HC Deb 15 January 1991 vol 183 cc827-32

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

10.24 pm
Ms. Hilary Armstrong (Durham, North-West)

The debate arises from specific problems in South West Durham health authority in ensuring that all school-age children for whom speech therapy is recognised as a need have access to appropriate therapy. My hon. Friend the Member for Bishop Auckland (Mr. Foster) and I wrote to the Minister requesting a meeting. The refusal of that request and the nature of the Minister's reply in health questions on 18 December prompted me to apply for the debate.

The areas of difficulty are clear in South West Durham, but I know that they are not unique to South West Durham. There is a shortage of speech therapists nationally which has been highlighted in the House on a number of occasions and in Government reports. There is a great drop-out rate from the profession—almost equal that of teachers—and much demoralisation which was exemplified in the evidence given in the equal value case pursued by Dr. Enderby and Mrs. Clark, and supported by my trade union, the Manufacturing, Science and Finance Union. I should make it clear that I am sponsored by that organisation, but that I am not speaking on its behalf tonight.

The position of children who are identified as part of a statement of educational need as requiring speech therapy is particularly difficult. If a health authority recognises that a child requires speech therapy but is unable to make it available, what happens? The response from the Under-Secretary of State for Education to a question from the hon. Member for Bolton, North-East (Mr. Thurnham) is not helpful. It says of the Court of Appeal ruling on the Lancashire case, as it is now known, that speech therapy could be considered either educational or non-educational provision. However, the ruling does not diminish health authorities' general responsibilities under the National Health Service Reorganisation Act 1973 to provide speech therapy, and it does not mean that education authorities are under any legal obligation to fund speech therapy."— [Official Report, 10 December 1990; Vol. 182, c. 288.] In other words, the Minister says that it is a responsibility of the Department of Health.

The general problems to which I have referred are highlighted in the South West Durham area. The health authority covers part of my constituency and part of that of my hon. Friend the Member for Bishop Auckland. Other Durham county Members have been involved in representations because of constituents who are affected.

In south west Durham the decision was taken nearly two years ago that the cover being given on a general referral basis was so inadequate that it was virtually useless. A decision was taken to prioritise. The process has highlighted serious deficiencies and made them clear to people seeking speech therapy, to general practitioners, and so on. It may be that other means would not have highlighted the shortages quite so much, but that is what happened in south west Durham. I know that there are severe problems in other parts of the country.

The system of priorities led to 409 children over five years of age being discharged from therapy. By now, that number has presumably increased. Those children were not referred on a whim. Speech therapy was identified as necessary to their learning.

I quote the case of five-year-old Andrew Wayman of Watling terrace, Willington. The report from the speech therapist, as part of the statementing process under the Education Act 1981, recommended that Andrew needs weekly speech therapy, a language programme devised by a speech therapist and implemented daily as part of his everyday routine by his teaching staff and parents and additional support in school to assist that work.

The need for speech therapy of that nature was subsequently confirmed in the statement issued on 3 August 1990. By that time, Andrew had received speech therapy four times, and his parents had been notified that he did not come within the priority system and therapy was being withdrawn. The local education authority has considered joint funding for speech therapy posts in the district health area. However, there are six health authorities within the Durham county council area and to provide posts for all those authorities would be exceptionally expensive at a time when the local education authority is having to reduce expenditure to comply with Government spending regulations.

Andrew's mother, Mrs. Wayman, is to be congratulated on her determination to get the very best for Andrew. She has co-operated with the authorities at every stage, but knows that Andrew and many others like him are simply denied the help that it is acknowledged they need. I am sure that I need not remind the Minister that Her Majesty's inspectorate's report on reading, published only last week, said that problems in getting prompt and sufficient specialist help for those children with severe reading difficulties deserved to be taken seriously. Those problems are taken seriously by parents like Mrs. Wayman, speech therapists and organisations such as the Association for All Speech Impaired Children, who know about the effect of lack of speech therapy.

This evening we are looking to the Government to demonstrate that they take the problems seriously and are prepared to do something about them.

Mr. Gerry Steinberg (City of Durham)

I suspect that the child of whom my hon. Friend is talking may well have attended or be attending the school in Spennymoor of which I was head teacher for nearly 10 years and which local children attended. I am absolutely appalled to find that that school now gets no speech therapy. There are children in my constituency who attend my ex-school whose parents have written to me. The policy of South West Durham health authority is that no child over five will receive speech therapy. It is an appalling disgrace that children in special education who desperately need speech therapy do not receive it from that health authority.

I hope that my hon. Friend will pursue the Minister tonight to get a solution to that problem that involves not only the Government, but the South West Durham health authority making more funds available so that more speech therapists can be employed.

Ms. Armstrong

My hon. Friend makes his points cogently. The child attends a special school now. When he was first identified, he was in the nursery class attached to Willington Church of England-aided school. The head told me when I visited the school that six of the 22 children in the class required speech therapy. South West Durham has allocated its priorities in such a way that, unless children between the ages of five and 16 have a specifically identified disability, they do not receive speech therapy.

It would be beyond my professional expertise to comment on whether the priorities that the authority has identified are the right ones, but I know about and can comment on the inadequacies in the service that those priorities have highlighted, and their serious consequences. I understand that the Government are funding a project with the College of Speech Therapists to compile standards for the future provision of speech therapy. When will that project be completed? Will the Government take prompt action on its completion to promote and secure those standards nationwide? Can the Minister outline the steps he will take to ensure that South West Durham upholds those standards and has the resources to do so?

My hon. Friend the Member for City of Durham (Mr. Steinberg) may be interested to know that South West Durham spends more per head of population on speech therapy than neighbouring Durham and North West Durham. Yet it still faces enormous difficulties which leave constituents with problems that they should not have to face.

Will the Government initiate urgent discussions with the Department of Education and Science to sort out the unholy mess surrounding responsibility for speech therapy for children with special educational needs? The Government must recognise their responsibility in this area. Ever since the Education Act 1981, the issue has been tossed around between Departments. Numerous people and organisations have contacted me in the past few days, some of them disputing the interpretation of the decision of the Court of Appeal by a Minister in the Department of Education and Science. It is critical that Departments work together so that parents are not left in the indescribable position of being told by one Department that the matter is the responsibility of another. They are often left in the middle, feeling that they have let their children down even though it is not their fault.

Children such as Andrew Wayman do not have a second chance. Children should not have to look for a second chance; we should give them the best possible chance first time around. This is a pressing issue for South West Durham, and I hope that the Government will commit themselves to ensuring that children get the therapy they need, when they need it.

10.38 pm
The Parliamentary Under-Secretary of State for Health (Mr. Stephen Dorrell)

First, I apologise to the hon. Member for Durham, North-West (Ms. Armstrong) for the fact that she sought a meeting with me and, due to a misunderstanding in the Department, that was, not explicitly, but by implication, refused. If a meeting is sought by an hon. Member, my policy is to agree to it and I apologise for the fact that the impression was given that I was refusing to meet her on a issue where there is rather less division between her and the Government than perhaps our actions and her words might lead people to believe.

In reality, there is no dispute at all between the hon. Lady and the Government and between the Government and the speech therapy profession about the value of the speech therapy service to the users of it. It is a key service which has been developing quite fast within the national health service since 1979, during the period for which the Government are responsible, and that is because we recognise that it is a service which offers opportunities to people to develop or to rediscover a key life skill, and is, therefore, an important part of a comprehensive system of health care.

Understandably, in the context of the pattern of provision in South West Durham, the hon. Lady has concentrated on the importance of speech therapy to children between the ages of five and 16, but I am sure that she would be the first to acknowledge that that is not the only client group for whom speech therapy holds important benefits. Another client group that is often quoted and for which speech therapy holds particular benefits is stroke victims. The Government recognise and, as I shall seek to show, have developed the speech therapy service against the background of the recognition of the value of speech therapy in terms of developing life skills or of rediscovering them after the victim has suffered a stroke.

The best evidence of the Government's commitment to the importance of speech therapy is to be found in the Government's record since 1979 in committing resources to the development of speech therapy and in the employment of speech therapists within the NHS. The revenue expenditure on speech therapy services in England has risen by 120 per cent. in real terms during the past 12 years, with the result that in March 1990 we were employing 2,856 whole-time equivalent speech therapists in the NHS, compared with 1,510 12 years earlier. That is an increase in the number and capacity of the speech therapy arm of the NHS of 89 per cent. during the period for which the Government have been responsible.

We can demonstrate not only in words but in actions that there is no division about the importance of speech therapy and the benefits that speech therapy can offer. That is not to say, of course, that all the problems have been solved, and I shall deal with that in a moment.

Mr. Steinberg

A constituent of mine whose child was attending my ex-school received a letter which said: Due to the ever-increasing demands on the speech therapy service, South West Durham health authority has to implement a policy whereby we provide therapy only to children under five years of age. Although your child may still require help with his speech and language, unfortunately we are unable to offer him speech therapy and his name has been taken off our lists. That is abominable and disgraceful. We must do something about it, whether that means the health authority or the Government allocating more resources or more speech therapists being trained.

Mr. Dorrell

With great respect to the hon. Gentleman, it would help the House if he allowed me to make my speech. He should agree that his intervention did not take the argument much beyond the points that were clearly made by his hon. Friend the Member for Durham, North-West. I was seeking to demonstrate that the Government do not need persuading of the importance of speech therapy. We also recognise that further progress needs to be made in the development of the service from the position in which we now find ourselves.

The service is significantly more developed than it was 12 years ago, but clearly further steps must be taken. The health service currently employs six speech therapists per 100,000 of population. As the hon. Lady came close to saying, that is roughly the ratio of speech therapists employed in South Durham. The Davies and Enderby study argued that there is a need for a significant increase, and pointed out the opportunities that exist for using skilled speech therapists more effectively than present delivery patterns allow, by making proper use of assistants, ensuring that skills are accurately targeted at those who need them most, and making certain that the therapist has the skill necessary to meet the needs of a particular patient.

We take all those factors on board and they form part of the speech therapy service's long-term planning. Also, we are currently reviewing the pay and grading system used in the employment of speech therapists against the background of the undoubted difficulties encountered in some areas of recruiting people of adequate skill. We have not only a record that demonstrates the importance that we recognise should be attached to speech therapy but plans to take the service further as resources become available, as part of a growing national health service.

We acknowledge the national need to develop the service and, as the hon. Lady knows, it is part of the NHS's management structure to define broad national objectives but to leave the design of the delivery of the service to local health authorities, because they have a degree of knowledge about the circumstances of a particular locality that cannot possibly be matched by the service's central management at Richmond house. We seek to encourage delegation of management decision-making because we believe that is by far the best way of providing for the effective use of resources in meeting identified health needs within a particular district.

The hon. Lady asked me to comment on the question of who has responsibility for the provision of speech therapy services. Although she may understandably feel, in the light of certain recent cases, some uncertainty in that respect, we are clear now that the primary responsibility rests with the national health service. It is a health issue. Ministers at both my Department and the Department of Education and Science, as well as the Council of Local Education Authorities, agree that prime responsibility for speech therapy should remain with district health authorities, in respect both of children with special educational needs and the generality of patients.

I do not seek to shuffle off responsibility for the service. It would be odd if I did, because it has developed significantly under this Government's period in office and is much more complete now, in terms of the service that it provides, than it was some years ago. We plan to develop it further, because we recognise the opportunities that exist for the effective use of resources in the speech therapy service.

I was keen to put that general picture on the record because it is important for it to be understood that the Government do not have an equivocal attitude towards the service. It is true that, in respect of the speech therapy service—as with all others within the health service, and as with the rest of private and public sector provision—there will always be choices to be made between relative priorities. We shall always want to develop it and other services faster than resources allow and, for resource reasons, we shall always have to put the brakes on the service's rate of development. However, we have developed the service and we fully intend that, against the background of a growing national health service, it should continue to develop.

I shall now comment on circumstances in the South West Durham health authority. It is important that the national health service should be run on the basis that general guidelines and, more important, general health objectives are agreed at the centre, and the delivery and design of the service in a particular locality are left to managers there, who are far better placed to decide the detailed design of the service for their area than are Ministers in Whitehall.

The service that the hon. Member for Durham, North-West has described is significantly different from the type of service provided in the generality of health districts. Health authorities have a responsibility to provide, within available resources, a speech therapy service to meet the needs of all their local population.

I am pleased to say that, to ensure the most effective and efficient delivery of speech therapy services in South West Durham, the district health authority has now invited the Department's speech therapy officer to review provision of that service within the area, probably with a professional colleague from outside the Department.

I hope that the hon. Lady will take that as evidence of our desire to ensure that the design of speech therapy services in that health district conforms with a proper national expectation of the sort of speech therapy service that we want to be delivered there and elsewhere in the country. It is not an indication that the health authority has, to put it crudely, got it wrong, but simply a desire to ensure that, in using the scarce resources at its disposal, the health authority either has produced or will produce a design for the speech therapy service that meets the proper expectations that people have for that service, against the background of a health service which is committed to the development of speech therapy services and fully understands the benefit that it can bring to patient groups.

Question put and agreed to.

Adjourned accordingly at nine minutes to Eleven o'clock.