HC Deb 04 February 1974 vol 868 cc882-90
The Secretary of State for Social Services (Sir Keith Joseph)

With permission Mr. Speaker, I should like to make a statement on behalf of myself and my right honourable Friends, the Secretaries of State for Education and Science, for Scotland, and for Wales about the Report of the Committee of Inquiry into the Speech Therapy Services which was published in October 1972.

The Government accepted in May of last year two important recommendations of the report that the 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. This new arrangement will be effective from 1st April this year.

My right honourable Friends and I have now, subject to modifications and reservations to which I shall refer later, accepted the remaining recommendations which concern us directly, and we shall be commending the report to the new health authorities on which the burden of implementing it will mainly fall. The House will appreciate that the new health authorities, which will be given guidance on various aspects of the report, will be able to proceed only at the pace economic circumstances permit. Any measures they introduce will have regard to other priorities and will have to be kept within the resources of finance and manpower available to them.

In the present economic situation progress will inevitably be slow. We have already invited the College of Speech Therapists to discuss the integration of the speech therapy services into the new health service.

On other points of particular importance which we shall also wish to discuss with the college, we recognise the aspirations of the profession that in the long term all training should be at degree level, but we consider that a mixed pattern of diploma and degree courses will have to continue for an indefinite period, and we need to examine in more detail the proposals for a Central Council for Speech Therapy and the provision for advance at national level.

In conclusion, my right hon. Friends and I should like to pay tribute to the work of Professor Quirk and his committee on the preparation of their report. It has proved to be a most thorough and constructive document and will be regarded by all as the starting point for a better organised and more effective speech therapy service.

Dr. Summerskill

Does the right hon. Gentleman accept that his statement, which was so eagerly awaited by so many, is, in fact, a non-statement and that it will be extremely disappointing to the speech therapy profession and to the people it serves? There is no excuse for inactivity, bearing in mind the length of time the Secretary of State has had the report. He has had the report long enough. He will be aware of the wishes of the profession from the degree of consultation which I know he has had—I took part in the consultations on one occasion. The House has debated the report.

Would the right hon. Gentleman not agree that in commending the report to the area health authorities he is, at the same time, putting them in a financial straitjacket?

The House will recall that the report presented a depressing picture of the speech therapy services battling against acute staff shortages, unsatisfactory working conditions and inadequate professional status. What is the Government's target for recruitment to the profession. The number of people now engaged in full-time speech therapy in Britain is approximately 900, yet 2,500 was the figure recommended as a target by the Quirk report. What special steps are being taken towards recruiting more married women and, more important, towards preventing wastage from the profession? Why could not the Minister concede the crucial demand of the College of Speech Therapists for the establishment of a central council for the approval of training courses and registration and for the appointment of national advisers at departmental level? Is there any possibility of Government finance to encourage urgent implementation of the Quirk recommendations, such as those dealing with improved accommodation, training facilities, research into speech defects and refresher courses?

Last, but not least, has the Secretary of State any intention of carrying out improvements, or of encouraging improvements, in the pay of speech therapists, who continue to be another exploited group of women who are involved in the running of the health service?

Sir K. Joseph

There will be some disappointment that the Government cannot push down the accelerator in connection with the recommendations by Professor Quirk and his committee, but any such move would have to be matched against competing priorities and inevitably limited resources. The report makes many recommendations.

The Government accept the report's target of 2,500 speech therapists, plus 1,500 speech therapy aides in post, compared with the present total of 900. The target would mean a quadrupling of the service, but, as the report recommends, we accept that that target should be tackled over a 20-year period. That is the recommendation of the Quirk committee.

We shall certainly seek within the budget available to encourage the authorities to improve accommodation in order to reduce the sense of isolation within which speech therapists work. We shall rely upon the Chief Scientist's committee to encourage research, but I must point out that pay is a matter for the Whitley Council.

Dame Irene Ward

I have had a lot of experience, over many years, with the Chartered Society of Physiotherapy and supplementary medicines groups. I would prefer to hear from those bodies about their views on the report rather than necessarily hear from the Opposition. Will my right hon. Friend accept—[An HON. MEMBER: "No."] Of course he will accept my feeling that when he puts up a light with the Treasury, the Treasury pays more attention perhaps to industrial workers than it does to professional bodies. I wish to be assured that the professional bodies get the amount of attention which they ought to get from the Treasury. I am not happy that as a party we do all we ought to do for the professional bodies, and I hope that my right hon. Friend will give me an—

Mr. Speaker

Order. This is a case of a bad example leading to a similar development, because on the Opposition Front Bench the hon. Lady made three statements and asked about 11 questions, or so it seemed. Will the hon. Lady the Member for Tynemouth (Dame Irene Ward) please ask a question?

Dame Irene Ward

Mr. Speaker, may I just say to you that as for years I have represented in Parliament the Chartered Society of Physiotherapy. [An HON. MEMBER: "The hon. Lady has not."] Indeed, I have.

Mr. Speaker

Order. We cannot debate this matter. I have called the hon. Lady for a supplementary question.

Dame Irene Ward

My supplementary question is: will my right hon. Friend, when he hears the views that have been expressed to me, allow a debate on the subject so that the professions can have their case presented properly and not just from the Opposition?

Sir K. Joseph

The House will be very pleased to know that my hon. Friend has recovered so promptly from the accident that she had earlier today. We are very glad that she has suffered no severe damage.

I can assure my hon. Friend that we take the condition of the professions intensely seriously.

Mr. Pardoe

Will the Secretary of State say exactly why it has taken 15 months to announce, after the publication of the report, that progress will be slow. Is he aware that there is a desperate shortage of speech therapists throughout the country and that this is affecting the quality of education in the whole education service? While noting that the right hon. Gentleman is going to commend this report to the health authorities, what they will want to know is—how much cash? May I ask him how much cash there is in it?

Sir K. Joseph

The House will recollect that eight months ago the Government accepted the two most important recommendations, and announced that through my right hon. Friend the Secretary of State for Education and Science. Consultations on the remaining recommendations have continued during those eight months. I have told the House that progress on this, as on many other matters vital to the health authorities, must be contained within the overall finance available to the health service and is, as hon. Members opposite must surely be ready to accept, essentially a matter of priorities. I am constantly deploring the fact that this country's growth rate is not such as to enable us to expand the health and other services faster than we can. However, the expansion of the services has been relatively fast—not fast enough for anybody, but relatively faster under this Government than ever before. Within those expanding resources this is a new priority which must be accommodated by local decision.

Mr. Costain

Does my right hon. Friend recall that when he made a statement on this matter earlier I drew his attention to the wonderful work being done by speech therapists in Australia? What inquiry has he made there? Does he realise that whilst I was there over Christmas speech therapists considered that investment for rehabilitation after motor car accidents could result in money being saved and not wasted?

Sir K. Joseph

Alas, the same truth applies to many other improvements in the service. They would be good investments if we had the resources for them. This is a service which we intend, on the excellent advice given us, to improve and expand.

Mr. Driberg

Would not the resources be increased greatly if the right hon. Gentleman could stop prescribing under brand names? Secondly, would the right hon. Gentleman say whereabouts in the Government's scale of priority he puts the most under-privileged group of all, who need speech therapy and much more besides—the relatively few children and adolescents who are autistic?

Sir K. Joseph

The hon. Gentleman has picked on one of the most clinically intractable groups where we need more knowledge as well as more resources if we are to be able to help. As for brand names, the health of the people of this country, and indeed of the world, has benefited enormously from the profit-based research which has led to the extraordinary success of drug companies all over the world, including those in this country.

Mr. Maude

Is my right hon. Friend aware that, whatever may be the hopes for the future, a great many parents and relatives have found it almost impossible to get adequate treatment in time during the last year or two? Is he aware also that, although we recognise the need to consider priorities, in this case it is often true that the longer treatment is deferred the more difficult it is to get adequate treatment in the end?

Sir K. Joseph

I agree with every word that my hon. Friend has said. Alas, it applies not only to speech therapy but to many other aspects of the National Health Service. It remains true that we are providing increasing resources—never enough, but we have to use those resources to the best of our priorities.

Mr. Pavitt

I welcomed a most excellent statement by the right hon. Gentleman in my constituency a few hours ago on a different matter, but is he aware that that makes this one appalling? Does he realise that unless he considerably shortens the 20-year time scale he will not have a speech therapy service in 20 months? On the question of cash, does it mean that the career structure which allows increases under phase 3 will permit under the area health authorities a principal in the National Health Service who is now getting £2,000 to be equated with someone under the Inner London Education Authority who gets £2,900? Will he appoint a central advisory officer on speech therapy in his Department as well as one on each area health authority?

Sir K. Joseph

I must defer the answer to the last point until the consultations have been carried out. I ask the House to note the end of paragraph 7.52 of the Quirk Committee's Report, which specifically recommends us to aim to reach our target within 20 years at most.

Mr. John Wells

I appreciate the economic difficulties of the time which make a very difficult background for my right hon. Friend's statement, but may I ask if he can say anything further about the 1,500 aides whom it is aimed to produce within this period, because this must be coupled with my right hon. Friend's other phrase about the ending of the isolation in which speech therapists work? As regards the requirement about better premises, can my right hon. Friend give some specific assurance that speech therapists will get better premises to work in, because, although this may cost money, the throughput of patients will be much greater if the therapists do not have to deal with the paper work? For very little money we shall get a very much better throughput of patients.

Sir K. Joseph

I agree with everything that my hon. Friend, who has taken such an interest in this subject, says. The Quirk Committee proposes that routine work should be delegated to aides working under the supervision of speech therapists. We shall be discussing with professional and staff interests the way in which this can be achieved. The aim recommended by the Quirk Committee is not 1,500 aides, to which I wrongly referred, but 1,900 aides.

Mr. Marks

The Secretary of State has said that he cannot yet put on the accelerator. Is he quite sure that he is not going to go into reverse? Can he assure the House that in 1974–75 the service and the linked educational service will not be actually cut?

Sir K. Joseph

There is no intention whatsoever of going into reverse. The problem in this service is not so much one of recruiting as the wastage, for very well known reasons such as young women leaving to marry. Our job with the new health authorities is to try so to arrange conditions, including premises and removing the sense of isolation, as to attract back the more mature women who have been trained originally as speech therapists. This will be our purpose.

Mr. Gardner

Wastage is certainly an important factor. Is my right hon. Friend aware that speech therapists in my constituency, no doubt in common with those in constituencies throughout the country, have over the last year or so been expressing their severe anxiety about recruitment to the service? Is he aware that these people look forward eagerly to the full implementation of this report ultimately?

Sir K. Joseph

The answer to both parts of my hon. and learned Friend's supplementary is, "Yes, Sir."

Mr. William Hamilton

May I ask the right hon. Gentleman whether the professional organisations with which he has been in consultation have agreed with the bulk of his statement or parts of it? Is there anything in his proposals now or for the future which will erase the wastage which is a major problem within the service?

Sir K. Joseph

Not for a moment would I expect the professional interests to be content with the pace of progress either recommended by the Quirk Committee or accepted by the Government. I have to consult the professional interests on the implications of the acceptance by the Government of the recommendations in the report.

Mr. Money

In the light of the important long-term effects of what my right hon. Friend has said, will he give an assurance that he will recommend to the regional hospital boards that the areas which are acknowledged to be most badly served will be specially considered? Further, will he say something about research?

Sir K. Joseph

Yes, I shall be urging regional and area health authorities to improve speech therapy services within their budgets. I must emphasise that they will have many priorities to serve within their only slowly expanding resources. I have said that I shall be asking the Chief Scientist to advise the Government how research into this matter, as recommended by the committee, can be fitted in.

Mr. Atkinson

Is the right hon. Gentleman saying that he does not expect the growth rate to be as much in the next 20 years as it has been in the past 20 years? Does he not anticipate that by 1994 there will be sufficient growth for him or his successors to allocate that which is recommended by the report?

Sir K. Joseph

If we could better organise our affairs, including industrial relations, I should have no doubt about Britain's capacity to improve enormously its growth rate. However, to quadruple the number of staff in service is not a mean target even for 20 years.