Auditory Verbal Therapy

09:30:00

I beg to move, That this House has considered the provision of auditory verbal therapy. It is an honour to serve under your chairmanship this fine morning, Mr Western. I thank all hon. Members, especially the new Members, who have come along to speak in this all-important debate, which I have the privilege of opening. I thank the Minister for Care, my hon. Friend the Member for Aberafan Maesteg (Stephen Kinnock) and the shadow Minister, the hon. Member for Hinckley and Bosworth (Dr Evans) for attending. I am delighted to see in the Gallery Sam and his parents, whom I met when I sponsored Auditory Verbal UK’s parliamentary drop-in back in October last year—how time flies! At that reception, I was talking to Sam and some of the other young people there, and I asked whether any deaf children had come along, only to be told that all the children I had been talking to were actually deaf, including Sam. That is the difference this therapy can make, and why I am so passionately supporting and making this case today. Sam was diagnosed as being profoundly deaf at five weeks old. It was not until Auditory Verbal UK was recommended to Sam’s parents by a friend of a friend, by chance, that his fate changed forever. With the help of auditory verbal therapy, Sam learned to listen and talk just like his peers. Now 13 years old, Sam can speak and do anything he puts his mind to. He is doing really well at school, I am told, and will enjoy the same opportunities as his hearing friends. For children like Sam, Auditory Verbal UK has been life-changing. Its specialist work and support provided to deaf children and their families is truly remarkable. I am therefore glad to also see representatives from AVUK here today. They will always have my support and should be very proud of the work they do. Sam stands today as living proof that when deaf children and their families have access to early, effective support to develop language and communication, opportunities are transformed. If the Government, or anyone here or watching at home, need convincing of the clear, compelling and existing evidence of the benefits of auditory verbal therapy, they have only to look to children like Sam. Although all deaf children would benefit extraordinarily from auditory verbal therapy, the truth is that they will not all be as lucky as Sam. The current reality is that more than 90% of deaf children under the age of five in the UK are unable to access auditory verbal therapy, because there is little to no provision through publicly funded services. Currently, there are a mere 33 certified auditory verbal therapists in the UK. It is clear that these wonderful therapists, who hold the potential to transform the lives of our deaf children, are sadly few and far between. In the whole of the north-east, there are no qualified auditory verbal therapists. Deaf children in my constituency of Washington and Gateshead South, for example, are unable to access this support through publicly funded services. This postcode-lottery approach to healthcare is simply unacceptable. This is the situation in spite of public research that shows that a huge 83% of adults from the north-east believe that auditory verbal therapy should be available to all deaf children via publicly funded services. We know the therapy works and that there is public support for its roll-out throughout the country, so what are we waiting for? Raising awareness that support is out there is just the first hurdle, because if impacted families are aware of the therapy but have no qualified therapists in their area, their challenges persist. Even Sam’s journey from discovering auditory verbal therapy to completing it was far from smooth sailing. With no access to the therapy via public services local to him, he and his family had to travel weekly to Oxfordshire from Eastbourne so that they could access this life-changing therapy. Not all deaf children and their families can afford the privilege of time or money to go to such lengths every week, as much as they may want to. Certainly, not all deaf children have the privilege of having a qualified therapist in their area, which is a clear problem. We absolutely need to address that inequality of access. To extend access, we need to train more specialist practitioners in auditory verbal therapy. By equipping a small proportion of the speech and language therapists, audiologists and teachers of the deaf who are currently working in the public sector with additional skills in this approach, we can enable every family who wants their deaf child to learn to listen and talk to access auditory verbal therapy through publicly funded services close to where they live. Training is already happening, with UK professionals already qualified and others on their training journey. This is possible only thanks to the fundraising efforts of the charity Auditory Verbal UK, including two teachers of the deaf in the north-east who remain in training. There is a clear route for professionals to become trained in auditory verbal therapy, as well as a cohort of public sector professionals who can then share their experience of training and how it has enhanced their practice. Research points towards the fact that as a result of pursuing the training and qualifying as listening and spoken language specialists, professionals recognise significant growth in their knowledge and skills, equipping them to train others who can then do the same—the “train the trainers” model. There are around 50,000 deaf children in the UK, and 7,200 of them are under the age of five. They currently face the prospect of lower academic achievement and employment, and they are at a higher risk of poor mental health, bullying and social exclusion. Deaf children are almost twice as likely as all children to complete their first year of school without having achieved a good level of development in relation to the early years foundation. The statistics clearly highlight a stark difference between hearing and non-hearing peers in quality of life, educational attainment, employment rates and mental wellbeing. If the moral argument is not convincing enough, surely no one can deny the huge economic returns. Economic analysis based on His Majesty’s Treasury guidelines shows that an investment of just £2 million per year for the next 10 years for training a proportion of the existing public sector workforce could deliver a whopping £152 million of economic benefit to the UK. That is a massive £11.7 billion over a 50-year period. The economic savings are huge, including £3.4 billion through less need for one-to-one support throughout primary school; £1 billion of increased employment; £4 billion due to increased quality of life; a £7.5 million decrease in Government support; and £30.5 million saved through avoided injury. It is a small economic investment that will transform the lives of some of the most vulnerable children in this country, while also bringing us huge economic returns. Surely this is a no-brainer. So long as the UK remains unconvinced, we are falling behind as other countries trailblaze the way. Auditory verbal therapy is already state-funded in countries including Australia, New Zealand and Denmark, and the success rates speak volumes. In 2022, following a successful Government-funded pilot in Denmark that showed that 84% of children acquired age-equivalent spoken language after just three years of AVT, compared with 30% previously, auditory verbal therapy became part of the standard healthcare system there. The irony is that here in the UK we are now training many Danish professionals in AV therapy to deliver it to children in Denmark, despite being unable to support our own workforce to enhance their skills to get those outcomes for children here in the UK. That cannot be right. I thank the Minister for his time and leave him with three questions. First, what scope is there for the UK to implement a pilot scheme, in the same way that Denmark did, at least to prove the transformation potential of this therapy in a couple of areas, for those who remain unconvinced? Secondly, will he commit to supporting the need to increase access to auditory verbal therapy, and provide the investment needed when the funding allows? Thirdly, will he meet the deaf children and families charity Auditory Verbal UK, from which representatives are here today, to hear at first hand about the impact of early support, and the charity’s tangible plans to enable families to access the therapy wherever they live in the UK? I thank the Minister in advance and look forward to hearing the other speakers. I look forward to the Minister’s response after he has listened to colleagues’ perspectives in this very important debate.

Order. I remind Members that they should bob if they wish to be called in the debate. I never thought I would be saying these words, but it is my pleasure to invite Mr Jim Shannon to speak.

09:40:00

Thank you very much, Mr Western. I wish you well in your new role as Chair for Westminster Hall debates. I hope there will be many occasions on which you will call me to speak, although maybe not always first. It is a pleasure to see you in the Chair. It is also a pleasure to see the Minister in his place, and I look forward to his response. I look forward to the contribution of the shadow Minister, who has a deep interest in health issues. I give special thanks to the hon. Member for Washington and Gateshead South (Mrs Hodgson) for bringing this important topic to Westminster Hall for debate, and for her compassionate introduction. She has a deep interest in the subject matter and in making lives better, which is of course why we are all here. This issue affects children throughout this great United Kingdom of Great Britain and Northern Ireland. The information sent across by Auditory Verbal UK is a challenging read. It states: “Deaf children in the UK currently face a lifetime of disadvantage without access to early and effective support to develop language and communication and less than 10% of deaf children who could benefit from Auditory Verbal therapy to learn to listen and talk can currently access it.” That is the key issue and our key ask. This debate gives us the opportunity to raise awareness and make help available for all the deaf children who need support across this United Kingdom of Great Britain and Northern Ireland. The fact that 90% of children who could benefit from this therapy to improve their lives, including their social, educational and future working lives—I suspect the Government are planning for children with deafness not just for today, but for their future engagement in working life—cannot access such help does not sit well with me or anybody else here. I know the Minister feels the same angst about the issue, which is why I very much look forward to his response to our requests. It is clear that more must be done to facilitate access to auditory verbal therapy, which is why I am happy to support the hon. Member for Washington and Gateshead South and speak on behalf of the deaf children in my area and throughout Northern Ireland. The Consortium for Research in Deaf Education found that there were at least 1,428 deaf children in Northern Ireland. Some 77% of deaf school-age children attended mainstream schools, 1% attended mainstream schools with resource provisions—which there should be—and 21% attended special needs schools not specifically for deaf children. This is a devolved matter, so the Minister does not have any responsibility for that, but those figures reflect what happens in the United Kingdom mainland. Some 36% of deaf children were recorded as having another additional special educational need; that has increased from 27% in 2021. The stats do not make good reading because they illustrate the shortfall and where there is need. My staff and my office have been in touch with the Department back home to chase up the matter. An issue raised by the research was that the number of qualified teachers of the deaf in employment and working in a peripatetic role, in resource provision and/or in a special school or college not specifically for deaf children has decreased by 7% since 2022—just in the last two years—and by 40% since the survey started in 2011. There is a real need to train people to help to give young deaf children the opportunity to do better and get ready for employment in the future. I am keen to hear the Minister’s thoughts; perhaps there will be a role for an Education Minister in that work as well. It is clear that there is a real need to focus on how we support these children, and that there is much more to be done. I suppose that is the ultimate reason for the debate. Some 80% of children who attend an auditory verbal therapy programme for at least two years achieve the same level of spoken language as their hearing peers—wow: that is why we need this; those are the results—rising to 97% of children without additional needs. They attain educational outcomes on a par with hearing children, and the majority attend mainstream schools. That truly speaks for itself. With an investment of just over £2 million per year over the next 10 years, the Government could transform the landscape of auditory verbal provision and unlock £152 million of economic benefit. On the returns on investment, it is said that we have to speculate to accumulate; in reality, we have to spend time and money on the children to ensure that the economic benefit for all of us, but especially for them, rises to £11.7 billion within the next 50 years. We need to spend that money early and get the returns and, more importantly help people to prepare for life. We must ensure that UK children have access to this most basic of support and that we give them the lifelong tools that are beneficial for them and for society as a whole. We are long past the days of believing that being born with a different ability means a different life; there are just too many success stories for us to believe that that is a death sentence for normality. I seek in this debate to ensure that young deaf children have the same opportunities as other young children. If we can manage that, I will be very pleased. We know that a full life can be achieved, but the groundwork must be done in this place with sustained UK funding for auditory verbal therapy. I look forward to the Minister outlining how and when we can expect more for those who need it most. Has he had the opportunity, in the short time he has had, to make contact with the Health Minister in Northern Ireland and other responsible Ministers to see how we can exchange ideas, do it better together and raise awareness, which is very important?

09:48:00

It is a pleasure to serve under your chairship, Mr Western. I congratulate my hon. Friend the Member for Washington and Gateshead South (Mrs Hodgson) on securing this important debate. We come together today with a shared purpose to champion equity, opportunity and the unshakeable belief that every child deserves the best possible start in life. This debate is about more than a single policy; it is about ensuring that no family feels left behind when it comes to their deaf children’s future. Some 65% of deaf children complete their first year of school without achieving a good level of development. That is not just a statistic: it is a rallying cry that demands urgent action. Why is this happening? The National Deaf Children’s Society offers a stark insight: we are failing to assess and invest in the right primary support mechanisms for each deaf child. That failure is a systemic one and strikes at the most crucial time, the early years, when the foundations of language and communication are laid. The Deafness Resource Centre is clear that early childhood development is deeply social and emotional, thriving on successful interactions with caregivers. By failing to provide tailored support to deaf children, we risk leaving many feeling isolated, frustrated and deprived of the sense of belonging that every child deserves. I am deeply grateful that one such primary support mechanism, auditory verbal therapy, is being recognised here today. I am deeply grateful that one such primary support mechanism, auditory verbal therapy, is being recognised here today. For so many families it is truly transformative—the proof is here in this room—and I commend my hon. Friend for her unwavering commitment to improving its provision. Let us be clear, auditory verbal therapy is not a silver bullet. There is no one-size-fits-all solution. Every deaf child is unique, and so are their needs. Auditory verbal therapy is incredibly important, but I want to take a moment to emphasise the importance of addressing each child’s needs, case by case. Picture this: a deaf child in a deaf family, thriving in a sign-first environment where British Sign Language nurtures heartfelt, seamless connections with their loved ones. Now imagine another child, their confidence flourishing through intensive auditory verbal therapy. Both scenarios are valid and beautiful. What truly matters is meeting the unique needs of each child, guided by expert assessment. Bolton Deaf Society, located in my constituency, is a charity I am deeply proud to represent and support in Parliament. Its work serves as a beacon of hope and heritage for deaf children and their families. It champions deaf culture, celebrates British Sign Language and recognises that oral communication is not, and should never need to be, for everyone. Although auditory verbal therapy can be life-changing, there are many in the deaf, deafened and hard-of-hearing community in Bolton who would not choose it, even if it were readily available. For some families auditory verbal therapy is tied to the medical model of disability, a framing that implies hearing loss as something to fix, potentially sidelining deaf culture, identity and pride. For other families, like many we have heard about today, that is not the case. For the families in Bolton who are seeking auditory verbal therapy for their child, I wholeheartedly agree with my hon. Friend the Member for Washington and Gateshead South that we must urgently train more specialist practitioners to extend access. In Bolton alone, there are more than 300 deaf children; across the north-west, that number rises to 6,000, yet there are just five certified auditory verbal therapists in our region. Right now, as my hon. Friend mentioned, a postcode lottery determines whether a family can access the support that their child needs. That is not equity or fairness; it is a failure that we must urgently address. Deaf children in Bolton deserve better. I strongly urge the Minister to expand access to AVT across the north-west. More than that, I urge him to expand access to primary support mechanisms across the board. Success lies in providing a well-funded, comprehensive, holistic system of support, ensuring that every child can thrive in a way that fits them best. I sincerely hope the Minister agrees.

09:52:00

It is pleasure to speak under your chairmanship, Mr Western. I congratulate my hon. Friend the Member for Washington and Gateshead South (Mrs Hodgson) on securing this important debate and on her contribution to ensuring that this profound therapy is better heard, better known and more available to choose for a great many in our society. When there is so much to resolve, so much to fix and sort out, it feels like smaller causes struggle to be heard or seen. Our politics seems too busy to care about even more causes; it is all just too much. Alternatively, it can be said that the last Parliament did good things for the deaf community, so to expect new money for new causes is a stretch too far, naive even. We must believe in better. Each Parliament has the opportunity to help the underserved, and there are always issues that, with the right political heat and weight, can be transformed. Such issues have long been on the roll of Government successes, whatever the political weather. Think of the long-standing injustices, new medicines on the NHS, or social equalities we have addressed. The missions of this Government delivered their enormous parliamentary majority and a mandate to renew, reform and transform. Auditory verbal therapy takes the Government’s vital missions for health, for children, for the smashing of barriers to opportunity, and for growth, and it brings them to life. This cause gives the missions cause to blossom. There may not be a better example of a cause that, for such a fraction of an investment, can be transformational. I know what we are asking for will not be green-lit today, but I know what we need. Former Health Secretaries I have met have spoken of the “whiteboard moment”, when we get the issue on to the whiteboard. That is the goal. It is the moment when the Minister asks their civil service teams to make something possible—to draft a plan to take us from where we are to where we need to be. It is a pilot, a tester, a starter for 10, where the Government do not just take our word for it, but see for themselves. Should there be concern among our deaf community, let me say that this is not about undermining the celebrated protected status of British Sign Language. We celebrate BSL as a language—a unique cultural identity—and the last Parliament’s recognition of BSL in law was a landmark achievement. The argument for auditory verbal therapy is an argument for choice—choice for the child, their family and their future—and ensuring that families have the knowledge and support to choose the best path for them. It is not about competing choices, but having access to all of them. The demand is that these families’ cause is heard, and the majority of the country agrees. In a recent YouGov poll, 85% of UK adults believed that auditory verbal therapy should be available to all children via publicly funded services such as the NHS. The first years of a child’s life are critical. It is when their brains are most receptive to language and communication. For deaf children, early intervention is essential. Auditory verbal therapy enables deaf children to develop listening and spoken language skills and equips them to thrive alongside their hearing peers. With AVT, 97% of deaf children without additional needs achieve age-appropriate spoken language within two years. That is the transformation we seek. It is not a big ask, but it has giant implications for the impact that AVT can have if we can reach that whiteboard moment and have civil service teams working with experts to bring this therapy into NHS early years programmes. It is preventive healthcare at its best: cost-effective, compassionate and life-changing. For someone who learns that their child is deaf, navigating this new world is disorientating and complex, and they will feel unsure. It is also the moment where we should ensure that parents learn that there is a therapy that could help their child to communicate on a par with their hearing peers. The option of AVT should be as freely considered as learning to sign, and traditional or developing means. Withholding this therapy after people have learned of its existence cannot remain the position, yet learning of AVT only to be told that it is unavailable, unaffordable or simply not an option where someone lives is the reality for far too many families. With only 33 certified auditory verbal therapists across the UK, access to AVT is exclusive and rare. Most families will never hear of it. By removing the barriers, we can give parents and their children the opportunity to decide for themselves. That means training more therapists—supported by Government bursaries—to meet growing demand, building regional hubs, expanding telepractice services so that no family is left behind, and raising public awareness to ensure that families know that AVT is an option. If the heart of the argument does not move us, the head can. This therapy means economic growth and a sound investment in families’ futures and ours. This cause is transformational for not just them but the economy. For £2 million annually—a fraction, or a rounding error, when it comes to the NHS budget—we could ensure that thousands of deaf children access AVT. According to independent economic analysis, this investment would unlock £11.7 billion in benefits over 50 years, and here is how. We would reduce education costs, as early intervention means less reliance on one-to-one support, saving £3.4 billion. We would increase employment, with confident, independent deaf adults contributing £1 billion to economy. And we would improve quality of life, with thriving, independent individuals generate £4 billion in societal benefits. Without early intervention, the costs are far greater. Delayed support leads to unfulfilled promise or potential, higher unemployment, mental health challenges and long-term reliance on public services. The new Government have wasted no time identifying waste to be cut from their spending. The Cabinet Office has pledged to reduce the £7 billion per year spent on consultants. Official analysis found that total spending on consultancy in 2022-23 was £1.2 billion, with the Department of Health and Social Care among the highest spenders, at £281 million. I share this Government’s instincts: the money saved must now transform the lives of those accessing AVT. Does the Minister agree? For just £2 million a year, we can train more specialists in order to remove the barriers to opportunity, expand access through the NHS and ensure that every family makes informed decisions. We are not asking for those decisions today, but for a commitment to start this journey and to draft a plan that takes us from this underserved system to one that provides choice and opportunity for every deaf child and their family. With parents given every option to choose for them, their children are given the best chance to thrive. When all deaf children thrive, our society is stronger, more inclusive and more prosperous. This underserved issue can benefit from the Government’s mission to transform. As the campaign says, “Hear Us Now.”

10:02:00

It is a pleasure to serve under your chairmanship, Mr Western. I thank my hon. Friend the Member for Washington and Gateshead South (Mrs Hodgson) for securing the debate, as well as colleagues who have spoken. I will not repeat what everybody has said, but I will mention a few things. As has been said, auditory verbal therapy provides numerous benefits for deaf children, and that is particularly true of their educational prospects. We need to bridge the gap between the educational attainment of deaf children and their classmates, which is created by the barriers they face in integrating realistically in the classroom. With investment in an AVT programme, we can overcome those barriers. In 2019, the average deaf GCSE student faced a gap of 17.5 months in learning, compared with classmates with no special needs. That is only a three-month decrease from 2011, so not a lot has changed. AVT would help to deliver the promise of bridging that gap, by intervening in the earlier stages of language development. Accessing that early intervention lays the foundation for a more successful future, which will help deaf children to realise their educational potential. It will also be an integral part of boosting their self-esteem, ensuring that they are not hindered in interacting with their friends and classmates or participating in lessons. AVT also has the potential to foster a sense of social inclusion, and therefore provide deaf children with the skills and confidence to succeed at the same level as their peers who have no special needs, both in the classroom and beyond. There are currently 7,200 deaf children below the age of five, which is a target subset of AVT. As it stands, there are not enough qualified auditory verbal therapists—I believe there are only 33 in the whole country—so we need more of them to be able to see these children. However, one challenge faced by many families is that they do not have sufficient spare money to spend on these services. The fact that services are so limited, and provision is so hit and miss across the United Kingdom, presents even more of a challenge. A programme that trains speech and language therapists in AVT would make sure that all deaf children have equal access to quality therapy. It is a cause that it is well worth the Government spending money on. We train professionals from other countries who then go back to their countries, such as Denmark and others. Our deaf children deserve the same care and attention, and we must not forget that there are 50,000 deaf children in our country. If we train more therapists, we can share in the success of such initiatives. As my hon. Friend the Member for Bury North (Mr Frith) said, it is morally right that we look after our young people, but it also makes economic sense to ensure that deaf children are well educated and able to integrate and to be part of the fantastic workforce we need for the future. Finally, I thank the campaigners and the families who have been campaigning on this issue for the tremendous work they have done. I also thank my hon. Friend the Member for Washington and Gateshead South for bringing this really important matter forward for debate. I have to declare an interest: although I am not deaf in the sense that these children are, I am hard of hearing, so this issue is quite close to me personally.

10:07:00

It is a pleasure to serve under your chairship, Mr Western. I also thank my hon. Friend the Member for Washington and Gateshead South (Mrs Hodgson) for raising this incredibly important topic and securing the debate. You may not know this, but Derby and Derbyshire have the largest deaf community outside of London. The Royal School for the Deaf Derby sits in the neighbouring constituency of Derby North, and the staff do an absolutely fantastic job supporting deaf children and young people to access the very best education they can. However, despite the work of such specialist schools, deaf children nationally face huge educational inequality, which is compounded by the lack of access to critical therapies such as auditory verbal therapy. It is staggering that only 38% of deaf children in England completed their first year of school having achieved their expected levels of development, compared with 66% of all children. We have seen huge strides forward in support for our deaf community, with pioneering gene therapy delivered just last year, allowing a UK girl who was born deaf to hear unaided. Medical professionals across the country should rightly be recognised for their hard work in delivering such innovative treatments to support our deaf community. These success stories should be celebrated, but unfortunately access to critical therapies and support is often unequal, with less than 10% of deaf children in the UK currently able to access them. Auditory visual therapy is one of those inequalities. Children in the east midlands and across the UK are missing out on the benefits it can offer. As we have heard today, those benefits are life-changing, with research showing that 80% of deaf children can achieve age-appropriate spoken language following AVT. They are missing out on an incredible opportunity. Let us be really honest: it is no surprise that the provision of AVT is a postcode lottery, because years of Tory austerity have brought the NHS to its knees. I have been so pleased to see our Labour Government turning the page on that austerity nightmare, committing to the biggest NHS funding uplift since 2010, outside covid. It is vital that AVT provision sees the benefits of Labour’s investment in our public services, supporting deaf children and their families, wherever they live in the UK.

10:10:00

It is a pleasure to serve with you in the Chair, Mr Western. I thank the hon. Member for Washington and Gateshead South (Mrs Hodgson) for introducing the debate, as well as Sam, his family and Auditory Verbal UK for campaigning on this important issue. I confess that I am quite new to auditory verbal therapy, and it has been fascinating to research the issue more for the debate and to listen to hon. Members’ contributions. The hon. Member for Washington and Gateshead South made a hugely compelling argument for improving access to auditory verbal therapy, setting out not only the benefits for the children who would be able to improve their ability to listen and speak, but the economic benefit that would derive from what I think we can all agree is a small investment—as an accountant, I can confirm that £2 million is probably a rounding error in most instances. I also thank other Members for their useful speeches today, not least the hon. Member for Bury North (Mr Frith), who highlighted the importance of early intervention, and the hon. Member for Derby South (Baggy Shanker), who highlighted the educational impact that early access to appropriate therapy can have. There are more than 50,000 deaf children in the UK. Around 7,200 of them are under the age of five. Some 90% of deaf children are born to hearing parents, who do not have the experience of dealing with hearing impairment. Although deafness is not a learning disability, deaf children face a significant attainment gap during their time at school, and their educational outcomes are poorer. There is also a higher risk of poor mental health. In addition, deaf people are less likely to have decent employment, and suffer generally from inequality as a result of being hearing impaired. It is important to say up front that all deaf and hearing-impaired people have the right to participate fully and independently in society. Too often at the moment, those rights are not being fully realised. Liberal Democrats believe, as I am sure hon. Members from all parties do, that every deaf child deserves the best possible start in life, the opportunity to flourish and for their families to be supported, so that they can express themselves and communicate with ease, in the way that is most comfortable for them. The hon. Member for Bolton North East (Kirith Entwistle) highlighted that offering a range of therapies is the best way to support families who have a child who is deaf, and that they should be able to exercise choice when deciding which therapy is most suitable for them. Under section 17 of the Children Act 1989, local authorities in England have a duty “to safeguard and promote the welfare of children within their area who are in need” by providing “a range and level of services appropriate to those children’s needs.” A child is defined as being in need if they are disabled, and the Act says that a child is considered disabled if they are deaf. We are therefore in a position where it seems that local authorities must be compelled to provide appropriate support for deaf children and their families. The National Deaf Children’s Society notes that “in some cases, local authorities do provide funding to help” a child “access AVT”. The problem is that the Government have confirmed that audiology services are commissioned locally and that “the responsibility for meeting the needs of non-hearing children lies with…National Health Service commissioners.” That leaves us with the dreaded postcode lottery. It would be helpful if the Government provided guidance to local authorities on the level of support they should be providing, particularly, in the context of this debate, for AVT. Locally in Shropshire, headteachers report an inability to access basic speech and language therapy for hearing children. The strain on local government finances will clearly have a significant impact on what is available to children in each area. Will the Minister confirm whether provision of AVT will be a responsibility of the Department of Health and Social Care or local government? Therapies such as this might sometimes fall into the gap between the two, and it would be useful to understand how it can best be delivered. As I mentioned, I am slightly new to this topic but Liberal Democrats have long campaigned for better support for people who are deaf, and particularly for those who communicate through British Sign Language. We would like BSL to have official, equal status to the UK’s other languages, and would like free access to sign language lessons for parents and guardians of deaf children. We welcome all the developments in improving outcomes for deaf children, including technology such as cued speech visual systems, for which there is a major centre in the constituency of my hon. Friend the Member for South Devon (Caroline Voaden). I echo the call of the hon. Member for Washington and Gateshead South for a pilot scheme—that seems a sensible way forward. The existing research on AVT is promising but the evidence base is still narrow and a pilot scheme seems the best way to broaden that evidence base and convince those who have not yet been convinced by meeting children who have benefited profoundly from the therapy. More broadly, the Government should strengthen the availability of basic speech and language therapy training for people working with children to ensure that children who are struggling with hearing impairment can be identified, that their progress is monitored and supported, and that an equal outcome is found for them. In conclusion, will the Minister confirm whether the provision of AVT is the responsibility of the Department of Health and Social Care or a local government issue, bearing in mind that the provision of such assistance comes through local government? Will he also confirm that the 10-year plan will address services such as AVT for deaf children and adults? Finally, will he consider a pilot scheme to broaden our understanding of the benefits of AVT?

10:17:00

It is a pleasure to serve under your chairmanship, Mr Western. I congratulate the hon. Member for Washington and Gateshead South (Mrs Hodgson) on leading this debate and pay tribute to Auditory Verbal UK for its tireless advocacy in this area. I know that, to obey parliamentary protocol, I should never direct comments to the audience but I would like to say thank you to Sam for his advocacy and for being here to watch this debate. Maybe one day he will be on these green Benches, advocating for further changes, although I hope the Government will have served that purpose by then. If Sam is listening, I hope it is okay, Mr Western, to put those comments to him through you. As Members have noted, the provision of auditory verbal therapy was previously discussed in the House in December 2023. In the aftermath of that debate, I understand that AVUK held discussions with the Department of Health and Social Care and received support from two Ministers in the last Government: Maria Caulfield, the former Member for Lewes, and Dame Andrea Leadsom, the former Member for South Northamptonshire. I also understand from the charity that, before the election, the last Government were considering how to roll out training for auditory verbal therapy and to upskill the existing speech and language therapist workforce. That is part of the workforce plan for the NHS and I am pleased to see that the current Government are continuing in that vein. Helen Keller said that the only thing worse than being blind is having sight but no vision. Since the election, it appears that the Government are possibly stepping back from this area. Recent responses to written questions have indicated that the Government have no plans to review the adequacy of the provision of AVT and have stated doubts about the strength of the current evidence supporting its effectiveness, but today we have heard arguments made about a range of studies that suggest AVT really can support deaf children to develop age-appropriate spoken language and attain educational outcomes on par with hearing children. It is not for us, at this point, to make a decision but it is for this House to raise this topic. As a first step, will the Minister commit today to meeting Auditory Verbal UK so that it can present the latest evidence and research from the UK and abroad? We know that integrated care boards are responsible for commissioning services for their local communities, including the provision of auditory verbal therapy. Thanks to charitable funding and efforts from AVUK, there are now 33 certified AV therapists across the UK. However, as other Members have noticed, there are still major gaps in provision, particularly in the public sector. Will the Minister therefore commission a review about the impact and effectiveness of the AVT that is currently taking place in the NHS? Although there are five AV therapists in Manchester, there is just one for the whole of the west midlands, and, as the hon. Member for Washington and Gateshead South mentioned, there are currently no AV therapists in the north-east. The hon. Member for Bolton North East (Kirith Entwistle) also said that there are none in the north-west. That highlights the postcode lottery, which needs to be addressed—especially when, as we have heard, there are 50,000 deaf children in the UK. AVUK has argued that national guidance to ICBs could help to improve provision across England. Although the National Institute for Health and Care Excellence has guidance on hearing loss for adults, there is no such guidance for children. We know we need an evidence base for guidance, and, given that NICE is the organisation responsible for that, it seems reasonable to focus our attention on it. Can the Minister commit to speaking to NHS England and NICE about current guidance for hearing loss and whether it needs to be updated in the light of the emerging evidence around AVT? Much has been said by Members today about the return on investment we can see from putting more money into AVT. AVUK has said that for every £1 invested in therapy, there could be as much as a £4 return. We have seen in other areas—for example, the children’s hospice grant—how a small amount of national funding can go a long way in supporting community services across England. Therefore, as decisions are made on the allocation of NHS funding announced in the autumn Budget, will the Minister consider AVUK’s ask to provide funding to train more public sector workers in AVT? I think it was also Helen Keller who said, “I cannot do everything, but I can do something. I must not fail to do something that I can do.” I congratulate the hon. Member for Washington and Gateshead South on securing this important debate and raising these issues. Deaf children across the land are lucky to have an advocate in her—she is doing her part. I thank the hon. Members for Strangford (Jim Shannon), for Bolton North East, for Bury North (Mr Frith), for Bolton South and Walkden (Yasmin Qureshi), for Derby South (Baggy Shanker) and for North Shropshire (Helen Morgan); they too, are doing their part by raising the issue in this debate. I thank AVUK for all it does; it is doing its part. I hope, in raising constructive questions as His Majesty’s Opposition, I am doing my part, too. In turn, I hope that the Minister will answer my questions and others raised today, meet AVUK and assess its evidence, and make appropriate recommendations and changes with the Department of Health and Social Care and the NHS so that deaf children can reach their full potential—in doing so, he will fulfil his part.

10:23:00

It is a great pleasure to serve under your chairship, Mr Western. I thank my hon. Friend the Member for Washington and Gateshead South (Mrs Hodgson) for securing this vitally important debate, and for her powerful and moving contribution to our discussion. I would also like to break with protocol and welcome Sam to Parliament today. He is clearly a remarkable young man, and an inspiration to us all—thank you for being here, Sam. Like the shadow Minister, the hon. Member for Hinckley and Bosworth (Dr Evans), I thank hon. Members for their excellent contributions today. We have had a range of contributions, including from the shadow Minister, and from the hon. Members for North Shropshire (Helen Morgan) and for Strangford (Jim Shannon), and my hon. Friends the Members for Bury North (Mr Frith), for Bolton North East (Kirith Entwistle), for Derby South (Baggy Shanker) and for Bolton South and Walkden (Yasmin Qureshi). I think that may be all, but huge apologies if I have missed anybody. All their contributions were excellent and very well put. My hon. Friend the Member for Washington and Gateshead South has done so much work to champion the interests of children with special educational needs and disabilities, including non-hearing children. I know that she also has an excellent partnership with Auditory Verbal UK, which I welcome to Parliament today. I would, of course, be happy to meet its representatives to follow up on all the points made in this debate. This Government are committed to raising the healthiest generation of children ever. We will deliver on this ambition through the health and opportunity missions, and through the Government’s child poverty strategy. This is not about silos, with each Department delivering one part of a puzzle that does not fit together properly; this is about systemic, holistic change, and ensuring that we join up analysis, expertise and delivery across Government. Our mission-driven Government will drive long-lasting and sustainable change for children now and in the future. We will break down barriers to opportunity and ensure that every child has the best start in life. This includes all children and young people with special educational needs and disabilities, including non-hearing children. We know that developing early communication skills is a key foundation for life, and there are serious knock-on consequences when that development is delayed. That is why we are committed to improving access to early interventions so that every child can find their voice. With the right support, children with hearing loss can develop effective communication skills, live fulfilling lives and enjoy the same opportunities as everyone else. The Government recognise the importance of the earliest days of an infant’s life. There is strong evidence that the 1,001 days from conception to the age of two set the foundations for our cognitive, emotional and physical development. That is why we are giving a £126 million boost for families to give every child the best start in life. Thousands of families across England will be able to access family hubs, which will act as a one-stop shop for help with infant feeding advice, parenting classes and perinatal mental health support, among other things. Figures from the National Deaf Children’s Society show that there were more than 45,000 deaf children and young people in the UK in 2023. Between one and two babies in every 1,000 are born with permanent hearing loss in one or both ears. This number increases to about one in every 100 for babies who have spent more than 48 hours in intensive care. Early and effective support is crucial for these children and their families. Permanent hearing loss can significantly affect a baby’s development, so early and effective support is crucial for these children and their families. It is vital that we intervene at birth. The NHS newborn hearing screening programme—the NHSP—aims to find babies who have hearing loss as early as possible so that the right support and advice can be offered right from the start. As we all know, 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 therapies, such as speech, language and auditory verbal therapy. However, as we have heard today, those children are not always receiving the support that they need. We recognise the important role of auditory verbal therapy as one of the therapies that can be useful for children with hearing loss. NHS audiology services, including the provision of therapies for children with hearing loss, are locally commissioned, and responsibility for meeting the needs of children with hearing loss lies with local NHS commissioners, because local systems are best placed to meet the needs of their own communities. After 14 years of Tory neglect, incompetence and austerity, our NHS and care service are on their knees, but this Government are committed to properly funding the NHS, and we recently provided a £26 billion boost for health and social care in the autumn Budget. NHS England is responsible for determining allocations of financial resources. Each ICB will then commission the services they need for their local area, taking into account their annual budget, planning guidance and the wider needs of the population they cover. NHS England is supporting integrated care boards to make informed decisions about the provision of audiology services so they can provide consistent, high-quality and integrated care to non-hearing children. In July 2016, NHS England published “Commissioning Services for People with Hearing Loss: A framework for clinical commissioning groups”. The framework supports NHS ICBs to make informed decisions to address inequalities in access and outcomes between hearing services.

Does the Minister agree that, for all the good intentions of ICBs, our healthcare system is atomised, but that if they were to take instruction from guidance provided nationally, the pillar-to-post experience of a lot of families seeking auditory verbal therapy would end? Will he commit to updating the nine-year-old guidance to ICBs, or at least acknowledge that it needs updating, with a national pilot that proves the efficacy of AVT for families seeking that intervention?

My hon. Friend will know that one of the constant challenges in the system is getting the right balance between empowering those operating at the coalface—those who are close to the communities and know them best—to ensure they are delivering the best possible services, and ensuring consistency and coherence, both strategic and operational, across the entire system. It is safe to say that we are not always getting that balance right. One of the key objectives of the 10-year planning process that we are going through will be to address the so-called postcode lottery—variation between regions—across the whole range of health and care. Without that cross-cutting strategic look at the system, it will not be possible to get the balance right. I absolutely take the point, but one thing I will say is that we are crystal clear when we issue guidance to ICBs that they must take that guidance into account, and their performance is monitored on that basis.

Am I right in thinking, from what the Minister has just said, that he will issue revised guidance following today’s debate? Am I right that the Government, having given an extra £26 billion to local areas, will give them guidance that they should be looking to commission these services on a much bigger scale, so that we have more than 33 AVT therapists?

I can certainly tell my hon. Friend that this is a very dynamic situation. A system never stands still. For a system to work, we have to be constantly reviewing its performance and whether it is delivering to its objectives. I believe that the 10-year plan that we are producing will absolutely lead to a radical rewiring of the way our health and care system works. It will be driven by three big shifts: from hospital to community, from sickness to prevention, and from analogue to digital. There is no doubt at all that where there are therapies and treatments that are working—that are clearly delivering big results, and value for money for the taxpayer—it is right that we give those priority in the way that we deliver. It is clear that AVT has huge potential, and it appears to have unexplored potential. I cannot pre-empt today how this is all going to pan out in terms of the system and the reforms that we are looking to push forward, but I can assure my hon. Friend that we are committed to innovating and to building a system that is fit for the future. In 2019, 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. The guide provides practical advice on ensuring that non-hearing children receive the support they need. Auditory verbal therapy is one type of therapy to support children with hearing loss, and it is important that local commissioners know their population and have the discretion to decide how best to meet its needs. When it comes to commissioning and providing services for children with hearing loss, we have been crystal clear with ICBs and NHS trusts that they must take the relevant guidelines into account. We recognise the real need to improve access to therapies for all children who need them, including children with hearing loss. In recent years, in very difficult circumstances, the NHS has increased the number of speech and language therapists working in the service, but we know that more needs to be done. That is why the Government are committed to fixing the NHS and building a service that is fit for the future, with the workforce it needs to get patients seen on time.

The Minister rightly points out the need to try to deal with the postcode lottery and to ensure that there are reviews and sharing of best practice, but may I draw him back to my comments about guidelines? One thing he could do is ask NICE to look at the current evidence and consider what national guidance should be in place. ICBs have the right to choose what kind of treatment they think works best, and they will be driven by the clinical evidence and clinical guidelines; if there are no clinical guidelines, they will simply make their own decisions. Will the Minister commit to doing that?

The hon. Gentleman will know that NICE has a prioritisation board, and ultimately that is the decision-making process for prioritising guidelines and the entire operating framework for what falls under NICE’s remit. This is something that absolutely should be on the radar, and of course we are constantly in conversation with NICE about its prioritisation, but it is important that it takes an objective clinical stance on the question. We have committed to develop a 10-year plan to deliver a national health service that is fit for the future. The engagement process has been launched. As we work to develop and finalise the plan, I encourage those concerned about the availability of services to support children with hearing loss, including auditory verbal therapy, to engage with that process to allow us to fully understand what is not working, as well as what should be working better and the potential solutions. I encourage all hon. Members present to go to change.nhs.uk to make their voice heard. This summer, we will publish a refreshed long-term workforce plan to deliver the transformed health service we will need to build over the next decade to treat patients on time and deliver far better patient outcomes. We are also in the process of commissioning research to understand the gaps between the supply and demand of different therapy types for children and young people with special educational needs and disabilities. That will help us to understand the demand for speech and language therapists and inform effective workforce planning.

I am pleased to hear that the Government have increased the number of speech and language therapists, which is so important for young people who are struggling to achieve their potential in an educational setting, but will the Minister address the specific point on commissioning by local authorities? Often, they are so strapped for cash that they are effectively trying to limit demand.

Commissioning is led by ICBs. It is important that ICBs have open channels of communication with local government. We in the Department of Health and Social Care have close contact and engagement with colleagues in the Ministry of Housing, Communities and Local Government, and it is important that that relationship and interaction feeds down through the entire system, but the leading organisations on commissioning are the ICBs. A number of colleagues raised the question of a pilot scheme to identify how our existing workforce can work differently. The early language and support for every child programme is an excellent example of different professions coming together to support children and young people—local authorities, schools, and the health and care system working together in the community to support our children and young people. The ELSEC workforce model focuses on recruiting pre-qualification speech and language therapy support workers into the workforce to improve the capacity and knowledge of staff who support children with emerging or mild to moderate speech, language and communication needs in early years and school settings. Nine regional pathfinder partnerships are trialling new ways of working to better identify and support children in early years settings and primary schools. We have asked pathfinders to consider how to make the model sustainable after the project period. The therapy assistant roles have the potential to attract individuals to train to become speech and language therapists through the apprenticeship route. I understand that Auditory Verbal UK is progressing a National Institute for Health and Care Research grant application to support a pilot, and I would welcome an update from AVUK about how that is going when we get the chance to meet. We welcome the work that AVUK is doing to upskill health professionals to deliver auditory verbal therapy. On the point made by the shadow Minister, the hon. Member for Hinckley and Bosworth, there are as yet no NICE guidelines on hearing loss in children, and NICE has not made any recommendations on AVT specifically. Decisions on the need for guidelines on new topics and updates to existing guidance are made by NICE’s prioritisation board, in line with NICE’s published common prioritisation framework. I understand that NHS England met with AVUK and discussed the need for more high-level research evidence for the intervention and the need to develop evaluations of impact. I am pleased that AVUK has been invited to join the chief scientific officer’s audiology stakeholder group, where it will contribute to decision making. We recognise the impact on the lives of children of timely access to high-quality services, including different therapies to help children to develop the right skills to engage with education. The Government’s ambition is that all children and young people with SEND or in alternative provision receive the right support to succeed in their education and as they move into adult life. We will strengthen accountability on mainstream settings to be inclusive, including through the work of Ofsted, by supporting the mainstream workforce to increase their SEND expertise and by encouraging schools to set up resourced provision or SEN units to increase capacity in mainstream schools. That work forms part of the Government’s opportunity mission, which will break the unfair link between background and opportunity, starting with giving every child, including those with SEND, the best possible start in life. We will work with the sector, as essential and valued partners, to deliver our shared mission and restore parents’ trust. I again thank my hon. Friend the Member for Washington and Gateshead South for securing this debate and sharing her insight on the vital issue of early interventions for non-hearing children. We recognise the importance of such services and the life-changing impact they can have on the lives of children. We are committed to ensuring that all children receive the support they need to live healthy, fulfilling lives. I will continue to work closely with NHS England and the Department for Education as we strain every sinew to deliver on those commitments.

10:43:00

I thank everyone who has taken the time to come along and made such excellent contributions on this vital issue. I thank the Minister, the hon. Member for Hinckley and Bosworth (Dr Evans), who spoke for the Opposition, and the hon. Member for North Shropshire (Helen Morgan), who spoke for the Lib Dems, for listening. I was happy to hear that the Minister will meet AVUK and explore the potential of a pilot. That is great news. I hope that he might also get a chance to speak to Sam today—that would be wonderful. I also hope that, if NICE deems—as we all have—that this therapy is both clinically and economically valuable, he will update the guidance to ICBs. The Minister also mentioned the NHS 10-year plan. I hope he recognises that it has already been nine years since the guidance was updated and that the issue needs urgent attention, perhaps towards the start of the 10-year plan rather than the end of it; otherwise, we will be getting on for 20 years. Today, we have the opportunity—the Minister especially—to change the fate of deaf children in this country. They deserve the same opportunities and outcomes as their hearing peers. That surely cannot be a controversial position. These children are the future. We must invest in them, not only because it is the right thing to do morally, but because any financial investment will produce economic returns in abundance. Mainly, we should invest in them because our children deserve it.

I also thank Sam and his family for attending this morning. Question put and agreed to. Resolved, That this House has considered the provision of auditory verbal therapy.

10:45:00