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Auditory Verbal Therapy

Volume 742: debated on Tuesday 12 December 2023

I beg to move,

That this House has considered the provision of auditory verbal therapy.

It is a pleasure to speak under your chairwomanship, Dame Maria. There are about 50,000 deaf children in the UK, with over 7,000 under the age of five. They face the prospect of lower academic achievement and lower employment and are at a high risk of poor mental health, bullying and social exclusion. But it does not have to be this way: when deaf children and their families have access to early, effective support, opportunities are transformed.

Expanding opportunities for children with special educational needs, including deaf children, so that they can reach their full potential is really important to them, their families and us as legislators. Early support should be available to all deaf children, whether their parents choose to communicate with spoken language, sign language or both.

Auditory verbal therapy is an early-intervention strategy rather than a communication approach in itself. It is a family-centred coaching programme that equips parents and care-givers with the tools to support the development of their child’s listening and speaking. The robust, evidence-based specialist therapy supports deaf children to process the sound they get from their hearing technology, such as cochlear implants and hearing aids, and to develop language so that they can learn to talk like their hearing friends.

Deaf children in the UK currently face a lifetime of disadvantage without access to early and effective support. Less than 10% of deaf children who could benefit from auditory verbal therapy can currently access it. Auditory verbal therapy is delivered by speech and language therapists, audiologists and teachers of the deaf who have undertaken around three years of additional training and have qualified to become internationally accredited listening and spoken language specialists. It is usually delivered in a child’s first three and a half years, when the brain’s connections for processing sound are developing fastest. The National Deaf Children’s Society notes:

“Professionals who promote AVT believe that by working intensively with children in their early years they will require much less support as they get older.”

Specifically, it notes:

“Its aim is to ensure that deaf children develop age-appropriate language by the time they start school.”

Although the UK has one of the best newborn hearing screening programmes in the world and state-of-the-art hearing technology is available to babies and young people on the NHS, deaf children are not reaching their full potential, and we are not maximising the investment being made in screening and technology.

At present, more than 92% of deaf children under the age of five in the UK are unable to access an auditory verbal programme, because there is little to no provision through publicly funded services and there are only 30 auditory verbal therapists in the UK. There are just over 460 deaf children living in East Sussex. There are no auditory verbal therapists in Hastings and Rye or in East Sussex. Other developed countries, such as Australia, New Zealand and Denmark, already provide state funding for auditory verbal therapy, and the UK should strive to match that investment.

About 80% of children who attend an auditory verbal programme for at least two years achieve the same level of spoken language as their hearing peers, rising to 97% of children without additional needs. Most of these children attend mainstream schools and attain educational outcomes on a par with those of hearing children. Auditory verbal therapy is part of the Early Intervention Foundation guidebook.

To increase access to specialist support, we need to train more specialist practitioners in the auditory verbal approach. For an investment of just over £2 million a year over the next decade, we can transform the landscape of auditory verbal provision. Economic analysis has shown that training a small proportion of the current public sector workforce in order to embed 300 auditory verbal therapists across the UK can deliver £150 million of economic benefit, rising to £11.7 billion in the next 50 years, through improved quality of life, employment prospects, the lower cost of schooling, and avoided injuries. Furthermore, analysis from the charity Auditory Verbal UK, based on His Majesty’s Treasury models, shows that within 50 years the NHS would save £30.5 million through the avoidance of injury alone.

I have met amazing deaf children and young people who are brimming with confidence and self-esteem, and we have some sitting here with us today. Quite by chance, I have Noli here with me, who is doing a day’s work experience with me. I met her at the auditory verbal therapy event in Parliament. She is studying at Durham University and has huge confidence and self-esteem. Many young deaf people far exceed the expectations associated with their disability—although, to them, being deaf is not a disability, because of the early intervention they have received. Every deaf child deserves that.

It is a real pleasure to serve under your chairpersonship, Dame Maria. I will give the view from Scotland, which is probably what most people in the room expect me to do, because the NHS in Scotland is different. However, before I start, I thank the hon. Member for Hastings and Rye (Sally-Ann Hart) for securing this important debate, and the charity AV UK for its briefing.

The Scottish Government want to make Scotland the best place to grow up for deaf children and those who have hearing loss, based on their “Getting it right for every child”—GIRFEC—approach. The Scottish Government fund the Scottish Sensory Centre and CALL Scotland to provide advice and training to school staff on support, including the use of assistive technology, for children and young people with specific communication and sensory needs. In fact, there is a unit attached to a primary school in my constituency.

As we know, auditory verbal therapy supports deaf children to learn how to make sense of the sound they receive through their hearing technology, such as hearing aids or cochlear implants, so that they can learn to talk like their hearing friends and family. It is an intensive programme of therapy that focuses on the development of active listening, or auditory, skills and speaking, or verbal, skills. This highly specialist early-intervention family-centred coaching programme equips parents and care-givers with the tools needed to support the development of a deaf child’s spoken language.

The charity Auditory Verbal UK has done good work in Shetland. There are only two AV specialists in Scotland, and I welcome the fact that the hon. Member for Hastings and Rye talked about the dearth of specialists across the UK and about how little it would cost to improve the numbers and the training in particular specialisms. One would hope that Scotland would get the Barnett consequentials for that.

On the point about the lack of individuals who are skilled up to deal with this issue, which the hon. Member for Hastings and Rye (Sally-Ann Hart) also made, does the hon. Lady agree that today’s debate might play a small part in ensuring that various Departments, wherever they are in the UK, will skill up the necessary personnel so that we do not face this problem in five or 10 years’ time?

I absolutely agree with the hon. Gentleman, because the issue is really important. We are discovering new ways of helping deaf children. We need not just to have the technology but to train the people to help deaf children.

In general, concerns have been raised that young children’s language development has been affected by the public health measures implemented to prevent and control the spread of covid-19. Again, we have a backlog of things that need to be done.

Developing channels for better communication is vital for a child or young person’s development and wellbeing. Speech and language therapy generally supports children and young people with communication needs, as those needs may interfere with everyday life. Treatment approaches aim to enable children, young people and their carers to maximise their skills. In Scotland, NHS health boards and local authorities are responsible for the provision of, and funding for, services for deaf children. That includes the provision of specific therapeutic approaches.

The Scottish Government are, as ever, committed to improving the services, support and care available to people with any kind of sensory deprivation. Their long-term strategy, See Hear, commits to ensuring that children, young people and adults have the same access as everyone else to opportunities and public services, including health, social care, education and leisure.

In 2019, the first UK-wide allied health professions public health strategic framework, which went from 2019 to 2024, was published by all four nations. It was intended to help AHPs and partners further develop their role in public health. As the hon. Member for Hastings and Rye said, we need money to make things better, and we need more investment by all Governments, including the UK Government, to make this approach work.

In the Scottish Government’s Scottish allied health professions public health strategic framework implementation plan for 2022 to 2027, several examples show AHPs in action and provide examples of good practice in Scotland. One case study highlights the speech and language therapy at NHS Forth Valley as

“a transformational approach for children and young people”.

The Scottish Government’s shared vision is that children and young people in Forth Valley will demonstrate improved outcomes through access to a speech and language therapy service

“that is based on relationships”—

again, we are talking about people—and that

“is accessible, person centred, outcome focused, integrated and delivers quality universal, targeted and individualised support.”

Again, it is important that we up the number of specialists so that those with cochlear implants, for example, learn to hear and speak very early on.

There is also the Scottish Sensory Centre, which is for

“everyone who is involved in the education of deaf children, deafblind children and visually impaired children and young people, the young people themselves”

and importantly, their families. Its mission is

“to foster educational, research and development activities relating to children and young people with a sensory impairment in Scotland.”

It also aims to support the Scottish Government

“by embracing the values and principles of ‘Getting it Right for Every Child’ and by promoting a positive ethos that reflects the components of a Curriculum for Excellence.”

That is a different way of giving cross-subject education to young people, and it works extremely well in primary schools in Scotland.

CALL Scotland is a support service to help children and young people across Scotland

“to overcome disability and barriers to learning”,

and it is funded primarily by the Scottish Government. CALL Scotland’s service includes pupil assessment support, professional learning, specialist information and expert advice, assistive technology loans and technical support, and strategic leadership. It is intended for managers, teachers and everyone who works with, in this case, deaf children.

“Getting it right for every child” is the national approach in Scotland, and it is about supporting all children. However, it would be especially useful if we could encourage more auditory and verbal specialists to come to Scotland and promote the good work that society already does there.

It is important that there is additional support not only within but outwith education, so that there is a whole-child approach and not just action in schools. Education authorities can speak to other agencies, and they work closely with NHS boards and social work services in Scotland to help deaf children. That multi-agency support is an excellent model.

I fully support the hon. Member for Hastings and Rye in her appeal, and I hope that the debate focuses minds in Governments across the UK on this problem.

Thank you for stepping into the breach this morning, Dame Maria. It is a pleasure to serve under your chairship. I am grateful to the hon. Member for Hastings and Rye (Sally-Ann Hart) for securing the important debate, and I pay tribute to AV UK for its work on supporting deaf children, children with hearing loss, and some of the families here today, who have had such a positive experience of auditory verbal therapy.

As the hon. Member said, auditory verbal therapy is an evidence-based approach, and I am grateful to her for setting out the evidence base for its effectiveness. I am also grateful to the hon. Member for Motherwell and Wishaw (Marion Fellows) for setting out some of the detail of how the system for supporting deaf children and children with hearing loss works in Scotland.

There are an estimated 50,000 deaf children in the UK, with around 7,200 under the age of five. Given the right support and intervention, many deaf children can participate fully and thrive in mainstream schools, whether they choose to use spoken language, sign language or both. There is a particular responsibility to get our special educational needs and disabilities system of support right, especially by designing interventions to support children who need not suffer any other disadvantage in the education system if the support they need is provided appropriately from the start.

Unfortunately, as today’s debate has shown, that is not the case in many parts of the country. Research by the Education Policy Institute found a staggering attainment gap between deaf children and their peers. That gap already equates to 8.8 months of learning by key stage 1, and it grows throughout school to 17.5 months at the age of 16—almost a year and half of education. That translates into an average grade for GCSE English and maths that is 1.3 grades below the average grade for deaf children’s peers. Deaf children are also more likely to experience poor mental health, bullying and social exclusion, all posing further barriers to their education and personal development. Alongside each child are the parents and carers who all too often have to fight constantly for the support their child needs.

Although the number of deaf children in education has risen by more than 10,000 since 2011, the number of qualified teachers of the deaf in employment has fallen by 19%, according to the Consortium for Research into Deaf Education. Specialist teachers for the deaf and specialist teaching assistants perform vital work to help their students access education. I witnessed that on a recent visit to Jubilee Primary School in Lambeth, just outside my constituency, which benefits from a full-time teacher of the deaf. However, teachers of the deaf are facing ever-growing case loads, reducing the time they can spend with each individual child.

Labour wants to see a properly inclusive system that meets the needs of all children and young people, including deaf children and children with hearing loss. We have been clear that we would put inclusion at the heart of our education system, with a focus on providing the interventions that are needed earlier and on ensuring that school staff have the specialist skills they need to meet every child’s needs. It is also vital that families get the support they need as early as possible, before their children start school, to help them communicate with their children and to develop their children’s language and communication skills.

Help that is provided early in a child’s life can be transformative, avoiding the need for much greater support later, and helping more children to thrive in mainstream education. Across the country, guidance and support for parents varies greatly between local authorities. We know that deaf children in more disadvantaged areas experience a greater attainment gap than their peers elsewhere in the country. There is a wealth of low-cost interventions already being delivered in some parts of the country to give parents and families the skills they need to support their child’s development and communicate with them. This needs to happen everywhere. These include courses in British Sign Language offered by the National Deaf Children’s Society, and Auditory Verbal UK’s approach to developing spoken language through listening.

I know there are families and young people in the Gallery today who have really benefited from auditory verbal support. Labour wants to see the right support for every child, and it is important that we learn from evidence and best practice, and understand what is working for families in areas of the country that manage to achieve the very best outcomes. We are looking carefully at this, and we are looking at the wider framework of SEND support from early years throughout education, involving early intervention, especially with communication, speech and language skills. We are also looking at the skills available to professionals working in mainstream education and at how the Ofsted assessment framework for schools can be used to drive improved inclusivity across our system. Within a transformed framework for SEND support, we will look to ensure that evidence-based interventions are available wherever they are needed.

I want to use this opportunity to press the Minister on the wider issue of how the Government plan to improve inclusion in mainstream schools, as set out in the SEND and alternative provision improvement plan. As I have set out, the Opposition share the ambition to improve inclusion in the mainstream, but the Government have not set out a clear plan to achieve it. There is no workforce plan or strategy to ensure that schools have the specialist staff needed, including teachers of the deaf, while much of the plan will not come into effect until 2026, leaving families waiting three years longer before they will see any reform. It will be helpful to know what the Minister is doing now to address the vacancy gap for teachers of the deaf.

The Labour party is clear that in government we would put children first and at the heart of our programme, and break down the barriers that hold far too many back from thriving in education and building strong relationships, including deaf children. We would be working with professionals, children and families to deliver a SEND system that works to support the needs of every child.

It is a pleasure to serve under your chairmanship, Dame Maria. I start by congratulating my constituency neighbour and hon. Friend the Member for Hastings and Rye (Sally-Ann Hart) on securing the debate on this important topic. I reassure her and all Members today that the Government are committed to improving outcomes and experiences for all children and young people with special educational needs and disabilities, including children with hearing loss.

As I am sure colleagues are aware, figures from the National Deaf Children’s Society show that there are more than 50,000 deaf children and young people across the UK. Between one and two babies in every thousand are born with permanent hearing loss in one or both ears, and we know that early and effective support is crucial for these children and their families. My hon. Friend pointed out how important it is that help and support is there as soon as possible. She also pointed out that, without intervention, children with speech and language needs are at higher risk of facing longer-term challenges, including in education. It is vital that we intervene at birth, which is why we are investing in hearing screening for newborns to identify babies who have permanent hearing loss as early as possible, so that we can intervene as quickly as possible.

We know that language is linked to social, emotional and learning outcomes. From birth through to childhood, children and young people with hearing loss might need a range of therapy, such as speech, language and auditory verbal therapies. As we have heard today, however, those children are not always receiving the help they need. It is important that we start by pointing out that the commissioning of many of these services, including the provision of therapies for children with hearing loss, happens at the local level. This now sits with our 42 integrated care boards, which means that the responsibility for meeting the needs of a local community of non-hearing children lies with local NHS commissioners.

The National Institute for Health and Care Excellence has issued guidance on the topic of cochlear implants for children and adults with severe to profound deafness. When it comes to commissioning and providing services for children with hearing loss, we have been crystal clear with those ICBs and NHS trusts that they must take those relevant guidelines into account. As yet, however, there are no NICE guidelines on hearing loss for children in general, and until now NICE had not made any specific recommendations on auditory verbal therapy.

I am pleased that NHS England has met with Auditory Verbal UK this year and discussed the need for more high-level research evidence, for the intervention and for evaluations of impact to be developed. NICE will not make recommendations without that evidence base, and getting that information absolutely must be the priority now, so that decisions and recommendations can be made. It is right that Auditory Verbal UK was invited to join the chief scientific officer’s audiology stakeholder group; I am sure it will have a lasting impact on the decisions being made. I am very happy to work with my hon. Friend and Auditory Verbal UK to ensure that progress is happening.

The Government will continue to prioritise investment into the NHS, and we have seen record levels in cash terms, rising to £165 billion in the coming year. We are using that money to support ICBs to make informed decision about the provision of hearing loss services, so that they can provide consistent high-quality integrated care to children with hearing loss. In 2016, NHS England published “Commissioning Services for People with Hearing Loss: A framework for clinical commissioning groups”, which also supports NHS commissioners to address inequalities in access and outcomes between hearing services.

With input from the National Deaf Children’s Society, NHS England produced a guide for commissioners and providers who support children and young people with hearing loss. That guide provides practical advice on ensuring that children with hearing loss receive the necessary support. More recently in May, the NHS service specification for cochlear implant services for adults and children recognised AVTs as part of multidisciplinary teams’ decision-making processes, enabling them to provide rehabilitation services alongside a range of healthcare professionals providing other services.

I fully recognise my hon. Friend’s point that we are not where we want to be in improving access to therapies for children with hearing loss. The limiting factor, as she pointed out, is the number of therapists working in the NHS—the SNP spokesperson, the hon. Member for Motherwell and Wishaw (Marion Fellows), also raised that issue in Scotland. We are increasing the numbers and have seen a 17% increase in speech and language therapists since 2018.

That is also why we are undertaking the biggest nursing, midwifery and allied health professional recruitment drive in decades with our long-term workforce plan, which includes the recruitment of speech and language therapists. AHP training places will increase by 13% to 17,000 in the next five years, with an 8% increase just next year, and by 25% to over 18,800 in the next 10 years. I am very happy to speak to the Minister responsible for the long-term workforce plan to particularly focus on the AVT element of that. Recruiting speech and language therapists is important, but I have clearly heard the point in this debate about the added training required to ensure that more therapists are available across England.

As committed to in the SEND implementation plan, we are exploring options to commission research to understand the health needs of children and young people through the National Institute for Health and Care Research. As I said previously, without NICE recommendations and the evidence base to inform those recommendations, we will not make progress as quickly as we would like. We are therefore working to improve access to speech and language therapy through service innovations.

We are including Early Language and Support for Every Child projects in our £70 million change programme, in partnership with NHS England. That programme is funding innovative workforce models to identify and support children and young people with speech, language and communication needs at an early stage. That will reduce exacerbation of need that might lead to a referral for specialist speech and language therapy or for an education, health and care plan. I welcome the work of Auditory Verbal UK on its plans to upskill health professionals to deliver AVT. Whether that is through speech and language therapists or upskilling other healthcare professionals, I am very keen to hear about its work and to see what more we can do to get those skills in place to help children and young people.

My hon. Friend the Member for Hastings and Rye spoke powerfully about the importance of early identification and intervention for children with hearing loss. The shadow Minister, the hon. Member for Dulwich and West Norwood (Helen Hayes), touched on schools in particular. She will know that teachers of deaf children have to hold the mandatory qualification in sensory impairment. There are currently six providers of that, and a seventh will come on stream next year. I am working closely with the Minister for children, and I will absolutely take her points to him to make sure there is a joined-up approach. This issue is not just about health, but about education—it is a cross-Government issue. We are committed to joining up the dots and working together to get children help and support wherever they need it, whether in healthcare or in school.

My hon. Friend the Member for Hastings and Rye and I share the same ICB. I recommend that all local MPs lobby their ICBs on the importance of commissioning these services. I recognise that we have to do more nationally to train practitioners who teach AVT, but we need local commissioners to commission those services and upskill their own local workforce. I have heard that message very powerfully and look forward to working with my hon. Friend and all Members across the House to deliver for children with hearing problems in the months ahead.

I thank the hon. Member for Motherwell and Wishaw (Marion Fellows) for her contribution from the Scottish perspective. She highlighted a whole-child approach both inside and outside education. We need to get it right for all children to help them thrive. Given the right support and intervention, we can do so. I thank the shadow Minister, the hon. Member for Dulwich and West Norwood (Helen Hayes), for her positive comments on the need for early intervention for deaf children and their families and for a joined-up approach across Government. That is very helpful.

I thank the Minister for her understanding of the issue and of the need for early intervention. Will she meet with Auditory Verbal UK to help to support the organisation in ensuring that the right evidence is provided to the NHS, so that the NICE guidelines can reflect the need for early intervention at both national and ICB levels? Regarding auditory verbal therapists in the NHS for the long-term workforce plan, it is very clear that we have to think ahead. Getting things in place now is really important.

Question put and agreed to.


That this House has considered the provision of auditory verbal therapy.

Sitting suspended.