§ 3.1 p.m.
§ LORD SEGAL rose to call attention to the problems of handicapped children, and in particular, to the problems likely to arise from the transfer of the education and training of mentally-handicapped children to the Department of Education and Science; and to move for Papers. The noble Lord said: My Lords, I rise to move the Motion standing in my name on the Order Paper. This Motion deals specifically with children, and covers the whole field of the physically and the mentally handicapped children as well as the complicated groups who are at the same time handicapped both mentally and physically. Enormous advances have been made in recent years in providing for the treatment and rehabilitation of the physically handicapped. Of their problems I shall say very little to-day: that field can best be left to other speakers who will follow me and who can speak on the subject with greater authority
§ But first I should like to say with what intense pleasure we look forward to the maiden speech of the noble Lord, Lord Maybray-King. He has chosen to speak on a subject which is very dear to his own heart, and we all know how generous and warm a heart it is. To us, he has symbolised that great virtue of patience, which so often has to be endured by mentally handicapped children throughout their lives. And we can well imagine his feelings to-day, after having had to listen to countless—I almost said endless—maiden speeches in another place, now at last to be able to make a maiden speech of his own in the slightly more serene atmosphere of your Lordships' House. We welcome him most warmly this afternoon
§ we look forward also to hearing from others who can speak from a wealth of experience in their own special fields. In particular, I would draw your Lordships' attention to that extremely valuable Report entitled Living with Handicap, produced by the Working Party on Children, set up by the National Children's Bureau in October, 1967. This Working Party began under the distinguished chairmanship of my noble friend Lady Serota, and reported in 1970. 328 Its Report was put down for debate in this House in a Motion under the name of the noble Baroness, Lady Elliot of Harwood. It was by the mere chance of an incident last June that I find myself now on this side of the House. And I suppose, it was equally by the luck of the draw that to-day's debate should have fallen to an Opposition Motion. I am grateful to my own Front Bench for widening the scope of this debate to encompass also the Motion standing in the name of the noble Baroness, Lady Elliot of Harwood. We are delighted to have both Lady Serota and the noble Baroness, Lady Elliot of Harwood, among our speakers this afternoon, and we look forward eagerly to their contributions to the debate. In addition, we have on our list the noble Baroness, Lady Phillips, who while in office rendered such distinguished service to the cause of mentally handicapped children, and both the noble Lords, Lord Stoneham and Lord Grenfell, who have, for so many years, rendered valuable services to the National Society for Mentally Handicapped Children.
§ To-day also happens to be the first opportunity since the appointed day, April 1, of inviting the Government to lay bare its soul, without fear and without reproach, on its intentions with regard to the Education (Handicapped Children's) Act. This was an Act fathered originally by my own Party in April, 1970, and gently handed over to the care of its foster parent, the present Government, after the incident last June to which I have already referred. May I add, however, that after the sustained exchanges of the past two days we have come into this House, unlike Balaam in the Bible story, not to curse but to bless We hope at the end of the day that our blessings will still remain on behalf of those countless children who stand in need of the Government's help.
§ There are quite a few questions that I should like to ask of the Government, of which they have had previous notice. It has been estimated that, on the appointed day. the educational charge of some 25,000 additional mentally handicapped children will have been transferred to the Department of Education and Science. These are the children from the junior training centres. If this number is added to the 62,000 mentally handicapped children now receiving 329 special education, the total will amount to over 87,000 children—a figure which still excludes all mentally handicapped children below the age of 5 years. How will the teaching needs of these extra 25,000 children he met? What provision will be made for the training of the extra teachers required? And I unhesitatingly place the training of teachers at the head of my list of questions, because all of the Government's good intentions must stand or fall on this crucial issue.
§ Will there be enough trained teachers to make a success of this transfer, not only enough to replace the losses by retirement but also to recruit the extra teachers needed? What type of training will these teachers be given? Will it combine special teacher training with some degree of nursing skill and some knowledge of the signs of mental retardation in children? Will refresher courses be organised for those who are already teaching? How far will the recommendations of the Working Party on the status and salary scales be implemented? Will the salary scales be adequate to attract the extra number of teachers required for special training?
§ Secondly, what provisions will be made for the training of ancillary staffs, of the extra nursing assistants, and of welfare assistants? And how many of these are to be recruited? Thirdly, what kind of assessment scheme is envisaged? Will consultants be obtained in sufficient numbers to assess the educational capacity of each child? Will there be any access to educational psychologists? Will neurologists be brought in to advise where skilled diagnosis of organic disease is called for? Will speech therapists be available in sufficient numbers? What provision will be made for physiotherapists, play therapists, occupational therapists and teachers of the deaf?
§ Fourthly, will a new concept of specialised buildings be made available? What building programme is envisaged and how long will it take? Fifthly, since the education of these children is, of necessity. Slower, will their educational programme begin earlier? Will educational provision be made at pre-nursery stage, from the age of 3 or earlier, where a special examination shows that the child is likely to be mentally retarded? What provision can be made for a special 330 Examination to be held around the age of 2 where the parents or the general practitioner have reason to believe that a child may be mentally retarded?
§ Sixthly, at the other end of the scale, what provision will be made, after the age of 16, for those children who are still able to benefit from further education, either full or part-time, up to the age of 19? And where the need for vocational training is clearly obvious, how will the Department of Education and Science dovetail into the Department of Employment and Productivity? What special provision will be made for continued education even beyond the age of 19, where the child can clearly benefit?
§ Seventhly, what provision will be made for special care units where the child needs extra-sensory education and special training'? Eighthly, how far is an extension planned of special schools within hospitals, and how far, in certain cases, will physically handicapped children be educated in hospital, or conveyed from hospital to special training units in specially adapted vehicles? Ninthly, to what extent will parent-teacher association be developed with the parents of mentally handicapped children, and what plans will be organised for parent counseling once the child's special education has begun'? Tenthly and finally, how far will a change of community atmosphere be developed, and how will the responsibility for the training of these children be shared with outside organisations, especially the clubs and play centres set up by voluntary organisations, to enable mentally handicapped children to take their rightful place in the life of the community?
§ I think this decalogue of questions is enough to ask of the Government in their opening statement; but these are only some of the problems preoccupying the minds of tens of thousands of parents of mentally handicapped children at the present time. The whole problem of the mentally retarded child is totally different from that of mental illness, where modern methods of treatment can often effect a marked degree of improvement. The mentally handicapped child has to learn to live with his handicap and also to adjust himself to the world outside. He has to acquire, within his limited capabilities, whatever skills or aptitudes can 331 be taught to him by the concentrated attention of a highly trained teacher.
§ Why are so many hopes now centered on this transfer from the Department of Health to the Department of Education and Science? We have first to acknowledge the enormous debt we owe to the nursing staffs of our special hospitals who have given such devoted service to our mentally handicapped children over the years. These services are often rendered under appalling conditions, in buildings long out-of-date and ill-adapted for a long-term stay, especially where children are concerned. Whatever changes are made in improving the lot of the children must necessarily radiate out from these hospitals, and with the active co-operation of these staffs.
§ These changes must henceforth be child-orientated, assessed in terms of the special needs of each individual child and not of the institution in which he is housed. It is well-known that a certain proportion of children still in our large hospitals to-day respond far better if housed in smaller units. Here the person in charge can devote all her time to the study of the children's personality pattern, train them to do their own feeding and toileting, encourage them to take a pride in their own clothes, to have their own pictures and toys, to have access to privacy in moments when they need it, and to strengthen the tics of affection that hind them to their family circle.
§ If I may here digress for a moment, I would say that we often fail to realize how fortunate we are in this country in our hospitals, our social services and our voluntary organisations. Although there is no room at all for complacency we are, nevertheless, too apt to form our impressions as a result of some isolated exposure or from sensational headlines in the Press. But, after having visited many children's institutions in four Continents, I would say what a relief it is to get back to this country and to see here how we care for the welfare of our children.
§ Only two months ago I saw in a large orphanage out in the Far East handicapped children crawling around the floor in all stages of neglect, many with limbs in ill-fitting splints, or in plaster casts that caused them the utmost discomfort. One of these children, a bright-eyed boy 332 of eight, had his right leg flexed at both the hip and knee in almost complete contracture. Yet, on bending down to try and extend it, with a little persuasion the leg straightened out quite easily, and then flexed back almost immediately into its more comfortable position of complete contracture. That child, unless treated very soon, will grow tip into a hopeless cripple, a burden to himself and to the community.
§ In another hospital, I saw a boy of seven, a severe case of mental retardation, who was devotedly cared for by doctors and nurses. On asking whether the parents came to visit him often I was told, "Parents! We don't know who the parents are. That child was found abandoned in the streets four years ago and picked up by a compassionate passer-by". Those unknown parents can go on breeding more and more mentally retarded children without any restraint, and the thought came to my mind: it only that country, and every other country, could have an organisation of parents such as we have here in England in our National Society for Mentally Handicapped Children—of parents who care for their own children and for the handicapped children of others, how much more could be done to prevent unnecessary misery and suffering in the world!
§ My Lords, there is a limit as to how far the State can sometimes intervene, and our own voluntary organisations are quite irreplaceable. How fortunate we are to have in this country the devotion and dedication of these voluntary workers, with all their limitations, who are able to help others in need, to subsidise research and to see that the wider public are made aware of the needs of our handicapped children.
§ What are these basic needs to which every child, whether handicapped or normal, is entitled as a matter of right? First, the need to receive, as well as to give, affection Secondly, not to be excluded from the world outside; to have access to some of the joys of colour and music and to the beauties of nature. Thirdly, a right to education—to an education geared to these children's needs, however modest and undemanding, but enabling them to achieve their own desire for self-fulfillment. Fourthly, the need of a training to equip them to lead a useful, 333 self-respecting life, and to enable them to take their rightful place in the life of the community. Let us remember that, as they grow into adult life, the links with their parents and home will gradually fade away and be broken. But they themselves will still have to struggle on, denied the chances of a normal home life, which other children can achieve.
§ In conclusion, my Lords, we hope that the Department of Education and Science, on taking over its new responsibilities, will not be merely a new name affixed to an old problem and trailing along in the wake of public opinion. Instead, we all hope that the Department will be able to give a new lead and help to create a better future for all our handicapped children. My Lords, I beg to move for Papers.
§ 3.21 p.m.
§ THE PARLIAMENTARY UNDERSECRETARY OF STATE, DEPARTMENT OF EDUCATION AND SCIENCE (LORD BELSTEAD)
My Lords, the House is grateful to the noble Lord, Lord Segal, not least because he brings to our debate to-day different Members of this House. The noble Baroness, Lady Serota, will be speaking later in the debate. As a former Minister of State, her interest and expertise in child care, and her chairmanship at the outset of the Working Party on Living with Handicap, ensure that the House will be listening with great attention to the noble Baroness, as of course to her colleague Lady Phillips. On this side of the House, the Department of Education and Science and the Department of Health and Social Security, in the shape of my noble friend Lord Aberdare and myself, will be attempting to reply to the debate, about which so many people feel so deeply and about which there is a great deal of expertise. Then there are many other noble Lords who are interested in this subject, not least Members of this House who represent the devoted work of the voluntary organizations—and, of course, the noble Lord. Lord Segal, himself is Chairman of the National Society for Mentally Handicapped Children.
The whole House, as has been quite obvious from the speech of Lord Segal, is very pleased to welcome to-day the noble Lord, Lord Maybray-King. Noble Lords speaking to-day in particular appreciate that it is with his very long teach- 334 ing experience, which goes over many more years than many Members of this House perhaps realise, and with his very close interest in this field, that the noble Lord has decided to make his maiden speech on this subject to-day.
When your Lordships debated the Second Reading of the Education (Handicapped Children) Bill the noble Lord, Lord Segal, expressed the hope that the Department of Education and Science would see that the intentions of the Act were carried Alto effect with all speed. It is those wishes which the noble Lord has reiterated to-day. What has taken place, I would suggest, is not a mere transfer of functions between two Departments. April 1 marked the birth of a completely new responsibility: to educate some 35,000 children who were previously regarded as unsuitable for education. The foundations of a good service have been well and truly laid by the Department of Health and Social Security and the local health authorities. Several supervisors of former junior training centres have been asked by officials at the Department of Education and Science what was the greatest benefit that they might expect to derive from a new set-up. Their reply has been expressed, not in terms of buildings or staff, important though these are, but in terms of the educational advice and resources that should be available to them, perhaps in some cases for the first time. It is bound to be not a quick process for this advice and these resources to permeate the new special schools.
To prepare, a great deal of planning and administrative action has been taken. Over 400 new special schools have been formed out of former junior training centres and hospital schools. The number of existing special schools and the number of handicapped children already in special schools are small in comparison with the number of ordinary schools and the children in them; but the new recruits add as much as two-fifths to the special schools and nearly one-third to the handicapped children who are in attendance in them. My Department and the Department of Health and Social Security have issued several documents to clarify the position of staff and property being transferred and of independent establishments for mentally handicapped children. The Department of Education and 335 science also organised a very successful conference at Harrogate in February, which was attended by representatives of 129 local education authorities and was designed to provide an opportunity for them to discuss the problems arising out of the new responsibility. If in speaking to-day I do not refer to many of the "nuts and bolts" problems which were discussed at Harrogate at that time, it really does not mean that these have not been uppermost in the minds of those at the Department of Education and Science. I shall be listening carefully, on behalf of my right honourable friend, to any problems of this kind which noble Lords will be raising during this debate.
We have been particularly concerned to ensure that the arrangements about the status and pay of teaching staff operative from April 1 were notified to local education authorities before that date. And here I come to the first of quite a long line of questions which the noble Lord, Lord Segal, put. I think we may regard the arrangements which have been made as not only just but often generous. I should like here to pay tribute to the helpfulness and understanding of the representatives of the transferred and the existing teachers in arriving at and accepting these solutions. Both status and salary are safeguarded in the following ways. About 40 per cent of the staff of the former training centres posses the Diploma in the Teaching of Mentally Handicapped Children. So of course they are recognized as fully qualified to teach these children. Now they will be able to teach in any maintained special school and will be paid on the Burnham qualified teacher scale. Those who have already completed five years' satisfactory post-Diploma service on the date of transfer—and there are some hundreds of them—are at once eligible for qualified teacher status in the technical sense as well as pay, including the special school addition, and will be able to serve in any maintained school. The other Diploma holders will become eligible for qualified teacher status on completion of five years' satisfactory service, unless of course they have opted, as indeed some are opting at the moment, for the conversion one-year courses. Those who continue in maintained special schools will become entitled to the special schools addition.
336 At the time of the Second Reading of the Bill of last year, the Government recognised that there had been some controversy about the length of service which should be required before technical qualified teacher status can be attained. I said, at my right honourable friend's request, that the Department had put in hand consultations with the bodies concerned about the possibility of fixing a rather shorter period. The decision to pay Diploma holders on the Burnham qualified teacher scale immediately represented an advance on previous thinking; and thanks are due to those in this House who represented the claims of these teachers—not least my noble friend Lord Aberdare, and the noble Lords, Lord Grenfell, Lord Segal himself, and Lord Beaumont of Whitley. In the event, it became apparent that any move to improve the proposals still further in the interests of the transferred staff could prejudice their acceptance into the education service.
The period for qualified teacher status has thus remained at five years from the date of gaining the Diploma. I think it is fair to say that teachers of the mentally handicapped recognise that the proposals, taken as a whole, should be accepted. Holders of the declaration of recognition will be eligible for qualified teacher status when they have completed five years' teaching in maintained special schools, and many transferred staff, particularly the heads of the new special schools, will receive a substantial increase in pay; the prospect of a significantly higher maximum for all the transferred teaching staff will of course now be included in the forthcoming Burnham negotiations.
The noble Lord, Lord Segal, inquired about the training which teachers are going to undergo in future, and this was a matter to which the Working Party on Living with Handicap drew attention; and the noble Lord spoke of "extra teachers" being needed. Staffing ratios in the former junior training centres average one to nine, but none the less our plans for training provide a substantial number of new recruits to work in this field. Some 300 teachers of mentally handicapped children have been gaining the Training Council's diploma each year. Of these about 200 were doing the two-year course and about 100 were doing the one-year course. From now on 337 the normal pattern of training will be the three-year initial teacher training course in a college or department of education with a special emphasis on mental handicap. By 1970 six of these courses had been established, offering 125 places.
In preparing for the change care has been taken to ensure that the addition of the extra one year to the normal training period under the Diploma scheme will not lead to a drop in the number of trained staff during the transitional period. This has been achieved by continuing the Diploma course side by side with the three-year initial teacher training course for just a few years, and it is expected that the last Diploma holders will emerge in 1973. May I take this opportunity to acknowledge the work of the Training Council, from which of course the education services will now be benefiting The Council has been most helpful in co-operating on the new training arrangement which I have just described, and will of course be continuing its valuable work in the adult field.
In 1969 and 1970 Diploma courses of both types recruited about 300 students each year. By September, 1971—that is next September—there will be 12 of the three-year courses and they will also be recruiting about 300, but this will represent a gain in real terms because the Diploma recruits come mainly from within the service, whereas the majority of the three-year course recruits come mainly from outside the service—at least from outside the teaching of the mentally handicapped. Proposals for more courses in subsequent years are already under consideration and it is likely that at least two more will begin recruitment in 1972 and more can be established as the need arises. There will also be some who are at present employed as teachers and who will not be able to obtain qualified teacher status. My Department appreciates their work—
§ LORD STONHAM
My Lords, will the noble Lord allow me to interrupt him, please? Can he say what is the target figure for the annual outturn of special teachers? Also the course they have, and the additional courses which are projected—some are short and some are long courses? Also how many specially trained teachers are likely to be provided each year?
§ LORD BELSTEAD
No, my Lords, not off the cuff, I am afraid, but I think I can feed the information to the noble Lord. Really the noble Lord, Lord Stoneham, is asking me to go on to a new subject, namely, part-time training, to which I was going to refer somewhat briefly. I was hoping that the House would be more interested in the major factor here, which of course is the changeover from the Diploma to the three-year course. But I will certainly get the information for the noble Lord. This of course takes into account that the present training arrangements which were in existence before April 1 will not drop.
Referring to the teachers who are not qualified, I was saying that my Department appreciates their work and it intends to make some special provision for these teachers in its future programme of short courses. I hope that local education authorities will also bear in mind the special needs of this group for in-service training. It is a striking tribute to the enterprise of D.H.S.S. and the local health authorities that out of about 360 training centres in January, 1971, some 250 were purpose-built. Nevertheless, a number of former training centres are housed in premises which perhaps are less than suitable, and in the coming year the staff of the Department of Education and Science will be making some sort of survey of the premises of the new schools. In the meantime we have taken over from the Department of Health and Social Security—and again this is a question which the noble Lord asked me—and will make available to local education authorities allocations which come a little short of £1 million for each of the years 1971–72 and 1972–73.
From 1973–74 onwards building projects for the new special schools will be integrated into the general special schools programme. A small Working Party, involving the architects and building branch of the Department and Her Majesty's Inspectors, is investigating the particular needs of children suffering from severe mental handicap Noble Lords with far greater experience than I will know only too well that one has only to visit to see that perhaps one of the greatest needs of these children, when one is designing, is space. Unfortunately, as we made clear in our Circular of July of last year, we have to keep within cost 339 limits, both within the Department of Health and Social Security and within the Department of Education and Science For this reason, at the moment no development projects are planned; but the intention is to draw up guidelines for the planning of new schools and units and to make them available to authorities.
I now come to special care units and the expansion of existing schools within hospitals for the mentally handicapped, which the noble Lord, Lord Segal, specifically asked about. We are anxious that, so far as possible, special care units should be attached to special schools and should cease to have a separate identity within them. We feel that this would signalise the fact that children requiring special care need education too, just like the other children in a former training centre. In hospitals it has been estimated that just about half the 8,000 or so children have been attending a school. Reaching the children who have not received any education up to now will present a big challenge to local education authorities. Under the Act, inescapably, the head of a hospital school from now onwards will be concerned with providing education on the wards as well as teaching the children who come to the classrooms. Progress can be achieved only through the closest understanding and co-operation between the education service and the hospital authorities, who of course remain responsible for the care of the children.
If the hospital schools can and will arrange the stimulation for these children from which, after all, education for all young children springs, and if educational assessment is added to the medical care and the medical assessment which children now receive, then it may be that the Act really will break new ground (to which the noble Lord, Lord Segal, drew attention) at many points, not least in the extra personal supervision which could be given, and the opportunities for children to be able to go outside the hospital for their education, which is the desire of us all.
My noble friend Lord Aberdare will be speaking about the varied needs of the assessment services and I hope, too, about counseling. I would only say that medical assessment has always 340 seemed to me to be the first vital step, but following the Summerfield Report, steps are being taken to train more educational psychologists. Local education authorities already employ educational psychologists, speech therapists and physiotherapists, and the services of these people are essential to many children in special schools.
Your Lordships may remember that last autumn the Department of Education and Science and Her Majesty's Inspectors published a survey on diagnostic and assessment units. It was apparent from that survey that few of the children who were actually entering these units had disorders which had not already been diagnosed. None the less the value of the work within the units was recognised, but the striking point of the survey was the evidence from the lips of teachers themselves that the work of continuing assessment with a wide range of disabilities needed the support of medical advice. April 1 does not signal a transfer: it is the beginning of an attempt to add the services of education to all that has been done and will be done, and Her Majesty's Government enormously appreciate the co-operation between local education authorities and their colleagues in health and in the hospitals, to see that in the interests of the children the new plans get off to the best possible start.
There is no legal difficulty about examining children at any age from 2 onwards, or in making education provision for them. Section 34 of the 1944 Education Act places a duty upon local education authorities to ascertain the children of 2 years of age and over who require special educational treatment; and authorities have to comply with a request from parents that their children should be medically examined. There are, however, I must admit to your Lordships, at present very few school places available for handicapped children below the age of 5, except for the blind and the deaf. My right honourable friend is reviewing the whole question of the provision of nursery education, and takes very seriously the remarks which have been made on this subject in Living With Handicap and we are taking very much into account the needs of the handicapped as well as of the ordinary child.
341 At the other end of the scale, boys and girls can legally stay at school until their 19th birthday. This again was a subject of which the noble Lord, Lord Segal, spoke. Some will be making much more rapid educational progress than before in their late teens. In many cases might it not be better for these young people to move into a more adult environment before the age of 19? Local education authorities have the power to provide further education that—is technically what it is—for mentally handicapped young people, either in a college of further education or, by arrangement, in an adult training centre. I hope and believe that the assumption by local education authorities of responsibility for the former junior training centres will throw into sharper relief the educational potential of some children suffering from severe mental handicap, and will stimulate the authorities to increase and diversify further educational provision for them. In the main, the training of persons in adult training centres will continue to be the responsibility of the staff of those centres, who from April 1 are employed by the social services department of local authorities.
On various occasions some of your Lordships have made it clear that it is a disservice to parents to view the subject of this debate to-day through rose-coloured glasses, but let us reflect that handicapped children are not the only people to be deprived. There are homes in which there is no conversation, no ideas, no books, where people, it may be said, are culturally deprived. They may he spiritually deprived. Many are deprived of the support of family and of home. For none of them would anyone suggest that possible relief or opportunity should simply pass by on the other side. Parliament has taken the view that the best opportunities for these children he in an alliance of the services of health and education and, of course, the new social services committees, and now it is up to us all to justify that view.
§ 3.43 p.m.
§ LORD MAYBRAY-KING
My Lords, perhaps the House will appreciate the more than usual trepidation with which the former Speaker of another place ventures to make his maiden speech, asks for your indulgence and, to paraphrase what, in another capacity, he used to ask 342 for in this very House, "the most favourable construction" on what he has to say. May I add, in opening, that I have been deeply moved by the speech of my noble friend Lord Segal and the encouraging progress report of the noble Lord, Lord Belstead.
My Lords, I have no expert advice to offer. My only qualification to speak is a lifelong interest in children, and especially in handicapped children. I want to paint a broad, constructive picture this afternoon. I believe that the hallmark of a good society is to be found in what it does for the less fortunate: the very old, the very young, the sick and the less than normal. We have advanced along the good road during my long life. It is worth remembering that centuries ago the deformed and the handicapped were figures of fun; that kings and princes kept them at their courts for amusement, and that less than 100 years ago deaf people were regarded as mentally defective.
All through history, however, there have been wonderful people who have devoted themselves voluntarily to easing the burdens of the handicapped. Teaching of the deaf and dumb, first by writing, then by sign language and lip reading, developed at the turn of the 18th century. The great Frenchman, Abbé Lépée pioneered in this field at the time of the French Revolution. And then, at long last, in Britain, the State came in, and at the turn of the last century education for the deaf and dumb became compulsory.
Similarly in the case of the blind, civilization is eternally indebted to another Frenchman, Braille, who invented an alphabet now worldwide in its use. Again the story is the same: first voluntary work, then the State here stepping in and accepting responsibility for the welfare and education of the blind. Helen Keller, blind, deaf and dumb, surmounted all three obstacles with the help of an even greater woman. Miss Sullivan; and their joint triumph inspired much of the massive progress that we have made in this field of multiple handicap As for orthopædics, I think, for example, of the great Treloar Hospital in Hampshire. In these great orthopedic institutions we are 343 tackling the problems of preventing children from remaining cripples. So it is true to say that we are indeed to some extent helping the dumb to speak, the blind to see, and the lame to walk.
It is against that background of voluntary work, followed by State intervention, and then, gloriously, State and voluntary workers co-operating, existing side by side, that I want us to look at the problems of the mentally handicapped. I share the view expressed by the noble Lord, Lord Segal, that we have already achieved much. In my lifetime we have separated the different kinds of mental handicap. When I was a boy they were all just the same: just mental, just handicapped. We now recognise the spastic, the epileptic, the autistic, the spina bifida children, the psychologically or emotionally maladjusted, the mirror-sighted, the mentally retarded. Each group presents different problems, each now the subject of research into teaching methods, into early diagnosis, into treatment, into examination of the causes, and some day, one would hope, into prevention and perhaps even cure.
In a splendid Act of Parliament last year, some of my friends in another place, led by Mr. Alfred Morris, helped by a team of devotees in both Houses, have set out the rights of the disabled Now we complement that Act by saying that this month the responsibility of the mentally handicapped child shall be placed entirely in the hands of the educational authorities. This is no magic wand; certainly it is no criticism of the wonderful work that all of us have seen done for children in our mental hospitals. But it is a declaration of faith. We are saying that there is no such person as an ineducable child. In the State of Ohio they have a definition of the subnormal child as "One who is usually normal in all respects except one". For all of them are children. I have seen too many severely handicapped children to have any illusions about the magnitude of the problem. But the goal is a clear one: to give every child, however handicapped, the fullest opportunities to get the best he can out of life.
My Lords, we need more teachers specially trained to cope with the problems of the handicapped, and I am delighted to hear from the Minister of the 344 progress that we are making in this field. We have long passed the day, when I was a young teacher, when the able teacher taught only the able child. We now realise that the teaching of the average and under-average requires much greater skill than the teaching of the brilliant sixth-former. We need more research into the causes and treatment of mental disabilities. My friend, the eminent surgeon, Mr. Zachary, is working on the problem of spina bifida, and he holds the belief that if this complaint in a child is diagnosed early enough, within hours of birth, perhaps even before, surgical treatment may provide the remedy. In every other field of handicap the same research is going on.
We need more special schools; we need more occupation centres. It is to be my joy to-morrow to see a boy of 23 with the brain of a three-year-old—a boy who cannot speak—going back happily to the occupation centre to which he goes day by day. I know the wonderful work going on in the limited number of special schools and occupational centres that we have. We need more of each. But whatever the State can do, this needs always to be supplemented by voluntary effort. There is no conflict between the State and the good will of people. We need more people to join the vast group of people up and down this country who care.
Let me illustrate this point. Some years ago a few Jews who had mentally handicapped children bought a house. They got one person to look after the house, and set up a home for their mentally handicapped children. This is now "Ravenswood". I can never forget making an appeal at a dinner for what is now a marvelous institution and having handed to me that night gifts totaling over £70,000—not from parents of handicapped children, but from parents of normal children, and even from normal children themselves who wished to help others. I think also of a voluntary home up in Sunderland. There, mothers bring in mentally handicapped children to be looked after by a few volunteer adults for a few hours so that the mothers can have a rest from their 24-hour burden. I was very proud, when I visited that home last year, to see girls from our secondary schools, and girls from shops and offices, giving their spare time in the 345 evenings to look after handicapped children.
In my own city we have nearly a dozen voluntary societies where parents can share their problems and help each other, and where friends can raise funds: one such fund to provide holidays for children so that mother can have a rest; one, very successful at the moment, to set up a centre for autistic children—and how great is the problem of the parents with autistic children! Up and down the country, my Lords, these societies, and groups like Rotary, Lions, and the Round Table, are lending a hand. Every mental hospital has its group of friends, just as every hospital in the country has its group of friends—proving that when you establish State intervention you do not dry up the wells of human kindness. This is perhaps the heart of what I wish to say. I know mothers with children of 20 or 30 years of age but with mental ages of three or four. It is impossible to describe, to pay enough tribute to, the love which these mothers lavish on their children; and anything that society, or individuals, can do to bear some of the burden which these mothers carry night and day we should count it a privilege to do.
Fortunately, the mentally handicapped are not unhappy; it is the parent who needs help as much as the child. As the noble Lord, Lord Segal, rightly pointed out, we have made much progress; but the need for educational advance in this field is urgent. A child has only one childhood. Whatever children lose during their childhood in the way of education they lose for all time. I am indeed grateful to the noble Lord, Lord Segal, not only for raising this topic to-day, not only for his moving speech, but for his own great life's work for the mentally handicapped. I know that thousands of parents, including some who are Members of either House, will be grateful to him for having raised this topic for debate to-day.
My Lords, when I look back on the progress that we have made in the first hundred years of State education for the able, for the average, and for some subnormal children, I am confident that the next 50 years will indeed be happier and more fruitful years for the handicapped children and for their wonderful parents. As has happened with the blind, the deaf 346 and the dumb, the pattern will be the same: State effort, reinforced by the help of loving and generous voluntary workers. I have often said that Parents with normal children ought to thank God for their good fortune, and the way to thank Him is by helping those whose burden is such a heavy one.
§ 3.56 p.m.
§ BARONESS PHILLIPS
My Lords, a great privilege falls to my lot; the privilege of complimenting the noble Lord. Lord Maybray-King, a most distinguished addition to your Lordships' House, on his very sympathetic, wise and touching maiden speech. I am sure that many of your Lordships will have seen him in the other place and watched him at work, showing the great tact and marvelous sense of humour that he always displayed in carrying out his extremely difficult job. We all know his great love of children, as well as the work that he has done with them. I have frequently met him on my tours through the House surrounded by a great band of these children that he loves. I know that his words to-day will be noticed, and I know that we shall have the opportunity of hearing again from him on many occasions.
My Lords, I can assure you that I will not speak for long this afternoon, as I am suffering with a slight handicap myself—I hope of a temporary duration, as at times it is a little disturbing—because my voice disappears altogether. We are extremely grateful to the noble Lord, Lord Segal—and I was very glad that the noble Lord, Lord Maybray-King, mentioned the great work that he does—for introducing this subject this afternoon. My noble friend Lady Serota will be dealing in much more detail with the points that will be raised in the debate, and my speech is of a rather more limited sphere. I take, as it were, my two texts from two different documents. First, the very interesting little Report, which I receive regularly, from the Department of Education and Science; and they have called this one, The Last To Come In. In it they give some outline of the transfer of the mentally handicapped children to their Department. I feel that this sums up what we are all trying to say:
What does education mean for mentally handicapped children? Some people in the past have thought it was devaluing education to apply it to children previously thought only 347 suitable for training, which suggests the idea of getting them to repeat unthinkingly certain patterns of behaviors. Education is much wider than learning to read or write; it is learning to live, and developing the personality and powers of each individual. It has social, emotional and physical aspects, as well as intellectual.Secondly, from that splendid little document, Living With Handicap, the Report of the Working Party which has already been referred to:
The focus should be on the child and his family in their community, and his developmental needs as a child, rather than primarily on a handicapping condition. The physical, emotional, educational and social aspects of the child with special needs must be kept in constant balance with each other.The needs of the mentally handicapped child are not too different from the ordinary child, particularly in relation to his education. They need small classes, which all children need; individual attention; plenty of light, warmth, space for playas the Minister has so well pointed out—materials of all kinds; and to be cared for by adults of a very special kind, who are understanding, patient and sympathetic. Thank God that these people have been forthcoming!
Of course it is only this week that we are seeing the beginning of the working of the Act, and I feel that it is a little early to comment in any way upon how it will work. I listened with great interest to the points raised by the Minister in connection with the qualified teacher status. I recall that the noble Lord, Lord Aberdare, and several other noble Lords, put many questions to me during the discussion of the Bill. That discussion is written on my heart like Calais, as it dealt not only with mentally handicapped children, but with students' mistresses—and as I recall we spent rather more time on the one than on the other. But I could not quite decide, from listening very carefully to the noble Lord, Lord Belstead, whether the five-year diploma is any different from the one which I put forward on behalf of the Government at that time. As I recall, the noble Lord, Lord Aberdare, asked for a shorter period and perhaps he could let me know about that when he is winding-up, or in a letter. I should also like to know a little more about the one-year courses. The Minister told us about them, but he was not specific about how many have actually been started. I do not neces- 348 sarily want precise details, but I hope he can say that they are already in being.
§ BARONESS PHILLIPS
I thank the noble Lord. I noted with great interest the point about the special schools and the special buildings. But when discussing this subject the other day with an architect who deals entirely with school buildings, I was rather startled to learn that although special attention is being given to the buildings, it is not being done in the way some of the architects themselves thought necessary. The architects have been told, for instance, that very thick glass is not necessary. But those of us who have dealt with children who have behavior problems, know that glass has an extraordinary attraction for them. That is a small point, but there were various other points which the architects were rather surprised to find had not been included in the plans.
Next I should like to know what sort of instructions are to be issued to the local education authorities. The whole value of the Act rests on the way in which the local education authorities carry it out. Only this week I have received details of a very distressing case relating to blind children. We should all agree that, whether children are physically or mentally handicapped, ideally they should be with their own parents as much as possible. No one would gainsay that fact. But facilities for education for the children in question cannot be found in ordinary schools and they go to a boarding school. They are small children, and I understand that this causes them great distress. As your Lordships can imagine, to be blind and then to be separated from your parents can be a traumatic experience. Each weekend the children return home, and each weekend their parents have to go some forty miles. They leave Cardiff—I will name the authority—every Friday at one o'clock and do not return until six o'clock. Then on Sunday they have to take the children back again.
I have here a letter from the education authority, stating that there is no money to help those hard-pressed parents. I know that the noble Lord, Lord Aberdare, to whom I was going to write, will follow up this case. But I feel that that is an example of how something can go wrong 349 if the right directive is not given from the top. Why is there no money for those poor, harassed parents? I find it disturbing that the children cannot be educated locally, but the fact that they cannot be assisted to return to their own homes at the weekend is even more disturbing.
In dealing with all handicapped children, it is very apparent that we must look most carefully to the supporting services. I was delighted that my noble friend Lord Maybray-King paid tribute to the many voluntary services which are in operation. I have had the privilege of working with them for many years. But we must get over to the ordinary members of the community, who I find will always rise to a request of the right kind, the need for sitting-in services, for more home helps, for more opportunities for the children to have holidays and, indeed, for the parents to have the children taken away, even for a short time.
I have been reading, in a little booklet called Communication, issued by the National Society for Austistic Children, a wonderful article written by a mother. She called it "Suffer little Children", and she described with great poignancy how she copes not only with an autistic child, but with a physically handicapped child as well. In one phrase she states:
Just try carrying a baby, a shopping bag and a swinging toddler for even a short distance.She described the long months of taking the little boy, the autistic child, from one hospital to another. The final diagnosis was made only when a doctor who was examining her physically handicapped child recommended another doctor, who said that her son was autistic. Early diagnosis is vital, and there is little doubt that a great deal of suffering could thus be avoided. Indeed, children could be enabled to lead normal lives much earlier if we could concentrate on early diagnosis.
In Living with Handicap, the suggestion was made that our educational divisions are, perhaps, not ideal. I should certainly go along with the suggestion that we could subdivide much more clearly into visual handicap, hearing impairment, speech and language disorder, specific learning disorder, intellectual handicap, emotional handicap, severe personality 350 disorder, severe environmental disorder—as the Minister has said—and severe multi-handicap. I am sure that our education authorities will be looking much more to a different concept from that with which they have worked for so many years. The acceptance that all children can he educated is at once revolutionary and imaginative, and the Act can bring opportunity and happiness to a very large number of people. I pray, and indeed I know, that the Government will rise to the occasion.
§ 4.8 p.m.
My Lords, I know that we were delighted with the wonderful speech of the noble Lord, Lord Maybray-King. His interest in handicapped children is so well-known, and I know that the House will welcome him heartily to the ranks of those of us who talk on this subject in your Lordships' House. I am grateful to the noble Lord, Lord Segal, for initiating this debate. I propose to say a few words about the highly important subject of the change of responsibility for mentally handicapped children from Health to Education, and then to put before your Lordships the problem of the higher education of austistic and psychotic children.
When I last spoke on the transfer of responsibility, I made a plea to all parents to he patient and not to expect wonders to happen overnight. I reiterate that, as it appears to me that there will be mistakes until local education authorities have had time to understand fully the great task that is before them. Apart from that, we are in the course of reorganising local government throughout Great Britain, and that will inevitably tend to slow up the smooth transition of the transfer as the ultimate responsibility is as yet not finally defined. There are many problems to be sorted out before the intention of the Act is realized—that all mentally handicapped children who can benefit from education will be given it, and that teachers will be fully trained to get the best out of the children. I am convinced that this will come about, but it will take time and we must be patient.
I pass for a few minutes to the training of the very severely subnormal in our hospitals and special care units. Without intending to be in the least frivolous, this may he described as a demarcation problem: in other words, "who does 351 what". The House will know that in many hospitals there are a number of children diagnosed by psychologists as unable to accept education, and these children do not attend school but so far as possible are trained by nurses in the social requirements of life. The fact that the Act lays down that every child will receive an education may tend parents to demand that their children should attend school, however handicapped they are.
It would be ridiculous, and a criminal waste of money, for the State to provide teachers for these children, beloved as they are who are quite unable to assimilate any teaching whatsoever. But the real problem arises as to the demarcation point. I believe this point must be decided by educational psychologists under the Ministry (and I was glad to hear my noble friend say that they are being trained) who will make an assessment of each child, not only once but at frequent intervals, as children can improve and, alas!, can deteriorate. I am convinced the decision must now come under psychologists employed by the Department of Education and Science, as that Department will have the full responsibility.
My Lords, I understand that under the Act more children in the children's hospital of which I am chairman will be admitted to education; but the problem arises, and will indeed arise everywhere, as to where they will be taught. The children will have to be taught either in schools or in wards. In the case of my hospital, the local authority has decided to have one head teacher who will supervise the present school and also have an added responsibility for teaching on the wards. But perhaps in the not-too-distant future we may hope to have an extension to the present school. To my mind, this would be far more satisfactory.
This brings me to the situation of the teachers. On the whole, I think they have had a very fair deal, but there is one matter which I find deeply disturbing. When a teacher who has qualified, either by obtaining the Training Council Diploma and five years' teaching experience, and maybe a conversion course, or, in the future, by the Ministry's three-year course, obtains qualified teacher status, will he or she be accepted in any inter- 352 view for headmaster or headmistress of a normal school if they have spent all their life teaching in mentally handicapped schools? In theory, of course, they should be, but in practice will not their future be limited to the few senior posts in the mentally handicapped field? Transversely, will the person who has trained as a teacher of normal children be able to switch to mentally handicapped teaching without a conversion course?
What is puzzling me—and I believe it to be vitally important—is whether we are trying to create a unified profession out of two professions which are in fact poles apart. Are we in fact falling between two stools, on the one hand producing a teacher who, although fully qualified to teach all children, will not, in fact, be eligible because of his or her past record of teaching the mentally handicapped and, on the other hand, a teacher who again is fully qualified in theory by the normal entry but has no idea how to teach the mentally handicapped? I do not think the answer can be given to-night, but I think that the Ministry should consider carefully the career structures of the teachers of the mentally handicapped and their future, as it is possible that recruitment in the future may be difficult, especially when, at a later date, the devoted unqualified teachers tend to disappear from the scene.
Finally, my Lords, may I turn to the subject of the higher education of the autistic and psychotic child? At present in most schools for these children the higher age limit is about 14 or 15, with admittance at about six or seven. It is hoped that considerable progress will have been made, but for many the full rehabilitation will not have been achieved. It is vital that at this important age, when the children are reaching puberty, the care and education should be continued so that they do not end up in a subnormal hospital where they do not belong, or have to return to their parents who in many cases simply cannot cope. I believe that some sort of teaching accommodation must be provided for this admittedly small number of children, but so important is the fact that it is hoped that many can be cured and be able to lead a normal life. In so many cases the lot of these parents is harder than that of the parents of a 353 mentally handicapped child, as their children in many cases show no affection and in some cases actual hostility. These children can be helped, and it is desperately wrong to discharge them from our care at the most critical stage of their life. Their number is not great, but their need is indeed great.
My Lords, this is a short speech, and there are many other subjects that I could cover; but we are in a transitional period both in health and in education, as we are awaiting the White Paper from the Ministry of Health and we are in the stage of changing over to education with the subnormal. But I know that all your Lordships will join with me in extending to my noble friend Lord Belstead and his Ministry every good wish and support in the great tasks ahead.
§ 4.18 p.m.
§ LORD STONHAM
My Lords, as so many others have done, I would express my very grateful thanks to my noble friend Lord Segal for introducing this very important debate. I would also, if I may, express my congratulations to Lord Maybray-King on the kind of maiden speech that we who know him would have expected him to make. It was a speech which had wisdom, knowledge and humanity, and no speech needs any more than that. Indeed, my Lords, it is a great pleasure to have this evidence that he has emerged from the other place with his faculties, not only unimpaired but, if anything, enhanced; and I am sure that we all look forward to hearing him on many more occasions.
I think this afternoon started disastrously, with the Question by the noble Baroness, Lady Masham of Ilton. I say "disastrously" because it was so depressing to hear Lord Aberdare completely unable to say that the Government were doing anything about the Chronically Sick and Disabled Persons Act. Indeed, I put it worse than that—because he was pressed to say what steps they were going to take with a view to doing something. I felt that, if that was the kind of answer we were to get from the Government on these vital subjects, it: was a terribly bad start to this debate.
The noble Lord, Lord Grenfell, repeated his plea to parents to be patient. I am not blessed with a mentally handicapped child, but I sometimes boil with 354 impatience over the lack of progress we make despite the tremendous efforts of the Society. If I had a mentally handicapped child, I think that my impatience would be homicidal. It is very difficult to be patient in the circumstances which confront us. My noble friend Lord Segal asked ten questions. There were faint murmurs opposite and one or two murmurs behind me at the number of questions. But not one of those questions was superfluous; all of them very badly needed an answer. Indeed, my only surprise is that there should be such a long series of important questions for the Government to answer when they have already had time to get things going.
To me, this story started on November 26, 1968, when my right honourable friend Mr. Harold Wilson, then Prime Minister, announced:
… the Government have decided to accept in principle that the responsibility for the education of mentally handicapped children in England and Wales should he transferred from the Health to the Education service.He added:The necessary legislation will be prepared to give effect to the change in England and Wales, and the date on which this can take place will be settled as soon as possible."—[OFFICIAL REPORT, Commons, 26 / 11/68, col. 302.]To me, that was a vastly important statement. It is the most important statement ever to have been made in this field; because at long last a gross injustice was to be removed. The parents of subnormal children, like all parents, had had the duty placed on them 100 years ago to see that their children were educated. They could not comply with that statutory duty because there was no education for their children and the 1944 Act excluded them. This was to go. It was acknowledged that no child was indeucable; that we had not educated them because successive Governments had failed to provide the right kind of education. I thought that this was a very important happening.
In November, 1969, Mr. Edward Short, then Minister of Education, told us that invaluable consultations had taken place and good progress had been made during the year. That good progress was fully maintained by the present Government; because they took over the Bill which had been prepared, it became law in July last year and was implemented this 355 month. There is no possible breath of complaint about the Government's record in this matter so far as legislation is concerned.
It became operative, as I have said, on April 1. But is it operating? That is what I should like to know. If so, how is it operating and how well is it operating? Since the statement of November, 1968, was made, only three years ago, there has been a tendency to say that the Government have not yet had time. That is something I do not accept. They have had time to set up teacher training courses to begin to get teachers trained; they have had time to build at least some purpose-built schools; they have had time to do a great many things. They may have done them. Indeed, Lord Belstead's speech, for which I thank him, appeared to contain some encouragement. It will repay reading again.
But this progress has to be judged in the face of the facts which Lord Segal gave. There are 87,623 mentally handicapped children of school age in England and Wales. Most of them are not E.S.M. children but severely subnormal; and every one is a separate problem. Out of those 87,000 nearly 25,000 became new pupils on April 1. This 25.000 is made up of some 22,000 attending general training centres provided by local authorities and nearly 4,000 attending the so-called schools provided by the regional hospital boards in hospitals. They automatically qualify for education. I want to know how many new places—not how many places—in general training centres have been transferred and called school places. You do not convert a general training centre into a school merely by putting the word "school" over the gate. This is one of the things that I am very much afraid of. It is really something we cannot allow the Government to get away with.
I have no parental experience in this field, but I have seen a great many parents and a great many mentally-handicapped children. Words cannot express how they all suffer and how bravely the parents suffer, and with virtually no complaint—not that complaints would do any good. They are used to disappointment; they have 356 always been disappointed. But there is a difference between disappointment and betrayal. I think that any attempt to paper over difficulties and problems would be a betrayal. These people are entitled to know the truth. I think that implementation of the Act was agreed too quickly. Perhaps it should have been put off for another couple of years. If that is the case, let us say so. Let us know clearly where we are and where we are going.
§ LORD BELSTEAD
My Lords, I wonder whether I may help the noble Lord? The new places which were provided for 1971–72 in special education numbered 4,520 and the new places which have been provided in 1970 under the D.H.S.S. programme number 22,500. Of course, the 1971–72 places which will be provided are under building programmes arranged by the previous Administration.
§ LORD STONHAM
I shall carefully study what the noble Lord said, but the very nature of the figures he has given indicates that they are not places in special schools for severely subnormal patients. I do not think we should need 22,000, but I should very much like to see them. My Lords, the people who are now to be educated are not only healthy, happy normal children who run about on their occasions and could easily go to school. They include mentally subnormal and partially physically handicapped patients who are lying in bed in hospitals. They have an equal right to education, but their needs are vastly different. It is no good dealing with this problem lightly or thinking that it may be solved easily. Ministers have a very hard task before them, and deserve every sympathy and help, because 87,000 individual problems all need separate attention and assessment. They all need special schools; and special teachers who do not merely have the normal qualifications of a teacher—skill and patience. They must also be dedicated and love their pupils. They must be highly trained; and there must be a sufficiency of them to be able to give proper teaching. There are 357 25,000 new pupils, and of the other 67,000 there are 10,000 on the waiting list for places. That is why I had some doubt about the noble Lord's figures.
The immediate and most urgent problem—this is why I interrupted the noble Lord to ask my question—is the matter of sufficient teachers. There are 25,000 places wanted immediately. Anyone may make his estimate, but probably 10,000 teachers are wanted for these children. It sounds incredible, I know, but there must he a very high ratio of teachers to pupils. Once that problem has been solved we must have the buildings. I should be very grateful if the Minister could tell me how many purpose-built schools have been provided under the Act. If it is not possible for him to give me that information, can he say how many purpose-built schools are planned or projected, or are being built? In those schools how many places will be provided? Again, when those schools are built and ready for occupation, how many teachers will be available to staff them? As I say, my Lords, you cannot count these junior training places again and call them school places. The transfer which is enshrined in the Act should be a real transfer.
We need dedicated teachers; but they must also have vision and imagination. It takes something extra special to be a teacher of retarded children. Such teachers do not get quick rewards. All teachers have their frustrations; but the frustrations, which have to be suppressed, even irritations, which have to be suppressed, by teachers of handicapped children are far the greater. I should like a reassurance from the Minister that the pay and conditions for those qualified will not be less favourable than the pay and conditions for other teachers. People do not do this work for money or reward, but I firmly believe that teachers of mentally handicapped and severely subnormal children should have better pay and conditions than those who teach normal children. Heaven knows! they deserve it, and it would be nice if sometimes people got what they deserved.
Many of the points made by the noble Baroness, Lady Masham of Ilion, about her Act apply to the handicapped. Those points need careful thinking out. That is why I say that these buildings must be purpose-built. The equipment must be 358 sufficiently varied and in the right quantities. I wonder whether the Minister has impressed this on local authorities. Have the circulars been sent out? I have tried to find out, but I have not been able to get any information. I have talked to my friends. I spoke to my chauffeur who brings me to the House and takes me home again. He has a mentally handicapped daughter, a girl of about fifteen. Yesterday I asked him where she was, whether she was at school. He said, "Not at school. She goes to the junior training centre, but there is no talk of any school." He lives in the area of an enlightened and progressive local authority, but it has not yet provided a school.
So, my Lords, we need some assurance, some word of comfort, from the noble Lord, Lord Aberdare, when he replies to the debate. If he cannot say that anything is being done—which would be tragic—I hope that he may be able to say, "We know what is involved; we know the numbers involved and that each child's need is great. We know that it will be difficult to get teachers and to train them sufficiently and well. But we are going to do it. We mean to see that every child in this country receives an education, provided by the State, which it can absorb." if the noble Lord can give us such an assurance, backed, I hope, with some facts, I shall be very glad; and this debate will have been more than worth while.
§ 4.40 p.m.
THE LORD BISHOP OF TRURO
My Lords, I am sure that a word will be expected from these Benches on so important and urgent and compassionate a subject as the one before the House. I could only wish that one of the right reverend Prelates, my brothers, who as more experience and knowledge of this subject, was able to come and speak about it. I am glad to do so, not least because, remembering my own maiden speech and as I am just embarking on my second speech in your Lordships' House, it gives me the opportunity of expressing from these Benches congratulations and thanks to the noble Lord, Lord Maybray-King, on his maiden speech this afternoon. From all the vast experience and knowledge he must have gained in another place, it is a compliment to the noble Lord, Lord Segal, and to the 359 cares and claims of the handicapped, that Lord Maybray-King should have chosen this subject and addressed the House with obvious knowledge, sympathy and understanding on it.
In speaking from these Benches, I make no claim for a monopoly of concern or service for the Church or Churches. I take warning—though I feel that I have no opportunity of giving the noble Lord warning—from the apparent claims of the noble Lord, Lord Soper, two afternoons ago, on behalf of his Church. I make no claim that the coming of the Kingdom is entirely dependent upon the efforts of the Church of England. But, as Christians, we have our orders, our Standing Orders, our King's Regulations or trade union rules, in whichever way we may like to consider them. We have already been reminded of the admonition:Suffer little children to come unto Me," and of the one that followed,forbid them not;and of the warnings to those who place stumbling blocks in their way or to whom it can be said,In as much as ye did it not …The Church knows, cares and is concerned to help. Every parish priest and minister doing his job knows the homes of families where there are handicapped children, where it is a family tragedy and a problem.
Often in the past, and still to some extent to-day, the mentally handicapped are hidden away or ridiculed. "In with the cakes and out with the buns," they say in Devon, or "A scat behind," in Cornwall. There is, together with that, the shame and resentment, and sometimes the guilty feeling of parents, the social stigma of Form 2HP, the exclusion from formal education at school, the "failed" not at 11-plus but at 5-minus.
We have seen in our generation two revolutionary changes in attitude and awareness of possibilities. We learn from the younger generation. Alongside the much publicised violence and protest and all the eccentricities (as we regard them) of dress and behaviour, there is the much less publicized compassion and eagerness to get something done and readiness to understand the handicapped 360 and aged and helpless. We have seen in the last few years almost in the whole community a change in the attitude to those who are called spastics. We have discovered that the so-called uneducable can and do respond, not only to training of habit and behaviour but to teaching. They are much more than just salvageable; many can, with understanding help, make a contribution to the life of the family and the community, and in so doing not only save expense to the social services but realise for themselves a fulfillment and enjoyment of life.
So we have found in Cornwall. It is not peculiar to Cornwall and no doubt much more is being achieved in other parts. But in many ways Cornwall is pioneering, determined, as we say, "to do things proper." At the opening in 1962 of the Curnow Centre for handicapped children (making all allowances for the encouraging noises that are expected of V.I.P.s on such occasions) the then Minister of Health who opened the centre asked, "How did you manage to get so far ahead?" And in taking over the school and hostel at Double-trees, St. Blazey, the local education authority expressed surprise and delight that the buildings were better than any new school.
Now I come to mentally handicapped children, who have proved responsive to teaching. The Department of Education and Science can provide better and wider facilities for that teaching, but this teaching has had high priority in the Department of Health and I would ask: can the Department of Education and Science, concerned as it is with so many priorities, provide the same? By the Statutory Instruments already mentioned, teachers of the mentally handicapped, both those with diplomas and those with no paper qualifications but great devotion, are to be recognised. But there is urgent need for more teachers qualified to teach these children. This need can be met, and to some extent is already being met, by the provision of specialist courses for teachers of the handicapped in the initial training of teachers.
The Church of England is ready to offer full co-operation through their own colleges of education. Already such 361 courses are available at two of the Church colleges, Culham and King Alfred's, Winchester. The other colleges will be ready to establish such courses if the demand increases. At the same time, men and women already qualified as teachers, who have a special concern for the handicapped, could and should be encouraged to take courses of in-service training. But this will depend not only on the willingness of the teachers but even more on the readiness of local education authorities to provide the opportunity for them to go.
We have heard much of the 25,000 children in training centres and hospitals. There are many more severely handicapped outside the provision made under the Department of Health. In 1965, the Church of England Board of Education published Number Unknown, suggesting ways in which help could be given to handicapped children and their parents. We have already heard this afternoon several references to the Report, Living With Handicap. Of the many recommendations of this Report I particularly want to mention two. The first concerns help for parents—what is called "genetic counseling", giving advice even before parents contemplate a family, which no doubt comes somehow within the scope of family planning, and skilled help so soon as a handicapped child is born, and after.
The second is the need for the closest co-operation between all social workers concerned with families with handicapped children. Do school welfare officers not in the social work departments of local authorities and do probation officers come within that field? Because some handicapped children undoubtedly might become delinquent. All this co-operation must be (if I may borrow a popular T.V. word) nationwide. The Act of 1970 has driven out one devil, the devil of separating the child with handicap from his parents and (an ancient word, resurrected maybe in the Report, Living With Handicap) his siblings. We were reminded a long time ago that, having driven out one devil and leaving the house swept and garnished and doing nothing, several other devils may well enter in. There is now the opportunity for a great advance in the provision for the handicapped. But legislation is not enough. The seven or more, not devils, but social workers, must 362 enter in and be concerned and act together, and act quickly.
We thank the noble Lord, Lord Segal, for drawing the attention of your Lordships' House to these children and their problems. The Church would assure him and your Lordships of our readiness to help in every way possible in the home, in the school and in the colleges of education, to join with all who care and are concerned to give hope to the handicapped and to their families; hope, but not hope deferred; hope for their usefulness and happiness in this life here and now.
§ 4.52 p.m.
§ LORD RAGLAN
My Lords, may I join in congratulating the noble Lord, Lord Maybray-King, on what is, I suppose, his first Parliamentary speech, strictly speaking, for six years. It crossed my mind to wonder what sort of battle he may have had with Garter as to what his title was to be. I have long been aware of his interest in handicapped children, and I know that he was always prepared, when he was Speaker of another place, to place what services he could at the disposal of the handicapped. I am grateful that he has spoken this afternoon, because he has given me a lead-in on the few remarks that I wish to make. I feel that perhaps I owe your Lordships an apology for the fact that this is the third Wednesday running on which I have made a speech. My excuse is that on each day the subject under debate was one in which I. am particularly interested. I notice that the noble Lord, Lord Aberdare, will be replying for the third Wednesday running—he is being worked very hard.
§ LORD ABERDARE
My Lords, I apologise to the noble Lord for interrupting, but it is my fourth Wednesday running.
§ LORD RAGLAN
The noble Lord looks very well on the work he is doing, and long may he continue to do so!—at any rate for the life of this Parliament.
Until about twenty years ago the mentally handicapped did not receive the attention they should have done. The easiest way—or perhaps the only way—of dealing with them was to lock them away. And perhaps the saddest factor in this used to be the belief of so many parents of mentally handicapped children that their child's condition was somehow 363 a reflection upon them. Parents like to take pride and credit when their child is particularly bright, and likewise when the child suffers from a mental disability parents tend to consider that this is something to do with them. There are many things we do not know about the causes of mental retardation, but one we do know is that only in an infinitesimal number of cases can it possibly be said to be the fault of the parents.
It is the achievement, I think, particularly of the National Society for Mentally Handicapped Children, that this parental stigma is steadily disappearing; and it is this new attitude—the realisation that mentally disabled children are not children to be ashamed of and locked away, but are to he treated like all other children and drawn as much as possible into the normal life of the community—that has led at last to the transfer of responsibility for their education from the Department of Health to the Department of Education.
I mean nothing personal to anyone when I say that in a general sense, probably, we are all mentally handicapped to some extent: it is a matter of degree. Those children who could not pass their 11-plus exams could be said to be mentally handicapped as against those who could. These gradings are a convenience of a kind to educationists, but their arbitrariness can inflict a terrible and lifelong disability on a person. I hope that education officers, and special education officers who deal with the mentally retarded, will, so far as is possible, reject grading and concentrate upon encouraging children in what they can do, rather than dwelling upon what they cannot do.
But, my Lords, whatever is done for the mentally handicapped in the realm of education, we shall, in my view, be failing in our duty towards both future parents and future generations of children if we do not devote far more resources than we do at present to trying to find out why people are born mentally retarded. I hope that one of the effects of this transfer of responsibility to which I have just referred—that of bringing these children into the community—will be to make more of the public aware of this most distressing condition which is mental retardation, and thereby lead 364 them to inquire why people should be retarded and whether it is not possible to do something to find causes and, therefore, as the noble Lord, Lord Maybray-King, said, preventions or cures.
Four or five years ago the National Society for Mentally Handicapped Children, of which my noble friend Lord Segal is the Chairman, founded a body called the Institute for Research into Mental Retardation. I was asked to be the chairman of its Finance and General Purposes Committee. The invitation came from the late Lord Francis-Williams, and I shed a tear for the passing of his ample personality and pay tribute to his devotion and tenacity in establishing this Institute. It may seem extraordinary, but this Institute was, I think, except perhaps for one in America, the first of its kind in the world. We exist almost entirely out of subventions from the National Society, and with a very small staff we run symposia, correlate information, publish a research index and provide an information service. We have a unique library. When people are so generous as to give us money towards research, our most expert research committee allocates it towards what it thinks are the most deserving projects.
I am not to-day making any special plea for the particular Institute with which I am connected. We are short of funds, of course; but who is not? I expect that we shall struggle along. But if we were to go out of business, I should like, before we did so, to see that what this Institute has been trying to do is being done by some other body. At the moment, I cannot see it being done anywhere else in the country. Other research institutes may be founded (one has just established in Birmingham, and there may be others on the way), but at the moment nowhere else are attempts being made to correlate information or to co-ordinate research. I may be pushing at an open door here. I believe that the Government should either grant-aid this Institute with which I am connected, or assist in the setting up of a similar institute to do the work which we are trying to do, or take the work upon itself, as the Danish Government have done.
My Lords, there is much to do and a long way to go. The great thing is that 365 this work shall be done by somebody. I believe that the Department of Health are the only people who can ensure that it is done, and from what I have heard from the noble Lord, Lord Belstead this afternoon, of the Government's concern, I have considerable faith that they will do something.
§ 5.1 p.m.
§ BARONESS ELLIOT OF HARWOOD
My Lords, I should like to thank the noble Lord, Lord Segal, very much for inaugurating this debate to-day. I had a Motion on the Order Paper calling attention to a remarkable Report which some noble Lords have read, Living with Handicap. I was not fortunate enough to get your Lordships' time for a debate on this special Report. When the noble Lord, Lord Segal, suggested that I might combine with him and have a general debate, not only on mentally handicapped children but also on handicapped children, I was naturally delighted, and I am very happy indeed to have heard so many people already refer to this remarkable Report. I should also like to add my congratulations to the noble Lord, Lord Maybray-King, on a most moving and interesting speech. I was particularly touched and interested when he spoke so movingly about the voluntary societies with which he has had association for many years—indeed, he has had association with the statutory bodies as well. I would endorse every word that he has said, and stress how important it is that these two types of organisation should work very closely together. In this Report there are many instances of how voluntary organisations and statutory bodies in this field have co-operated and still co-operate very closely indeed.
There are two subjects I want to touch on. One is the Living with Handicap Report—and I have placed a shortened version of that Report in the Printed Paper Office for anybody who would like to read it. Then I want to say something about some of the work which has been done for autistic children by the National Society for Autistic Children of which I am President. The Report Living with Handicap owes its excellence and origin to three people. The first is the noble Baroness, Lady Serota, who is to speak after me in this debate, and who was the first Chairman of the Committee; secondly, Dame Eileen Young husband, a 366 social worker well known throughout the whole world who has done a magnificent job in social work everywhere, and who took on the chairmanship after the noble Baroness, Lady Serota, had to give it up; and thirdly, Dr. Kellmer Pringle, Director of the National Children's Bureau, who were the sponsors of this Report. The Carnegie United Kingdom Trust, of which I was at the time Chairman, gave money to make this Report possible, and this is an interesting and worthwhile piece of research by a group of absolutely first-class people. I know that the Carnegie trustees were absolutely delighted when the Report came out, and felt that the money that they had given was well spent and very valuable for anyone working in the field of social work.
The Report stresses what has been said by many of your Lordships, the great importance of looking at handicapped children in a community and family setting. 'The child is not an isolated child; it is not a handicapped child isolated from all its surroundings and its family; it is a family with a handicapped child. That is the first important point which is made in the Report. Other noble Lords have stressed the importance of helping the families of handicapped children by supporting services. Arising from the Social Work: Act, I am sure that the supporting services will be very much better than they have been in the past, because the supporting services will come from a united social work department in local authority service, and that united department will deal with all aspects of social work together, not separately. It has already started in Scotland, as I expect your Lordships know, for I have spoken about this often. We already have very good co-operation and help from different sides of social work for the family rather than the isolated individual who may have attracted a particular problem during the course of his life. This is really working well.
I should also like to cheer up the noble Lord, Lord Stoneham (and I am sorry that he is not in his place), on the subject of the inquiry and the work being done to implement the Alfred Morris Act, the Act for disabled persons. In the area of which I am Chairman of the social work committee we already have detailed inquiries going on into handicapped families and people. We are getting in touch 367 with people every day. I am quite sure that, when the Act becomes operative in England—we have had a whole year in Scotland to start it—it will be found that people are anxious to make these services available. After all, it is the job of the social work committee to do this. It is up to the elected representatives in local authorities to see that the job is done. People say, "Why do not the central Government do it?". But the point is that it is not the central Government but the local authority upon whom the responsibility falls and where all this information must be collected. I hope that the local authorities will really embrace this subject, work at it and do it properly, because they are the people who will be able to implement this Act. Of course, we want the help of the central departments. We have to have that help, but they quite rightly will say to us, "What are you doing about it?". In the area that I know best, and in other parts of Scotland, this is being done. I hope that my message will get to the noble Lord, Lord Stonham, and that he will feel a little more enthusiastic than he does at present.
There are one or two other points that I should like to mention in the Report. There is the very important co-operation that will be needed from the health services. The Report mentions assessment teams. That is excellent. The doctor, the health visitor, the social worker and the educational psychologist, all working together is of enormous importance. Also the continuing assessment of a child is of enormous importance. I believe my noble friend Lord Grenfell said that an assessment of a child can change, and we know that that is so. Some children get very much better, some are cured, and some go downhill. Therefore, periodic assessment, so that people know how the child is getting on, and how the family is getting on—because it is not only the child but also the family—is very important. The environment in which the child lives is, of course, vitally important.
The question about the educational authorities has been gone into very fully by many other speakers, and I welcome the fact that the special schools and educational training of all children is now to be taken over by local authorities. So long as the local authorities 368 are good and up to their job that is very good indeed. I hope very much that the special arrangements making it possible for severely handicapped children to be in the general community of the ordinary school will be carried through. There should be no stinting or economy in the practical way in which help can be made available for this to be done. Putting it at its lowest, simply on a financial basis, it is infinitely cheaper and better to keep a child in the community and in its home than to send it to a residential school. That is infinitely more expensive, and in my opinion nothing like so good for the child. I should like if possible to see all children kept within the orbit of the community in which they live. I believe that if some of the suggestions made in this Report were implemented it would be very much easier than it has ever been before.
I should also like to suggest that when special schools are necessary—I am not suggesting that there are not types of handicap where special schools are not necessary—those schools, day schools if possible, should be as near as possible to the centres in which the children are living. May I mention one which I know very well. Outside Shrewsbury there is a school for very severely handicapped children. It was established by a combination of a voluntary organisation in and around Shrewsbury, statutory money, and again the Carnegie United Kingdom Trust. The trustees at that period were anxious to make some experiments which we thought could be prototypes for the development of this type of school.
This school started in quite a small way, but it has been enlarged. It has excellent equipment and a great many teachers for the number of children—for these children are very severely handicapped indeed. I did not ask what kind of training the girls had, but I was enormously impressed by the care, the interest and the love which they had for these children as well as the contact that they have with the mothers and with the children who attend the school. Children are brought there every day, some in vehicles provided by local authorities and some by their mothers. There is a daily contact between the children in this school and the mothers and the family, and I think it has been a great 369 success. If I may add a slight personal note here, as a result of the money which the Carnegie Trust gave and the assistance which we tried to give, they have called the school the Katharine Elliot School. I am very proud of that. That is a school which could he a prototype for a day school for severely handicapped children. It does not take them away from their homes and families and it keeps them within the community.
I should also like to mention the suggestions about the pre-school provision. That has always been a difficulty. I well remember the difficulty of getting nursery schools started and the difficulties of preschool education. Local authorities ought to do it but are very apt not to. I think we could do more for the pre-school handicapped child than has been done before. I know that some children have to go to residential schools, but I hope that the number will be kept to a minimum. One of the jobs of education authorities is to do all that is possible to keep these children as near to their homes as possible and in the community. There is a great deal more in this Report, and I hope that the noble Baroness. Lady Serota, who knows it better than I do, will mention it. I think it has been a worthwhile exercise and has made a good contribution to the problem with which we are all concerned.
May I say one word about the National Society for Autistic Children. I was so glad to hear the noble Lord, Lord Maybray-King, mention that in Southampton a school has been started for autistic children. I was also interested to hear Lady Phillips's account which I read in the journal which is published by the Society, of that pathetic case of the woman describing her difficulties with her autistic child. We had an interesting debate in your Lordships' House not so long ago about autistic children and which drew the attention of people to this problem, which is one of the more recent diagnoses of mental difficulties. Many local authorities are only now beginning to think in terms of autistic children, of realising that the withdrawn child who is so difficult is not necessarily mentally defective. The child may be mentally rather intelligent but has this autistic condition which makes it so very difficult to educate and to get in touch with.
370 The small society of which I am the President, the National Society for Autistic Children, has pioneered a great deal of very good work. We have several schools: one at Ealing which the last Minister, Mr. Short, visited and was impressed by two day and boarding schools in London one in Kent, one in Sussex, one in Nottingham and four more to be opened this year, 1971. I would say, following on what the noble Lord, Lord Maybray-King, said, that this is a society which is most anxious to co-operate with the local authority. If the local authority will do the job, we are happy that they should do it. All we would ask is that we might be able to give some of the expertise which we have built up now, with an organisation which consists not only of parents, but of people like myself who are interested in the subject and want to help. We should like to be able to give advice to parents, teachers and to local authorities if they so asked.
It is not easy to know how many children are autistic, but in a survey carried out about a year ago it was estimated that something between 2 and 4.5 per cent. in 10,000 children are autistic. It is not an enormous number, but they represent a very difficult problem. I am anxious that if possible they should be included in the education and training of normal schools. It is not always possible. Some of them are too difficult and it is therefore necessary to have special schools, but in so far as they can advance to the point where they can come into a normal school we are most anxious that they should do so.
I should like to make a plea, too, for what the noble Lord, Lord Grenfell, said about not ending the education of psychotic and very difficult children at the age of 15 when they are thrown out into a world in which no provision is made for them. I hope it will be possible for some continuing supervision and education to he given to those who are very heavily handicapped in these ways. Just as the Living with Handicap Report speaks of the mixture of departments—education, social work, supporting local authorities and all the rest—I am certain that that is the kind of combination which will make it possible for us to do something really worth while. The framework must be working together, not in separate compartments. I was 371 encouraged by the speech of the noble Lord, Lord Belstead, and I am sure that we shall get the same encouragement from the noble Lord, Lord Aberdare. We want to work together on the subject, and I am certain that in that way we shall be able to make a real inroad into the problem which will be for the benefit of everyone, not only the children but the families, the community and the Government.
§ 5.20 p.m.
§ BARONESS MASHAM OF ILTON
My Lords, like other noble Lords, I should like to congratulate the noble Lord, Lord Maybray-King, on his inspired maiden speech and also I should like to thank all noble Lords for what I personally have learned here this afternoon in this debate. Especially I should like to add my thanks to the noble Lord, Lord Segal, for initiating this debate. If it does nothing else, I hope it will give encouragement to the parents of handicapped children, and to the people who are dealing with the many problems in this field, to know that there are people in this House who share their interests. The most important aspect, I feel, is that these people who are being discussed to-day are children. The child should come first and the handicap second. Sometimes the problems of the handicap are so great that they almost smother the fact that there is a real, living child with a soul.
The first problem to consider must be the one of how to prevent children from becoming handicapped. The need for more research into why some children are born with defects must surely be a priority, because this problem is on the increase due to the higher survival rate. There are some doctors specialising in the treatment of children with handicaps. I have been fortunate to meet a few of them and have found them most learned and dedicated people. But their numbers do not seem to be sufficient. So could encouragement be given to young doctors in their training so that they may become interested in this field of medicine? More encouragement and education could also be given to the public to prevent accidents in the home, and on road safety and general awareness to observe common-sense rules.
When a handicapped child is born, early detection of the disability is so 372 important in case it might be possible to cure or ameliorate before more damage is done. In acting quickly there is more likelihood of reducing the effects of the disability, so preventing it from becoming too much of a handicap. This is vital in cases such as spina bifida. When a badly handicapped baby is born the mother needs extra support from the time she is told. Before taking the baby home she needs instruction and practice in how to look after it. Mothers of handicapped children can become isolated, thinking there is a stigma attached to their babies. So often a mother finds she has to struggle and fight against so many difficulties. She can become frightened when the baby keeps swallowing air. The child may fight against food, spitting and vomiting it back. The mother will endlessly have to wash to try to keep the child and herself free from the clinging smell. There can be constant crying and noise from The child, and a great lack of sleep for the worried and sometimes frantic parents. I have often marveled at the patience and love some parents have for their very severely handicapped child. So often the mothers feel they are not listened to, which causes frustration and misunderstanding.
There seems to be a great need for co-ordination of services within local authorities. Very often handicapped children have multiple disabilities which are dealt with in different departments. The mother may have to drag her child from department to department meeting different people, asking the same questions and often receiving conflicting answers. Although improvement towards integrating services seems to be going ahead, families with disabled children are often absolutely bewildered by what is, or is not, available to them. They become confused and do not know whom to approach, and from where they should receive help.
There seems to be a need for more rapid development of assessment and treatment centres where the needs of the handicapped child can be met in a comprehensive way, without their having to go from one place to another to receive treatment. Very often one hears of good technical work being spoilt because of lack of understanding of the child's needs for all-round development. There is a crying need to find at least some level of 373 standards of facilities for the overall development of these children throughout the country. One woman I heard of who was the mother of two very handicapped girls in their early teens, both completely incontinent, went to her local authority to ask for some extra bedding and clothes. She was given £2 and told not to come, back. She was then on the point of breakdown. By now she is most likely in hospital!, and the two girls in care, costing her local authority well over £100 a week.
The expenses of a family with a handicapped child become heavy. Often there has to be special food, extra laundry, clothes and fares. The mother cannot go out to work and frequently the father has to take time off work, and therefore the family income is smaller. Because the mother has to give so much extra time to the child, the father may feel he is not receiving his share of attention. Therefore, there is a higher percentage of breakdowns in marriage where there is a handicapped child. To help with this extra strain, a home-help service and a trained baby-sitter service could be of great assistance.
A mother of a very handicapped child, who is a trained social worker, told me that she spends most of her week taking the child to places of treatment—physiotherapy, hydrotherapy, speech therapy, a play group, all on different days. If the family did not have two cars this would be impossible.
The supplying of equipment necessary for the correct development of a handicapped child can be vital, but often there are difficulties and delays. Parents bring their children to doctors for help. The difficulties and delays which arise simply accentuate their feelings of being rejected. Often they have to wait for three months before getting their wheelchair, and sometimes years before getting temporary care. Special equipment can help lift physical strain off the mother. It has been found in children whose handicaps are so great that they have to go into hospitals that they respond best in small family type units; they stand a better chance of development there. In large hospital wards they cannot receive individual stimulation and tend to become "vegetables".
374 last year I had the privilege of officially opening a play group for handicapped children, and I was pleased to see able-bodied children also attending. Two of the children were so handicapped that they lay on mattresses. But in their eyes one could see that they were happy to be among other children. I am sure there is a great need for more nursery and pre-school units. Education, as everyone knows, is vital to all children so that they can develop their full potential. It seems most unnatural to send a child aged two to boarding school. This does however happen, and it costs the authority about £1,000 a year. In cases of deaf children the problem is one of communication. Any child under five who is sent to boarding school must feel utterly discarded by its parents, and it is impossible to explain that it is clone for the good of the child. Could more instruction and teaching be given in the home for the under fives?
Last week I went to visit a special school. The children were delightful, and the staff and school excellent. The headmaster told me that they had just eradicated the word "special" as this was a stigma. Also, he told me that there were not enough links with the parents. For the overall development of the child, he felt it would be useful to know the home circumstances. As family doctors do not visit homes as frequently as they used to do, home problems often go undetected. If special schools for physically handicapped children could be incorporated in the campus of ordinary schools, I feel everyone would benefit. At a youth leadership course one girl told me that they would have had much better understanding of disabled children had they had some at her school. Children seem kinder than they used to be. I think the time has come for children to understand that they belong to the same species. Many of these children could be at normal schools, but they need help with the lavatory. It seems odd that in 1971 people can get to the moon, but a handicapped child cannot obtain help to go to the lavatory.
My Lords, it is so important that children grow normally, and I think all physically disabled children need physiotherapy supervision and regular medical check-ups, so that they do not grow 375 deformed. A child sitting in a wheelchair can so easily develop scoliosis. In Canada, there is excellent integration of handicapped children in schools, so perhaps we can study their methods.
If education authorities are to include some facilities for handicapped children in new school buildings, would it be possible for the Department of Education and Science to allow the additional cost over and above the normal cost limits for the extra facilities? For example, a lift Where there are existing buildings which need adaptations to make them suitable will the Government give a bigger minor building allocation? This would enable local authorities to include the facilities necessary in making their school accessible for wheelchairs, thus implementing, Section 8 of the Chronically Sick and Disabled Persons Act.
My Lords, some bright but badly disabled children can go on to university, but without some attention at night they cannot manage. In America, the State pays for an attendant, thus enabling the disabled student to obtain his degree. It is a great help for disabled people to go out into the world with good qualifications.
There is one small but important group of children I should like to include in this debate. These are the children of mothers in prison, who very often become psychologically disturbed, which can be a great handicap in later years. These children are at great risk. The Home Office Prison Department booklet issued in 1970, entitled Treatment of Women and Girls in Custody, says:The children, in particular, suffer from this deprivation, which can lead to the breakup of the home, even when there is a stable marriage.They agree that separation from the mother has a traumatic effect on the children and may be a cause of their future delinquency or other forms of instability.
On February 5, I received a letter from the noble Lord, Lord Windlesham, who said:We cannot at present accept into prison children who are over the age of nine months.I should like to ask the Government to look into the alternatives to prison for 376 women with young children, so that this vicious cycle of insecurity and its problems for these children can be broken.
My Lords, I should like to end on a brighter note. So often the good things are not news, so they are never known. Last week I went to a splendid exhibition of toys for handicapped children. Often these children have no desire to explore the unknown: they take refuge in a private world in defence against anxiety and become retarded by inactivity. Here there were fascinating toys, with colour, sound and movement, to encourage the child to reach out and take hold of the world. Going round the exhibition were many young students, who showed great interest. There does seem to be a great deal of interest taken in the problems of handicapped children. This must be the best sign for progress in the future. All children are different, as are the circumstances in which they live; so I feel that flexibility is needed throughout the development programme for every handicapped child.
§ 5.34 p.m.
§ LORD NAPIER AND ETTRICK
My Lords, I wish to intervene only briefly in your Lordships' debate this afternoon, simply because I have some slight knowledge of one particular handicap. But may I say first how interesting and worthwhile I think this debate has been, and may I add my sincere congratulations to those of other noble Lords to the noble Lord, Lord Maybray-King, on his most moving maiden speech. We have all heard about the great work that he has done among handicapped children over many years, and I, for one, shall always listen with the greatest interest whenever he cares to address your Lordships' House.
I believe that most noble Lords will understand me when I say that it is only when one becomes personally involved in the problems of educating the handicapped—and it does not matter what the handicap is that one can begin to appreciate the magnitude of the problem. I happen to have a deaf son. For this reason I shall confine most of my few remarks to the problems that I have found affecting the education of the deaf. In case some of your Lordships may be wondering what the cause was, I may say that it was quite simply rubella:
377 That is, German measles in early pregnancy. I fully accept that the medical profession now know much more about the effects of this disease on the unborn child than they did in 1962.
I do not wish to weary your Lordships with a personal case history, but I just want to illustrate the sort of problems with which any parent may be faced. Suffice it to say that for the first four years of my son's life no specialist, doctor or otologist would ever admit that the child was deaf. It so happened that about 1963–64 the "in thing" for children who failed to develop the power of speech was asphasic. If your child was asphasic he was considered at that time to be very "with it".
When my son was turned four, I was advised that a speech therapist was the answer and so, at no little expense, I obtained the services of such a person. Six months passed, and no progress whatsoever was apparent. I now know, of course, that this was hardly surprising, since without the assistance of hearing aids the child could hear virtually nothing. A school for the mentally handicapped was then recommended. A further series of consultations took place with pædiatricians and specialists. At last we found a doctor who said, "But this child is deaf. He is typical of a boy who has been missed. You have not a movement to lose." was a real breakthrough. Hearing aids were produced and education at a partially hearing unit was set in train. The point I wish to make is that it surely shows how vital is a correct medical diagnosis at the earliest possible stage, for without it one can never start to tackle the problems along the right lines.
I am very conscious that the teachers of all handicapped children are most dedicated people, and they are doing a wonderful job of work. Their patience and understanding has to be seen to be believed. However, I strongly believe that not everything is quite right with the educational system; and here of course I am referring only to schools for the deaf. The syllabus ought, in my view, to be much more closely allied to that which is taught in schools for perfectly normal children, and most particularly from the age of 8 upwards. I believe that there should be much greater integration of the deaf child in ordinary schools, with some 378 specialist facilities, such as the services of a trained teacher of the deaf being available. In my view, it is absolute nonsense to say that a child with a severe hearing loss cannot be fully integrated into a normal school. I know of several cases where it has worked extremely well.
This brings me to another important aspect: that the more you segregate a handicapped or disabled child, the more conscious that child becomes of his handicap and of the fact that he is different from other children. Similarly, the normal child becomes equally conscious of that difference. Integrate, and after a short while the whole thing is accepted as perfectly normal.
Another point about which I hold strong views is that a far better service of advice and help to parents should be available, and this applies to all handicapped children. The noble Lord, Lord Maybray-King, touched on this subject. The voluntary societies do all they can to help, but they cannot be expected to service the whole field. We all know that some counties and local education authorities are extremely good, but some others are not so good. I should like to see a much greater control of the education of the handicapped placed under the special services department of the Ministry of Education and Science, with not quite so much power left in the hands of the local authorities, for if you get a person in a local authority who happens to be unco-operative—and such people do exist, my Lords—the damage that such a person can do is enormous.
I welcome very greatly the transfer of the education and training of the mentally handicapped children to the Department of Education and Science. I believe it is absolutely right, and I know that it has the general welcome of the societies involved. This is particularly so with the British Council for the Rehabilitation of the Disabled, with which I am associated. They find themselves heavily involved in the educational problems of all handicapped when they reach the stage of further education. I suspect, however, that there may well be problems in the training and qualification of teachers, many of whom will be transferring from the Whitley scales to the Burnham scales. It will obviously take 379 some time for the transfer to become truly effective, and we cannot ignore the fact that many teachers in the present order have dedication and practical experience as their prime, if not only, qualification. Nevertheless, some of the statistics we have been given earlier by the noble Lord, Lord Belstead, are indeed encouraging, and I wish him and the noble Lord, Lord Aberdare, every success.
§ 5.41 p.m.
§ LORD MACPHERSON OF DRUMOCHTER
My Lords, I intervene in this debate to raise only one point. As I have been unable to listen to the speech of every noble Lord this afternoon, it is possible that the point I wish to make has been made by a previous speaker. If this is so, I hope that my few words will lend further emphasis. May I ask the noble Lord, Lord Segal, whether, in future, when he raises this question of handicapped children he will also include young people? It is very difficult to tell in this modern age at what age a child ceases to be a child. But there is a problem with young people. This has come about by the ravages of the motor car industry, and the overstress on the roads. We are getting many more road accidents, and young people, unfortunately, are suffering more and more of these injuries.
I feel that the type of person who has lived a normal life and then has been suddenly robbed of this normal life and come into the subnormal class is possibly an even more tragic case. I know from my own personal experience that we in this country have a terrible lack of facilities to help mentally and physically handicapped people, who usually suffer from a head injury, following a motor accident. Finally, may I ask the noble Lord who is to wind up this debate whether the Government will give special attention to this tragic class of person?
I should mention that I. like the noble Lord, Lord Napier and Ettrick, have a very personal interest in this subject, because my only son was knocked off his bicycle at the age of 17; he was unconscious for 12 months and has been hospitalized for the last four years, and I am afraid will stay that way for the rest of his life. The point I am trying to 380 get across is that from my experience there are so few facilities to handle these problems. In my own case I have managed to tackle this situation through a private hospital, and my son is very fortunate. But I am very concerned about those people who cannot afford a private hospital to handle the problem, and I sincerely hope the Government will devote some finance towards doing so.
§ 5.45 p.m.
§ BARONESS SEROTA
My Lords, the whole House is greatly indebted to the noble Lord, Lord Segal, for providing us with this opportunity to consider the needs of handicapped children generally, and in particular the transfer to the Department of Education and Science of the responsibility for the education of mentally handicapped children. Noble Lords on all sides of the House have spoken from wide personal experience and with very deep feeling on the many problems of the complex medical, educational, health and social problems involved over a range of handicapping conditions for children, for parents, for professional staff and for the community itself, but fortunately without the false sentimentality which can undoubtedly cloud the objective assessment of the issues involved on occasions of this kind.
Moreover, the Motion in the name of the noble Lord, Lord Segal, has enabled us to hear for the first time to-day from the noble Lord, Lord Maybray-King. The transition from such a high but lonely office cannot be an easy one, and I hope that by now the noble Lord knows that he is very warmly welcomed in this House, and that his immense experience, a lifetime of experience, particularly in the field of education, will be an invaluable asset to all our counsels here.
My noble friend Lord Segal, the noble Baroness, Lady Phillips, the noble Lord, Lord Belstead, speaking for the Government, and the noble Lord, Lord Grenfell, have all spoken in such detail already during our debate and stressed the particular problems involved in translating the administrative transfer embodied in the Education (Handicapped Children) Act 1970 into a reality that I myself do not intend to say a great deal more on this particular aspect of the noble Lord, Lord Segal's Motion. We all recognise—and this is important from the point of 381 view of social policy formation for the future—that April 1, 1971, marks the successful outcome of a long crusade, to see that every handicapped child in our community is educated in the mainstream of our education services. It is a landmark that in future no children will be excluded from school as ineducable.
At this stage of the debate, I only wish to add my tribute to the teachers and assistants in our local authority training centres and special care units, and to the nursing and teaching staff in our long stay hospitals who have made this much needed change possible, and who have made the tasks of so many families so much more bearable and the lives of so many handicapped children so much more tolerable and meaningful. They surely would be the first to agree with those noble Lords who have pointed out that more resources are needed both in terms of buildings and equipment and trained staff, if the spirit of the Act is to become effective, and if there is to be real equality of consideration for all our children, so that however or wherever they are being cared for, whether in their own homes, local authority or voluntary homes, private homes or hospitals, they shall have what every single parent has a right to demand for his child; namely, the right to education commensurate with the child's abilities and aptitudes.
I see this long overdue development as an essential part of the growing awareness and understanding of the need to move away from regarding the handicapped as needing to be segregated from the community, and providing for their closely inter-related needs, so far as possible, through the normal range of services in the community, where necessary, of course, with special assistance. The noble Baroness, Lady Elliot of Harwood, made an exactly similar point, and I seek only to underline it at this stage because we all regard it as a welcome move away from the situation where hard and often permanent lines were drawn between handicaps, with the resulting creation of separate specialist and segregated services.
Before turning to the wider issues involved in developing a range of comprehensive and multi-disciplinary services to meet the needs of handicapped children 382 generally, I should like to underline the point made by several noble Lords in the course of the debate, that appropriate and accessible—and I stress the word "accessible"—opportunities for education and training are but one aspect of the needs of mentally handicapped children. The noble Baroness, Lady Elliot of Harwood, made the case for a major expansion of community services, to provide domiciliary, day, and short term residential caring facilities to assist families to care for children as far as possible in their own homes, now that it is generally accepted that mental handicap is not a completely static condition requiring lifelong institutional care.
While recognising that the number of places in the local authority community based day training centres and special care units has been doubled in the last decade, and paying my tribute to the outstanding work that has been done for the children in them, I must point out that nearly half the local authorities have themselves, as yet, made no residential caring provision for their mentally handicapped children, and over one-third still have no special residential facilities of their own for adults. Although some 4.000 mentally handicapped children and adults are now maintained in a mixture of new residential homes, and 2,400 in homes run by voluntary bodies or private individuals, the number of people in all our hospitals for the mentally handicapped has, in fact, slightly increased in the last 10 years. There has, I am glad to say, been a slight reduction in the number of children, but there are still some 7,000 mentally handicapped children accommodated in them, and most are now so full that they can admit only the most urgent cases.
I believe that a long history of misplacement of both adults and children he's at the root of the problems which the hospitals for the mentally handicapped are now facing. These, after all, are the last of the all-age residential institutions which were left behind in our social provision after 1948. Surely the time has come when there should be a clear policy decision that no new hospitals will be built for mentally handicapped children and adults together, and that no child should ever be admitted to a hospital unless he or she is in need of continuous medical and nursing care. This 383 debate has indicated the general agreement of those noble Lords who have spoken on the conditions for children in our long stay hospitals, that this is where some of the most difficult problems are to be found and need to be tackled if the now recognised multi-disciplinary needs of handicapped children and adolescents for education, training and occupation to develop to the full their potential for independence (however small or large this may be), are to be met, in addition to providing physiotherapy, speech-therapy, nursing and medical care. Moreover, be they physically or mentally handicapped their needs must be regularly re-assessed, and their progress in every aspect—medical, educational, psychological and social—reviewed from time to time.
No one could be more conscious than I of the impossible burdens that are being carried in the long stay hospitals to-day by our overburdened medical and nursing staff. The best way I can illustrate the level of unmet need in what I regard to be the most deprived and underprivileged sector of the Health Service, is the gross shortage of professional and technical staff to give specialist help and assessment services to the children concened. The noble Baroness, Lady Masham of Ilton, in a most moving and thoughtful speech, reminded us of the need for physiotherapy. Although there are over 1,000 children in our long stay hospitals with severe difficulties that could be helped by physiotherapists, there were, in 1969, only a total full-time equivalent of 27 physiotherapists altogether, including students. In addition to the needs of the children, there were some 3,000 adult patients who could not walk.
There were only 18 speech therapists, including students, although there were some 20,000 children and adults out of a total population of 60,000—that is, one-third of the patient population—who could not speak, or had some speech defects. One hundred and one hospitals had no social workers at all, and there were only 21 trained and 36 untrained social workers in the remainder. In addition there is the need for dental care—surely a vital service for the mentally handicapped where the agonies of toothache can cause the most disturbed behaviour. These facilities too 384 were extremely poor over the range of our hospitals.
But of no less importance are the general social needs of the children, for whom the hospitals at present, and for some time to come in many cases, will have to act as a home and provide the close personal relationships and affection which mentally handicapped children need just as much, if not more, than other children, especially as the hospitals over the years have, through pressure from the community and through shortages of alternative forms of residential care, had to accept a residual social responsibility for children who could not be cared for in their own homes. Again I refer to the speech of the noble Baroness, Lady, Masham, when she talked, so rightly, about the need for small family type units in our large long-stay mental hospitals, and above all perhaps for the need to develop play facilities in our wards for those children who, for one reason or another, cannot be taught in the schools now to be transferred to the education service.
At a time when all of us will agree that the services for the mentally handicapped need to be assisted and supported through a period of major change and transition, there is, I suggest, a now long overdue need for the Government to give a strong and unequivocal lead and to focus public debate by stating their commitment to change, by identifying the main objectives for a major reconstruction of the services, and by announcing their determination to reduce the gross overcrowding and understaffing in our long stay hospitals and to redress the existing imbalance between hospital and local authority services by making the necessary resources available for dynamic development programs of this kind.
I can assure the House that I am not making a Party political point here. I am concerned only that the impetus to change which was beginning to develop in the last year and a half should be accelerated and not lost, and that the energies of local authorities and hospital authorities and the additional monies that are now being made available should be devoted to the systematic preparation and execution of concerted plans for every locality within the wide framework 385 of stated national objectives, since the much needed immediate short-term measures, which we all know are desirable to improve standards in our hospitals, must surely be consistent with the future development of all the services used by the retarded.
A further reason for an overall national plan and a Government statement on policy is that the success of plans prepared by government, both central and local, requires and depends in the main on the support and activities of local people—not only of professionally paid staff, but also of committee members, voluntary helpers, members of voluntary organisations and, most of all, of parents. For major changes of this kind depend above all, I believe, on an informed and sympathetic understanding of the problems of the mentally handicapped among the public as a whole and on our willingness to accept them fully, with all their disabilities, as neighbors and members of the local community. In the last resort, it is the public that must will the resources needed to provide acceptable standards of service for the mentally handicapped.
It was only the intervention of the General Election last June that prevented the previous Administration from publishing a full and detailed policy statement, setting out that Government's long-term aims for a comprehensive pattern of services for the care of the mentally handicapped, and a specific, detailed five-year programme involving action by local authorities and hospital authorities, or their successors in the proposed reorganisation of the Health Service. We were convinced, and I still am convinced, that services for the mentally handicapped must be planned as a whole and bridge across administrative frontiers, if we are to give a new priority and emphasis to their needs and really establish, at last, higher standards of expectation and of care.
Clearly, any new Government need a little time to assess the situation they inherit from their predecessors and to formulate their own policies, in this as in all other fields. But, to my mind, nine months is too long. This may be a normal period of gestation in other contexts, but even then we have now exceeded the nine months. All con- 386 cerned with the needs of the mentally handicapped warmly welcomed the Government's announcement last November that they were making additional money available for hospitals and local authorities over the next four years to improve the service. But the promised guidance on policy, and a firm and clear lead and commitment to change, is still awaited and is now long overdue. I have not pressed the Government on this issue until now, but I hope that when he comes to reply to the debate to-night the noble Lord, Lord Aberdare, will be able to tell us exactly when the Government really will make their long-promised policy statement on these matters. Morale is slipping and the staffs of the services concerned must surely know how best to use the additional resources within the context of overall policy.
Turning now to some of the issues which have been raised in the debate affecting the services for handicapped children generally I believe that the noble Lord. Lord Segal, could not have put down his Motion at a more opportune time to assess the present situation, to measure the progress we have achieved so far and to plan the tasks for the future, because, as has already been indicated, we are now embarked on major changes in the organisation and structure of the personal health and social services. Some of these changes are already in train or are under consideration.
We also—and this has been a great asset in focusing our debate—have before us the Report of the National Children's Bureau's Working Party, Living with Handicap. The noble Baroness, Lady Elliot of Harwood, in the tributes she so rightly paid to the distinguished Chairman of the Working Party. Dame Eileen Younghusband, and to the Director and staff of the National Children's Bureau, completely omitted to mention that that study was only possible as a result of the generosity of the Carnegie Trust at a time when she herself was Chairman of it. The handicapped children of this country and their parents owe a very great debt of gratitude to the noble Baroness, Lady Elliot, not only for sponsoring this particular study, but also for a lifetime of service in their cause. We all listened with the greatest interest to 387 her clear exposition, and to the strong emphasis she laid on the principles on which the findings of the Report were based.
I must confess that in spite of the very kind words that have been said about my connection with this Report, I certainly cannot claim any personal credit for the work involved, although I was connected with its early stages. I can only add my own congratulations to Dame Eileen and the members of the Working Party. as well as to the Director and staff of the Bureau, on this excellent and valuable Report, knowing only too well from my association with the formation of the Working Party and from working with it for its first few months of existence, just how great were the difficulties and tasks which it faced and how admirably suited they were to tackle them. I was delighted to hear from the noble Lord, Lord Belstead—and I am sure we shall hear more in a few more moments from the noble Lord. Lord Aberdare—that the Government have given very careful consideration to this Report, and I sincerely hope that many of its findings and recommendations will be incorporated in future social policy in relation to services for handicapped children.
My only criticism of the Report is that the Working Party were unable. through sheer pressure of time and lack of resources, to consider the problems and needs of socially handicapped and socially disadvantaged children, which the noble Lord, Lord Belstead, and the noble Baroness, Lady Masham of Eton, have both mentioned in the course of the debate. I can only hope—and perhaps the noble Baroness, Lady Elliot, can arrange this as well—that some way will be found for the Bureau to undertake such a study in the near future. Perhaps the Government will be able to assist with funds, perhaps a private trust could help, or, perhaps best of all, there could be a joint venture by Government and a private trust in this field.
I naturally welcome and endorse the emphasis throughout the Report on the need to focus on the child in his family and to advance his all-round development as a child, rather than concentrating on his handicap. I also welcome the emphasis on the need to concentrate on providing supporting services in the corn- 388 munity, for the reasons that so many noble Lords have already given. I took particular interest in that section of the Report which focused on the need to bring our existing fragmented assessment facilities together as quickly as possible into comprehensive assessment centres, wherever they are based, which can be served by the whole range of professional skills involved. Most important of all, looking towards the future I welcome the emphasis which the Report placed on the need to make pre-school facilities available for handicapped children under 5, preferably in association with existing day nurseries, nursery schools and playgroups, so that their disabilities can be compensated for through all-round development and learning that is fostered through skilled help from the earliest date.
I was not at all surprised at the Report's findings relating to the present organisation of the services involved and at the emphasis it placed on the lack of overall planning. The boundaries between our existing authorities providing the services, and the gaps that he between them, undoubtedly militate against providing the very element of continuity of care, treatment and support, which is so essential to the balanced development of all children from their earliest years, through into adolesence and on to adult life.
Since the publication of the Report last summer, the Local Authorities Social Services Act 1970 has come into operation in order to implement the main recommendations of the Seebohm Report. Local authorities are now bringing together, or have brought together, into a single and unified social services department, under a social services committee and a new director of social services, all the functions of the former children's and welfare departments and the personal social services of the existing local authority health departments, together with the stock of domiciliary, day, occupational and residential facilities which form an integral part of these services.
Furthermore, my Lords, they will be responsible for the critical new functions which, under the Chronically Sick and Disabled Persons Act, are now mandatory on all local authorities. The new departments will no longer be fragmented minority services. They will form, at 389 last, a single major service; and, like the noble Baroness, Lady Elliot of Harwood, I hope and believe that the new department will be able to provide much better personal social services in future to the handicapped, as well as to other groups needing services in the community. I hope that they will do this by using flexibly the very wide range of professional skills, stocks of accommodation and contacts that will now be brought together in them. Social workers and residential caring staff with a background in the Children's Service will. I believe, have a great deal to contribute to families with handicapped children. Foster parents who may already he known to child care officers, for example, may be prepared to take handicapped children. Some needing short-term care may be accommodated in our children's homes; staff who have worked in children's homes may be willing to work for a time in the specialised children's homes which are so desperately needed for some of our severely handicapped children.
I hope, too, my Lords, that the Government will agree with the recommendation of the Working Party that the local authority social services departments should be responsible for continuity of care from the point of detection of handicap onwards, and provide casework support and counseling services, and other services, to handicapped children and their families, in closest co-operation with the health and education services. I also hope the Government will agree—and I attach very great importance to this recommendation, although it affects only a very few children—that the social services department should act in loco parents to children who are in long-stay hospitals and are without parents or guardians.
I was very moved by the speech of the noble Lord, Lord Napier and Ettrick, about his experience of finding first the right diagnosis and then the right kind of care, education and treatment for his own son. I know that he will understand when I say that he, of course, had the resources and the persistence to do this successfully for his child. That is what all our children need, and if their parents cannot achieve it entirely by themselves I believe it should be for the social services department to assist parents in find- 390 ing the services which their children need.
My Lords, the noble Lord, Lord Grenfell, reminded us that we were not only in a period of reorganisation and change in our personal social services but were also on the verge of the reorganisation and integration of the now separate wings of the National Health Service itself. Indeed, the Local Authority Social Services Act was not conceived by the previous Administration in isolation; it was part of a comprehensive review—the first comprehensive review of our health and social services since 1948. I do not want to detain the House for too long, but I would remind your Lordships that, with the local authority social services departments corning into being this month, and with the now-published plans of the Government for the reorganisation of local government itself, we are still waiting for the Government's proposals on the future structure of the National Health Service. I am deeply concerned that the medical officers of health and the staffs in the local authority health departments have now been waiting in a limbo for over a year: with many of their former responsibilities transferred to social services departments, they are still uncertain of their future.
I hope that the noble Lord, Lord Aberdare, will be able to tell us to-night when we are to have the Government Statement on the future re-organisation of the Health Service, because it is crystal clear from this debate that in the field of services for the handicapped there will be a particular need for health authorities and social services departments to plan and to work closely together at all levels. The plans each make must fit closely with the plans made by the other; and in all the thinking that preceded the publication of the second Green Paper by the previous Administration and the Local Authority Social Services Act, we were very conscious of the need for close working links between health and social services even though the Health Service was to be reorganised outside local government. Again I am conscious that the new Government needed time to consider their plans in this important field and relate them to their plans for local government reform. I make the point because it is absolutely fundamental to the 391 development of the services for the handicapped that the Health Service, the personal social services and the educational services in local government must be organised and administered through coterminous areas wherever possible, with overlapping membership, if we are to get a true interlinking between the services for handicapped children over the range of their needs.
My Lords, may I conclude by thanking the noble Lord, Lord Segal, for enabling the House to play a part in the continuous and dynamic dialogue which I believe is needed between all concerned in the medical, educational and social services for the handicapped children—parents, professionals, Members of Parliament, Ministers, members of local authorities, voluntary organisations and ordinary members of the community itself—if we are to formulate the effective policies and develop the necessary services to deal with the complex and multi-disciplinary nature of the problems involved, and if, above all (and I think this is the main theme which has flowed through this debate) we are to improve the quality of life of children who are born handicapped or become handicapped through illness or accident.
My Lords, although the primary responsibility for their children does and should rest with parents, in the past the parents of handicapped children have only too often been left to care for their children and carry impossible burdens, with little help or understanding from others. When they could no longer do so, the full responsibility was handed over completely to hospital or the local authority staff, whose work has never had the recognition and appreciation that it really deserves. To-day, with, as noble Lords have mentioned, the outstanding developments that have taken place in recent years in medical knowledge and pædiatric care in the early months of life, many children who previously would have died are living, although many of them may still have some form of handicap. In future, I believe, the responsibility of the handicapped children must be shared—shared within each community between parents, professional staff and volunteers. And this can come about, my Lords, only if there is the clear lead by Government and the informed 392 understanding and acceptance by the community itself of their needs at national, local and neighborhood level.
§ 6.20 p.m.
§ LORD ABERDARE
My Lords, in the course of the debate, the noble Lord, Lord Raglan, reminded the House that this was the fourth Wednesday in succession on which I have replied to a debate. I think that I owe your Lordships an apology for inflicting myself upon you once again on this occasion. But I must say that of those four I feel that this is the most difficult debate to answer because so many of your Lordships have such very deep knowledge and experience of these very difficult problems and have raised such human problems demanding a very real answer; but I will certainly do my best to pick up the points made.
We all congratulate the noble Lord, Lord Segal, for giving us the opportunity for discussing this matter. I have heard some speakers in your Lordships' House rebuked for not asking questions at the right time; but the noble Lord went very far in the opposite direction and asked more in the first five minutes of his speech than I have heard before. But we were grateful for the fact that he had given private Notice of them, and I hope that my noble friend Lord Belstead in his admirable speech satisfactorily answered the noble Lord's detailed questions on points he raised.
May I also join with other noble Lords who have expressed their delight that the noble Lord, Lord Maybray-King, chose this opportunity to make his admirable maiden speech. As all who know him are aware, this is a subject in which he has always taken a sympathetic and human interest. He spoke with great feeling and knowledge and particularly appealed to me in mentioning the special value of voluntary work in giving additional help to the facilities provided by the State. After such a long and distinguished tenure of the Speaker's Chair in another place, I am sure that it is a great satisfaction to your Lordships to know that his voice is no longer gagged and that he is able to devote his wisdom to our debates.
If there is one thing that is absolutely certain it is that handicap among children 393 is increasing. Progress in medicine has resulted in an increased likelihood of survival among children with certain disabling diseases and has produced remedies for previously fatal illnesses. At a very rough estimate, there are at present upward of 100,000 handicapped children in England and Wales; and this number seems to be rising. If I may I will try to give some logical framework to what I have to say by taking it in chronological sequence. To begin with, the period before the child is born, it is obviously desirable, if possible, that we should be in a position to advise those parents especially liable to give birth to a handicapped child of the risks they run. The memorandum on human genetics prepared by the Standing Medical Advisory Committee which was intended to alert family doctors to the problem of genetic disease, presents in simple form the medical implications of human genetics and the rôle of genetic counseling. There are now about twenty genetic advisory centres throughout the country, and in their experience most inquiries come from parents who have already a child suffering a possibly hereditary condition and who wish to know about the chances of recurrence in a subsequent child. Family planning has a part to play in this field and has already brought about a reduction in the number of births to older women which may affect, for example, the number of children horn with Downs Syndrome.
Recent developments hold out new hope for a reduction in the number of handicapped children born. The prevention of hemolytic disease in the newborn by anti-D immunoglobin is an important start. Modern intensive care for certain new-born babies can be expected to reduce cerebral damage among those of low birth weight and vaccination against rubella of girls should reduce the number of children born deaf or blind or both. I listened very closely to the account my noble friend Lord Napier and Ettrick gave of his personal experience with his own deaf son. I sympathies with him deeply and I was interested to hear what he said. I hope that the progress of routine vaccination against rubella of girls between their 11th and 14th birthdays which began last September will be a real contribution in the future to the solution of this problem.
394 Research is continuing into the prenatal diagnosis of certain congenital and inherited conditions—and I was interested to hear what the noble Lord, Lord Raglan, said. I agree with him on the importance of co-ordination of research. Most important, obviously, is early recognition of handicap. The recent reports of the Peel Committee advocated 100 per cent. hospital confinement and this would of course be an advantage in the prevention and early diagnosis of handicap. We are still considering the Report and certainly there will be mothers who prefer to have their babies born at home. But there is a tendency for more hospital confinements and at present some 83 to 84 per cent. take place there. The advantages are that the full resources of modern medical care are readily available to both mother and baby, including close co-operation between general practitioner, obstetrician and pediatricians.
When babies are born with certain inherited defects it is possible by appropriate treatment to prevent mental handicap developing or significantly to reduce its severity. To detect these conditions as early as possible, routine screening is carried out on the blood of all new-born babies. Regular development of screening of young children, particularly those at special risk, is essential to detect as early as possible deviant mental and physical development. My Department has studied the report of an expert group chaired by Sir William Sheldon on the needs of new-born infants and particularly the prevention of handicap, agree with what the noble Baroness, Lady Serota, said. Once the child's disability has been identified it is so important that many different specialties and professions are involved in the process of assessment, treatment and care: pediatricians, orthopedics surgeons, neurologists, nurses, social workers, general practitioners, health visitors, physiotherapists and speech therapists—one can go on a long time. All these and others may well have an important part to play depending on the particular handicap.
It is important to remember that educational assessment should be included at the earliest possible stage. Clearly, the wide range of possible participants in such multi-disciplinary 395 Assessment poses a problem of co-ordination. This was recognised as long ago as March, 1966, in a circular issued jointly by the Department of Education and Science and the then Ministry of Health. This circular rightly recognised the useful contribution that case conferences could make towards keeping all the parties informed and achieving consistency of action. The same need for co-ordination was recognised in Living with Handicap, the report of the Working Party which started life under the able chairmanship of the noble Baroness, Lady Serota. Many of your Lordships, including my noble friend Lady Elliot of Harwood, mentioned this Report; and its general theme is fully in line with our feelings. It emphasis's that the focus should be on the child and the family in the community and on his developmental needs as a child rather than primarily on handicapping conditions. We are giving close consideration to this Report.
It is clearly important that there should be proper co-ordination of the child's subsequent treatment. This is a problem to which we are now giving attention. In the child's earlier years, while the primary handicap is medical, the pediatrician is most probably the best person to coordinate. But there is, as the noble Baroness said, a strong case for suggesting that the social worker is in the best position to carry out the important role throughout of acting as the continuity man or woman whose job is to keep in touch with the child and its family at all times, and to make sure that gaps in the support and care do not occur. So far as the subsequent care of the handicapped child is concerned, there is no doubt in my mind that the ideal is that he should live at home with his family, unless special treatment or care is necessary or, for some reason, the home is unsatisfactory.
As several of your Lordships made clear, parents who look after a handicapped child will need help. In the first place, they need advice and information. The presence of a handicapped child in the family causes great strain, and the responsibility may well increase rather than diminish over the years. Moreover, there are other problems when there is more than one child in the family.
396 For all these reasons, my Lords, early advice and help is essential. Often it is best given by the family doctor, but in other cases it may be given by the social worker or health visitor, or by another member of the assessment team. Again, it is important that educational advice should be available early to the mother and that, where possible, she should be given help by finding the child a place in a nursery school, a day nursery or a play group. This is certainly a field where voluntary organisations, such as the Society for Mentally Handicapped Children and the Handicap Adventure Playground Association, have a big part to play. May I also say how interested I was in what was said by the right reverend Prelate the Bishop of Truro, and how very much we rely on the cooperation of the Churches in all our dealings with handicapped children?
Under our capital building programme for the next three years, and the third phase of the urban programme, an additional 3,000 places in day nurseries are planned. Some of them will be available to handicapped children. Often, too, as was mentioned by one of your Lordships, home-helps can be a considerable assistance to families where there is a handicapped child. Section 13 of the Health Services and Public Health Act 1968 obliges local authorities to provide adequate home-help service and this section has now been implemented from April 1. In the discussion on the rate-support grant for 1971–72 and 1972–73 it was agreed that the provision of an extra £1.25 million and £2.5 million respectively should be made to allow for an expansion of this service. The same section empowers local authorities to provide laundry services, which again can be of significant help to some families.
The provision of a sitting-in service is another field where voluntary organisations may make a great contribution. Temporary residential care has been mentioned to provide a period of total relief for the family who may well be able to cope for most of the year, yet who need relief for a time. This is another important requirement. It entails the provision of hostels with short-stay accommodation, either to give the family 397 a much-needed break or during times of family crisis. Hospitals, local authorities, voluntary hospitals and holiday homes can all help to meet this need. Where for some reason care in the home is not possible, the next best thing is care in a foster home or hostel. Here again a great deal is being done by voluntary organisations, as well as by local authorities. Hostels providing a mixture of short-stay and long-stay care for children or for adults are particularly important, as they give parents some assurance that in the event of their death their child will have somewhere to go where he does not feel a total stranger.
Now, my Lords, I come to the hospital service, which has a considerable part to play, not only in the assessment of the handicapped child but also in providing a routine out-patient consultancy service for children suffering from physical or mental handicaps. So far as in-patient treatment is concerned, a survey, carried out in April, 1959, showed that there were then about 1,500 children under the age of 15 who had been, or were likely to be, in long-stay care and under psychiatric hospital accommodation for four months or more. Of these, about 200 could have been discharged had suitable facilities been available. Similarly, many of the mentally handicapped children now in hospital would be more suitably placed in a hostel or other accommodation in the community.
This again emphasis's the importance of comprehensive assessment, regular re-assessment, close links between hospital and community services and the provision of day hospital facilities. However, we have to recognise that a child's handicap may be such that he needs the care and treatment that can be given only if he is a hospital in-patient. In these circumstances, our aim must be the highest possible quality of life. Whether a child stays in hospital for a short time or a long time, the hospital becomes, in effect, his home. Full facilities for play, education and treatment should therefore be available; and above all the atmosphere should be as domestic as possible. The ultimate aim of rehabilitating a child into the community should never be forgotten. This is a guiding principle, and in attempting to provide for the many needs of these children, we must never 398 overlook the importance of treating them wherever possible within the community.
I do not want to keep your Lordships for much longer, but perhaps I may quickly answer some of the individual points which have been made. The noble Baroness, Lady Phillips, reminded me that we had some exchanges on her previous Bill about teachers of handicapped children. May I say that she always showed great sympathy in our dealings. The difference, as I understand it, between the proposals that we have now implemented and the proposals of the Labour Government he's in the fact that under our proposals the teacher holding a diploma for teaching mentally handicapped children immediately comes on to the Burnham qualified teacher salary scale. After five years post-diploma service he attains qualified teacher status and is paid the special school allowance of £137 per annum as a teacher in a special school, and can teach in any maintained school; whereas under the proposals of the previous Government the holder of a diploma who had not yet done five years' qualification period was paid as an unqualified teacher. So I think I may claim that our proposals have benefited the teachers with the diploma.
The noble Baroness asked whether we had given advice to local authorities and in fact we have, in Circular 15/70 of last year. She also raised the matter of transport required for blind children in Cardiff. I think that my noble friend Lord Belstead would be the right person to tackle about that.
My noble friends Lord Grenfell and Lady Elliot of Harwood—who has herself done such a tremendous amount in this work, particularly in connection with autistic children—asked me something about further education for autistic children. My Lords, as knowledge of the underlying causes of autism is far from complete, psychiatrists can help to only a limited extent, although there is a fair amount of research in progress, involving children in hospitals for the mentally handicapped, and it is clear that some autistic children do benefit from psychiatric help. However, more children benefit from special educational help, and it is in this field that most has been done and most may be expected.
The Department of Education will shortly be issuing to local education 399 authorities a circular on special education for autistic children. This will describe the more promising aspects of the various approaches which have been adopted and will include a request for more detailed information about existing and planned provision for these children. I would also emphasise that education is already possible up to the 19th birthday of these children, and this depends on the local authorities concerned. I know that some of them are very helpful.
Unfortunately the noble Lord, Lord Stoneham, has gone. He was extremely gloomy and, I felt, very unfair to the Government over the Chronically Sick and Disabled Persons Act. It really was not like him. I hope that he is feeling all right and has not been driven away for that reason. My noble friend Lady Elliot of Harwood did him a power of good by reminding him of the progress made in Scotland, and no doubt we shall make equally good progress in England, now that we have the same kind of opportunities. I hope the noble Lord will study carefully what she said. We also have plenty of plans for dealing with the future, and I think it would be best if I wrote, or if my noble friend wrote, to the noble Lord to ease his worries.
The noble Baroness, Lady Masham of Ilton, made a number of interesting points, and I will take up a couple of them. She laid stress on the difficulties sometimes involved because of lack of co-ordination between different departments. The fact that so many people have an interest in the problems of handicapped children has worried many noble Lords. It is a situation we have to take into consideration and which the previous Government took into consideration, particularly in the context of the Act. If I may, I will quote a phrase from a speech made by the noble Baroness, Lady Serota, on this topic, when she wisely said that the interests of the handicapped "are as wide as life itself".
I believe that this is the difficulty in trying to separate them off into any one department. Problems can be exaggerated, but they have in many ways been reduced by the present Government's arrangements. Health, personal social services and social security are now all together in the Department of Health and 400 Social Security; education remaining with the Department of Education and Science; access, housing and transport are all concentrated in the Department of the Environment. Of course, if there is any doubt about any other service of the central Government, my Department is always willing to advise and help through the ordinary day-to-day process of coordination between Departments.
The local situation must also be considered. What does happen to the handicapped usually happens at home, and here again it would not be good sense to dilute the responsibility by creating an artificial specialism for dealing with the wide varieties of care. Doctors must be regarded as leaders in health care. The Housing Department must take proper account of housing need. But the new personal social services departments created by the last Administration can also, besides providing social work and practical help, assist handicapped people to make their case to others; and I am sure that the directors of social services will see it that way.
The noble Lady also asked me about handicapped children in ordinary schools, and referred to Section 8 of the Act. Within the context of the resources available for educational buildings, the Secretary of State has given sympathetic consideration to proposals from local education authorities to make some of their buildings suitable for use by disabled persons, and ramps and special toilet facilities are among the items which may be required. Nevertheless, many physically handicapped pupils will continue to require the facilities which the special schools provide. These include small classes, nursing and child care, physiotherapy and medical treatment.
We all listened with deep sympathy to the speech of my noble friend Lord Macpherson of Drumochter. I do not think the hard figures are much comfort to him, but I would remind him that my right honourable friend announced on November 11 that £3 million has been set aside over the next four years for the provision of separate accommodation for the younger chronically sick in hospitals. If he has any further helpful advice and can give me further information about his personal experience, I shall be only too happy to listen to anything he has to tell me.
401 I have tried to sketch in the outlines of the overall health provisions for handicapped children in general, and the educational provision for the mentally handicapped has been lucidly described by my noble friend Lord Belstead. I hope that I have not given an impression of complacency. The Government do care; and who, indeed, could possibly not care about these children? We are taking action. For the first time in this country we are introducing an attendance allowance, and for the first time in this country we are introducing a disability allowance. We are devoting increased resources to the problems of the handicapped, both in the hospital service and in local authority care through the rates support grant. We are awaiting the conclusions of the Office of Population Censuses and Surveys, a survey of handicapped adults living at home. My right honourable friend the Secretary of State intends to take this opportunity to review provision for them and at the same time take into full account the conclusions of Living with Handicap.
The noble Baroness, Lady Serota, asked me about the policy documents on the mentally handicapped. Much useful work was done on this by the former Government, but when they went out of office finance had not been allocated beyond 1971–72; nor had the authorities or principal professional bodies been consulted. The policies, with which we are in broad agreement, have been reconsidered, and we have also considered finance and held the necessary consultations. But I regret to tell the noble Baroness that she must he patient a little longer. We expect the document to be issued within the next two or three months.
In conclusion, my Lords, may I say again how much I welcome this opportunity to tell your Lordships the Government's view on this very difficult subject and again thank the noble Lord, Lord Segal, for initiating the debate.
§ 6.47 p.m.
§ LORD SEGAL
My Lords, I think it would be wrong of me to detain the House for any length of time at this late hour. We have had a most interesting and notable debate and I should like to thank most sincerely all those Members of the House who have taken part 402 in it. Many questions have been asked and I myself have been one of the offenders. I should like to pay special tribute to the two members of the Government Front Bench who have participated in the debate. They have given us something in the nature of an interim statement, and we look forward to the implementation of their good intentions.
To the noble Lord, Lord Aberdare, I would say that after his fourth successive Wednesday, at least he may take some comfort in the fact that he will not have five in a row. May I also say to the Government that they start off in their efforts on behalf of handicapped children with the utmost goodwill from all sides of the House. If there may seem occasions when they are lagging in their footsteps, we may take the opportunity of prodding them on.
It may seem rather invidious to single out names, but may I especially mention two or three contributions to the debate that have impressed me. We had a memorable maiden speech from the noble Lord. Lord Maybray-King. I was deeply touched by the speech of the noble Baroness, Lady Masham of ilton. I should also like to thank the noble Lords, Lord Napier and Ettrick and Lord McPherson of Drumochter, for their own personal contributions, which I am sure found a deep re-echo in the House. I thank, too, the right reverend Prelate the Bishop of Truro for his outstanding contribution. Finally, may I thank all the noble Lords who have participated in this debate and beg leave to withdraw my Motion for Papers.
§ Motion for Papers, by leave, withdrawn.