§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Neubert.]
§ Mr. David Alton (Liverpool, Mossley Hill)
May I first thank you, Mr. Deputy Speaker, for this opportunity to raise, on the Adjournment of the House, the provision of speech therapy and the remuneration of speech therapists in the Greater Liverpool area.
My interest in the provision of services for people with special needs stems from the six years that I spent before coming to this House as a teacher of children with special needs. I also spent eight years as a member of Liverpool education authority—much of that time as a member of the personal services sub-committee. More recently I spent a fascinating afternoon at the Myrtle Street hospital where the Liverpool speech therapy department is based. The Minister, whom I welcome to the Dispatch Box tonight, will recall that the unit is situated in a hospital just a stone's throw from the building which once housed the Liverpool Institute for Girls, the school where she herself was educated.
During my visit to the speech therapy unit I met Sheila Wilson, Pauline Furness, Susan Rees and Margaret Bishop, four members of the Liverpool speech therapy team. I was immensely impressed by their work, dedication and commitment. I specifically suggested to them that they might write to the Minister and invite her back to Liverpool to see for herself the work that is undertaken there. Perhaps tonight she can give that undertaking. I am also glad to see the hon. Member for Birkenhead (Mr. Field) in his place; he has entered the Chamber on cue. I know that he will be hoping to catch your eye, Mr. Deputy Speaker, later in the debate to reinforce the arguments for improving speech therapy provision in Merseyside. Although he cannot be here tonight, I know that the hon. Member for Crosby (Mr. Thornton) also wishes to he associated with the arguments being put before the House.
Those arguments might best be summarised in the following way.
First, there is a national under-provision of speech therapy services. Those arguments are highlighted in the words of early-day motion 361 standing in the name of my hon. Friend the Member for Cambridgeshire, North-East (Mr. Freud) and now signed by over 50 Members from all parts of the House. It states:That this House is gravely concerned about the wholly inadequate level of provision of speech therapists for specifically speech and language impaired children and young people; notes that the resources of the service have failed to keep pace with the increasing demands of an estimated three million of the United Kingdom population; and calls upon Her Majesty's Government to take urgent steps to ameliorate the situation.
§ Mr. Michael Meadowcroft (Leeds, West)
Although this Adjournment debate is specifically about Merseyside, the early-day motion refers to the national position. Is my hon. Friend aware that in Leeds people are being transported across the city, often in delicate circumstances, because of the shortage of speech therapists? Parents are anxious that their children are not transported great distances to receive the special attention that they deserve. Is that also the case in Merseyside?
§ Mr. Alton
My hon. Friend makes a good point about the overall provision for speech therapy throughout the 711 country. I am glad to see that my hon. Friend the Member for Cambridgeshire, North-East, who tabled the early-day motion, is now in his place.
Apart from the debate on under-provision, there is an argument whether speech therapy is a service provided by the Health Service or the education service. The case of the Oxfordshire parent who recently lost her bid to force the local education authority to provide the speech therapy that her son had been shown to need eloquently demonstrates that the Education Act 1981 is a toothless wonder. That Act offers pious statements and ambitious hopes rather than the services that special needs groups require. The special twist in that case was that the severely speech disordered nine-year-old in question was assessed as requiring therapy that could be provided only by the local health authority—but that statement was binding only on the education authority. It is a classic demarcation dispute, and without the powerful statutory rights that parents enjoy in countries such as the United States, it leaves the needy without any clearly defined rights or services.
Inadequate remuneration might be added to the list as the third argument that Merseyside speech therapists and others throughout the country would wish me to raise with the Minister tonight. Speech therapists are highly skilled and highly motivated, but poorly paid. A graduate entrant can expect to earn £6,096 a year. At the top of the speech therapy tree, a district speech therapist will not earn a great deal more than £13,000. A clinical therapist can work for 30 years, gaining a vast amount of experience, and still expect to earn only a little over £8,000. There is no serious career grade for clinical therapists, nor does the career structure of the profession reflect the degree of responsibility held by staff in their work.
The recent 6 per cent. pay rise was described in the editorial of Therapy Weekly as "simply an insult". A good illustration of the position of therapists is highlighted in an advertisement in this morning's Guardian for a senior administrative secretary at a salary of between £11,371 and £16,136—more than double that which a graduate entrant to the speech therapy service could expect to earn.
Perhaps this is not the correct time and place to try to negotiate a pay increase for speech therapists—yet it is one of the chief reasons why morale in the profession is so low. Levels of pay are, of course, an obvious factor in speech therapy provision.
The wastage rate in the profession, as the Quirk report noted, is inordinately high. That is partly because there is a drain to other professions. As Mary Pletts, the coordinator of the speech sciences degree at the National Hospitals College of Speech Sciences, said in a recent letter to Ken Mack, a veteran campaigner:This year I have heard that one or two of our graduates from a couple of years back have left the profession because of lack of money, career structure etc.—having found that what they have learned on the course has made them highly marketable for other professions…Unless things really improve for us in the profession I fear this small trickle could become a steady stream.The shortage of speech therapists and its effect on provision of the service can easily be illustrated by reference to figures from the Mersey health region. I hope that the Minister will seriously ponder these figures. Perhaps tonight she will be able to offer some advice to speech therapists in the Mersey region as to how they can 712 cope with their increasingly burdensome work load. She may even be able to suggest ways in which recruitment can be improved.
In 1972, the Quirk report recommended that there should be six full-time speech therapists per 100,000 of the population. Speech therapists know that that is a serious under-estimate. The Under-Secretary of State and her predecessor admitted as much last year. Information pooled from throughout the United Kingdom shows that a ratio of 10 speech therapists per 100,000 is much closer to the mark. In 1972, Quirk also estimated that there were 325,000 communication-impaired people in the United Kingdom.
We know also from the report by Enderby and Philipp in 1976 that the figure is, at a conservative estimate, probably 2.3 million. It is estimated in one early-day motion to be some 3 million. The Enderby and Philipp report broke that down into 1.5 million people with noticeable speech and language difficulties and 800,000 people with severe communication disorders.
The average number of speech therapists per 100,000 of the population in the United Kingdom stands at 5.7 whole-time equivalents. The best ratios are in Scotland at 7: 100,000, in Northern Ireland at 6.6:100,000, South East Thames at 6.6: 100,000 and North West Thames at 6.4: 100,000. The lowest ratios are in the following regions: Wessex at 4.4: 100,000, Mersey at 4.7:100,000 and Yorkshire at 4.7:100,000. That is one league where Merseyside certainly comes bottom.
Within the health authorities that comprise the Mersey region, a similar picture emerges. Under-establishment in Liverpool—part of the Mersey region—is 45.6 per cent., in the Wirral—no doubt the hon. Member for Birkenhead will touch on that—60.4 per cent., Crewe 45.7 per cent., Chester 63.6 per cent., Halton 58.6 per cent., Macclesfield 56.4 per cent., St. Helens and Knowsley 34 per cent., Southport and Formby—the North Sefton area—59.3 per cent., South Sefton 60.6 per cent. and Warrington 55.6 per cent.
The South Sefton health authority has two speech therapist posts filled. Five have been vacant since April, and the position could worsen soon. One of the two speech therapists is to leave at the end of this year. The authority is trying to recruit, but to no avail. The post is not a very attractive prospect. There is a small establishment with poor career prospects. New therapists would have to work in complete isolation with an extremely high work load. New therapists would not have the opportunity to benefit from working with fellow professionals more experienced than themselves, nor would they have the time to keep up the academic side of their work. Surely the Minister can see the depressing effect that working in such circumstances would quickly have.
Merseyside speech therapists told me during my meeting with them how truly demoralised they feel about the way in which the Government have responded to their plight. They are simply not well-meaning elocutionists, dressed up in white coats. They are part of a highly qualified graduate profession that, sadly, has a status usually accorded a Cinderella.
I should not like to leave the House with the impression that all the pressure is coming from the therapists. Liverool alone needs another 40 therapists and could use 15 more tomorrow. The failure to provide these posts leaves parents and clients frustrated and angry. I know that they have been writing to the Secretary of State in 713 their hundreds. I shall quote briefly from three letters. I know some of the parents well. Some are constituents and others are people whose children I worked with when I worked with children who have special needs.
A parent from the Walton area said:I am a parent of a handicapped child who is three and a half years old. Since he's been coming for speech therapy, John has learnt to play and how to talk. He doesn't have temper tantrums now he can talk. We had to wait 5 months for an appointment. This was a long time. We were worried about John. It would have been more helpful if he could have been seen earlier.A lady from Tue Brook said:I am the mother of a six year old child. Thanks to the expertise and dedication of our speech therapists my daughter was helped to develop from a sad, non-communicative introverted child to a happy, fluent and extremely chatty member of our family. Without their help this transformation could not have taken place. Their value must be appreciated financially or there will be no prospects for other such afflicted children.I should also like to quote from a letter sent to the Secretary of State by someone in Childwall, who said:I waited 5 months for an appointment to see a speech therapist. I have been feeling helpless at not being able to communicate with my own son. After seeing a speech therapist it only took 6 months to have him talking correctly but 5 months were wasted at the beginning.It is a brave person who would question the value of adequately providing for a service that can turn a sad, non-communicative, introverted child into a happy and confident youngster.
There is an urgent need to improve provision, remuneration and definition of clear lines of responsibility. There is a desperate need to boost morale and to produce more than the usual expressions of gratitude to speech therapists for the work that they do. The situation, as I have tried to demonstrate, is especially bad on Merseyside and I hope that tonight's debate will go a little way to convince the Government of the need to take urgent steps to improve matters.
§ Mr. Frank Field (Birkenhead)
I am grateful to the hon. Member for Liverpool, Mossley Hill (Mr. Alton) for allowing me to participate in the debate. As it is the first time that I have faced the Minister across the Dispatch Box I should say how pleased I am to see her there. Like the Minister herself, I am one of her fans. I am slightly worried however, because one of the reasons why I am a fan is that I believe that she has the fight to control, as anyone can control, the Civil Service. Therefore, I am slightly alarmed that she has only one minder tonight. I hope that that is not a sign that the Civil Service thinks that it is getting on top of the Minister. The Opposition will judge how effectively she controls her Department by the way in which she responds to tonight's debate, not necessarily in what she says tonight but in the follow-up.
The case has been eloquently put by the hon. Member for Mossley Hill. He has made the case for the under-establishment of speech therapists. That is clearly linked to their low pay. We have a Government who say that it is wrong to strike, bully patients or rough up the public, and many of us, in normal circumstances, would agree with that. However, there is another part to that argument. If any of us put forward those views, we have a duty placed on us to ensure that those who do have a genuine grievance can have that grievance met in a civilised way. I do not 714 believe that the Government are facing up to that issue. Under-establishment and low pay are particular grievances of speech therapists but there are general conclusions to be drawn from this case as to how we settle unfairnesses in pay in our society.
I want to bring a message from some of my constituents who have benefited from the speech therapists. I must confess if I had not been lobbied I would not have been as well briefed about their work as I am. They came to my surgery and quietly put forward their case. They asked me to visit their surgery when I was next at the Arrowe Park hospital. I made a special visit. My constituents said that the speech therapists give them a passport back to life. We want to know from the Minister whether that passport will be spread to many more of our constituents and whether it will be spread by mere nice sounding phrases from the Minister or whether she has some effective action up her sleeve that may annoy some people in the official Box and beyond.
§ The Parliamentary Under-Secretary of State for Health and Social Security (Mrs. Edwina Currie)
I first congratulate the hon. Member for Liverpool, Mossley Hill (Mr. Alton) on his sucess in the ballot and on raising this important topic. I also thank the hon. Member for Birkenhead (Mr. Field) for his kind remarks. I have always thought that the best comment made about the hon. Member for Birkenhead was that he is the only real Tory that the Labour party has ever had.
I had the privilege of learning about speech therapy some years ago when I was involved in the Health Service in Birmingham. I had the opportunity to spend a whole day with speech therapists in that city working in hospitals and the community. I entirely agree with the hon. Member for Mossley Hill. The range of their work is astonishing. They work not only with child stammers and stutters, but with children with a range of psychological and physical disabilities. Their work with adults has grown dramatically in recent years—not only with adults suffering from strokes or head injuries following accidents, but also involving people with laryngectomies. Speech therapists perform miraculous work to enable people without voice boxes to speak again.
I must stress that health authorities have recognised the important and increasing role of speech therapists in helping patients of all ages and all kinds to overcome speech impairment. The result of that recognition is that speech therapy has expanded very quickly, at a greater average rate than the general average rate of increase in Health Service expenditure. I mean not merely to say that but to prove it.
Expenditure on the Health Service since 1974 has increased nearly threefold. Expenditure on speech therapy has increased nearly ninefold in that period. In 1974–75 £2.9 million was spent on speech therapy. The 1985–86 figure—already a year out of date—was £24.7 million. As a result, it is possible to understand that the expenditure on speech therapy has grown very quickly. The results are reflected in the number of speech therapists employed in the service. In 1973 there were 1,461 whole-time equivalent speech therapists employed in the Health Service in Great Britain. By 1979, that figure had risen to 1,870. By 1985, there were 2,790. The rate of growth between 1979 and 1985 was 49 per cent. That is a 715 tremendous hike in the number of people employed in the service. In England, the increase between 1979 and 1985 was even greater at 55 per cent.
Many of the concerns expressed by the hon. Member for Mossley Hill and the hon. Member for Birkenhead have been taken on board by local authorities. I venture to suggest very gently that, whatever difficulties the service may be experiencing now, they must have been much worse when there were fewer speech therapists under the control of a Government of a different political colour.
The question has been raised as to whether speech therapy is education or health. As I have said, for some years speech therapists have been employed by the Health Service. The Wallace case has tested that to some extent, but I understand that that is up for appeal, so we may receive further information on that point. It is a long time since speech therapists were employed en masse in the education service. Given the increased importance of the adult therapy that they provide, it is appropriate that they should be in the Health Service. The bulk of patients and the greatest need will come from that area.
One of the problems that is often raised is why they are not treated in the same way as such professions as physiotherapy, occupational therapy and others. The reasons for that are historical. I understand that speech therapists have always felt that they were a separate profession and they were concerned about losing their independence. They have always claimed that they are capable of independent diagnosis and the delivery of treatment. Therefore, they do not have to take referrals from doctors. As a simple matter of fact, the vast majority of referrals come from a doctor or another therapist if the case is referred back to a doctor for medical advice. However, that is the view taken by the speech therapists. As a result, they excluded themselves from the Professions Supplementary to Medicine Act 1960, and therefore speech therapy is not a registered profession under that Act. Until 1982 however, they were included with the other professions in the professional and technical A Whitley council for pay purposes. In 1983, the pay review body for nursing staff, midwives, health visitors and professions allied to medicine was set up. Speech therapists were again invited to take part but again refused to do so. While most speech therapists said that they were not opposed to the principle of a review body, they did not want to be linked with the other professional groups with whom they felt that they had little in common.
That was the crucial decision. I understand that some speech therapists now regret it, but that is the situation as it stands. Representatives of speech therapists negotiate with the management side of the Scientific and Professional Staffs Council, which is an ad hoc arrangement, until the trade union side can agree on the formation of a new council.
In 1985, speech therapists made a formal claim for pay parity with other graduate professions, and eventually received the same percentage increase as other staff groups, but the management side agreed to examine jointly with the staff side the arguments which bore on the graduate element of their claim. That claim is, as hon. Members know, still under way.
There is one point about the comparison with graduate professions elsewhere. Speech therapy had for many years been a graduate entry profession, but not all speech 716 therapists are graduates. For historical reasons, speech therapists work 33 hours a week, whereas pharmacists, for example work 39 hours a week and psychologists' hours are unconditional. These elements have to be taken into account in the discussions.
§ Mrs. Currie
I understand that the figures that hon. Members have quoted for pay are accurate, but it is possible to go up to £15,000 a year and, at my estimation, there are only six people at the moment in the basic scale, which would probably give somebody less than £7,000. It remains true, however, that the largest single group of speech therapists are in the senior II grade which, at the moment, gives a salary with a minimum of £7,368 and a maximum of £8,676. I therefore do not dispute the sort of figures that are being offered.
As for Merseyside, I have taken the opportunity today to discuss some of these questions with the chairman of the regional health authority, Sir Don Wilson. I am sure that hon. Members will join me in sending our warm congratulations on the award of his much deserved knighthood in the new year honours list.
I think that hon. Members will agree that it has been the case for many years now that the level of service is a matter for individual health authorities, which must decide how to use their resources in a way which best serves the needs of their populations, That is what decentralisation is all about. Hon. Members are a little unfair in the way in which they use their figures because, whatever may be happening in a snapshot taken at the moment, recently Mersey has been doing rather better. The overall plans in the Mersey regional health authority, some of which have already been carried out, show very substantial improvements. The drift of the argument advanced by the hon. Member for Mossley Hill is accepted in Mersey. It simply cannot be done overnight. A substantial amount is already being done.
I have here figures of staff in post full-time equivalents between June 1985 and September 1986, which are the most recent figures. As a simple matter of fact, between those two points in time, the total number of speech therapists employed in Mersey went up from 96.3 whole-time equivalents to 101.7 whole-time equivalents. That is an increase of five and half whole-time bodies in 18 months, which is a substantial improvement and is against a planned establishment of 110.5. That gap of rather less than 9 per cent. would match almost any level of vacancies anywhere else in the service. It is certainly not the enormous gap that was being described.
In the Liverpool health authority, which covers the constituency of the hon. Member for Mossley Hill, the number of speech therapists has risen from 16 to 18 in post, which is a rise of two whole-time equivalents. If we go through the figures for the other health authorities we find that, from June 1985 to September 1986, Chester, Crewe and Halton have stayed roughly the same, Macclesfield's staff in post has doubled, Warrington has increased, St. Helens and Knowsley has stayed roughly the same, Southport and Formby has also nearly doubled and Wirral is up. The only one that has shown a sharp drop is South Sefton.
717 It is worth remembering that the figures for South Sefton should he looked at jointly with Liverpool, as the latter provides speech therapy services for children at Fazackerly and Walton hospitals, which are the administrative responsibility of South Sefton. Two of those districts, Warrington and St. Helens, offer provisions for their populations that are substantially above the national average. Two—Crewe and Macclesfield—are very close to achieving that level of provision. South Sefton alone is well down on the level of provision and that is substantially for the reasons that I have mentioned. Only four out of the 11 districts showed vacancies in September 1986. That is not a bad record.
The chairman of the regional health authority has pointed out to me that, in March 1984, there were only 77 whole-time equivalent speech therapists in the region and now there are 110 funded and 102 in post. The numbers have risen from 77 to 102 in a matter of two and a half years and that is a remarkable increase. By 1994 the plan is for staff numbers to increase to 150. That is not only a remarkable achievement in terms of what the authority has already done, but shows that it has taken matters in hand.
§ Mr. Alton
I am grateful to the Minister for giving way and also for the reply that she is giving. Obviously she is satisfied with the arguments that she is putting forward and, at the risk of accusing her of some complacency, I ask whether she would be prepared to take me up on my earlier invitation to come up and explain the situation to the therapists?
§ Mrs. Currie
I am always interested to visit my home town, especially as the hon. Gentleman is my mother's Member of Parliament.
§ Mrs. Currie
I shall bear that invitation in mind.
I asked the chairman of the regional health authority exactly what the authority proposed to do to ensure that it continued recruiting at the same rate as it has done. I should be grateful if hon. Members would recognise what the authority has already done.
718 The authority is considering the introduction of a supply register, effectively a bank of speech therapists, to cover temporary absences, including maternity leave. In this profession, as in any profession that employs a substantially large number of young women, such leave is a problem.
The regional authority is considering supporting a number of training places at Manchester polytechnic through the sponsorship of degree level students. The districts already co-operate with the polytechnic in providing training placements for the training school's three-year ordinary and four-year honours degree courses in speech therapy.
Speech therapy is an item on the agenda at the district health authorities chairmen's meeting on 22 January. They meet regularly and I am sure that that item has nothing to do with this Adjournment debate. South, Sefton, which is the authority with particular problems, is in active discussion with the regional health authority about how to overcome those problems. It is not satisfied that it has fully explored the possibilities through advertising and adopting a more flexible approach to posts. I am sure that those approaches will be valuable. I look forward to witnessing further improvements and I hope that the hon. Member for Mossley Hill will call another Adjournment debate in 1994 to congratulate the health authorities on what they have done.
We consider that speech therapists are most important. Their excellent work is well known and the results are spectacular. Pay is under consideration. The alarm raised about the Mersey regional health authority is a little bit exaggerated. It has done very well so far and if it is to achieve further growth it will need to be imaginative in its recruitment and training. We must all hope that discussions of those matters will come to a successful conclusion.
§ The Question having been proposed after Ten o'clock on Monday evening and the debate having continued for half an hour, MR. DEPUTY SPEAKER adjourned the House without Question put, pursuant to the Standing Order.
§ Adjourned accordingly at twelve minutes past Twelve o'clock.