THERAPY SERVICES (QUIRK REPORT)

HC Deb 06 July 1973 vol 859 cc948-83

2.6 p.m.

The Under-Secretary of State for Education and Science (Mr. Norman St. John-Stevas)

I beg to move,

That this House takes note of the Quirk Committee Report on Speech Therapy Services.

It is generally agreed that "speech therapy" is not a particularly felicitous description. The head of one of the schools of speech therapy told the Quirk Committee that the term 'speech' is wholly inadequate and 'therapist' wholly misleading". Indeed, the phrase may have suggested to some hon. Members—and I congratulate them on their patience in waiting for a considerable time for this debate to begin; it shows the interest which they have in this subject—that this debate was going to provide useful information about the more effective use of one of the tools of our trade, namely, public speaking, but we have seen from the previous debate that that is unnecessary.

More narrowly, the speech therapist conjures up to some the picture of an elocutionist in a white coat. "Therapy" emphasises therapeutic functions and ignores diagnostic ones, and "speech" strictly refers only to the executive or motor functions of the vocal organs, whereas the speech therapist is concerned with all forms of language, including gesture and writing. Even now, insufficient attention is paid to the importance of communication between people in the development of personality, and in this normal speech and language are crucial factors.

Speech itself is an extremely complicated process and, although the small profession of speech therapists played a pioneer rôle in this field, many other professions are involved in the assessment and management of speech disorders. The normal development of speech depends upon hearing, and on linking sounds, written symbols and the expression of language in spoken words.

Many complex nerve pathways are involved, as well as the psychological and emotional aspects of the desire to listen and the wish to communicate. There are plenty of opportunities for things to go wrong, and it is perhaps surprising that most of us develop speech, as it seems, almost automatically. When something does go wrong, doctors, audiologists and psychologists as well as speech therapists have a part to play in the full assessment of disordered speech.

Why did four Departments—my Department, the Department of Health and Social Security and the Welsh and Scottish Offices—decide in 1969 that an inquiry into speech therapy services was required? The prime reason was the severe shortage of therapists. The 1951 Cope Report on Medical Auxiliaries, which included speech therapists in its remit, found a need for at least 750 in Great Britain as compared with a practising strength of about 290, and by the beginning of 1969 the supply and the demand had both increased substantially. The supply also was not evenly distributed. The shortage was particularly acute in the north-east Midlands, the West County, Wales and northern Scotland.

Nor did numbers working bear a satisfactory relation to numbers trained. The majority of freshly-qualified therapists left full-time service after working for only two or three years, many on the occasion of marriage or pregnancy. Of these, only one fifth appear to return to service later. In addition, isolation, lack of opportunities for promotion and poor working conditions were all discouraging factors.

The second main reason was the precarious position of a small autonomous profession poised between education and medicine, claiming affinity with both but refusing to be dominated by either. The search for identity was complicated by the existence of two types of service, an education service provided by local education authorities, as part of the school health service and a hospital-based service forming part of the National Health Service. About three times as many therapists are in LEA employment as in the hospital service. Therapists in the two services tend, as the Quirk Committee found, to develop different attitudes, thus reinforcing a dichotomy in the profession. At the same time, both in the hospital and in the education service inter-professional co-operation has often been impeded by lack of understanding of what a speech therapist can and cannot do.

The third factor which led to the appointment of the Committee was that the pattern of training needed review. It had largely been unchanged since 1945, apart from the establishment of a degree-level course at Newcastle in 1964. Courses tended to be fragmented rather than integrated, and to be overloaded with doubtfully relevant pieces of information. The shortage of speech therapists, particularly the lack of senior appointments, had also led to a shortage of suitable placements for students undertaking clinical practice as part of their training.

The Quirk Committee in less than three years produced a thorough analysis of the problems confronting the profession and made some far-reaching proposals for dealing with them. A rapid expansion of the profession was considered necessary. The committee regarded the present full-time equivalent staff of 820 as quite insufficient and set a target of 2,500 speech therapists as a long-term aim. These would be backed by a new class of aides, who would undertake the more repetitive and routine work under supervision and thus reduce the number of therapists needed by about 1,000 from 3,500 to 2,500.

The present output of trained therapists would need to be more than doubled over the next 20 years, from 160 to 350, to achieve this target, and the Committee recommended an energetic publicity campaign directed at both school leavers and women who left the profession on marriage. A broad-based training at degree level which brought both students and staff into contact with other faculties was regarded as essential.

The committee had no doubt that the present divided structure of speech therapy services was wasteful of resources and had hindered the development of the profession. Despite the difference between work with children and work with adults, they were convinced that there was a fundamental unity in the work undertaken by therapists in the education service and by those working in hospitals. Further, unification would help to secure continuity of treatment from the pre-school years through school days to, if necessary, adult life, and it would make possible a better career structure and opportunities for specialisation, thus increasing the attractiveness of speech therapy as a career.

In addition to recommending that the organisation of speech therapy services should be unified, the committee recommended that they should in future be organised under area health authorities in England and Wales and under health boards in Scotland. They preferred this solution to organisation under LEAs or social services departments of local authorities, because they believed that speech therapy had much less affinity with remedial teaching or social work than with medical therapy.

They also considered that advances in speech pathology must proceed hand-in-hand with advances in related medical and other disciplines. Moreover, as a result of the reorganisation of the National Health Service, most of the speech therapist's colleagues in the school health service would come under the area health authorities. The committee recognised that special arrangements might be necessary to enable LEAs to employ speech therapists, for example to serve full time in special schools, though it hoped this need might be met by long-term secondment from the unified area service.

There were a number of other recommendations either linked to the key ones I have mentioned or dealing with other important topics, for instance, the establishment of a central council for speech therapy and the need for research. I will leave it to hon. Members to refer to any in which they are particularly interested. Perhaps I might express interest in the committee's conviction that a better balance between men and women is essential for the stability of the profession ". We hear so often about professions that are almost entirely a male preserve; speech therapy is the reverse. In contrast to the position in some other countries, more than 99 per cent. of practising speech therapists are women.

Without subscribing to the old-fashioned view that men are needed to provide leadership, or even that it takes a man to cope with technical devices—I am sure that the hon. Member for Fife. West (Mr. William Hamilton), who I see hovering here, would put me right on that—I can see some force in the argument that men might provide more stability in the profession and introduce a career approach. But there is imbalance here. No doubt if he catches the eye of the Chair, we shall hear some reflections from the hon. Member on this issue. I suspect that the preponderance of women in this profession may not give him an unqualified occasion for rejoicing.

I am told that the work of the committee, of whose members about one third were drawn from speech therapy, education and medicine, proceeded with remarkable smoothness and that a common mind emerged on many issues at a comparatively early stage. I am sure that hon. Members would agree that much of this was owed to the leadership of the chairman, Professor Randolph Quirk, Quain Professor of English Language and Literature at University College, London. He combined a formidable capacity for work with an acute critical mind and the rare ability to produce bold and original ideas. He preferred to argue issues out rather than to paper over the cracks with a compromise form of words, as though he were negotiating some kind of Treaty of Gastein. It was largely due to his determination and to his skill and courtesy as chairman that a unanimous report was produced in a field of complex and highly contentious issues.

What is the Government's attitude to the committee's recommendations? I know that that is the question to which hon. Members would like to have an answer.

Dame Irene Ward (Tynemouth)

Hear. hear.

Mr. St. John-Stevas

I am glad to have the support of my hon. Friend, although I fear that it will be only temporary. Unfortunately, this debate, although welcome, is a little premature. We have not yet concluded our deliberations on the highly complicated issues which are involved and which involve different Departments. Her Majesty's Government hope to be able to make a further statement by the autumn.

I say "a further statement", because my right hon. Friend the Secretary of State said in reply to a Question on 15th May that three other Secretaries of State and she had …now accepted the Committee's recommendations that speech therapy services should be unified and that they should in future be organised under area health authorities in England and Wales and under health boards in Scotland."—[OFFICIAL REPORT, 15th May 1973; Vol. 856, c. 276.] The bodies that made comment on these recommendations supported unification, and only four out of the 15 consulted by my Department opposed unification under health authorities, though some of the others were anxious to ensure that educational needs are adequately met.

It is quite understandable that educational bodies should have fears that the needs of the education service may be overlooked if control of the speech therapy service passes into the hands of health authorities. The same fears have been expressed in relation to the school health service—and the same answer applies—namely, that the need for close collaboration between health and education authorities is a fundamental principle of the new set-up, and it will be up to the education service to make its needs known and press for them to be met.

Further, unification of the profession within a reorganised National Health Service will help to develop the teamwork approach which is so necessary in the assessment and management of speech disorders, and will reduce the isolation from which many speech therapists have suffered in the past. The special expertise and skill of the therapist, both in diagnosis and treatment, should, with a team approach, be better appreciated by the other professions concerned, and the therapists themselves should understand better the roles and skills of those professions.

The acceptance of these two key recommendations establishes an organisational framework for the future. That, at least, has already been settled, and when the Government announce their decisions on the other recommendations addressed to them I am sure that the hopes of the Quirk Committee will be realised. A pattern of development will be set which will, in the words of the report be of use firstly in improving the outlook for those suffering from disorders of speech and language, and secondly in assisting the speech therapy profession and individual speech therapists who have, by their vitality and dedication earned the esteem of us all. We welcome this debate. We shall pay careful attention to the views expressed by hon. Members on both sides, and they will be taken fully into account when we make our further and definitive statement later in the year.

2.23 p.m.

Dr. Shirley Summerskill (Halifax)

The gift of being able to communicate is perhaps taken for granted by those of us fortunate enough to have the normal power of speech. The valuable report before us presents a depressing picture of a speech therapy service battling against acute staff shortages, unsatisfactory working conditions and inadequate professional status. The ultimate victims are deprived children and adults struggling against an invisible disability, and with nobody to help them.

It is fitting and appropriate that in this debate we have opening from the Front Benches respectively a spokesman for education on the one side and for health on the other. We welcome the proposed reorganisation and unification of the speech therapy service under the new area health authorities in England and Wales and under the health boards in Scotland, but it is to be hoped that this will be only a start. Alone, it cannot solve the serious problems revealed in the report. It is regrettable that we are being asked to take note of the report: we should like to see action taken upon the many recommendations in the report, and we eagerly await the Government's further statement. I know that Professor Quirk has publicly deplored the delay in the implementation of the committee's recommendations, and it is to be hoped that the Government will treat the report with a sense of urgency.

The Under-Secretary, answering a Written Question from my hon. Friend the Member for Stoke-on-Trent, South (Mr. Ashley) in May this year, said that the number of full-time speech therapists or the equivalent of speech therapists working in the education and hospital services in Britain was about 900. This would seem to be a shamefully low figure to serve the whole of Great Britain and is the most serious revelation in the report.

This acute shortage, which I am sure was already known to most hon. Members, affects certain areas more than others, as has been pointed out. The southern region, excluding London, had at the end of 1970, 91.8 educational speech therapists, whereas the northern region had only 21.4. Only a few weeks ago I received a letter from a constituent, the mother of a primary school child, who wrote: I am very worried at not being able to receive any speech training for my son as it is making it very difficult for him at school although the teachers are very good and help all they can, hut since he had to give up speech classes last year about November he has not got on very well. I was told that there would be another class held when it was possible, but what do we do in the meantime? I sent this letter to the Under-Secretary, the hon. Member for Barkston Ash (Mr. Alison), and I received a reply this morning which points out: In Halifax … at present only one part-time therapist is employed who works mainly with adult in-patients. The local health and education authorities have a joint establishment for two full-time speech therapists and both posts are currently vacant … one speech therapist left at the beginning of December 1972 and although the authorities have since been advertising these posts, they have been unable to fill them. Meanwhile this primary school boy goes on at a critical time in his life without any speech therapy at all. I am sure that this situation can be multiplied in many constituencies.

The hospital story is no better. In reply to my hon. Friend the Member for Manchester, Wythenshawe (Mr. Alfred Morris) on 31st December last year, the Minister pointed out that of 102 hospitals and units which had at least one subnormal or severely sub-normal person under the age of 16, 61 had no speech therapist at all on their staff.

Some authorities are unable to recruit therapists after years of advertising, and the College of Speech Therapists had over 100 vacancies advertised in February 1972. Meanwhile there are these people, particularly the very old and the young, waiting for attention. There are geriatric patients, after strokes, unable to receive speech therapy, and people who have had surgery or suffered in road accidents. I know personally of a woman who had a stroke which left her almost speechless but was unable to get a speech therapist to come from the hospital. So the family paid £70 for a course of speech therapy privately. This is, clearly, discrimination against those who cannot afford £70 to pay to have their relatives treated. There are children growing up, particularly the mentally handicapped, lacking help, those who get no systematic screening and so get delays in treatment.

Then there is the hidden need which is mentioned in the report—a growing and ill-defined need which is unquantifiable. Thousands might benefit if the therapists were available and if the scope of what they can do was fully understood, but, as people know that the speech therapists are not available, they are not coming forward for treatment.

We feel that with speech therapy today we may be dealing only with the tip of a very large iceberg. As the hon. Gentleman has said, services throughout the country are under-staffed by about one-third and need to recruit at least 2,500 more staff. Yet what is being done in training?

The Under-Secretary of State for Education and Science in another Written Answer—he has written many answers recently—on 23rd May pointed out that Facilities for training speech therapists have also been expanded. My heart rose. Then the reply went on: Six extra places are available on an existing course in England.'—[OFFICIAL REPORT. 23rd May 1973; Vol. 857, c. 91.] That was over the last five years. Clearly, there is a great deal to be done in training more therapists.

How do we tackle this acute shortage in a vitally important profession? The hon. Gentleman pointed out that it is predominantly female. He has a high intellect, for which I have great regard, but he did not pursue this remark by asking himself or the House—perhaps he did ask himself—why it is predominantly female. Why are physiotherapists, occupational therapists, dieticians and speech therapists female? It is a question to which there is, clearly, an answer. When wages are inexcusably low, men always say that women are best suited to that type of work. The reason why there are not more speech therapists is that their wage is totally inadequate in relation to the responsibilities that they carry, their qualifications and the training needed.

More than 99 per cent. of speech therapists are women. The number of men in practice as speech therapists today is nine. I suspect that those nine may feel that they are so dedicated to the profession that they cannot think of doing anything else. But the basic grade pay for a speech therapist is £1,107 rising to £1,815. The large majority of speech therapists are earning the basic rate of pay. Only a very few go above that to the senior grade. So the maximum that they can expect is £1,815.

To illustrate further the point that speech therapy is female-dominated not by a natural process of evolution but because the pay is low, in America and other countries it is not female-dominated and there is a far more even sex distribution because of the simple fact that the pay is much higher. Is this career being projected as a career to men or is it regarded as one of the women's jobs paid with women's rates, which is what I suspect? Bearing in mind that in the last year the cost of living rose by 8.2 per cent. in this country, £1,107 is totally inadequate.

All these people are dedicated but exploited. That applies to so many who work in the health service, and to a large extent, in the teaching profession. A point which is forgotten when discussing women's wages is that many of these speech therapists are supporting parents or children as well as themselves. So if there is to be a greater recruitment and more people in the profession, there must be an improvement in the pay.

In Canada the commencing salary for a speech therapist is £3,000. As is said in the report, scores of speech therapists have taken jobs abroad. There is a brain drain, or a speech therapy drain. The Under-Secretary may say that this has nothing to do with the Government but is for the Whitley Council. But it seems to me that the Whitley Council needs a great deal of reform. The Labour Party is committed to reforming the Whitley Council. Certainly the speech therapists should organise themselves into some powerful trade union.

Mr. John Wells (Maidstone)

Two thousand of them?

Dr. Summerskill

They should join together with other similarly oppressed professions, such as the physiotherapists and the occupational therapists. These are all suffering from the same exploitation.

Then there should be an improvement of status. The report says At present circumstances are such that speech therapists cannot give a service of the quality that they feel to be needed, or of which they feel themselves to be capable. There is a sense of professional frustration among many speech therapists. The lack of senior appointments is a frustration, because those appointments depend on the number of staff supervised. If there is a low number of staff anyway, one's chance of supervising a large number is accordingly diminished. There are heavy work loads, and the average therapists' current case load is 100 at any one time.

There are other examples in the report of had and unsatisfactory working conditions, and, if not discouragement, no positive encouragement from the medical profession. The doctors and consultants could give far more encouragement to speech therapists.

Then we come to the opportunities for part-time work. Over one third of speech therapists are working part time out of a total of about 1,280 practising, and those part-timers are, clearly, the therapists who are married. There seems a great need for more flexibility among local authorities to employ part-time speech therapists. Many authorities just refuse or make it so difficult that the women despair and do not try any more. Married women, as with so many married women teachers and doctors, need encouragement to return when they have left a profession for a few years. They want refresher courses, incentives and good working conditions. Again, we return to better remuneration and professional status.

Then there are those who practise privately. Nearly 300 speech therapists listed in the college's directory are engaged only in private practice. Why is that so? It is because the money is better. So we come back to the same thing again. Here we have married women, often part-timers, in private practice who should, in my view—perhaps not in the Government's view—be working in the National Health Service in the future. They are creating a situation where patients who are better off are able to buy speech therapy privately, when others go without.

In conclusion, this is a most valuable debate, but I say again that the House and the Government should not be satisfied with merely taking note of the report. They must secure the development of this vitally important and dedicated profession to its full potential. There is a growing need for speech therapy, which must be met urgently. This excellent report reveals the huge deficiencies in the existing service and recommends the actions which we must take.

2.38 p.m.

Mr. John Wells (Maidstone)

I agree almost entirely with the hon. Member for Halifax (Dr. Summerskill), apart from one or two deplorable and cheap Socialist smears that she managed to bring in for the sake of her party. But the sense of her speech was, indeed, extremely good sense.

The most important point that we have to go for is paying speech therapists more. Unless we pay these dedicated people a proper salary, the profession will continue to bumble along at about a total of 2,000.

Not only is adequate pay vital; the significant point of professional status needs particularly to be examined. I should prefer to look at the matter of professional status from the moment of training onwards.

At present, these young people, who leave school and go into speech therapy training with at least two good A-levels, work far harder than the average university undergraduate for far longer hours and in a far more dedicated manner. They do their work on the fringe of the universities or teaching hospitals and come away with a diploma.

Some of them then wish to go for higher training, and their diploma is viewed as something that the university authorities do not understand and do not want to know about. The authorities merely ask them what A-levels they have and they then have to take a first degree in divinity, or some other totally irrelevant topic, in order to proceed for six years further for a higher degree in speech therapy. Let us get clear in our minds straight away the two crying needs—proper degree status for the existing courses, which are far harder than the average university course in any similar topic and, secondly, infinitely better pay.

The hon. Member for Halifax did the House a great service by pointing to the lamentably low wages of speech therapists. But that will continue until we get county councils and other employing authorities to take a far more generous view of their overall conditions of employment. Speech therapists are frequently expected to interview their children in a sort of brush cupboard, or in part of the staff room, or, if the staff have a meeting, who knows where? They are pushed away into the most unattractive working conditions.

In my part of the world, as in every part of this country, by law the agricultural labourer gets a three-weeks' holiday. How long a holiday do speech therapists get? In most employing authorities they get two weeks' holiday. This is inconceivable in the professional situation in which we want these people, to work.

If numbers are to be increased, not only must they have a proper career structure but they must have Opportunities to control other staff. It is no good talking about controlling other staff unless some staff exist. We do not want a world in which there are all chiefs and no Indians. At present, there are perishing few Indians, and we want a great many more. I think that the hon. Lady was wrong when she said that there were nine men in practice; I believe that at the moment there are 11. But whether there are nine or 11 is scarcely here or there.

I deplored the hon. Lady's rather cheap attack on those therapists who are doing valuable work in private practice. Had her attack been directed at the local authorities that are too inflexible and too unintelligent to offer a part-time career structure to those willing to work part time I should have appreciated her remarks.

Dr. Summerskill

I was not attacking the therapists; I was attacking the system that forces those married women who want to do part-time work into private practice because the wages are so abysmally low elsewhere.

Mr. Wells

Precisely. That is the point I am making. It is because of the lamentable conduct of the local authorities. That is what we should be attacking.

I hope that my two hon. Friends and my five right hon. Friends who are involved with this profession in one way or another will collectively have a go at the local authorities. If we are promised Government action in the autumn, let us have a go at the employers before we get to that position. The hon. Lady mentioned her party's desire to put a bomb under the Whitley Council, but this profession is so small that it is time for Her Majesty's Government to speak firmly on the topic and say that if the profession is to be increased it must be properly paid. The sort of salary now considered is about 80 per cent. too low.

I turn from the subject of pay and conditions to the vital topic of research. I pay tribute to Professor Gimson and his team in the National Trust for Speech Therapy Research. They are doing an extremely good job. They have met hon. Members on both sides of the House and explained what they are trying to do.

It is exceedingly difficult for a voluntary body to have to go begging for private money for research unless the Government come clean about their intentions. I hope that my hon. Friend will give us some idea of what the Government mean to do towards helping with research. If we cannot have an answer this afternoon, perhaps those interested in the topic may have a written explanation later. I hope that in the autumn, when the policy is announced, generous provision for research will be made.

It is essential that the would-be part-time therapists mentioned in both opening speeches should have their lot made easier. It is not only pay; it is not only annual holidays; it is the general flexibility and the understanding of the problems of the school-age mum, the problems of highly trained people whose services are now being lost to the nation.

So far we have been speaking perhaps too much of school children and their needs. Looking around and counting heads—although counts are out of fashion—I believe that by the law of averages one of us now present ought to be seriously injured in a motor accident this year. It is a gloomy thought, but that is the national average.

This mythical accident in which one of us is statistically to be involved may deprive him of his speech. We are a windbaggy old lot in this honourable House and if any of us was deprived of his speech, it would be deplorable to him, however agreeable to his family. The fact must remain that unless there is a far greater increase in speech therapy services available to adults injured by accident, and deliberately by the surgeon's knife, many people will be deprived of the most primitive but necessary method of communication with their fellows.

My hon. Friend who is to conclude the debate is the Minister responsible for old people, just as my hon. Friend who opened it is the Minister responsible for young people. I hope that the geriatrics and the road accidents will be considered, but they can be considered only if the therapists themselves are considered.

2.48 p.m.

Mr. Laurie Pavitt (Willesden, West)

I agree with virtually all that the hon. Member for Maidstone (Mr. John Wells) has said. I commend to the House the excellent work that he does elsewhere in this Palace for those in whom I know him to have a keen interest. The only part of his speech with which he would not expect me to agree was his opening comment about the excellent speech and the excellent Socialist sentiments of my hon. Friend the Member for Halifax (Dr. Summerskill). However, this is mainly a bipartisan occasion—a consensus across the back benches. I cannot extend that courtesy to the Front Benches.

We all have a personal interest in this subject. If only hon. Members on both sides of the House would not mumble so much, it would not be so difficult to hear what they are trying to say. If the House gets an occupational health service, as I hope, I also hope that one of the first things it will have will be a speech therapist. For some hours I have had to listen to the hon. Member for Down, North (Mr. Kilfedder) talking about Northern Ireland, but I have found it difficult to hear what he has been saying.

I accuse the Government of being dilatory. They have a shocking record here. I acquit the Under-Secretary of any bad diction in opening the debate. He read his brief admirably. It was only when he turned round from time to time to address his hon. Friends behind him that we lost what he had to say. I confess that his complacency appalled me. I am delighted that the Government are to accept the recommendation of the Quirk Report to take this subject away from education and give it to area health authorities. We may get more of a sense of urgency from the Department of Health and Social Security than we have had from the Department of Education.

The Government are indicted and stand guilty in this area, as in all the professions supplementary to medicine. It is amazing that this should be so when the Secretary of State is so much aware of the problems of disability, the mentally handicapped, long-stay hospitals and the problems in medicine generally. This morning we read that £15 million is to be given to the doctors at the drop of a hat. The doctors always get their money at the drop of a hat, yet, as my hon. Friend the Member for Halifax rightly said, not only speech therapists but psycho-therapists, physio-therapists and all those people without whom a good deal of the Health Service would almost certainly grind to a halt, are neglected. The Government have a blind spot about them.

This is the most under-nourishsed, even starved, area of the Health Service. Unless the Government do something about it fairly rapidly it will die of starvation. That will affect many other areas of health and education. Let me give some examples of the kind of invaluable and devoted work which speech therapists do. The House is aware of my hon. Friend the Member for Stoke-on-Trent, South (Mr. Ashley), who is a living example of what can be done by someone to rehabilitate himself after a disability. The House will also be wishing good luck to Jack Hawkins, that marvellous British actor who is struggling for his life at the moment. Before he had his recent operation he was able to rehabilitate himself in his particular sphere of activity, in which he had so much to offer the public. That was thanks to the devotion and patience of speech therapists, following an operation upon him for cancer of the throat.

Another example is Douglas Ritchie. I commend his book "Stroke". Those who have read it know that for five years following a stroke he struggled to be able to communicate. He had been employed by the BBC. Thanks to the devoted work of speech therapists, and his own efforts, he was able to return to the community and not be pushed into a backwater as a disabled person who had had a stroke and was only part of a human being. It is such people whose voices ought to be heard when we are trying to twist the arm of the Chancellor of the Exchequer for adequate finance and endeavouring to get a little animation into the Department of Health and Social Security.

Page 121 of the Quirk Report deals with the organisation of the speech therapy services. Conditions are deplorable. A speech therapist in the education service does a session in a school—probably in the headmistress's room or some out of-the-way corner—with no proper equipment or facilities. This is almost a return to Victorian slum conditions. The salary scales are ridiculous. If any hon. Gentleman cares to walk 200 yards from this place he will see a notice in Victoria Street asking for temporary shorthand-typists and offering wages of £200 per month.

An occupational speech therapist, if he or she is lucky, begins work with ILEA at £1,233 a year at age 21. This follows a considerable amount of effort and training. The salary rises over the years to £1,941. ILEA is at the top of the three. Its scales are higher than anywhere else. There is a difference between the two Departments covering Education on the one hand and Health on the other and I hope that the implementation of the promise given by the Under-Secretary to integrate all speech therapy under the DHSS will mean that this will come to an end. At present a principal speech therapist with ILEA receives £2,970, whereas a principal in the National Health Service receives just over £2,000 a year. It is ridiculous that people with the same qualifications and responsibilities should have such a gap in this case £900 in their take-home pay.

An example of the wages situations was given to me by the West End Hospital speech therapy training school—part of the St. Charles group. The scale at the Central School of Speech and Drama, Eton Avenue, London, for a senior lecturer is £3,131 compared with the National Health Service scale, for a deputy principal, of £1,878. A supervisor of studies receives £1,845. The complacency of the Government in the light of this kind of evidence—which they have had for years and years—is fantastic.

Mr. John Wells

"Years and years" takes us back to a Labour Government.

Mr. Pavitt

I am afraid it takes us back to 1961. I was a member of a Standing Committee considering the Professions Supplementary to Medicine Bill when a good deal of this evidence was given to the right hon. and learned Member for Hertfordshire, East (Sir D. Walker Smith) who was then Minister of Health. I accept our share of the responsibility. We should have been able to move much more quickly.

I turn now to the lack of attention being paid to the teaching of lip reading, and the refusal of the hon. Gentleman, given in answer to a question of mine the other day, to give any advice to LEA's about the size of classes for lip reading. Many authorities will not reduce the size of classes because the regulations do not permit them to do so. Yet the size of a class for persons able to gain from learning to lip read should not exceed 10. There is, equally, an inadequacy of lip-reading teachers and training courses. Even with the good areas, such as ILEA, there is an annual allocation for cash, and classes can only be organised within the budget. There are teachers and facilities and pupils wanting to learn how to cope with deafness, yet there can be a sudden cessation of the classes because the money has run out. This is ridiculous in a civilised community.

The Medical Research Council now has a working party under Professor Howarth combining research between the Social Science Research Council, the Medical Research Council and the Science Research Council. This working party is looking into the possibilities for speech therapy and the art of communication and understanding. There are two parts to speech therapy, falling into distinct compartments. There is therapy for those pre-lingually deaf and therapy for those post-lingually deaf. There is the whole aspect of language and cognition of the signals received through sound. Work on this subject is going on at the moment in a number of universities. The project by the Science Research Council and the Medical Research Council will be able to give a good indication of further activity.

Whatever kind of report is delivered, such as the Quirk Report, the only thing that makes it tick is cash—we all know that. We must put cash behind research, and when a project is put forward an allocation of funds must be made, otherwise it is just another beautiful report lying on somebody's shelf collecting more and more dust.

I warn the Government of a complete breakdown in the whole of our speech therapy services unless they take more immediate action to implement this report than seems possible from the speech of the Under-Secretary of State. People are leaving speech therapy through wastage, and there is a lack of recruitment. As the hon. Gentleman and my hon. Friend the Member for Halifax pointed out, whole areas of the country have no speech therapists—indeed, no service at all. We cannot wait for area health authorities to start their work on this on 1st April 1974. The Secretary of State should act now.

The Minister has indicated that the Government may be prepared to go further in the autumn, but unless there is immediate and almost drastic action of a kind that we would have if we were at war, where the need is understood with sufficient force of cash and consultation—it is fantastic that since the Quirk Report there has been no consultation with the College of Speech Therapy and no round table conferences—the Government will find themselves in splendid isolation. The Minister can be assured that the present motion is so totally inadequate that we should perhaps think of a vote of censure on the Government.

3.2 p.m.

Dame Irene Ward (Tynemouth)

I, too, was a little deterred when I looked at the motion simply to take note. I am always for action, and I think a great deal of action is necessary in the speech therapy service. But when I heard the excellent speech by my hon. Friend the Under-Secretary of State I realised how wise it was to have a debate of this kind so that the House, which is not particularly well attended, could understand what speech therapists not only want but require. I am grateful for the terms in which my hon. Friend opened the debate.

I have myself exerted quite a lot of pressure over the years for the things I have thought necessary in medicine and in services to the community, and I want to put on record how proud I am that the Government which I have the honour to represent have taken real action in so many sectors. It is true that many sectors still remain where action is needed, but the Government have started the process and I am proud of what they have done, which is a great deal more than the last Government did. We can all talk about the need for more money and for doing this, that and the other, but the Conservative Government have really taken action.

The hon. Member for Halifax (Dr. Summerskill) made some comments about physiotherapists which I found rather difficult to follow. For quite a long time I have had the great good fortune to represent Parliament on the Chartered Society of Physiotherapists, and I have had some very good letters from the society telling me how glad it is that the Secretary of State for Social Services has taken the trouble he has in connection with the requirements of the physiotherapists. Perhaps the hon. Lady has not bothered to get all her facts quite right before making her speech.

Dr. Summerskill

I cannot understand how the hon. Lady should think that physiotherapists are satisfied with their lot. My hon. Friend the Member for Willesden, West (Mr. Pavitt) can bear me out. We met a deputation of physiotherapists only two weeks ago. The members of the deputation pointed out that physiotherapists are extremely dissatisfied with their pay. Whether the hon. Lady is referring to other matters do not know, but from the point of view of their pay, which was the point I was making in my speech, they are far from satisfied.

Dame Irene Ward

The hon. Lady is right. I am saying that after the physiotherapists had had their recent meeting with my right hon. Friend the Secretary of State they felt that they had had a sympathetic reception——

Mr. Pavitt

Sympathy, but no cash.

Dame Irene Ward

Hon. Members are always talking about cash. Just for once, listen to me. I have had letters from the Chartered Society of Physiotherapists, and I am its representative. The physiotherapists felt that the Secretary of State was sympathetic to them in the way he met them and listened to their point of view and in the action that he had taken. It is unfortunate that the hon. Lady does not know all that goes on behind the scenes. I am delighted that my right hon. Friend has met the Council for Professions Supplementary to Medicine led by the Chartered Society of Physiotherapists and that action is in the pipeline.

Dr. Summerskill

Good.

Dame Irene Ward

When we are fighting for what we want, as we have to, we must not exaggerate the difficulties or fail to give recognition to what is done by those who are responsible.

I always like to make a balanced speech and I am rarely satisfied with what we are able to do. The foreword to the Quirk Report is signed by my right hon. Friends the Secretary of State for Education, the Secretary of State for Social Services and the Secretary of State for Scotland and my right hon. and learned Friend the Secretary of State for Wales. I am sorry to say that the last paragraph of the foreword is not very encouraging. Secretaries of State have the opportunity to influence the Chancellor of the Exchequer, and when any of my hon. Friends who are Secretaries of State want assistance I am only too delighted to support their arguments with the Treasury. The paragraph to which I have referred does not demand sufficient action.

The salaries of staff who are in the Chartered Society of Physiotherapists, the nursing profession and the Council for Professions Supplementary to Medicine are much too low. The Government are sympathetic in these matters, and I hope that they will recognise that the remuneration of these categories of people is so low. When this question is raised I get tired of being told by certain Secretaries of State—I will not nominate them—that this is a matter for the Whitley Council.

I was interested to hear the honourable Lady the Member for Halifax say that the Labour Government—if ever again they come to power—would reorganise the Whitley Council. Well, they certainly were in power long enough to appreciate the defects of the Whitley Council. I get a little fed up with constantly being told in respect of negotiations over salary rates in the professions and also in other sections of the community, "This is a matter for the Whitley Council."

Members of Parliament are not stupid and one well knows that the management side of the Whitley Council represents the views of the Secretary of State. It is fair to say that the Secretary of State's views are bound to be linked with the success or lack of success the right hon. Gentleman has with the Treasury. The management side of the Whitley Council is under the control of the various Secretaries of State or the Government Departments concerned. I have tabled a penetrating Parliamentary Question about the nursing profession which I shall ask the Secretary of State for Social Services next week. I hope that the Government in future, instead of saying "This is a matter for the Whitley Council", will say whether they are in favour of increasing salary rates in the professions. I am pretty certain that the Secretaries of State who find themselves faced with these matters are in favour of increased salary scales, which are very necessary indeed.

We all recognise that resources must be taken into consideration and that the resources which are available will be fairly and justly distributed. The Opposition seem to take no interest in how the money is provided and appear to take the view that the money has always been there. I sometimes think it would be a much better idea if the Labour Party were to take the view that everybody in the country should do a fair day's work for a fair day's pay. I know that people in the professions do a fair day's work, but if the same attitude prevailed in the whole of the country there would be much more money available to put into the professions which we are discussing today. I believe that the Conservative Party would see to it that there was a fairer and more realistic distribution of available resources, but I am not so sure that this would apply to a Labour Government, because members of the Labour Party seem to labour under so many ridiculous inhibitions.

I am delighted to have had the opportunity to take part in this debate. I believe it is a good thing that in considering the desires of speech therapists the Secretary of State for Education and Science and also the Secretary of State for Social Services should be linked in a common endeavour to assist the therapists and their work. That will give greater strength to the case which the Quirk Committee sets out in very great detail.

I also agree with the hon. Member for Halifax that the Quirk Committee was right to say that power must be exercised upon the local authorities. Often this depends upon the types of councillors who are elected. But those who speak for the professions ought themselves to exercise a little more pressure so that when council elections are held the needs of the professions are expressed.

Those who elect our councillors often do not realise that if they want more speech therapists, nurses, physiotherapists dieticians, and the like, they must express those views during council elections. In that way members of the public are alerted to the needs of people who do such great service to try to improve the health of our nation.

In terms of salary scales it is very important that a great step forward is made to ensure that trained people who carry great responsibility and are essential if health conditions are to be improved are adequately remunerated. I cannot help thinking that certain people exercise more pressure on the Treasury and get better treatment as a result than can be achieved by certain sections of the National Health Service in which many of us are deeply interested. But that is what happens in life.

Very often in this House of Commons it is essential for hon. Members to obliterate their party differences. In a debate of this kind the Opposition Front Bench spokesman must always get in "a bit" about this Government. I am afraid that sometimes I feel that I must get in my bit about the Opposition when they were in power. But I happen to know quite a lot about this subject and about what is needed in my part of the world. The North-East Coast is under-serviced. But it is a great pity that when we discuss these matters we tend to forget that quite a number of parts of the service are not political matters but professional matters. I wish that we could discuss them purely on the basis of their being professional matters and that we could eliminate the political controversy.

I hope that my hon. Friend the Under Secretary of State will be able to say that the professions will be properly and adequately remunerated and that the management side of the Whitley Council will be instructed to that effect by the Secretary of State.

We have a magnificent Chancellor of the Exchequer. It a case is put to him, if the evidence is produced and if he has the money, which depends on the efforts of the country as a whole, I believe that we can go forward sure in the knowledge that when the next election comes these professional people will be properly remunerated. A great many of them are very much on the side of the methods which my Government have operated. I hope that we shall be able to show that we can find the money to ensure that those who do so much to help the country and the under-privileged in the matter of health are adequately and properly paid. I am sure that that is the desire of all the Government Secretaries of State.

3.20 p.m.

Mr. William Hamilton (Fife, West)

On occasion the hon. Member for Tyne-mouth (Dame Irene Ward) speaks with several forked tongues and a singular lack of judgment. This was no exception, particularly when she described the speech of the Under-Secretary of State for Education and Science as an excellent one. The hon. Gentleman himself knew that it was not. He could not conceal the fact. He was a computerised Minister fed with bromides, who was signing off. He gave all the impression of one who was glad to be rid of something.

I am not sure that the hon. Gentleman was right about that. It is proposed that we hand over this service to bodies that will not be democratically elected. I agree with the hon. Lady to that extent. We are to have area health boards that are not democratically elected.

I am sorry that no representative of the Scottish Office is present, for in Scotland the appointments to area health boards, which are already made, are deliberately politically biased. In my area of Fife, which is a predominantly Labour county, there are seven known Tories on the area boards and only three known Labour people.

The hon. Lady said that she was proud of her Government's record. The Government were not very proud of the result of the by-election at Manchester, Exchange, where they polled 600 votes and the Tory candidate lost his deposit. There were no signs there, anyhow, that the general public appreciate what the Government are doing.

The Quirk Report is a good example of the inadequate attention which the wealthy, educated community pays to the needs of minorities who themselves are often inarticulate, unorganised, and embarrassed by their disabilities and for whom care and attention too often involve unrewarding, unromantic work which rarely hits the headlines.

I find the report very well written and readable but thoroughly depressing. Not the least impressive part of it is the historical account of the pioneers in speech therapy in the late nineteenth century. Mothers have been at this since Adam and Eve, in a not very scientific way but always anxious to tell their friends and relatives when their child makes the first articulate sounds.

The pioneering work of individuals and then, I am glad to say, the first local authority clinic in Manchester followed by the hospital clinics in London at St. Bartholomew's and St. Thomas's about 60 years ago indicates the gradual development of the recognition of a problem and of the ways of treating it.

It is interesting to note that the organised professional training for this work began principally at the end of the First World War. Up to then speech disorders had been, generally speaking, left by the medical profession to teachers of elocution and even teachers of singing and vocal production. By 1935 there were four established schools of speech therapy offering two-year courses of training. Three of these were predominantly medical in background and orientation, while the fourth was educationally orientated.

In many ways, the story of the historical development of this service is a sad commentary on our so-called civilised society, in that very often it takes a world war to inspire invention, innovation, and revolutionary progress in a field which might otherwise have been neglected. The report points out that during the First World War young men were coming back with severe head injuries which led to speech handicaps which in turn led to educative therapy and medical treatment. That is the revolutionary story of the development of this service.

The First World War and its aftermath inspired the establishment by Professor Norman Nott's rehabilitation team for neurosurgical cases at the Bangour Head Injuries Unit near Edinburgh, and the speech therapist appointed was the first full-time speech therapist in the hospital service.

Subsequent to that, there was the organisation and development of the service into, on the educational side, the Association of Speech Therapists, and on the medical side, the British Society of Speech Therapists. That was the position until the Second World War brought those two bodies together in the new College of Speech Therapists. It is difficult to pay too great a tribute to the pioneers right up to the Second World War.

We now have a relatively new profession of speech therapy with courses of training which have improved since the initial stages but which need still further improving. Since the passing of the Education Act 1944 and the Health Service Act 1948 there has been clear and increasing evidence that the demand for this service has exceeded the supply. I need not go into the figures, as they have already been produced in this debate. The output of the 11 courses of training is a miserable 150 a year, but perhaps the Minister has more up-to-date figures.

Qualifications for entry to the college are high. They are higher than, or at least as high as, those required for entry to university. Indeed, there is a degree course only at Newcastle University, though others may be in the pipeline.

This is a highly professional body which deals with exceedingly complex problems of human communication, and not just with stammering. At one time it was devoted almost entirely to dealing with stammering. I remember my own school days, when a boy or girl who stammered and stuttered was a figure of fun and ridicule. Indeed, I am sorry to say that is still often the case.

This science has been developed to a much more sophisticated degree and, as one would expect, an association has been found between speech defects and deafness or partial deafness, acquired brain damage, mental handicap. autism, severe social deprivation—to which I shall refer in a moment—and dyslexia. A combination of two or all of those things can lead to severe defects of one kind and another.

Complaints have been made in the report and in the debate about the inadequacy of the career structure. The same qualifications are required within the education service as within the National Health Service, but local education authorities can legally employ unqualified persons and they cannot stop private unqualified persons from practising. I do not know how extensive that abuse is, but perhaps the Minister could tell us and the extent to which he has authority to stop it. In Scotland, of course, we do things better. The National Health Service Regulations 1964 cover the employment of speech therapists in both local authorities and the National Health Service. There is no difference of treatment.

The problem which has exercised the mind of every speaker in this debate is the salary structure and the consequent and inevitable sex structure of the service. According to the Department of Employment Gazette that I was looking at yesterday, the average weekly earnings for men in manufacturing industry were £36.20 in October 1972. The highest gross pay for an assistant speech therapist after six years is £1,431, or £27 a week. So, after six years of service as a speech therapist one gets £9 a week less than the manual male worker in manufacturing industry.

If one goes right to the top, a senior speech therapist, after 10 years, gets £2,079 maximum—roughly £40 a week. So, after 13 years of highly-dedicated skilled and qualified service the senior speech therapist gets £4 a week more than average male earnings in manufacturing industry.

In the light of those figures, no one will be surprised to know that the entrants for training as speech therapists are nearly all girls. No boy would look at a career carrying that kind of prospect. Figures have been quoted in the report. In 1968–69, of 764 applications for training, 15 were men—one in 50—and only two of those 15 accepted places. The 1971 intake included five men, and the hon. Member for Maidstone (Mr. John Wells) said that there were only 11 male speech therapists in practice. I do not know whether the Minister has any accurate figure—I had thought that there were nine—but it is a minute proportion of the total.

Another point in the report is worth recording, that another 26 men, trained as qualified senior speech therapists since 1944, have left altogether, not surprising. Many of them have gone to other countries. My hon. Friend the Member for Halifax (Dr. Summerskill) mentioned the United States. According to figures that I got from the Library, the median salaries in elementary and secondary schools in the United States in 1970—three years ago—were £4,000 a year.

After these people have trained in this country, they go to Canada, where the starting salary is £3,000. Salaries are higher also in South Africa and Australia. We invest this money in expensive training and then we lose the value of these people's services. As a consequence we face an almost criminal shortage where there is an increasing demand. Calculations were made in 1945 that local education authorities should have one speech therapist for every 10,000 of school population. This was far from reached, especially in the socially deprived areas. Table II in the report shows that all the deprived areas suffer from shortages of speech therapists. They are, therefore, deprived in this respect as well as in education, housing and environment. In these areas it is a comprehensive deprivation.

The shortfall in the hospital service is equally serious. The Under-Secretary of State for Education and Science spoke of a formidable problem of wastage. He said the average length of service of speech therapists was about three to five years. He pointed out that the obvious cause of this wastage was an earlier marriage, but that itself underlines the need to enable married women to come back to the service after they have brought up their children. They ought to have the facilities to encourage them to take a course of retraining and to have their children looked after so that they can then offer their qualified service to the community.

This is a struggling profession, on inadequate salary and given extremely poor, almost disgraceful working conditions tolerated by a dedicated group of people grappling with a problem of unknown but obviously great dimension, and watched by a relatively indifferent public and, up to now, by indifferent Governments of both political complexions.

I understand that salary scales are now being negotiated and will be applicable from 1st April last. I should be glad if the Minister can tell us whether they will come within phase 2 of the incomes policy. If they do, it is quite clear that these people will suffer a fall in their standard of living, despite what the hon. Lady the Member for Tynemouth says. If the amount is to be £1 plus 4 per cent. it inevitably means that the standard of living of these people will fall. Or are they to be treated as a special case? We should be told.

There is too much ignorance amongst the general public about the work being done, and too little publicity. The Government should start a vastly increased publicity campaign. Too little attention is paid to the medical training, for instance. The committee made its own estimate that, far from the 1945 ratio of one speech therapist to every 10,000 children, the ratio should be more in the region of one to 5,000.

We have not had any survey of speech disorder in the adult population. I hope that the Minister will tell us that the Government will put in hand some such survey to find out the extent of the problem, not only among school children, where it may be established fairly accurately, but amongst the adult population, where we are in deeper waters. The committee estimated that 40,000 adults in Great Britain needed speech therapy of one kind or another. The 200,000 children, the 40,000 adults, together with the under-school-age children, gives a figure of getting on towards 300,000—and we have in post 822 speech therapists.

I do not need to labour the point about publicity for the nature of the problem and how it should be tackled. I will only say that the Scottish speech therapists have declared to me that they support the report and want its recommendations implemented as soon as possible. I do not know whether the Government have attempted any costing of the implementation, but if they have not they should have done. An implementation of the report is no less important than Maplin or the Channel Tunnel. The improvement of the quality of speech of our people is far more important as a means of communication than the construction of either of those projects. It would certainly cost far less in monetary terms and would give far greater return in human terms.

As a nation, we are prone to get our priorities wildly and inhumanely wrong. If we can afford £900 million, which is the recent estimate of the cost of Maplin—it will be double that figure by the time it is finished—we can afford to spend £10 million, £20 million or £50 million on speech therapists. That is the most effective form of human communication that we have.

3.40 p.m.

Mr. Marcus Worsley (Chelsea)

I shall be brief. I am very glad to join in the debate.

The hon. Member for Willesden, West (Mr. Pavitt) complained about the form of the debate and what he called a weak motion by the Government. He is wrong about that. It is right that the Government should come to the House before they take final decisions to let us have "take note" debates on an issue such as this, where there are many views to which they want to listen. It is right that the House should be consulted at this sort of stage. It was rather unfair of the hon. Member to say that it is a weak motion. It is a highly desirable practice on the part of the Government to consult the House before taking final decisions and I hope that it will be encouraged. It is a very good use of Government Fridays.

Enough has been said about the remuneration of speech therapists. I support what has been said. I want to deal with an aspect of this matter which has been less stressed—the question of training. What the report is about is a charter for speech therapy as a profession. It is right that remuneration is critical to that. But we shall not get the kind of profession that we want unless at the same time we have the kind of training which brings about the status and the remuneration which is desirable. Therefore, I hope that my hon. Friend the Under-Secretary will be able to say something about this critically important recommendation in the report that training should be at any degree level. This is as important as anything else in the whole report.

The second aspect with which I want to deal is based on the position of the profession, unified, as we have been told, within the health service, and its position vis-à-vis the other Departments with which it is involved. Clearly, like other professions such as social work, which find that they are placed, properly, in a certain area and unified, its work goes very much beyond health and into education.

In spite of what the hon. Member for Fife, West (Mr. William Hamilton) said, the fact that in England—I believe this is true of Scotland, too—outside London, education authorities and health areas will be the same areas will help the kind of co-operation which the hon. Gentleman and I want between speech therapists working within the health service on the one hand and the education authorities on the other.

I have said previously in the House that the links are still not close enough between the health service and local authorities. I want to see a health service responsible to local authorities. However, perhaps this is not the right time to develop that theme again.

The Government must state their intentions in this matter, and before too long, because the whole of the speech therapy profession will be under the aegis of the National Health Service and, therefore, within the Government's responsibility rather than that of local government.

It is critically important that in the reformulations that are going on in advance of April 1974 the interests of speech therapy should not be forgotten. The College of Speech Therapists is very concerned; it has received from the Department a letter in which it is told that it will be several months before consultations can begin on these matters. As we are having this debate I ask my hon. Friend that it be not several months before these discussions take place, because there is among speech therapists a feeling of uncertainty; with all these changes going on they are not clear where they will find themselves and whether their responsibilities will be properly exercised. I therefore press my hon. Friend to take a rather more vigorous approach to the consultations and to let them begin soon.

My final point has been touched on already, particularly by the hon. Lady the Member for Halifax (Dr. Summerskill)—the question of encouraging and helping married women to take part-time work and use their skills. I hope that my hon. Friend, when replying to the debate will state his intention of studying the obstacles that clearly exist—they are not exclusively financial ones—to encouraging married women to come back into this profession. The gap between the numbers required in speech therapy and the numbers at present practising is so large, and the time will be so long before enough more therapists can be trained, that there really is no other means available to us in the short term to bridge this gap than encouraging and helping married women to come back into active work, which, given the right conditions, I believe they would profit from and enjoy doing. I hope that my hon. Friend will give an assurance that he will look very carefully at this matter and look at the impediments which at the moment exist.

3.47 p.m.

The Under-Secretary of State for Health and Social Security (Mr. Michael Alison)

The Government, in taking the initiative to debate this report, have, I hope, indicated to the House the importance and significance which they themselves attach to the subject, to the skilled personnel who are involved and, above all, to the people in need of the remedial treatment which is available through speech therapy.

The common theme running through the debate—one to which I deeply subscribe, largely as a result of experience that I have had in going round particular health establishments—is that one of the fundamental aspects of life on this planet is that it is social, and that an indispensable element in social life is communication. If communication in the case of an individual breaks down, that individual is literally and specifically dehumanised. It is my belief that the curious phenomenon of defects in speech and hearing—stammering was the instance which the hon. Member for Fife, West (Mr. William Hamilton) referred to, and we all know about the public effect of hearing defects—giving rise to ridicule and mockery, is brought about precisely because human beings instinctively class those who suffer from these defects as in some way dehumanised.

It is entirely regrettable, indeed appalling, that this should be the case, but the effect of a loss in communication is to dehumanise someone and this is how ridicule and mockery arise. They do not arise in the case of the blind, for example. In that instance, solace, sympathy and care are engendered, not mockery. We are here concerned with something fundamental to the claim of a group of human beings in our society that they are utterly human in their attitude. That is why the report is extremely important.

I add in passing that one of the features of the hon. Member for Willesden, West (Mr. Pavitt) that always impresses me is not the skill with which he hears words that are uttered by others but the skill with which he utters words in return, because one of the most significant effects of the loss of hearing is the loss of the capacity to monitor one's own speech, and the two hang extremely closely together.

That is precisely why speech therapy is crucial in the context of these two features of the loss of communication. Often one of the most tragic aspects of early deafness in children is the recogition that without the help of speech therapists, among others, they will have this double disability of being unable to hear clearly and being unable to monitor their own speech. That is why we are doubly concerned with the Quirk element no less than the problems of the hard of hearing.

The hon. Member for Fife, West made a fair point when talking about minorities. This country has woken up very late to the phenomenon of disability. The blind have always been with us and there has been no shortage of voluntary organisations and public bodies happy and willing to do something for them. But it is staggering to reflect how recent is public awareness and concern about the range of disabilities that Amelia Harris has brought before an unsuspecting public.

There are 3 million men and women over the age of 16 and living at home who have some greater or lesser degree of sensory, mental, or physical impairment. Only in the late 1960s did we begin to become aware of this and only in 1970, after 1,900 years of Christian civilisation, has the country begun seriously to tackle the problems of the minority groups that the hon. Member for Fife, West discussed. The epileptic, the mentally handicapped, the mentally ill, the hard of hearing, a whole range of mobility conditions and so on—only in this decade are we beginning to tackle them.

At last we are doing it, but the charge that minorities have always been neglected until they themselves have managed to break through into public recognition by their powerful and tireless attitudes is a fact that reflects on the records of all parties in this country. The only way in which we can atone for the shortcomings of the past is to make certain that we do something effective for the future.

I invite the House to maintain a reasonable sense of perspective now that we have brought forward the Quirk Report and invited the House to consider it.

In a fair and understandable introductory speech, the hon. Lady the Member for Halifax (Dr. Summerskill) deplored the shortage of therapists. The hon. Member for Fife, West, in what I thought an extreme phrase, talked about it as being criminal. My hon. Friend the Member for Tynemouth (Dame Irene Ward) talked particularly about local government shortcomings, of which we have been conscious, in the administration of some of these services in the past.

But we must not allow too extreme a note of gloom to spread over us in this context. We must remember what has happened. and the Quirk Report itself makes it clear. I ask the House to study the table in paragraph 5.13. It is remarkable that in the past 17 years just over 2,000 therapists have entered the profession. It is within a time-scale of 20 years from now that Professor Quirk recommends we should increase the full-time force of therapists to 2,500. That is saying a great deal. He is asking us to have a slightly greater rate of increase over a slightly longer period of time. It is not entirely out of the question, and it shows that something has been achieved.

Above all, it shows that the growth forecast by Professor Quirk is not impossible. What comes quite clearly out of the figures that Professor Quirk presents us with, and again I refer to paragraphs 5.13 and 5.14, is the catastrophic wastage of the work force. The net increase over the past 17 years is pitiably small. We only just keep up in our output. The latest figure I have is 152 in 1971.

Clearly, salaries are relevant. I confirm most of the figures that have been mentioned. Since April 1972 the basic rate salary has been between £1,107 and £1,815 and for the senior grade from £1,554 to £2,079. The Whitley Council has recently agreed in principle to a revision of salaries, to be operative from 1st April 1973. Details of the agreement will have to be submitted for the approval of the Pay Board before being implemented. I cannot say anything further, not having the right to disclose, or to have any formal knowledge of, these recommendations before the Pay Board pronounces upon them. An increase is agreed in this voluntary Whitley machinery representing both sides. It awaits the imprimatur of the Pay Board.

I invite the House to consider that the scale of wastage associated with this predominantly female work force, which tends to get married within three or four years of qualification, is not one which could be significantly arrested by massive increases in wages. What can be done is to take active steps to encourage these women to return to work after they have married and brought up a family. Local authorities have been criticised for the way in which they have sometimes failed to react imaginatively to the conditions and needs of married women and to provide them with part-time sessions and facilities.

The reorganisation of the National Health Service on 1st April 1974, with the full transfer of these professional people into the ambit of the NHS, will mean that we shall be looking at the deployment of speech therapists, full-time or part-time, from a single viewpoint, systematically over the whole country. We shall be able to repair some of the defects. Local authorities should be assured that we shall do everything necessary to sustain the level of service which they are providing, even when the speech therapists whom they are at present employing come within the ambit of the NHS. We shall want to see that at least the present service is maintained. We shall want to do more by facilitating the return to the profession of married women.

I have noted the points made by my hon. Friend the Member for Chelsea (Mr. Worsley). particularly about the uncertainty which lies over some of the future. We shall take note of that and try to put it right.

Question put and agreed to.

Resolved,

That this House takes note of the Quirk Committee Report on Speech Therapy Services.