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Speech Therapy Services (Children)

Volume 517: debated on Wednesday 3 November 2010

Motion made, and Question proposed, That the sitting be now adjourned.—(Stephen Crabb.)

Thank you for calling me to speak in this important debate, Mr Streeter. It is important because of the very large number of children in this country who require speech therapy to make the most of their lives. I am delighted that the Minister is able to join us today and apologise for dragging her away from the important work of putting together the Green Paper that we anticipate. I pay tribute to the personal interest she has shown in the matter not only since getting her job in government, but when she was in opposition.

I will not start by reciting the usual litany of depressing statistics associated with speech and language therapy as my opening gambit, which would be a little predictable. Instead, I will start by paying tribute to the work of some of the charities involved and to the previous Government. What we have today is the end result of a process. It started with a charity called I CAN, which ran the campaign, “Make Chatter Matter”, and spent three years building awareness among politicians, such as us, about the importance of speech and language communication. That led to the Bercow review, the better communication action plan—brought forward by the previous Government—the appointment of Jean Gross as communications champion and the designation of 2011 as the year of speech, language and communication.

We are part way along an important journey that was initiated by the previous Government and then taken up by the current Government. That is why it is really important to pay tribute to the fact that a Green Paper is now coming forward. Among all the organisational changes that we are planning in public services, I am delighted that the Government have found space in their schedule for a Green Paper on the important issue of special educational needs. It is a welcome opportunity to entrench greater choice for parents, earlier identification of the needs of those with speech and language difficulties, more tailored support and improved transition services, which I believe are so important.

Clearly, there is still work to be done. There is an organisation in the north-west called —why they have to add “” to everything these days, I do not know—which works in my constituency and many others in the region to encourage better quality speech and language provision. In its survey of SEN co-ordinators, it found that more than half had never heard of the Bercow report and were not even aware of that ongoing process.

Members must forgive me, for I will now embark on a bit of a shopping list of issues that I think still need to be considered in the Green Paper. Given the time available and the number of Members who wish to speak, they will have to forgive me if it turns into something like an episode of “Supermarket Sweep”, rather than a shopping list. I will do my best not to lose coherence.

It is crucially important that I pay tribute to my own speech therapist, Mrs Williams, who saw me for four years, between the ages of five and nine, to help me learn to communicate better. It was only when I was preparing for the debate that I began to think about what she had taught me, as I never really thought about it at the time. She was not teaching me to make a noise or how to speak, but how to communicate and get my message across. There is often a misconception that speech and language therapy is about putting stuff into people’s minds so that they have something to say. There was plenty going on in my mind—far too much, actually—so my mouth could not keep up when I was trying to express it all. She taught me to slow down and not to panic, stammer or trip over myself. Although that is not always ideal within a parliamentary setting, when one might have a six-minute speech limit, it is still a useful lesson today. There is no need to rush. Just because one has things to say, one does not need to get them all out in 30 seconds.

I congratulate the hon. Gentleman on securing the debate. Unfortunately, I will have to leave before the end to attend a meeting, which I apologise for. He rightly paid tribute to the work of his speech and language therapist. Does he agree with me that it is important that all levels of the Government work with the Royal College of Speech and Language when developing their policies in that area so as to maximise the potential benefit they can get from it?

I thank the hon. Gentleman for his intervention and agree entirely. Our speech and language therapists are a much underused resource, and as time moves on they will be in much more demand. A report shortly to be published by the International Longevity Centre will tell us how, with the growing incidence of Alzheimer’s and the difficulties that adults with communication problems will face, the pressure on speech and language therapists will increase far more.

I, too, congratulate the hon. Gentleman on securing the debate, and I congratulate the work of speech therapists. One issue that we have found in Northern Ireland relates to recruitment; perhaps he will comment on it. We find that of the 15 or so young ladies—it is predominantly young women—who start the course in college, only four or five are left trying to finish the course at the end of the year. The therapists do fantastic work, but there is a concern about the provision, and I would be interested to hear his comments on that.

I thank the hon. Gentleman for an interesting contribution, which highlights a problem that covers so many areas of medical training: what comes in at the beginning does not always come out at the end. We have to support those who are making a commitment to public service.

It is worth noting that speech and language therapists play an immensely important role across a wide range of areas. In the youth justice system, for example, the offenders are children, although we often do not think of them as such. The work that speech and language therapists do within young offender institutions is vital in reducing reoffending rates and crucial for improving life chances. The Children’s Communication Coalition made an interesting comment in its June 2010 report:

“The true costs of not supporting children with speech, language and communication needs—above and beyond those that are measurable in direct financial terms—are very great indeed. The personal and familial costs of poor educational attainment, descent into criminality and long-term exclusion from the mainstream are hugely significant and potentially corrosive to society at large. Poor educational outcomes often lead to poorly paid jobs or unemployment. In turn, this can lead to a perpetuation of the poverty trap and a vicious cycle of health problems and health inequalities”.

In a sense, that could sum up the entire debate in 30 seconds, and I could just sit down. It covers everything we need to be concerned about.

I congratulate the hon. Gentleman on securing the debate. Does he agree that communication competency needs to be a key performance indicator, along with literacy and numeracy, in our schools?

I agree entirely. The hon. Gentleman has anticipated my next point. Speech and language therapists are there not just to help children, but to help the entire children’s work force understand that communication needs to be the golden thread running through everything they do. They need to be equipped to train staff, teachers and others who work with children, as well as the children themselves. I ask the Minister to confirm that she will do all she can to ensure that we recruit more speech and language therapists to meet the unmet needs that are out there.

The better communication action plan made a specific commitment to universal screening as part of the healthy child programme. Many major bodies, including the Royal College of Speech and Language Therapists, which I suspect has managed to get many supporters to attend the debate, wants to see that occur at age two and five, in advance of the reading assessment. What steps will the Minister take to ensure that that aspect of the action plan is taken into account?

Another important aspect that is often overlooked is that when we discuss children’s speech therapy we often think of those aspects that are what I describe as being high incidence, but low need. In other words, many children face communication difficulties, such as language delay, but their support needs are actually quite low. There is a much smaller group, which has much more complex needs, but the incidence of that need is relatively low. That poses a particular problem in commissioning. I wonder what the Minister’s views are on how we balance those two competing aspects, because where there is low incidence but high need, it is often more of a health intervention, rather than an educational intervention, that is required.

Just this last year, I witnessed what I can only describe as the transformation of a young boy from being unable to communicate to being able to talk quite clearly within a matter of months, so I have seen at first hand the work that can be done. One of our concerns, which is shared by many people who look after young boys and who try to train them, relates to the financial provision. In relation to the comprehensive spending review cuts that have been made and how they will affect provision, does the hon. Gentleman agree that the front-line service of speech therapy should be retained and that people should know that the moneys are there for young people?

I thank the hon. Gentleman for his intervention. I agree entirely. That is why we say continually that the most vulnerable are those that really should be protected, and front-line services will be protected.

Whenever we try to abolish quangos in particular, we can always find one saving grace in every quango that gives us a justification for keeping it. With Becta, which provides educational technical equipment, one of the saving graces was the work that it did in the augmentative and assistive communication sector—AAC for short, to save me a bit of time. Can the Minister confirm whether the funding that was originally to go through Becta to the AAC sector will still go to it to fund not just the specialist provision of AAC equipment, but the leadership roles in the sector? That is another part of the better communication action plan that I hope will be continued throughout the year of speech, learning and communication in 2011. Will she also commit to re-examining the issues of provision in the AAC sector? She may not be aware of the problems facing the ACE—Aiding Communication in Education—centre in Oxford, which faces closure as a result of some of the changes in that charity and the funding of the wider sector.

Will the Minister support the proposals from the communication champion, Jean Gross, for a new AAC commissioning model that reflects the differences between high incidence, low need, and low incidence, higher need, which are crucial to a proper appreciation of the sector’s needs?

I said that I did not want continually to go in for shocking statistics, but let me give just one, which is that 55% of children in the more deprived areas arrive at primary school with some form of language delay. That does not necessarily mean that there is anything going on; it just means that they are delayed in the formation of basic skills. That happens for a range of reasons, but often it can be something as simple as mum and dad not talking to them when they were babies.

Booktrust, a charity of which many hon. Members may be aware, does fantastic work in more deprived areas just by handing out bags of books to young mums to encourage them to read and by saying to young dads, “It’s a good thing to sit down with your young child and read them a story. Don’t just watch the football match. Read “Peppa Pig” or whatever children’s literature you happen to have to hand; it helps your children.”

Can the Minister confirm, in light of the CSR, that the very important funding that Booktrust receives from the Government, which allows it to access £4 of private funding for every £1 of Government funding, will continue in order to help us to deal with that language delay and gap in the most deprived areas? That is just one example of the philosophy of early intervention, which is gradually receiving unanimous, all-party support as a principle. What it means in policy terms often varies greatly, but the principle of early intervention is now accepted by all in the House, I hope. It allows us to escape the departmental silo thinking that has bedevilled public policy formation in this country for far too long.

How does the Minister think that the pupil premium, which both coalition parties advocated pre-election, will benefit children requiring speech and language therapy at the moment? In particular, does she agree on the importance of appropriate diagnosis and that improving the quality of diagnosis might lead to fewer children being diagnosed as having special educational needs? Does she recognise that one goal of speech, language and communication therapy must be to take pupils off the SEN register because their language delay has been dealt with, the gaps have been filled and they are now able to participate fully in society? I ask that because there is a particular problem with stigmatisation.

Even 30 years ago, when I had speech therapy, I was taken out of my primary school and transported down to the village health centre. I was regarded as different—special—because I had to be taken out. That was 30 years ago; one would like to think that things had moved on. Unfortunately, the stigma is still there. I urge the Minister to ensure that more and more services can be delivered in the school setting and do not require the pupil to be stigmatised, or made to look different or special.

Let me explain one way of doing what I have described. At Fleetwood high school, in the constituency of Lancaster and Fleetwood, which neighbours mine, children with special educational needs are dealt with under the same umbrella as those who come under the gifted and talented scheme. There is not such a difference between them as one might think, because very many people with special educational needs, and in particular speech and language needs, are also very gifted and talented young men and women. The two are very often the same group. I urge the Minister to consider how such an approach can reduce stigmatisation.

I warmly welcome the ambition of the forthcoming Green Paper to equip parents to have more choice in and more say over how their children are treated by the “system”. One of the grave frustrations of so many parents whom I meet in my advice surgeries—and, I am sure, those whom other hon. Members meet in their surgeries—is that when they take their children to the office of the relevant public organisation and sit down to have a discussion about their child’s needs, they immediately find that there is a form before the public servant in front of them and they are then forced somehow to adjust their child’s needs to fit the existing boxes on the form. If their child’s needs do not quite fit, there is a problem; they do not quite get the tailored support that they need.

Can the Minister make any suggestions about how we start to change the tick-box culture? I think that this is the most crucial question in public policy at the moment: how do we get away from a situation in which services are designed for people to fit into and move to a situation in which services are designed to fit around the needs of the individual? That is important.

I congratulate my hon. Friend on securing the debate and on the contribution that he is making. He refers to the Green Paper. Does he share my concern about the risk to the statementing procedures posed by the potential withdrawal of the rights that currently apply under those procedures? An example of the importance to the statementing procedures of speech and language therapy is that 10% of cases at the special educational needs tribunal arise as a result of deficiency in speech and language therapy provision in schools.

That is a very important statistic and I thank my hon. Friend for making his intervention. I hope that it will be borne in mind that we have to get the process of diagnosis right. There is no point in merely diagnosing children with special educational needs as a shortcut to fulfilling some target in a back office somewhere. The system must be designed around the needs of each individual child.

Finally—as I am sure everyone will be pleased to hear—and most importantly, my biggest concern about the Green Paper is the fact that so much of what we shall require will have to come from the Department of Health as well as the Department for Education. My big fear, based on observing 20 years of public policy in this country, is that getting Departments to talk to each other, to sing from the same hymn sheet and to work to the same agenda is perhaps the hardest task in government. It is not enough just to have the smiling, happy faces of two Cabinet Ministers at the bottom of the introduction page of a Government document. There needs to be an alignment of strategic priorities, close partnership working and agreement. Can the Minister confirm what joint working is occurring with the Department of Health and how the plans for NHS reform, academies and special educational needs will coalesce seamlessly? That is the real challenge.

I do not want to go back into the statistics, but so many children are struggling at school through no fault of their own but merely because their needs have either not been identified or not catered for adequately. Too many children are trapped. It is a form of social exclusion that they are not able to participate fully in society. I strongly welcome all that the Minister is doing in this field, and I urge her to continue her work. I look forward to seeing the Green Paper, as I am sure many other people in the sector do, and I look forward to hearing the Minister’s answers to my questions today.

I congratulate the hon. Member for Blackpool North and Cleveleys (Paul Maynard) on securing this important debate, which is really important to me and to thousands of children and their families across the country.

The ability to communicate effectively is a key life skill. It underpins our ability to learn and to understand, to express our views and knowledge to others, and to understand their views and knowledge in return. Without good communication skills, we are not able to take our place alongside our peers in an increasingly complex world, in which good interpersonal communication skills are now as important—sometimes more so—than good qualifications.

I apologise for stating the obvious: communication is not just about being able to speak properly. It includes receptive language skills, which is the ability to understand and make sense of what is said to us, expressive language skills, which is the ability to speak clearly and make ourselves understood, and higher-order language skills, which is the ability to use and interpret humour, inference, scepticism, irony and other non-direct language.

There are many reasons why a child might fail to develop age-appropriate communication and language. For some children, there might be a link to a neurological or physiological problem, for instance oral dyspraxia, cerebral palsy or autism, but many more of them simply do not have access to the good language and stimulation that they need from an early age, and therefore enter our schools and nurseries with few, if any, information-carrying words.

In many children, communication disorders are complex and largely hidden. The child can speak, albeit with a limited vocabulary. He—it usually is a he—can go on to learn mechanically and by rote. On any crude measure of progress, such as reading age, the child might seem to be making good progress, but careful and specialist assessment by people such as speech therapists can identify that their grasp and understanding of what they have learned by rote is limited. They might appear to read well, but that reading is mechanical, with little or no understanding. As they have limited language and vocabulary, and their reading is mechanical rather than conscious and creative, their language-into-literacy skills do not develop as they should. That is largely why we have so many children failing to get good reading skills and go on to gain good skills in other areas. They do not have the basic understanding that they need to learn more complex concepts. That can lead to frustration in the classroom, and as a result a child can either become withdrawn, which can be misdiagnosed as a learning difficulty, or have tantrums and difficult behaviour, which can be misdiagnosed as a conduct or a behavioural disorder.

There are more than a million children in this country with speech, language and communication needs that are not the result of language neglect, lack of stimulation or other external factors. That means that in the average classroom there can be two or three children with such communication difficulties. Of that group, a large cohort has specific language impairment, meaning that their difficulty is not related to other general issues such as learning difficulties, hearing impairment, autism or cerebral palsy.

A child with a specific language impairment might well be cognitively able, which is a point made by the hon. Member for Blackpool North and Cleveleys. They will struggle, however, to understand the vocabulary used in the average classroom. A significantly greater number of children have speech, language and communication needs that could be classified as caused by language neglect and lack of stimulation in their early years. Those children need early and appropriate intervention. They and their needs cannot be ignored, nor can they be treated as less deserving simply because their needs are, in a sense, acquired rather than organic. Without appropriate intervention, those children will be diagnosed as conduct disordered or delinquent and will go on into a self-fulfilling prophecy, which will cost this country millions and millions of pounds.

We know from very clear evidence what happens to children with speech, language and communication disorders who do not get appropriate intervention and support. Youth offending services identify that 70% of young offenders have an underlying speech, language or communication disorder. The chief inspector of prisons tells us that more than 60% of prisoners have an underlying speech, language or communication disorder, as do a significant proportion of adults accessing our mental health services.

Is it not astonishing that 70% of people in our criminal justice system have a communication disability or disorder? Should not the Government invest in specific speech and language therapy support, particularly for the young people in our criminal justice system, so that they have a chance to get back into proper life?

I absolutely agree, and I can go on from that.

The National Autistic Society has identified that 70% of young people with autism, the vast majority of whom have an underlying language and/or communication disorder even if that is restricted to higher-order language difficulties, also have a mental health difficulty. Shelter tells us that a significant proportion of people classified as homeless have an underlying language and communication disorder. I could go on and on.

However, those issues are not limited to language and communication disorders; they are seen across many areas of children’s health, such as physiotherapy, occupational health and, one of the huge ones for me, child and adolescent mental health services. Review after review has identified that, to address the issues, diagnosis needs to be timely and carefully carried out by specialists—speech and language therapists—and services need to be appropriate to need and easily accessible, a point made by the hon. Member for Blackpool North and Cleveleys. Specialists in education and health need to work in partnership with the child and the family at the centre, not separately, and not, in the case of health, in a clinic far removed from the day-to-day life of the child in the classroom.

Unlike, I suspect, many other Members here, I do not see more and more speech and language therapists as the only answer. Although I want to add my thanks to specialist speech therapists for the incredible work that they do, and although I consider them part of the way forward, they are not the only answer. In my view and experience, early intervention and appropriate provision include four fundamental necessities. The first is better training for all early years education staff—teachers and support staff. Given that we know that in some cases there will be up to five children with a significant speech, language and communication disorder in an early years classroom, it seems reasonable that every such classroom should have within it one adult—a teacher or a specialist support assistant—who has additional experience or qualifications in this area. I was an assistant director of education in the constituency of my hon. Friend the Member for Washington and Sunderland West (Mrs Hodgson) a number of years ago, and we made that a requirement of our accessibility strategy. As a result, we saw a shift in the language-into-literacy issues—in the communication difficulties that were preventing children from learning to read and to progress in other areas.

Secondly, language development needs to be an integral part of the whole curriculum. The hon. Member for Blackpool North and Cleveleys talked about pulling children out of lessons and classrooms for one-to-one speech therapy sessions. Such sessions are isolated from what is going on in the child’s classroom, lessons and life, and are much less valuable than ensuring that the child is surrounded by a rich and appropriate vocabulary each and every day, and that lessons are planned and delivered to include language development as key steps.

Thirdly, specialist speech and language therapists need to be actively involved in curriculum design and delivery and in-service training for staff in schools. Finally, we need an accountability framework that understands the importance of language development in learning, and holds not only head teachers and governors, but those who commission children’s health services, to account for the training of staff and the outcomes of children with speech and language difficulties. By not intervening in an appropriate, timely and systemic manner we stand aside and allow generations of children to be labelled behaviourally disordered, conduct-disordered or odd and difficult, or as having learning difficulties. That is wrong and unnecessary, and too often it blights the lives of those children and their families.

As the Minister is here, I want to make a further plea to her to consider transferring the funding for children’s heath services to local authorities alongside funding for public health. It will not be sufficient funding, but at least it and the bulk of the responsibility will be in the same place, which will give parents a little more to hang their hats on when arguing for services.

Again, I congratulate the hon. Member for Blackpool North and Cleveleys on securing this important debate. I will work positively with anyone, on either side of the Chamber, who highlights these matters and is prepared to work with me to address them.

We have 14 minutes until wind-ups begin, and six colleagues are trying to catch my eye, so contributions of around seven or eight minutes would be most welcome.

It is a pleasure to serve under your chairmanship, Mr Streeter. I apologise that I will have to leave before the end of the debate; one of my constituents has organised a big rally in Old Palace yard for park home owners, and I should be standing alongside the banners that will, inevitably, be there.

I officially start by congratulating the hon. Member for Blackpool North and Cleveleys (Paul Maynard), who spoke elegantly and passionately. He brought the debate alive for us this morning. It is a timely debate because we are at a crossroads; we can look back over the excellent work that came out of the Bercow review, but we are at a point where we need to look forward, learn what we can from the past and take some steps forward. I appreciate the fact that the previous Government commissioned the Bercow report, committed resources—never enough, of course, but the resources were considerable—developed an action plan, appointed a communication champion and designated next year as the national year of speech, language and communication. Those were important steps forward.

As the hon. Gentleman and the hon. Member for North West Durham (Pat Glass) pointed out, there is a spectrum of needs, which is why the matter is complex to debate. At one end, there is high need, low incidence, which needs highly specialised skills and technology, some of which comes in very expensive packages, but what an enormous difference it can make to the quality of life of the child and whole family. I want to touch on the whole family throughout the debate because it is important. At the other end of the spectrum, there are issues that we know can be addressed through simple interventions, which I shall touch on.

It is highly significant that speech, language and communication needs feature in statements of special educational needs for 26.5% of mainstream educated children. How significant the problems are is absolutely staggering. Other Members have dwelt on the fact that if there is a communication problem, a behavioural problem often emerges. That is natural; for a three or four-year-old who cannot express themselves, with adults not responding in the way the child wishes, what else do they do? Inevitably, we will have behavioural problems; and that, of course, identifies the necessity of early intervention. Not intervening early means that problems escalate to widespread exclusions at secondary schools and the concerning percentage of young offenders who have speech and language difficulties. Obviously, we must emphasise that it is not a straight one to one causal relationship, but there is a significant link.

I was interested in the comments by Jean Gross because we are concerned about people thinking, “Oh, the child’s just lazy. There are lots of very clever people who didn’t start to speak until three or four. Do we need early intervention?” I passionately believe that we do. A mother came to me with a boy of four. He could not speak and his behaviour was getting out of control. I suggested that the mother went to the GP to ask for a specialist referral, and the GP came back at me and said, “How dare you tell me how to do my job?” I was rather pleased that I stirred that up. When we talk about training the whole work force in these needs, we need to include health workers, health visitors and GPs, as well as those in education.

I want to be brief, so I shall go over the key issues quickly. I recall that the Bercow report said that provision and joint working is patchy across the country. There were 16 pilots announced in 2009 to look at best practice in working together in health and education. I do not know if there has been a chance to evaluate them, but it is important to look at everything that has been initiated and evaluate it as soon as is timely. We have to learn from all of this, but it is difficult to come up with a national framework because the solutions have to be local.

I am concerned about health provision. We have speech therapists and we have teachers trained by specialist speech therapists, which is good but it must not be a substitute—it is an add-on. Too many authorities are using it as a substitute, but it is not. We must have sufficient qualified speech therapists. I cannot get a grip on what the shortage is. As the Minister is aware, I am always asking parliamentary questions about numbers of specialist workers, but I cannot home in on what the shortage is, and we must have a grasp of what the needs are. I can think of fantastic situations in which specialists trained up pre-school workers, for example, in children’s centres to work with children identified as having language delay. That is good for low-level speech and language problems, but we are not getting a grip on the exact size of the work force needed to address the issues, on how it is all pulled together and on where working together comes forth and provides an add-on. Simply saying, “All we’re doing is perfectly satisfactory,” when it is a substitute, is not good enough.

I emphasise the point the hon. Member for Blackpool North and Cleveleys made about the importance of an individual solution, particularly for a family. A mother who came to see me had six children including five-month-old twins, and one child in the middle had speech and language difficulties. A package was drawn up for her to give an amount of assistance a day. Of course involving parents and carers in the package is important, but, somewhere along the line, the family circumstances have to be taken on board.

Due to time, I shall end there. I endorse all the points made already, and I look to the Minister to focus on getting a grip on how all the services come together to give the best possible start to communication in a child’s life.

I join the tributes to the hon. Member for Blackpool North and Cleveleys (Paul Maynard) for his comprehensive and well informed speech. I congratulate him on securing this important debate. We are debating these matters when the economy could be in better shape. The hon. Gentleman and I were at a meeting in a Committee Room of the House of Lords last week, where the organisations of and for people with disabilities, particularly children with learning disabilities, got together to discuss what is happening, what might happen and what the problems might be given the current situation.

Lord Rix, who is my co-chair of the all-party disability group—perhaps I should put that the other way round—made an outstanding speech. The next day, he followed it up by reading a letter to the Minister responsible for disabled people, the hon. Member for Basingstoke (Maria Miller). Being the gentleman that he is, he apologised for the passion that he had shown the night before, although I do not think that he needed to apologise. Like his speech, his letter was profound, and I will quote an important paragraph from it:

“If support is adequately financed and provided for by all schools, children could remain in a setting in the heart of their local community. Placing this responsibility on parents in terms of their child’s education could be an additional burden in their already complex lives, if the right levels of support, information and advice are not adequately provided. This could also potentially lead to parents having to prioritise aspects of their child’s development—i.e. speech and language therapy over in-class support—which could have significant legal ramifications on issues concerning the responsibility of educating children with special educational needs.”

I am glad that Lord Rix made that point; it is repeated again and again.

Some of us—perhaps all of us—received representations this morning from the Royal College of Speech and Language Therapists, to which the hon. Member for Blackpool North and Cleveleys referred. In the hope of a reply, questions were put to the Minister that included:

“Will communication competency be seen as critical to the forthcoming Schools Paper and will the Minister consider mainstreaming communication competency as a measurable outcome within the school curriculum?”

Other questions raised may emerge during the debate. That underlines how vital education is to the problems that we are discussing—education, education, education.

In the time available, I would like to refer to the work carried out by the hon. Gentleman’s predecessor, Mrs Joan Humble. We were asked by the then Secretary of State for the Department of Children, Schools and Families to set up a review looking at the needs of disabled children and their families. I led that review and inevitably, based on evidence from parents, children, carers and those who work in social services, we had to focus on the importance of funding. If funding was important when things seemed to be affluent, it is much more important today given the financial outlook that we face.

My one regret is not about the findings of the group that I had the privilege to chair. The Department was funded through the allocation of an additional £340 million to look at issues such as early identification, which was one of the points raised by my hon. Friend the Member for North West Durham (Pat Glass). That included £34 million for Scottish children. My one regret is that, as far as I can see, not a penny reached children with special needs in Scotland. Without any consideration for ring-fencing, the Scottish Government allocated the money to local authorities to spend however they wished. All local authorities decided to keep council tax at the present level. There is not a shred of evidence to suggest that the priorities that we presented to the Department were taken on board by any local authority.

Given the comprehensive spending review and the issues that follow from that, my regret today is that the same issue might apply not only to education authorities but to health boards. I thought for a time that the problem applied only to Scotland, but when we examined where the money went in England, sadly in Wales and also in Northern Ireland, we saw that it did not go to where it was intended. Vulnerable children found that their needs were not being met, and other issues such as those discussed today, and those raised by Mencap and other bodies, are not being addressed.

Mencap has noted that certificated training in this area is not mandatory, and that few schools have sufficient professional development funding to sponsor staff who are doing certificated or master courses. That is one issue, but there are more. What goes on in the classroom, the environment and the community is hugely important to children with profound and multiple learning disabilities.

In view of the time, I will conclude by saying that we all want to see the problems that have been identified addressed. We want Parliament to be better informed, and we recognise the work of the various Select Committees. Yesterday, during Health questions, I put a question to the Minister of State, the hon. Member for Sutton and Cheam (Paul Burstow). I asked whether

“the confidential inquiry and the learning disabilities public health observatory will go beyond March and until the work is concluded”.

The Minister of State replied that

“we had a good debate in Westminster Hall earlier this year on this matter, in which I indicated the Government’s support for those observatories. We believe they play a very important role in our understanding of the issues.”—[Official Report, 2 November 2010; Vol. 517, c. 750.]

I welcome that, but I wonder whether the Minister will respond specifically to my question, and provide reassurance to those who support the work that is going on.

It is a pleasure to serve under your chairmanship, Mr Streeter. I congratulate my hon. Friend the Member for Blackpool North and Cleveleys (Paul Maynard) on securing this debate on an important issue. I will apply the principle that brevity is a virtue and not a vice, and keep my remarks short. First, I would like to put things into context from a Medway perspective. Medway local authority has a good and close relationship with speech and language therapy teams. It has been working collaboratively to develop capacity so that teachers and school staff can address most speech and language needs in school. That frees up time for speech and language therapists to give direct therapy to the children with the most complex needs.

In the current financial climate, where budgets are so closely scrutinised, will the Minister tell us how the Green Paper will address the anomaly of local authorities being responsible for funding speech and language therapy that is diagnosed by health bodies and written in a statement? Will the forthcoming Green Paper provide for a focus of speech and language therapy in early years; for example, through a refocused Sure Start that targets children living in poverty?

I join other hon. Members in congratulating the hon. Member for Blackpool North and Cleveleys (Paul Maynard) on securing this debate. Debates that take place in Westminster Hall are often significant. This is one such debate and it deserves a huge audience. It is not only in Parliament that we do not get to debate certain topics that, despite being mainstream, never capture the headlines they deserve.

Sometimes, when we discuss policy, these sorts of issues do not have as high a profile as they should. We are talking about millions of children and adults who cannot communicate effectively. The service that we provide is often a Cinderella service in terms of the demand that it makes of the system, and the way in which the system responds with the money and resources that it receives. Whatever the size of the pot, and we may argue about that, the service does not get its fair share. That is because, for some reason or other, it does not make a loud enough noise, which is why the debate secured by the hon. Gentleman today is vital.

I want to say a couple of things and to raise a particular case that demonstrates some of the problems we have. The project to encourage and help children with their communication, referred to by the hon. Gentleman, is especially important. One of our problems is that sometimes we say, “We need to involve the family,” and of course that is important, but in some of those families the parents cannot communicate particularly well. Their vocabulary is limited.

I do not mean any disrespect to anyone and I am not decrying any particular families; I am making a statement of reality about our social situation. Many of us have experience of what we see in schools, and not just in schools: the limited amount of vocabulary that some children have at two, three, four or five, compared with others of the same age, is frankly astonishing. If we talk to some of the parents—do not get me wrong, they are loving parents, who care and so on—again, we find that the communication stimulus that many of us would recognise in our own homes is not there. Such things are important. I think one problem is the talk of involving the parents, which of course is crucial, when the parents have limited vocabulary to provide in support. We need to develop that.

I do not want to make a political point. We know that we are in difficult times and that there are differences between the parties about spending and so on, but I want to raise a particular case in my constituency, that of Dylan Scothern.

Dylan Scothern is six years old and he is autistic. He cannot communicate. The vocabulary he has now is thanks to the work of his loving parents. His mother, Rachel Scothern, has been at the forefront of the campaign about Dylan that I will come to in a moment. With the help of speech and language therapists, Dylan can communicate with about 20 words. Rachel has put something on Facebook in which they do “The wheels on the truck”—no, I mean, “The wheels on the bus go round and round”—he communicates with it better than I do. He has been brought to that point through the speech and language therapists.

Nottingham Community Health NHS Trust says that its funding for Dylan’s speech and language therapists will now stop because he has reached six years of age. The trust has changed its policy so that only children of five years and under will get speech and language therapy.

As I said, I do not want to make the issue political. I do not care what the budget is for Nottingham Community Health, because I am going back to the point I made before: why is it that such services are always the first that people look to when making savings? That is the importance of the debate secured by the hon. Member for Blackpool North and Cleveleys. There are easy hits when it comes to cutting money—often it is youth services, rather than services for pensioners—and here we have an example in health. Again, that is an important point made by the hon. Gentleman.

The Minister, who I know will take the issue forward, needs to talk to her colleagues in the Department of Health, because there is a young child at a school—he is going to school—who is having his speech and language therapy taken away, not because of the actions of her Department but because of the actions of the Department of Health through Nottingham Community Health.

The case simply has to be revisited, and I am using the debate to ask the Minister to do so. I know she will not know about the case—I do not expect her to know all the details, but I will write to her with them—but can she raise it with her Department of Health colleagues, Nottingham Community Health and others with responsibility? Can she say that in the debate all of us recognised the importance of speech and language therapy for some of the most difficult young people in terms of their learning challenges, and that it is simply not acceptable to cut speech and language therapy for an autistic child because he has reached the age of six? Frankly, that is not good enough. The policy needs to be changed and looked at again.

With that, I shall finish, but going back to the point I made at the beginning. Let the debate be a clarion call not just for the case of Dylan and Rachel Scothern, a family who live in my constituency, but to all of those who provide such services, whether through health or education. We need to recognise their importance and understand that, simply because they are not necessarily front-page news all of the time, they are of fundamental and significant importance to countless families and young people up and down this country. If we mean to provide equal opportunities, we should ensure that those people receive those services, which should not be the first port of call for people with difficult budget decisions to make.

I congratulate my hon. Friend the Member for Blackpool North and Cleveleys (Paul Maynard) on how he introduced the debate. I agree with everything he had to say; indeed, I think that I have agreed with everything that everyone has said thus far, so I will not repeat things.

Just as my hon. Friend waxed lyrical about his experiences at school 30 years ago, with the indulgence of hon. Members I shall talk about my experiences at school 50 years ago. There I was, in a class of 56, in the east end of London, and my teacher, Miss Grey, asked my mother to come up to the school. My mother was worried, thinking her son had been disruptive, but the teacher said, “Do you realise that your son is nicknamed Double Dutch?” Apparently, I could not communicate with anyone—my sister used to interpret what I wanted to say to people. I could not make the sounds “st” or “th”, I had a bad stutter and for three years my mother walked three and a half miles with me to a speech therapist in West Ham lane—I can now hear the violins playing. For three years, it was, literally, “How now brown cow”, which is why I do not have a pure cockney accent. I had old-fashioned braces on my top teeth and on my bottom teeth.

My hon. Friend talked about 30 years ago, but I am talking about 50 years ago and I want to tell the Minister and our Government that all those years ago, in a class of 56 in a challenging part of the country, Miss Grey—to whom, with the speech therapist, I obviously owe everything—could identify me as having those particular problems. Therefore, why is it that in 2010, with all the advances that we rejoice in, I am sitting in the Chamber this morning listening to any number of problems and challenges? I simply want our Government to give children today the same opportunity that I was given all those years ago.

I join other Members in warmly congratulating the hon. Member for Blackpool North and Cleveleys (Paul Maynard) on securing this important debate. He spoke passionately, clearly from unrivalled personal experience and knowledge, about this important area. I agree with the high-quality contributions we have heard from all parts of the Chamber and I hope that the debate sends a powerful message to the Government about the importance of services in this area.

I want to speak in particular about the special value of the ACE—Aiding Communication in Education—centre to which the hon. Gentleman referred and which is based in my constituency, and of ACE North, which is based in Oldham. The centres provide a unique service for parents and professionals, with joint health and education-based approaches, combining whatever it takes to give children with severe communication difficulties access to communication, education and, thereby, independence.

I have seen at first hand the remarkable—often moving—difference the centres make in children’s lives. I took former Labour leader John Smith to the centre once and we were moved almost to tears watching a young girl learning to communicate using assistive technology, opening a world that would otherwise have been closed to her.

The centres provide a level of clinical expertise far beyond what is provided by the statutory services for children with such complex disabilities. Their intervention not only changes lives but saves money in later life. They also save money by preventing cases from reaching tribunals, which may be one of the reasons why some local authorities ask them for assistance.

The centres have a huge loan library of specialist equipment that children and their parents can try before they buy. That saves authorities buying unsuitable, expensive communication devices, which can cost many thousands of pounds and which would, if inappropriately purchased, end up in the school cupboard. The centres also work with the IT sector in a rapidly changing area to develop more effective aids to communication. At the point of use, advice to parents is free and independent, which is a lifeline for families learning to live with and support a child with severe communication difficulties.

The future of the centres and the services they provide is under pressure and under threat, and there are two main reasons for that. One is that the provision of direct funding, which central Government made available through grants and project support, is being shifted to local authorities. We should sound a note of caution to those who, under the mantra of localism, would shift all funding in the direction of local authorities, because highly specialist services can be marginalised and lose out in the process.

The other problem is that although the centres charge local authorities to recoup operation costs, the money is not always forthcoming at the necessary level. Furthermore, charitable donations, which the centres also attract, have decreased considerably due to the tougher competition facing all areas of the third sector in this difficult financial climate.

We therefore face a threat to a vital service. Were that service to go, we would lose something that, since 1984, has given thousands of severely disabled young people a voice and a chance in life. To run down these vital services in the national year of speech, language and communication would clearly be perverse and unacceptable.

I do not want to make a partisan point, but the previous Government showed great leadership on this topic. They set up the Bercow review, and the then Secretary of State for Children, Schools and Families established the communication champion. Does my right hon. Friend, like me, hope that the new Government will show the same energy, dedication and enthusiasm as the previous Government in pursuing change on this important topic?

Yes, I certainly endorse that, although I was not making a party political point, because the shift towards the presumption of local authority funding clearly did not start with the current Administration.

It would be disastrous and a tragedy if we removed the centres, losing their specialist experience and their huge loan library of communication equipment, in a climate where there is technology to help children, but the understanding, guidance and expertise to help them use it is often in desperately short supply. The same is true of the loss of specialist training for teachers and therapists in how to use the technology to support and motivate children in learning and moving towards independence.

The centres therefore face a serious situation, and I ask the Minister for an assurance that central Government sustainability funding for the ACE centres will continue for the full three years, until April 2012. On the centres’ service-level agreements with local authorities, what assurances can she give that councils will have, or will be guided to make available, the resources to ensure that the appropriate assessment and help is available in their area to children who need it? Will she look at providing immediate additional support from the sustainability services fund and the transition fund to ensure the future of the ACE centres? I should also be grateful if she could give an assurance that she will meet representatives of the centres to discuss the way forward so that we can save these valuable services.

I am delighted to serve under your chairmanship, Mr Streeter, and to make my first contribution to a Westminster Hall debate as a shadow Minister.

I congratulate the hon. Member for Blackpool North and Cleveleys (Paul Maynard) on securing this important debate. I compliment him on his well-informed and impassioned speech. Mrs Williams, his speech therapist, taught him not to rush, but to slow down, and a lot of us—especially me—could benefit from following that advice when making our speeches, even given the time constraints. I am delighted that so many Members are in the Chamber to contribute to this important discussion. They have raised many questions, which I hope that the Minister will answer today.

Many Members will know that I have a personal interest in this topic. I did not have speech therapy myself, but my son required it from the age of two and a half. I have put on record the problems we encountered when we moved around the country, and my hon. Friend the Member for Gedling (Vernon Coaker) mentioned a lot of similar issues when he talked about the case of Dylan. My son’s speech therapy stopped when he was seven, because we had moved from Gateshead to London, and we were told that speech therapy was not given to children over the age of five. Incidentally, when we moved back to Gateshead, local professionals said, “We know he’s 14, but he could really still benefit from speech therapy.” Members can imagine how I reacted to that, when he had missed out on seven years of possible speech therapy because of where I lived.

A lot of Members have spoken, and I want to give some quick tributes. My hon. Friend the Member for North West Durham (Pat Glass) gave a very intelligent and thoughtful speech, showing her immense knowledge from a long and successful professional career in the education and SEN sector. She is a true asset to the House, especially on this issue, and the Minister would be wise to pay particular attention to her contributions.

The hon. Member for Mid Dorset and North Poole (Annette Brooke) always speaks with good wisdom and great analysis on SEN matters, and that was evident once again today. My right hon. Friend the Member for Coatbridge, Chryston and Bellshill (Mr Clarke) is a long-standing campaigner on this issue, and I wish that he could have spoken for longer. The hon. Member for Gillingham and Rainham (Rehman Chishti) gave a short, concise, but important contribution.

My hon. Friend the Member for Gedling gave a very knowledgeable speech, as we would expect, and raised the important case of Dylan in his constituency. I hope that the fact that he has done so will lead to a change in Dylan’s situation. The hon. Member for Southend West (Mr Amess) and my right hon. Friend the Member for Oxford East (Mr Smith) also made excellent contributions.

I regret that I was unable to attend the reception in the Commons a couple of weeks ago to mark the launch of “Hello”, the national year of speech, language and communication, which ties in with this debate, but I look forward to hearing what is planned for 2011. If the Minister can give an assurance that departmental funding for that important initiative will survive the cuts that the Chancellor chose to make, it will signify a commendable commitment to the campaign.

The national year is, of course, one of the 40 recommendations of the Bercow review, an excellent and thorough piece of work, which was welcomed by everyone on both sides of the House. No one was more receptive to those recommendations than the former Secretary of State for Children, Schools and Families, my right hon. Friend the Member for Morley and Outwood (Ed Balls). Together with the Health Secretary at the time, he published an action plan and pledged £12 million to ensure that all the Bercow recommendations were put in place.

It is important to pay tribute to that commitment, as well as to the work of Mr Speaker, who will be keeping a keen eye on the debate. I am sure that commitment is shared by the Minister, and the debate gives her a good opportunity to give us an update on what progress has been made since the election on carrying on the good work that has been done.

The Government have, of course, recently consulted on an SEN and disability Green Paper, and I certainly look forward to reading the responses to it and scrutinising the conclusions that the Minister draws from them. One concern that has been raised with me is that work on the Green Paper is going on while the education and health systems are going through fundamental changes. I hope that the Minister will be able to confirm today that she meets Department of Health Ministers regularly to ensure that when children need support from NHS professionals, as is the case with the children we are discussing, the Government’s reforms will not have a negative impact on the provision of such support.

In that respect, my main concern is that the Green Paper should focus purely on improving services for young people with differing needs and not on reducing the money spent on such improvements. There is real concern in the sector that the results of the comprehensive spending review will force the Minister to do just that. If she could confirm that the funds for statemented children with speech, language and communication difficulties and other needs will be entirely on top of any pupil premium funding that they may attract, I think a lot of people’s fears will be put to rest.

When we include in the equation significant cuts to local government budgets, and the wholesale restructuring of the NHS, which employs the vast majority of the professionals such as Mrs Williams who help children with communication difficulties, we are left with inevitable pressure on funding for supporting those children—unless the Minister can tell us otherwise this morning. I look forward to her speech.

Concerns have also been raised, especially by the National Deaf Children’s Society, that budget cuts to existing Building Schools for the Future projects will mean that new facilities do not meet the standards set for acoustics. I would welcome comments from the Minister on how those effects can be mitigated.

The hon. Member for Blackpool North and Cleveleys described in his maiden speech how without speech therapy at an early age he might never have had the ability to be in the Chamber talking to us. He is a great example of early intervention reaping huge dividends. I am sure that if Mrs Williams is watching today she will be enormously proud of her work—and his.

One of the better things to be announced in connection with the CSR was that the Government are to go ahead with Labour’s plan of extending free nursery places to disadvantaged two-year-olds. Although I am slightly dubious about whether enough money has been committed to achieve that, I hope that doing so will present an opportunity for earlier identification of more children with speech, language and communication needs. Earlier intervention is important in tackling the problems that those difficulties can lead to later in the child’s school career. In some deprived areas, as we have already heard, 50% of children begin school with language delay already obvious. As they get older about two thirds of them will have behavioural problems. Because they are often not recognised as having difficulties that may be causing their behaviour, it leads to exclusion and the problems that go with that. It is no surprise, then, that well over half—probably more like two thirds—of young offenders are said to have those difficulties. With early intervention, I am confident that those depressing figures could be reduced, and I shall welcome any measures set out in the Green Paper to that effect.

I believe that the Government are committed to universal screening for two and five-year-olds, and I would be interested to hear from the Minister how that will be implemented. If we are to have early intervention, it will of course require funding for the extra cases that it brings to light. Training all teachers to spot risk factors at all stages of a child’s school life will require yet more funding. Again, I am not sure where all that funding will come from, and I think that pretty much takes my remarks full circle.

I think that hon. Members who have taken part in the debate are in unanimous agreement that action is needed to ensure that children get the right support. I am sure that the Minister shares that view. I realise that much of what constitutes future Government policy on speech and language therapy will rest on the outcome of the consultation for the Green Paper, so she may not be able to give too much away today; but I hope she can offer some reassurance to Members, as well as to the many parents, professionals and their advocates who will have a keen interest in this debate, that providing the best possible facilities and support for children and young people with speech, language and communication difficulties, as well as other special educational needs, will be a matter of principle and not of price.

I congratulate the hon. Member for Blackpool North and Cleveleys (Paul Maynard) on securing the debate. I know how committed he is to the issue, and I could not help but hope, as I listened to his speech, that Mrs Williams was beaming with pride, and watching the debate. Similarly I hoped, when my hon. Friend the Member for Southend West (Mr Amess) was speaking, that Miss Grey could hear his tribute to her help.

Perhaps she is listening from another place—if that is not to misuse parliamentary terminology.

I am hugely grateful to the hon. Member for Blackpool North and Cleveleys for securing the debate, and for speaking so knowledgeably and passionately. I was fortunate enough to attend a round-table meeting that he organised a few weeks ago on speech, language and communication needs. He is aware that I share his ambition. His expertise and the way he has campaigned on the issue since coming into Parliament is something that the sector recognises and is grateful for. The Government are grateful too.

The debate has come at an opportune moment because, as hon. Members will know—and as several hon. Members pointed out—several policy areas are in the process of being changed and developed. Consultation has just closed on the NHS White Paper, and we are drawing together White Papers on schools and on public health. The process in which I am personally involved is the production of a Green Paper on special educational needs and disability. Despite the suggestion that that might be a risk, I hope it may be seen as an opportunity. A key theme raised today was that of getting different services—local authorities, education and health—to work together. If everything is changed at the same time there is a much better chance of making sure that the elements of the new system will work closely together. Perhaps it is flippant of me to say so, but if Liberal Democrats and Conservatives can be got to co-operate in government, it cannot be beyond the wit of man to get health and education to work together.

In the past few months I have engaged in a series of small events and round-table meetings with the sector. I hope that hon. Members will not mind if I treat the debate as part of the Green Paper process. I shall do my best to respond to as many as possible of the issues that have been raised, but I shall not get to everyone. However, I shall pass on to the Department of Health the questions that have been raised, or make sure that they form part of our process of forming the Green Paper.

There were many knowledgeable speeches, including those by my hon. Friend the Member for Mid Dorset and North Poole (Annette Brooke), who has spoken on the issue over a long period; the hon. Member for North West Durham (Pat Glass), a new Member, to whom I always enjoy listening, and who speaks passionately on the subject; and the right hon. Member for Coatbridge, Chryston and Bellshill (Mr Clarke), who has campaigned on the issue for many years. I was particularly grateful, because those hon. Members have a long-standing interest in what we are debating.

Speech, language and communication skills are the bedrock of learning. If someone cannot communicate their needs, those needs are unlikely to be met. If they cannot explain what they do not understand, their questions are unlikely to be answered. If someone cannot tell another person how they feel, that person cannot help them; and it will probably be a struggle to make friends. Children with speech, language and communication needs can have a lonely childhood and a poor education, and it is no wonder that many go on to develop behavioural difficulties or that they are misdiagnosed.

As many hon. Members have said, the range of problems is huge, from speech delay to intractable and chronic problems that require intensive intervention. Speech, language and communication issues may occur alone or co-exist with other special educational needs or social disadvantage. The hon. Member for North West Durham focused on that overlap with social disadvantage, and I want to touch on it shortly.

Speech therapy and other services, allied to good teaching, are vital for children and young people with the difficulties in question, to help them learn and get the most out of life. There has been significant progress, and the Green Paper will build on the work that the previous Government did, not rip it up and start again. I recognise that, particularly in the matter of speech, language and communication needs, progress was made. I pay tribute to the part that Mr Speaker played in raising the profile of the issue. The Bercow review comprehensively mapped out the challenges in policy, and since then much progress has been made in accomplishing the action plan.

We are of course about to begin the first national year of speech, language and communication, and I congratulate the Communication Trust and the communication champion Jean Gross on their work to promote better information for professionals and parents. Raising awareness of speech, language and communication needs is the theme of the trust’s work and the “Hello” campaign that the hon. Member for Washington and Sunderland West (Mrs Hodgson) mentioned. If we are to make the best use of the expertise that we have in speech and language therapy, and in other matters, we must get much better at picking up problems earlier and putting in place the right package of support.

Several hon. Members mentioned the fact that more than 60% of young offenders have speech, language and communication difficulties. That is a shocking statistic and a clear reminder, if we should need any more, of the importance of intervening early to prevent problems later.

The Minister spoke about early intervention, which has huge support. However, we are hearing fairly reliable but worrying reports that the much-trumpeted pupil premium will not be paid for children under the age of five. Will the Minister confirm that it will be paid for all children in education from the age of two, and not be restricted to those over the age of five?

The hon. Lady will be aware that the consultation closed just before the comprehensive spending review. We will be making a much more detailed announcement on the pupil premium shortly, but we want to ensure that local authorities know much more about the scheme when they get their settlement.

I was about to speak about some of the issues raised by the hon. Lady in her speech. Early identification is vital for the child and the family; as she said, it will reduce costly interventions later. It is essential that more timely referrals are made to specialist services. That is why I asked Dame Claire Tickell, who is leading a review on the early years foundation stage, to look specifically at how to improve early identification of such problems by the EYFS. She is leading the process at the moment, and she will soon be reporting her findings to the Government.

For the same reason, we have extended the two-year-old offer to significantly more disadvantaged young children. About 130,000 disadvantaged two-year-olds will benefit from 15 hours of early education a week. That point was raised by a number of Members. Indeed, the hon. Member for Gedling (Vernon Coaker) said that children often arrive at nursery without the required language skills because they have not been exposed to language in the usual way. Offering high-quality early education is vital in giving those children the chance to pick up those skills.

The hon. Member for Gillingham and Rainham (Rehman Chishti) spoke about Sure Start centres. Many already provide speech and language therapy, but more use of such evidence-based programmes is definitely part of the reform programme that the Government want to institute. The Under-Secretary of State for Health, my hon. Friend the Member for Guildford (Anne Milton), who is responsible for public health, recently confirmed the Government’s intention during this Parliament to recruit and train 4,200 health visitors. Health visitors will be key in picking up on speech delay in very young children, ensuring that they are referred to the appropriate services, including Sure Start centres.

I am grateful that my hon. Friend made that point about health visitors. As we know, they carry out a uniform hearing test for very young children. It seems to me and many others that we should be training health visitors to take that sort of approach for speech, language and communication difficulties.

Health visitors are the key to picking up problems in the early years and making appropriate referrals. Some really interesting projects have been undertaken in Manchester, using community-based budgets; they linked health and education, realising that many children who fall behind when they get to nursery school have often missed health checks. Ways of sharing that data are important.

I thank the Minister for giving way. I thank her also for confirming that the Government will not rip up plans introduced by the previous Government to take forward this important agenda. However, some of us are concerned that the new commissioning agenda for the national health service might mean that specialist services for speech and language therapy will not be commissioned by GP consortiums. Will the Minister confirm that special efforts will be made to ensure that GP consortiums are fully aware of this important service and that they continue to make it available?

I shall turn to commissioning in a moment. First, I want to say something about the school work force, a theme that was developed during the debate. It is vital that teachers and other members of the children’s work force have access to information, and that they have the opportunity for professional development in supporting children with special educational needs. Those on the front line are often the first to pick up problems, and they are vital in implementing whatever is suggested by the specialists.

One Member—I noted the point but not who raised it—spoke about the need for speech and language therapy to be well integrated into what happens in school. There are some good examples of that. Indeed, it is the kind of good practice that we want to build on through the Green Paper, with speech and language therapists training teachers to ensure that the therapists’ work continues in the classroom once the specialist help is over. That is vital. Progress has been made in recent years with the development of dedicated resources for teacher trainers and trainees, with specialist professional development for special educational needs co-ordinators and with online training material for school staff on a range of special educational needs, including specific materials on speech, language and communication needs for teachers and other staff.

I am grateful to the Minister for giving way. The shortage of speech and language therapists for many schools means that when the need for specialist help arises it is not necessarily there. Often, only speech and language therapists themselves can deliver the necessary support, rather than the problem being passed on to the teacher every time.

We need a mix; that is why I said that speech and language therapists can often offer good professional advice to teachers, who are then able to do some of that work during the week. The number of speech and language therapists is rising consistently. The question of whether we have enough depends on commissioning, and the way in which those therapists are employed. The White Paper on schools and the special educational needs Green Paper will set out plans for developing the knowledge, understanding and skills of the children’s work force and will specifically address continuing professional development.

A number of Members asked about commissioning. I realise that we need to be much better at integrating the commissioning of services for children with special educational needs, as in many other areas. As I said earlier, I hope that the rapid change experienced in many areas will provide us with the opportunity to do much better. We are creating more diverse school systems with more freedom for schools to innovate; and the NHS White Paper focuses on creating locally based opportunities to improve patient care.

Improving outcomes is exactly what Mr Speaker wanted to achieve for children with such difficulties through his review. The challenge is to design future arrangements that work much better together and that focus specifically on the needs of children and families. I am working closely with colleagues at the Department of Health on all these matters. I am determined to ensure that we are better able to streamline the assessment process.

Only three minutes remain, and people are already arriving for the next debate. I still have five pages of notes, so I shall end up rushing.

The hon. Member for Gedling mentioned a constituent of his, and I will ensure that excerpts from his speech are passed to Ministers at the Department of Health so that the matter is drawn to their attention. Things falling between Departments is exactly what we want to address in the Green Paper.

There are a couple of other points that I shall not manage to answer, but the hon. Member for North West Durham raised the question of the differences in commissioning for high need with low incidence and low need with high incidence. I know that the Department of Health is aware of the communication champion’s views on commissioning, and those views will be taken into account in designing the system.

I shall finish with a few words about the Green Paper.

On that subject, my Department is considering the best way to secure support for children who require augmentative and alternative communication with colleagues in the Department of Health following the spending review. I hope that the right hon. Gentleman will understand that I am not able to give much detail on those commitments, because there is much yet to do.

I have one minute left, which is not enough time to say all that I want about the Green Paper. We have a real resource of knowledge in Parliament, and many Members have a real passion about the subject. The Green Paper is part of a consultation process, so I hope that right hon. and hon. Members will feel able to use their knowledge and expertise and get involved. I shall try to find ways to involve parliamentarians with such expertise; I am well aware of how much experience Members of Parliament have, both personally and in their campaigning role. I look forward to debating these issues again with those who are here today.