§ 11.20 a.m.
§ Mr. William Hamling (Woolwich, West)
I beg to move,That this House is of the opinion that responsibility for the education and training of all mentally handicapped children should be transferred from the Ministry of Health to the Department of Education and Science; that improved educational opportunities are the key to the proper development of these children; that their subsequent training and employment under sheltered conditions, or where possible in open industry, should be the responsibility of the Ministry of Labour; and that the Government should take powers to ensure that facilities for them should conform to a minimum standard not lower than that obtaining in the best authorities.I consider it a great honour and good fortune to have this opportunity of moving a Private Member's Motion so soon after having had the opportunity, about eight months ago, of moving a similar Motion about the supply of teachers. I consider that this subject is of equal importance and, in many respects, of even greater urgency, because of the disabilities of the children concerned and the lack of opportunities for them. I am very gratified to know that so many right hon. and hon. Members have expressed an interest in the subject and I am particularly gratified to see the right hon. Member for Birmingham, Handsworth (Sir E. Boyle) on the Opposition Front Bench. I know that in order to be present today he had to cancel a very important engagement in Oxford.
All the House knows my interest in education. I have taught in a variety of establishments. I taught backward children for a number of years and I have always had an interest in the unloved and the uncared for. So often backward children are just that. We know their 1708 potential and we know that they have the capacity to make good citizens, good mothers or good fathers, if given a chance. The same can be said of many mentally handicapped children if they are given the opportunity of training and education. When I was teaching children like this some of my friends used to tease me about my enthusiasm and say, "Bill, you think all your geese are swans". Some of them are swans, and even geese are useful.
Who are the children whom we are considering? We are not talking about the educationally subnormal, who are already the care of local education authorities and the Department of Education and Science. We are talking about those who are the care of the Ministry of Health and who are looked after by local health authorities. We do not know how many of them there are. There is a great need to find out more about mentally handicapped children, about the nature of their handicaps, for speedy diagnosis, for much more information than we now have.
The reason why we do not have this is that they are a forgotten group. I am sure that many people do not want to know about mentally handicapped children and meet them with suspicion and fear, and perhaps distaste. One of the purposes of the debate is to arouse public opinion on the subject and to excite the sympathy and imagination of the population about the needs of a very important group in our society, not only the children but their parents. We very readily accept physically handicapped children into our society. Blind or deaf children are accepted in our education system. They are not shunned and they are not rejected.
But I have a very vivid memory of the way in which working-class children, for example, used to treat mentally handicapped children when I was a boy living in Liverpool. There was a boy who lived down our street, near the south end of Liverpool's docks, Les Allen, who was much older than any of the other children but who was treated by them with tremendous cruelty. That used to be the pattern. Thank goodness, we have improved a lot in that respect. This boy lived a lonely and useless life, but how many children are there in our society today who are still living lonely and useless lives?
1709 The contrast to this I met a fortnight ago when I visited a newly opened training centre in my London Borough of Woolwich, where I saw mentally handicapped children being taught by teachers with modern methods and being cared for. I saw the smiles on their faces. When they are cared for, they respond.
The Motion refers to Ministerial responsibility for mentally handicapped children. Some may ask why I seek to change that. The answer is that I regard this as a teaching problem and not simply a matter of care or welfare. I am reinforced in that by a report of a working party of paediatricians in the south-east metropolitan region. The report said:It is, we believe, unfortunate that the Royal Commission should have found it necessary to recommend the continued separation of administrative responsibility for the education of school age children according to 'educability,' and that the Mental Health Act should have accepted the recommendation. It is true that the word 'ineducable' is now administratively banned…. But nevertheless a division is to remain, even sharper than that which constitutes failure in the eleven-plus examination, between those children thought to be capable of being taught in a school, who remain the responsibility of the Ministry of Education and Local Education Authorities, and the others incapable of being in a school, who become the responsibility, as heretofore, of the Ministry of Health and Local Health Authorities.The report went on to deplore this arbitrary distinction and the rather illogical assumption that educationists know best how to teach children with intelligent quotients of about 50 or 55, but not below. This is an education problem.
There is another point to this, and that is that hospitals for the mentally deficient are the Cinderella of the system. We know about expenditure and costs, and I do not want to go into that in detail. I have spoken about the Ministry of Labour and its responsibility in this case. The Ministry is now responsible for industrial training, for bridging the gap between dependent childhood and adult independence.
These children, too, are in need of this help, except that their dependence goes much deeper than that of other children, and perhaps lasts longer. Many of them are capable, with educational training, of becoming independent when they grow up, of going out to work and living the life of a normal adult citizen. It is our 1710 job to see that they get whatever help they need to do this. Their parents will not always be behind them and many will be left to stand on their own feet.
I also mentioned the unequal provision which exists. It is universally known and recognised that there are some parts of the country where provision is fair—and I suppose that that is an adjective which knowledgeable people would accept—but that there are other areas where the provision is certainly less than fair, and in some cases almost nonexistent. What is the evidence of neglect?
There has recently been a report by the British Psychological Society which is dealt with in The Times Educational Supplement, not a paper I would recommend when it comes to comprehensive schools, but one whose evidence I will accept in this field. It has a headline:Isolation of the Mentally Subnormal.Isolation is the operative word. The article reads:The isolation from the main stream of education of schools in hospitals for the mentally subnormal and training centres is regretted by the society in a new report. Children in Hospitals for the Subnormal. There are few channels of communication between the staff of such centres and schools within the educational system, they say. There is little awareness of the relevant educational or psychological research, and what little systematic or experimental education there is may well suffer from the absence of guidance and concrete help that could be given by a knowledgeable headmaster, an interested and informed educational psychologist or inspector of schools.For these reasons the society advocates that these training centres and hospital schools should be brought within the framework of the local education authority and Department of Education.
There is an even longer report in my union journal, The Teacher. Union journals perform a great service. This report is headed:Poor facilities for the subnormal.I will read the first sentence:Alarming inadequacies in the educational and training facilities available to children in hospitals for the subnormal are revealed in a newly published report by the British Psychological Society.The other evidence will be found in the working party report to which I have referred. This report speaks of:…a wide variey of different and more or less specific disabilities, physical and mental, in these children. Psychologists are only now 1711 exploring the field of perceptual defect and their resulting difficulties in learning of comprehension and communication. We also think that the kind of change which has been taking place in education practice for young 'normal' children…ought to have very important repercussions on ideas of how to develop the capacities of 'damaged' children. These are essentially problems for educationists, and we think they will only receive genuine consideration in so far as this is recognised…There is other evidence in the report and I would commend it to hon. Members. There has also been a report, by an expert, published by the Fabian Society. It is known as "The Mental Health Services". I would commend this, too, to the House, particularly that part of it dealing with children and hospital educational facilities.
I want to remove any impression from the mind of my hon. Friend the Parliamentary Secretary that I am in any way criticising his Ministry. This is a Friday and I am always benevolent on Fridays. This is rather an indictment of our community. It is a criticism of the fact that the community does not approach this subject with urgency. In my own part of London a meeting was held of parents from a grammar school which was to be incorporated in a new comprehensive school. Over 300 parents turned up and wide publicity was given to the meeting and to some of the criticisms. What publicity is given to this problem? How many meetings attended by well over 300 people, noted by local and national Press, are ever held to discuss the urgency of this problem? This is a matter of public responsibility.
So often we say, "This is up to the Ministry". This is up to society, not the Ministry. It is an indictment of our community that we do not care. One of my colleagues, who, unfortunately, cannot be present today, sent me a letter detailing a case in his constituency, illustrating the gap in the provisions for these children. The letter told of a child who went to a good school until the age of 15 and then had to go home because there was nothing else. Instead of maintaining his improvement, he went back. My colleague said, "This is a mockery. One is showing the child that things can be done and then one is taking away the opportunities later". This is a result of the failure of the public to be aroused to the needs of these children.
1712 There are relative shortages and there are absolute shortages. My attention was drawn to the problems of Service families who were brought up abroad. I understand that there are over 40,000 Service children in schools overseas. Many of these families have mentally handicapped children. The families are serving in places ranging from Hamburg to Hong Kong, but there are no facilities abroad for educating or training their mentally handicapped children. They find it very difficult to obtain places in residential hostels or hospital schools here. Quite clearly there is a need for residential hostels in every local education authority area.
There are further needs on the staff side for the training of teachers and instructors. I have looked at the Scott Report on this, and although the figures relate to 1959 I am certain that they have not materially altered since then. One of the most significant figures in any document on this subject is that of 2,149 members of staff in training centres, only five are university graduates.
I know that a great many people think that the possession of a university degree is some kind of technical or professional qualification. I do not share that view. I regard the possession of a university degree as evidence that the man or woman concerned has had a higher education, and that is all. How many of those who have had a higher education find their way back to work in this field? The obvious answer is, "Very few"—people who are dedicated men and women. The leaven should be spread more evenly throughout the community. The leaven of higher education should extend as far as mentally handicapped children.
This may be a commentary on the English system of education. I do not know what it is in Scotland. It is recorded that 1,789 of these people have no stated academic qualifications. This is a very large number of people who are supposed to be engaged in an educational and training job. There are only 42 recognised teachers. I know that quite a lot of them—363—have the N.A.M.H. diploma. There are 64 nursing nurses, 102 mental nurses, and 69 nurses or assistant nurses. But a vast number of them have no professional qualification.
1713 I do not think that we should overestimate the importance of professional qualifications. I started life as an un-certificated teacher. I always think that I learned the job of teaching as an un-certificated teacher and that anything I learned at university or in the university training department did not make me a better teacher. We used to say that the best teacher was the man or woman born to it. But qualifications are a very great help. Specialised training is of inestimable value to people who ultimately spend their lives doing this work.
We ask how many children are covered by the facilities. The answer is, by no means all. There are great gaps. I ask in the Motion that more teachers, not instructors, should be trained for this work. To my mind, a teacher is somebody who is interested in the child as a person and not simply in teaching him or her a skill, someone who will have sympathy, imagination and affection. It is people, of this sort that we want to come into this work, people who are interested in social education and in teaching the whole boy or the whole girl.
There is a great need for research into the methods of teaching mentally handicapped children. A fortnight ago I saw the exciting work which is going on in Greenwich. That was one of the happiest mornings of my life as a teacher. It was a tremendous experience.
When it comes to salaries, people who teach in schools for mentally handicapped children should be treated no less worthily than ordinary teachers. They should certainly be paid the Burnham scale plus for their specialist training and specialist work.
One question which has struck me over the years in dealing with mentally handicapped people, and, indeed, physically handicapped people, is whether they should be cared for at all. I am sure that there are some people who think that they are a great burden on the community and that we should opt out of our social responsibility for them because they are a great burden. People like that should stand up and be counted.
As an undergraduate I took part in a lot of debates. I remember going to Aberyslwyth—the only time that I have ever visited the town—to take part in a 1714 debate on the sterilisation of the unfit. I led for the opposition. Somebody said, "You know where you stand, don't you?". The question which I remember asking in that debate was: who decides who is unfit, and who decides who should be sterilised? Who decides who is unfit to take his place in our community on equal terms with the rest of us? How unfit does a person have to be? We know what happened in Germany in the 1930s, when it was said, "Do away with the socially unfit".
This House, and this nation, reject that conception. We are a Christian and humanist society which believes that all God's children should be taken care of, that all of them should have a fair chance and that there should be no first-class and second class tickets in our society. We care for them all. Then let us do the job properly and not in a niggardly spirit. I am reminded of the cynics' decalogue, "That shalt not kill—but needst not strive officiously to keep alive". This is the way in which our society is behaving too often in this field. We must not kill, but we do not do very much to help these people to lead worth-while lives—or the parents, the brave souls who cope so often with impossible situations and who are liable themselves to physical, psychological and moral breakdown. We owe a social duty to them, too.
§ 11.49 a.m.
§ Sir David Renton (Huntingdonshire)
I congratulate the hon. Member for Woolwich, West (Mr. Hamling) on raising this subject. We should also thank the hon. Member for Lichfield and Tamworth (Mr. Snow) for withdrawing his Motion on traffic regulations as they affect lorries and enabling this debate to take place so early. The hon. Member for Woolwich, West spoke as an experienced teacher in these matters. My experience is of a rather different kind. I happen to be the father of a mentally handicapped child.
It follows from what the hon. Gentleman said that scientific and social progress advances unevenly. There is not simultaneous progress in all subjects at all times. But this simple truth is startlingly revealed in relation to mental handicap. There has been great progress in antibiotic curative treatment. This has prevented many subnormal children from 1715 dying at an early age. In many cases we should be thankful for that. In some cases it has created an inescapable tragedy.
Great progress has been made in maternity services and obstetric medicine, so that the percentage of live births has risen steadly. It is, however, a solemn thought that as those things have improved, the proportion of children born with acute mental handicap and suffering and surviving indefinitely has greatly increased. As the infant mortality rate falls, the mental handicap rate increases. Putting it another way, the science for the detection, prevention and cure of mental defects has not yet caught up, as I hope it one day will, with the progress made in antibiotics and obstetrics.
Some progress has, of course, been made. There are, I believe, scores of causes of mental defects of pre-natal origin which are now known to the medical profession. The profession knows how to anticipate and prevent some of them, but it does not know how to cure many of them.
As the Ministry of Health is, I am glad to see, represented on the Front Bench, I suggest that this is essentially the field of preventive medicine. There is immense scope for further research in this matter. I doubt whether enough research is being done on the lines which I have indicated. I should like the Parliamentary Secretary to the Ministry of Health to give us the latest information about the research which is being done in this field of preventive medicine.
I suggest that owing to the growing nature of the problem, whenever feasible the case history of a mentally handicapped child and of its mother should be sent to a central registry so that causes and effects can be collated and studied on the widest possible scale. Not until this is done will this branch of medical science catch up with those other branches the progress of which is so admired, but which, have in their turn, contributed to a considerable extent to an increase of the problem of mental handicap.
As the hon. Member for Woolwich, West has said, not enough is known about the facts of mental handicap. This, I suggest, is largely because not enough effort is made to centralise the facts. I 1716 should have thought that without a tremendous administrative exercise, a great deal more could be done than is done at present.
It is not even known how many mentally handicapped children and young people there are in the country. I have heard the figure given as 1 per cent. of the child population. Incidentally, the figure of 40,000 Service children mentioned by the hon. Member means that there are 400 mentally handicapped Service children. I mention that merely as an illustration of the problem. But one is only guessing. We do not know.
I suggest, therefore, the establishment of a central registry so that the medical people engaged upon research have something to work upon. Meanwhile, we must remember that every mentally handicapped child is a living soul with a conscious personality, capable of joy and sorrow, and nearly always ready to be helped forward to a fuller life—perhaps only a slightly fuller life, but, nevertheless, ready to be helped forward—to the fullest extent of its capabilities, however limited they may be.
We cannot tell what the limit of the capabilities of a mentally handicapped child is, if there is one, until we try. I know this because of our experience with our youngest daughter, aged 11, who can scarcely do anything for herself. It is absurd to say that she cannot express herself because of the fact that she cannot talk. Express herself she can. But only those knowing her well and giving her personal attention can understand her well enough.
Let us consider for a moment how the advance of social science, as compared with medical science, has gone on in this field compared with the other advances that social science has made on a wide front. Social science in the field of mental handicap started late. It is slowly catching up, but it has a very long way to go. I remember the present Minister of Health and I, on different sides of the House, collaborating with my right hon. and learned Friend the Member for Hertfordshire, East (Sir D. Walker-Smith) in getting the Mental Health Act, 1959, through the House.
We know from that, and from other powers which the Ministry of Health and the Ministry of Education have, that all the powers exist for getting things done 1717 and for making progress in the social field. What is lacking are money, buildings and, as the hon. Member for Woolwich, West has pointed out, trained staff, although we must remember that there are some wonderfully dedicated people helping handicapped children, both inside and outside the National Health Service, helping with the local authorities and their homes and helping also in private homes which are recognised by the Ministry.
I did not draft the Motion, although the hon. Member for Woolwich, West courteously showed it to me and, I believe, to hon. Friends of mine on this side of the House. I agree in general with the Motion for the reasons that the hon. Member has given. I underline, in particular, the reference to the Ministry of Labour. I invite the Government's attention—they should know about it already—to what can be done to help in the industrial training of mentally handicapped people, because the National Society for Mentally Handicapped Children now has its Industrial Training Unit, at Slough, well established and it is doing fine work. It is filling exactly the gap to which the hon. Member referred. Many more places like that are needed, however, and they will not be forthcoming unless the Government take a hand in establishing them.
My one reservation about the Motion arises very largely because, as the hon. Member for Woolwich, West pointed out, this is a teacher problem. It follows, therefore, that those severely subnormal children who are truly ineducable, of a very low I.Q., or an I.Q. of almost nil, should remain the responsibility of the Ministry of Health. Perhaps that is implied in this Motion; I do not know. But I think that we should make it abundantly plain that they should remain the responsibility of the Ministry of Health.
They are best looked after, whoever is looking after them, in small homes, if they cannot be looked after in their own homes. Those severely subnormal children who are ineducable need more medical and nursing attention than others do because most of them have a dual handicap. Mostly, the mental handicap is so acute that in the very early years of infancy they have not been able to develop the powers of the body as 1718 children of normal mind do. Therefore, they nearly always need a very great deal of medical attention.
Although even the most handicapped children can benefit from training of some kind, the training from which they can benefit is of a very different kind, for which the Ministry of Education does not provide teachers, and cannot be expected to provide teachers, but the Ministry of Health might do so. The very helplessness of the severely subnormal ones means that they are the most difficult problem of all, and that is so, of course, especially if they can do nothing for themselves, and that fact, in its turn, makes it more difficult for them to be looked after in their own homes if there are other children in the family engaging the attention of their mother.
Their plight seems so desperate that it sometimes seems that time is better spent on training those less handicapped who can show more promise, but I must say that I think that that is an inhuman attitude—I agree with the hon. Gentleman. It is also a counsel of despair, because there have been cases in which children who have been thought to be utterly incapable of doing anything at the age of 3 have, by the time they were 13, learned to walk, and talk, and to lead a reasonably full life. Now when the severely subnormal children are in large institutions—and here I should like to have the attention of the Parliamentary Secretary to the Ministry of Health; he may be bored with what I am saying—
§ The Parliamentary Secretary to the Ministry of Health (Mr. Charles Loughlin)
No. Will the right hon. and learned Gentleman permit me? I really should not like him to think that I am bored. I was trying to turn up the information for which he had asked.
§ Sir D. Renton
I was trying to catch the hon. Gentleman's eye.
I should like the hon. Gentleman to realise, because this a point which affects his Ministry, that where these severely subnormal children are in large institutions the numbers involved make it difficult for the staff to do much more than attend to their basic needs; but, as I say, nearly all of them can be helped forward in one way or another provided that they are in small units, in small homes, and that means a rather high staff ratio.
1719 May I give an example from personal experience? When my youngest daughter was 7 it seemed unlikely that she would ever be able to walk, but would always have to be lifted and carried. That was an unfortunate prospect for her and for us, but, thanks to the skill and "know-how" of people—I do not know what qualifications they had; I do not suppose that they had all passed tests or held any diplomas or anything, though at any rate some of them had—at the "school" where she was, after a year of patient perserverance, she was taught to walk.
That, of course, in itself was a great thing, but the resulting benefits to her were tremendous and her morale improved greatly. She could not have been taught to walk if the numbers had been too great for the dedicated staff available. I should mention that at the place where she was most of the children were not fee-paying children; more than half of them were paid for by local authorities.
That small school, unfortunately—if "school" is the right word—closed down last summer. We have to find another suitable home for her to go to, and that has made us well aware of the shortage of this sort of small home where the most severely handicapped and ineducable can be sure of getting training based on personal attention. In some counties there are no such National Health Service facilities at all; and private homes are few and far between and have long waiting lists.
In my opinion, as I say, the solution of this problem lies in the small homes. How are we to get those? I think that perhaps the most promising way is by the extension of the already successful partnerships between voluntary and private enterprise and public authorities. There are a number of examples in different parts of the country of homes where either a charity has put forward money, or a private individual, and they have the blessing and advice of the local authority, and they have done great work, and they provide the right sort of home atmosphere, which is so essential.
I make this suggestion without any disrespect to some splendid attempts made within the National Health Service, of which I am aware, but, as I say, the best solution seems to have been 1720 found with the fairly small home where 20 or so children are looked after by voluntary bodies or private individuals with the blessing and advice of the local authorities—who also send many patients there; indeed, the homes could not keep going unless the local authorities did send patients there. Even these homes vary a bit, but I think that all of them could be raised to the high standard achieved by most of them.
There are not enough of them at present. More homes and more staff are needed, but I think that if it were generally known that efforts of this kind were to receive official encouragement—that is, from the Minister of Health—more money would be forthcoming from charitable sources and more people would feel prepared to devote their lives to the work, with or without also dedicating as much of their capital as they can spare. Certainly, however, if there were more homes of that kind that would greatly ease the Minister's own problem, to which I have referred, of the difficulty of care in large institutions, and it would give hope to many parents who, at present, are desperately concerned about the future of their children.
To me, there is no more terrifying knowledge than the knowledge that a child is suffering in its mind. Too many children are suffering in their minds today. Let us hope that, as a result of this debate, fewer will do so in future.
§ Mr. Julian Snow (Lichfield and Tamworth)
On a point of order. I should, perhaps with your consent, Mr. Speaker, explain, in response to the very courteous observation by the right hon. and learned Member for Huntingdonshire (Sir D. Renton), that I did not withdraw my Motion because of the importance of this one, although I shall hope to catch your eye in this debate later. I was obliged to withdraw my Motion because I had offended against the rule of anticipation, since the Motion that I wanted to move on traffic regulations governing motor lorries anticipated consideration of the Bill on road safety.
§ Sir D. Renton
May I be allowed to say that I appreciate what the hon. Member for Lichfield and Tamworth (Mr. Snow) says. I had attributed it to his customary generosity.
§ 12.10 p.m.
§ Dr. Shirley Summerskill (Halifax)
The essence of our debate today is that we are bringing to the attention of the House and the country as a whole our notice of the fact that a minority of people in the community are different from the normal.
The right hon. and learned Member for Huntingdonshire (Sir D. Renton) mentioned a possible figure, and it can be accepted that at least one baby in every hundred suffers from a mental handicap. That means, in other words, impaired intelligence, and it must be remembered that these babies are born to no particular section of the community. They are not the children of unintelligent parents; indeed, they are often the children of highly intelligent parents. They are not found in any particular income group or section of the community. It is possible for anyone at any time to be the parent of such a child.
So far, the responsibility for their care has been largely the job of doctors, teachers, social welfare workers and the parents themselves. As a result of the debate, I hope that everyone in the community will feel that they have also a responsibility. After all, babies are future citizens of the community, and however limited their potential talents may be, they must not be wasted. Our aim should be that these talents and capacities should be developed to their fullest possible limit, that the children should live as full a life as possible and that, in the end, they should become as independent and self-supporting as possible.
What are the problems that face doctors, teachers and parents? One main problem which is slowly arising is that these babies and children cannot be classified simply into educable and ineducable, as so often was done in the past. There is a whole range of intellects among them. In the old days, a person was either mentally sick or mentally normal. If he was mentally sick, he was put away. If he was normal, he was not. In a similar way, there has been a danger that these children should be classified simply as educable and ineducable.
We realise at last that mental illness has a whole range of severity, from extremely severe to very mild, and similarly 1722 these children cannot all be treated alike. They are separate individuals, and they must be treated as separate cases in different ways. Not all children who cannot reach a certain score in mental testing are automatically defective or ineducable, and it does not always follow that a mental handicap is accompanied by a physical handicap, although that sometimes is the case.
I agree with my hon. Friend the Member for Woolwich, West (Mr. Hamling) that, although it is largely a medical problem, as the children grow up it is primarily a problem of education. As with normal children, the vital years are between one and five. It is in the nursery school stage that the right education and treatment of these children is of vital importance. The discipline, the affection and the guidance that they receive between the ages of one and five make that period the vital stage of their school careers.
Everyone on this side, at any rate, who believes in comprehensive education realises that the ability and talent which every one of these handicapped children possesses should be discovered, revealed and fostered. The earlier that his limitations are recognised and the earlier in life that those limitations are treated, the greater his prospect of a satisfactory life.
Another problem that we face is that the whole study of the subject is a new and growing one. More is being discovered about it week by week, so that doctors, teachers and parents have a constant struggle to keep up with developments.
We have heard tributes paid to the dedicated and patient people who deal with mentally handicapped children. As has been said, small classes are vitally essential. It is impossible to cope with the work in over-sized classes. But the fact is that teachers of severely subnormal children are paid less than normal children. Is it surprising that we have a shortage of those teachers, with the result that we have over-sized classes?
For the most part, these teachers are completely untrained in the work that they have to do. One of the reasons that they are paid less is that they do not come under the entire supervision of the Minister of Education, as do teachers of normal children. There is a strong 1723 argument in favour of bringing them under the supervision of the Minister of Education
I am glad to say that in Halifax we are not suffering too great a shortage, but hon. Members will know that in most constituencies there is a severe lack of facilities for mentally handicapped children. In Great Britain, there is a waiting list of about 13,000 for places in special schools and of about 5,000 for places in training centres for the severely subnormal. Wherever one goes, there is a need for a hostel or some educational facility for such children.
The fact that the supervision of these children is split between two Ministries is bad. If their I.Q. is less than 80 but not lower than 55 they are considered to be educable and therefore they are supervised by the Minister of Education; but if their I.Q. is 55 or less then they are considered ineducable and severely subnormal and they come under the Minister of Health. Both the British Medical Association and the National Union of Teachers have firmly come out against that division. They believe that the ineducable or severely subnormal children should come under the auspices of the Minister of Education.
I want to draw the attention of hon. Members to the findings of a delegation of people interested in the welfare of mentally subnormal children who visited the U.S.S.R. recently. They went to Russia because they were extremely interested in the problem, and they found that great progress is being made there.
Of the 10,000 teachers in special schools in Russia, at least 30 per cent. of them have completed a four-year full-time course. The remainder have completed a five-year correspondence course. That applies to all the teachers in special schools in Russia. In that country there is also a research institute of defectology, which devotes its whole attention to the subject. In this institute there are 100 members on the staff, including 60 scientific workers, and all students entering this sort of work receive an extra grant of 15 per cent. This shows the progress which has been made in that country.
Future developments which we should encourage are as follows: far more small, intimate schools and hostels for these children. Fortunately we have moved 1724 away from the huge isolated colonies which used to be put up for children and people with mental diseases. I have visited a modern light one-storey building being put up for these children. The Ministry of Labour should provide sheltered work for them when they leave school, and they should receive full- and part-time day training. It is no good putting a great deal of attention and care into the education of these children up to the age of 14 or 15, and then suddenly submitting them to the outside world, unprepared and untrained to deal with everyday life. All through their training at school they should be prepared to do as useful, as interesting, and as fulfilling a job as their ability makes possible. There should be some form of transport or ambulance service to take many of these mentally handicapped children to school each day and back again. There should be full home care services for those who cannot go to school, and during the holidays there should be home helps to assist the parents. Social workers should keep an eye on these children when they leave school.
On the question of research, I am certain that both the Ministry of Health and the Department of Education and Science can do far more than they are doing at the moment to discover how to care for these children, why they are mentally handicapped, how to prevent it, and to increase our total knowledge, and it is essential that finance is available for this purpose. At the moment less than 0.2 per cent. of the national expenditure goes on education research, and of that no specific amount is set aside for mentally handicapped children. Similarly, out of the money provided for research by the National Health Service, no specific amount is allotted to mentally handicapped children.
I should like to see set up an Educational Research Council similar to the Medical Research Council. At the moment only about 12 people in the whole of Great Britain are doing any research into the learning processes of severely subnormal children.
§ Sir Edward Boyle (Birmingham, Handsworth)
Would not the hon. Lady agree that, whether or not we have a separate Educational Research Council, one of the greatest needs at the present time is to increase the output of 1725 researchers from the universities? The hon. Lady may remember that when I was Minister of State I concerned myself with this through the U.G.C. Surely this is one of the first priorities if we want to get more research?
§ Dr. Summerskill
I agree that the first priority is to have people to do it, and then to make sure that the money is available for them to do their work.
I feel that in the future the care of mentally handicapped children will depend less on the hospitals and more on their own homes and local community care. At the moment very much of their care depends on voluntary organisations, dedicated people, and to a lesser extent local authorities, and here again far more money is necessary before more can be done by local authorities. That part of the Motion which deals with certain minimum standards is very much to be welcomed. It is no good each area doing what it can on limited funds, unless it has a minimum standard at which to aim.
In conclusion, I say that more is being done today than ever before in this field, mostly by aroused and dedicated people, but progress is being impeded by the prejudice of many ordinary people who have been fortunate enough to have normal children. We must see that these mentally subnormal children have a place to fill in society, that they are fully integrated into the community, and that they are accepted by everyone, with sympathy and understanding.
§ 12.25 p.m.
§ Dame Joan Vickers (Plymouth, Devonport)
I am glad to have the opportunity to congratulate the hon. Member for Woolwich, West (Mr. Hamling) on choosing this subject which I think is all too rarely discussed. He talked about backward children being unloved, but my right hon. and learned Friend the Member for Huntingdonshire (Sir D. Renton), in a most moving speech, gave us a wonderful example of the extent to which backward children can be loved and cared for.
I should like to take up the point about members of the Armed Forces, because this is one of the problems which faces us, as I know only too well, having so many Service people in my constituency. It nearly always happens that wives cannot join their husbands and go overseas. 1726 They have to remain in this country with their children.
The details of handicapped people in the Ministry of Health's Report is not broken down. It shows that between 1960 and 1964 the number of mentally handicapped children rose from 7,700 to 11,750; on the other hand, the number of blind people decreased. Does this mean that more children are being born with some mental defect, or that more children are remaining alive? The hon. Lady the Member for Halifax (Dr. Summerskill) said that one in every hundred babies was considered to be defective. Does this mean that an even larger number are born mentally deficient than in 1960?
The Report shows that 1,300 children were admitted to hospitals. Are we sure that all these children needed to go there? What tests are given before a child is sent to the hospital? Is any test made to see whether there is a chance of using some other type of accommodation?
I notice that in the 1964 Report the Minister of Health commended to hospital authorities the advice given by the Standing Mental Health Advisory Committee, that an extra 25 beds per region were needed for long-staying patients. It is very depressing that we should need this increase, and it may bear out what my right hon. and learned Friend said, that too little is known about how to deal with these children at the beginning of their lives.
A handicapped child often means a handicapped family, and no praise can be too great for the mother who looks after such a child.
The National Society for the Mentally Handicapped provides a lead for dealing with handicapped children. I have read the book quoted by the hon. Member for Woolwich, West and the Fabian Report, which I thought backed up a great deal of its work.
I think that we must take a lead from President Kennedy. In America they now have the Mental Retardation Act, and when it was being signed he said:I think that in the years to come those who have been engaged in this enterprise can feel the greatest source of pride and satisfaction and they will recognise that there were not many things that they did during their term of office which has more of a lasting imprint on the welfare and happiness of many people.1727 I hope that we will adopt that attitude in this country after this debate.
I turn now to deal with the divisions among handicapped people, because I think one has to face the fact that there are many categories of them. Children who can be educated should be sent to special schools and should be taught to the highest possible standard. There are plenty of opportunities for the trainable child in occupational service. Many children who are not capable of learning from books can take part in occupational work, and thus be able to earn their living.
I come next to the untrainable child. Many parents are willing to keep this type of child at home if care centres can be provided by the local authorities where the child who is what we might term a cot case can be taken for the day. They are quite willing to have them at home if they can have some relief. I have seen some of the centres, and they are doing excellent work.
My right hon. Friend mentioned the question of research. When the Kennedy Foundation, started in 1964, put out an appeal, it received almost immediately 16 million dollars. By raising this matter in Parliament the hon. Member for Woolwich, West may make people realise that if we want this work done more quickly it is up to the community to take more interest. Some people in this country are doing excellent work. I would mention Professor Penrose, who has been awarded a sort of international Oscar by the Americans for his work in mental research.
I have been looking through a number of books and have discovered that, according to experts, it is possible to train young people with I.Q.s in the 30–40 range. It is stated that the mongols, the brain-injured, the cerebral palsied, the aphasic and the hyperactive kinetic type can be trained quite easily for vocational skills.
Most mongols are visually orientated. Indeed, most children in the categories to which I have referred are visually orientated, and this helps enormously in training, so I should like to see an Institution for Research on Exceptional Children. We must recognise the good work that is being done. One thinks of the experiments 1728 being carried on at Wirral, Epsom, Cheadle Royal, and in Bristol, at the Industrial Therapy Organisation, and I would mention in this connection Professor Tizard, who has done excellent work in educating these children and who has had some astonishing results.
However, as the hon. Member for Woolwich, West said, there is still, regrettably, a prejudice. I know of cases where mothers of normal children are not very happy when their children meet others of subnormal intelligence. We also hear of cases where, when homes for mentally retarded children are opened by local authorities, local residents protest. This kind of thing must be overcome. There is no need for any fear, and certainly not for any prejudice.
I turn now to the question of the training of teachers. There are 20 hospitals for the severely subnormal, and in 17 hospitals there are 100 teachers. It is difficult to discover what qualifications these teachers have. Perhaps the Parliamentary Secretary can let us know what numbers these teachers have in their classes, and how many hospitals employ qualified teachers.
The Scott Report presented a rather depressing picture, pointing out that only 3 per cent. of the staff at these hospitals even had the National Association for the Mentally Handicapped qualifications, and that 82 per cent. had had no formal training at all. The hon. Member for Halifax quoted her experiences of the work that is done in the Soviet Republic. I have been interested in experiments carried out in the United States of America. There, in the Janes School, children of very low I.Q.s—in the 30–40 range—have been trained sufficiently to work in sheltered workshops, going there themselves by bus, being able to take the precaution of reading signs to know that the bus is going in the right direction. They can go shopping to the stores, help to prepare meals, do certain home chores, undertake gardening and cutting the lawn, and take part in recreation, including dancing, bowling and scouting.
In Plymouth we have recently opened an occupational centre, and it is interesting to find that having begun with rather simple work—fitting springs to certain gauges and seeing that they were of the right size—the trainees are now able to 1729 do laundry work. They do all the laundry work for the local authority, wash cars, and make lampshades and tables. They are beginning to acquire considerable manufacturing skill. I have sent my car there to have it washed. They have the latest mechanical methods for this job and they receive the normal payment. This is very satisfying, both to the young persons and to their parents, because they feel that they are living a normal life. I understand that 11 of these trainees from this centre have now gone into permanent outside employment.
The question of maintaining contact after leaving school has also been referred to. I feel that in this respect youth employment officers could do more. One of the points raised in the Motion raises the question of what will happen to a young person when he or she leaves school. At the moment these young people have some authority to look after them from the moment they are born to the moment they die. We would have to consider who will have the care of these children once they leave school, especially if they are not able to go to work.
I noticed that in the Ministry of Health plan it was stated that by 1974 there should be 120 junior hostels, which will be able to accommodate 2,140 children. At present there are about 37, for 677 children. I should like to know whether the Parliamentary Secretary can tell us what progress is being made with regard to these centres for the very severely handicapped, described so well by my right hon. Friend, there is no medical remedy. The only thing that can be done is to provide them with educational therapy and continuing care. I wonder whether the real needs of education and social welfare are being met in hospitals or training centres. It would appear that they are not.
I would like to see the Ministries of Education, Health and Labour set up an inter-departmental committee to review the scale of the problem and to see what provision is needed for mentally deficient children. It might pay special attention to what local authorities are doing for education and training of mentally handicapped children and adolescents who are capable of having some kind of formal education. As the hon. Member for Woolwich, West pointed out, there is too 1730 much of a division at the moment. I would have thought that might be the right moment to set up this inter-departmental committee, if only to consider the way in which the different departments could co-operate before finally deciding to bring into operation the various recommendations in the Motion. It is necessary to get the co-operation of the Ministry of Labour especially in regard to its industrial training centres.
With full employment it is possible to obtain work much more easily than it has ever been in our history, for people who are not usually able to find normal work on the labour market but are capable of being trained, and with the aid of modern machinery this will become easier. We know how, in the war, blind people worked in ordnance factories when the jobs were broken down sufficiently, and in my opinion jobs could be broken down still more to enable handicapped people to do them. Next week, we are to consider the Abortion Bill. If this Bill—especially Clause I—passes, and bearing in mind what my right hon. Friend said about the further knowledge that the medical profession has about children before they are born, we may even be able to help with this problem and relieve some people of their anxiety about the possibility of having extremely deformed children.
I should like to support what has been said by my right hon. Friend about the need for small classes and small units to care for children who are cot cases. I have discussed this with a matron, who told me that one of the most depressing difficulties is to get people to nurse these children, because they have no chance of seeing any progress at all. I am not sure whether the children should not be attached to different wards, instead of all being nursed in one big ward. I hope that this will be considered: that some of the children should be attached to an old people's ward, where they are bedridden. I am talking only about cot cases now. This suggestion would make the work less arduous, and older people might take an interest in the children. I should like this point considered.
We have come a long way in our knowledge of the mentally handicapped, but there is one section where there seems to be very little progress. This is in the care of autistic children, who are among the most difficult for parents to cope with. 1731 As my right hon. Friend said, there is some way to get on with most children, but the autistic child seems to be a real difficulty. There should be special research into the needs of these children, because they are generally physically well-grown and appear to be capable and intelligent, if only one could find some way of breaking into their thoughts. The needs of these children should be considered in any allocation of money for research in the near future.
We have come a long way since Shuttleworth and Fletcher Beach and their Committee on Defective and Epileptic children. We should pay a tribute to the work of Madame Montessori of Italy, Decroly and Alice Descoeudres of Belgium, the National Association for Promoting the Welfare of the Feeble Minded—as early as 1896—and, in particular, Dame Ellen Pissent and Mary Dendry. These people were struggling in a world with very different boundaries and they laid the foundations for the 1904 Royal Commission on the Care and Control of the Feeble-Minded, which was a great step forward.
Although I am the first really lay Member to speak in the debate, I have been particularly interested in this work, and I feel that this subject is very important. I hope that this will mark another step forward in understanding and knowledge of the needs of the mentally handicapped, because it will bring tremendous happiness not only to the individual but also to his parents.
My last point concerns the parents. Many of these people are not financially very well off and I should like to see a special family allowance for a mentally handicapped child, especially those permanently at home. All is well while the children are at school or other children are in the family, but parents of a single child seldom get a day out together because they cannot pay for a home help or a baby-sitter. If some allowance could be made for those children who live at home, more people might be able to keep their children at home, and this would be of benefit to the children and to the parents as well.
§ 12.44 p.m.
§ Mr. Julian Snow (Lichfield and Tamworth)
I was interested in one of the concluding remarks of the hon. Lady 1732 the Member for Plymouth, Devonport (Dame Joan Vickers) about the care of, and consideration for, autistic children. Many years ago, I spoke in the House on the subject of psychiatric social clubs, which were then being considered and which, since that date—the late 1940s—have gained in general popularity and are now widespread all over the country. Although my later words may be construed as a criticism of certain aspects of the administration of the Minister of Health, they are my own words and I take responsibility for them.
I have been very concerned for many years about the disparity between mental health research and the necessary administrative action by the Ministry, conditioned as it is largely by financial considerations, but also by big disparities of view between various medical advisers. As the hon. Lady said, must has still to be learned about the best way of giving treatment to the autistic child. I accept, right away, that a layman like myself has to be extremely careful, not only of starting to expound medical theories, but in case, by any chance, his words are read by a larger public and give cause for undue optimism.
At the same time, however, the administration and practise of medicine is to some extent balanced equally between medical practice and research, on the one hand, and political and administrative action which must and should follow, on the other. What concerns so many of us is that, in the history of medicine, there is far too much evidence of political and administrative action lagging far behind the possibilities which are opened up by medical research.
As I understand the definition of an autistic child or patient, he is a patient whose mental state is such that there is some ground for assuming that he is not mentally deficient in the conventional usage of that term. Again, I think that one can over-simplify these definitions, especially when they are advanced by laymen, but such evidence as I have studied leads me to believe that there tends to be, in the collective mind of the Ministry, a blurring of the distinction between a child who is mentally deficient and a child who is autistic.
I have been following with great interest for some years the activities of the 1733 Marlborough Day Hospital, in London. This day hospital started as a form of institution for the day-time care of persons suffering from mental ill-health, who would normally go back to their own families at night, or, if they were capable, of looking after themselves. In other words, non-residential facilities are available. That has developed over the years, but, even so, there was and still is some residual prejudice against the work done by the academic staff of that hospital.
I said "prejudice" because I was reading recently an otherwise most admirable article which appeared in Hospital Management Planning and Equipment by the Chief Medical Officer of the Ministry of Health on the subject of a mental health service. In that article—and I emphasise that as far as I can judge it is a wholly admirable article, apart from the point which I now wish to make—there appears the observation that the writer, while on a visit to the United States, was asked to see Professor Ewen Cameron, in Montreal, and discuss with him the day hospital service which he had pioneered in that city.
The article goes on:Cameron thought of this as a way of supporting the patient, through his family, during treatment, and he showed that it could work even at an even earlier stage than the Marlborough Day Hospital here.Historically, that is wholly inaccurate. The research work in the establishment which led up to the start of the Marlborough Day Hospital preceded the work of Cameron, and it seems to me to be a great pity that there has been semi-official denigration of an exceptional piece of research work and the effective practical work carried out in this country under the auspices of the National Health Service.
I do not wish to labour this point, but the impression I have is that in the realm of mental health there has been a tendency to be highly suspicious of what is sometimes called, even in Ministry circles, "European" ideas of mental health treatment. This term "European" has, indeed, been used in a somewhat derogatory sense. This is a pity. I do not want to elaborate on the original work of people like Freud and Adler, but the fact is that treatment of mental problems in this country has benefited enormously from the: so-called Continental ideas.
1734 I mention this point because an extension of an establishment like the Marlborough Day Hospital to provide special care for autistic children is something which I suggest to my hon. Friend the Parliamentary Secretary should be looked at with a great deal more thoroughness. Even within the last few days I know of the medical officer of health of a north London borough who came to the Marlborough Day Hospital and pleaded for some facilities to be given to him for the care of children within this category coming from his borough—the point being that finance is not readily available. The general principle of day hospital treatment for autistic children seems not yet to be fully accepted, and there is even some ignorance of what work has been achieved.
The principles of treatment in a day hospital are far too obscure for consideration in this House, or even for description by myself, but the fact is that, as one understands it, the condition of many of these autistic children, who are unable to communicate with other people and especially with their mother, may originate in many cases from mental shock, a mental incident which happened, as I understand, at the so-called symbiotic stage, that is in the months following birth. The general principle of treatment, when the child is somewhat older, is getting the child back to that earlier stage, as it were, to start afresh. This seems to provide an opportunity for securing an improvement in the child's mental state at a later date.
These are theories, but theories which are being tried out now, not without success. If the Parliamentary Secretary will be kind enough to examine a paper which I can offer him—and I think that professional etiquette does not permit me to mention the authors—I will be glad to send it to him. An article on this very subject and this sort of treatment also appeared in the Nursing Times of 31st January, 1964.
Whereas I hope that I have not given an impression that there is a lack of forward-looking about mental health at the Ministry, it seems to me that with this category of child there is scope for greater energy, for more finance, and the propagation of ideas which at present show some signs of achieving something. In parentheses, I would mention that 1735 buildings for this relatively small number are not difficult to obtain. All properties, of course, are valuable these days, but there are large houses which are not very suitable for conversion into flats, and so forth—and the Marlborough Day Hospital is a case in point—which, nevertheless, are suitable for this sort of treatment.
The problem of the autistic child which appears to involve limited numbers at present may be demonstrably a more serious problem, worthy of greater public attention, as research goes on. When my hon. Friend the Member for Woolwich, West (Mr. Hamling), to whom we are all indebted for an opportunity to debate this subject, spoke about the problems from the teacher's point of view and the question of the potentiality of education, I think that one of his basic assumptions was that the children in question, as they came to him in his experience, were at a certain level of mental educability which would provide educational possibilities at the time when the child went to the school.
A matter of vital importance is that we must ask ourselves whether we really know what children there are who ought to be receiving this education and who have not had an opportunity of being readjusted at a lower age level. This is the important point. In so far as I may have criticised his Department, I hope that the Parliamentary Secretary will accept from me that, whereas I mentioned the balancing rôles of the worlds of medicine and of politics and administration, all I ask him to do is to secure some concentration of thought on this question in general and on the people in that branch of medicine who have done so much good work in this country, but to whom, so far, I think, insufficient thought and reward in the moral sense have been given.
§ 1.0 p.m.
§ Lord Balniel (Hertford)
I begin by expressing my envy of the hon. Member for Woolwich, West (Mr. Hamling) on so consistently winning the Ballot for Private Members' Motions, and not only my envy but my congratulations to him on having on this occasion chosen the subject of the care of mentally handicapped children, which, although it affects only 1736 a limited number of persons and families, is of crucial importance to all those who are concerned.
I congratulate the hon. Gentleman, also, on the way in which he has framed his Motion—in tangible and specific terms rather than in well-meaning generalities. I cannot help feeling that, by putting forward specific proposals for reform, the hon. Gentleman has contributed to a constructive debate rather than to a meandering discussion covering a wide range of different subjects yet contributing to none in any great depth.
Although the hon. Gentleman has been specific in his Motion, no one will dare to be dogmatic on this extremely complex problem as to how we can best provide care, education and training for the mentally handicapped. Their disabilities vary in intensity and they range over a whole spectrum of different types of disability, from the child who is slightly maladjusted to the psychotic child, from the child suffering from a small anxiety neurosis to the bad schizophrenic, or such a child as that spoken of by my right hon. and learned Friend the Member for Huntingdonshire (Sir D. Renton) from his own experience, that is, a child who can neither feed itself nor even move of its own volition.
I welcome the Motion. In my view, the broad lines of thought lying behind it should be supported by the Government, and I hope that that support will be indicated by the Parliamentary Secretary in response to the debate. But one is bound to express certain reservations about the possibility of this reform being implemented in the immediate future. The Motion calls for the transfer of responsibility for the training and education of mentally handicapped children from the Ministry of Health to the Department of Education and Science. This is an indication of the now widening acceptance among the public that a growing proportion of the mentally ill and mentally subnormal can be educated to lead a socially useful life, can be educated to lead a life which can contribute to the economic well-being of the community, and can be educated and trained to have a life which will bring greater happiness to themselves. The Motion puts forward an ideal towards which we should struggle, an ideal which, perhaps, before very long, we may be able to turn into a reality.
1737 The transfer of responsibility to the Ministry of Education would symbolise the change away from the custodial care which, at one time, though certainly not universally today, was regarded as the maximum responsibility of society towards mentally handicapped children. It seems to me to symbolise the move away from the pessimism and fear which surrounded for so long the mentally subnormal to a new theme of education and purpose more suited to the social and medical advances which have taken place in the past few years.
The training of mentally handicapped children and the equally crucial task of the training of specialised teachers for this purpose has, overwhelmingly, been pioneered by voluntary effort rather than by the Departments of State. To my mind, an extraordinary facet of the problems is how recent are all the dates marking the landmarks of advance. The association with which I am connected, the National Association for Mental Health, opened its voluntary occupation centre for the training of children only in this century, in 1919, and this was the first such occupation centre ever opened in this country. It was this same voluntary association which ran the first training courses for teachers of the mentally handicapped. As the service developed, the first three-week courses were organised in 1936 and, later—it was only in 1945—the first full-time training courses were organised.
It comes as a surprise to laymen who do not take a specialised interest in this matter that the only training body responsible for the running of courses for teachers of the mentally handicapped between 1945 and 1963 was this voluntary organisation, and such training was not undertaken by the Departments of State.
Since 1963, a great deal of progress has been made, and the public authorities have come in to take part of the burden—ultimately, one hopes, all the burden—of running these training courses for teachers of the mentally handicapped. We ourselves have extended our courses from one-year to two-year courses. Also, since 1946, we have been running refresher courses, to which 100 students come every year, for the staffs of junior training centres.
Looking at the other part of the Motion, that dealing with the subsequent 1738 training and employment of handicapped adolescents, it is interesting to note, as my right hon. and learned Friend pointed out, that one of the best workshops is the one at Slough run by the voluntary society to which he referred, the National Society for Mentally Handicapped Children.
During all this period since we began running training courses for teachers of mentally handicapped children, we have sent 1,500 trained teachers into the field with the qualification of the Diploma of the National Association for Mental Health. Although I give this figure of 1,500 trained and qualified people entering the field with a sense of pride in the achievement of this voluntary society, I do not give it with any sense of complacency. Looking at the overall position, one cannot fail to be exceedingly disturbed at the proportion of trained as opposed to untrained teachers.
The official inquiry to which the hon. Member for Woolwich, West referred, that is, the last official inquiry into the number and qualifications of staff—the Scott Committee on the Training of Staff of Training Centres for the Mentally Subnormal—showed—admittedly, back in 1959—that only 12 per cent. of the supervisors and assistant supervisors in hospital schools and junior training centres had the appropriate N.A.M.H. qualification and 66 per cent. had no stated qualifications at all.
One must, however, accept at once that most of these people had the invaluable qualification of a sense of dedication to the service which they were rendering. That official inquiry showed an even worse picture in the hospital schools. Here, only 3 per cent. had the N.A.M.H. qualification and 82 per cent. had no qualification at all. Only 1 per cent. of the staff in hospital schools had the qualification of the Burnham scale teacher.
Since 1963, there has been a substantial improvement. After a great deal of pressure, the Ministry of Health established a Training Centre Staffs Council, and this is now doing valuable work arranging courses and approving courses for teachers. Now about 30 per cent. of the staff of junior training centres have some training. I think that the House will agree that, whereas this is an improvement on the past, it is only a small 1739 step along the road that we all want to travel.
I must pay tribute to the people who have dedicated their lives, not only their working lives, but in many respects, their leisure hours, to one of the most difficult fields of work in which one could conceivably engage. Anyone who has visited the junior training centres, or the adult training centres, cannot but marvel at the achievements and the quality and calibre of the people who are giving their lives to this service.
The proportion of the trained staffs in the junior training centres is steadily improving. I do not know the figures for the hospital schools, but I have every reason to believe that the position in the hospital schools is far less satisfactory than that in the training centres. In spite of the fact that the Scott Committee showed that only 3 per cent. of the staffs in the hospital schools have qualifications, we have every reason to believe that few serious efforts are being made to increase the proportion of trained staffs in those schools.
I will give one example to indicate what room there is for improvement. We have at the moment a full-time training course during the current year for teachers of mentally handicapped children; 174 students are attending the course. Only 10 of them have been seconded from the hospitals, and the rest are being financed by the local authorities. I am told—though I cannot vouch for it from my personal experience—that the Ministry of Health has positively interfered in the secondment of staff from its hospitals to this training course, although it is the declared policy of the Training Council that staff should be seconded from the hospitals.
Another reason why one feels cause for concern about the hospital schools is that one which has already been referred to by the hon. Lady the Member for Halifax (Dr. Summerskill). The conditions of service are less satisfactory for the staff of hospital schools than for the staff of junior training centres. For instance, the staff of the hospital schools have shorter holidays. I would call the attention of the House to a letter, published in The Times on 9th February, from Dr. Heaton-Ward. He writes about the conditions for staff in hospital 1740 schools compared with those in junior training centres, and says:In their care of these patients local health authorities and hospitals for the mentally subnormal are in competition for the all-to-few trained staff available, often with different conditions of service for similar staff in the two branches of the service. In general, these different conditions of service are to the detriment of the medical staff and to the benefit of some other staff—e.g., staff of training centres—employed by the local health authority. Until a truly integrated service for the care of the mentally subnormal is established, with similar conditions of service for similar grades of staff throughout the service, present rivalries will continue, with the patients (and often their families) the inevitable sufferers.Dr. Heaton-Ward went on, however, to say that through the excellent liaison and good will which has been established between many hospitals and local health authorities, some of the difficulties are being overcome. I consider it essential that the Ministry of Health should look at the varying conditions of service and try to get similar conditions of service for people who are undertaking similar work, be they in the hospital schools or in the junior training centres.
The qualifications of teaching staff is only one aspect of the problem. Many hospitals have no schools at all, and other hospitals have training facilities which are woefully inadequate and cannot provide the training facilities even for the children in the hospitals who, it is known, would benefit. According to Mr. Mittler's recent pamphlet, there is evidence that children are being admitted to hospitals with levels of intelligence which might well make them suitable for education in the educationally subnormal schools—that is, the schools in the normal educational stream—but now because they are in hospital they are receiving either no education at all, or inadequate education given by unqualified staff.
In his research work called "The Education of Children in Hospitals for the Subnormal", Mr. Mittler gives figures which would lead one to believe that about a quarter of the children taken from a sample of 17 hospitals have intelligence quotients of over 55. From this one can reasonably assume that they could benefit from training of the educationally subnormal school type. Everything which appears from the research of Professor Clarke, or, as the hon. Lady has mentioned, of Professor Tizard, would lead 1741 one to believe that there are a considerable number of mentally subnormal children who are not receiving education, but if they were, could lead a more socially useful and richer life.
I accept that the Government may not be prepared to implement the Motion, although I hope that they will accept it as an ideal to what they should aspire. I should like to put forward two reforms which I think, should be undertaken immediately and which would take us some way along the road of progress which we want to travel. The first is that educationally subnormal classes or schools should be established within the hospitals, and that: they should be run not by the Ministry of Health, but by the local education authority and staffed by fully qualified teachers, as is the case in the E.S.N. schools.
The second reform, which is something for which the National Association for Mental Health has pressed, is as follows. I can see no reason why hospital schools should not be inspected and declared educationally efficient like any other residential school. The Department of Education and Science should take powers, if it has not got them at the moment, to lay down minimum standards for the care of the mentally handicapped and also to inspect the efficiency of the educational service which is being rendered to help them. National minimum standards should be laid down and should be enforced by an inspectorate similar to the ordinary schools inspectorate.
§ Sir E. Boyle
I should like to be clear exactly what it is that my hon. Friend the Member for Hertford (Lord Balniel) is suggesting in that last instance. Would he apply this only to the classes of children who would come, if they were not in the training centres or hospital schools, within the E.S.N. category; that is to say, children in a category for which local education authorities are responsible if they are outside the hospitals? Or would he apply it to all children in those schools and centres? I see difficulties about local education authorities being brought in to inspect centres or hospital schools dealing, so to speak, with a range of I.Q. below that with which they are dealing in any other context.
§ Lord Balniel
My right hon. Friend gives me the opportunity to elaborate. 1742 I fully accept the point. As a first step, one should lay down minimum national standards and also appoint an inspectorate to enforce them for schools which could provide help to those who are in hospital but who would benefit from E.S.N. standard teaching. I think that perhaps in the immediate future it would be going too far, and also, it would certainly raise different problems, if one were to cover the whole range of intelligence quotients.
Here, I agree with the hon. Member for Woolwich, West that this task is better undertaken by the Department of Education and Science than by the Ministry of Health. I am very well aware that the Ministry of Health is now fully alive to the importance of urgently providing facilities for mental health but for too long in the past it has displayed—and I say this with the utmost reluctance, but without qualification—an absolutely minimal interest in the educational aspects of mental health.
I say this with particular reluctance because the right hon. Gentleman the Minister of Health himself has devoted a life-long interest to this subject, but I find myself agreeing with the report by Mr. Mittler, published by the Fabian Society in February this year. He writes:The main indictment of educational services in hospitals is that they have been allowed to develop without any guidance from the Ministry of Health. There is no system of inspection or guidance, and hospitals are responsible to no one for the educational conduct of their schools and training centres. The Ministry of Health has failed to show any interest in educational matters, either in its hospital schools or local authority training centres. It has given no guidance on educational matters and no information is available on the work of hospital schools.
§ Lord Balniel
From time immemorial. This is a long-standing problem. If the hon. Gentleman is trying to make a party political point out of this kind of subject, then he makes an utterly deplorable contribution to the debate.
§ Mr. William Hamilton
The hon. Gentleman is putting words into my mouth. I am trying to establish that successive Ministers of Health have been guilty of neglect. I shall make the same 1743 kind of point as he is making if I should be called.
§ Lord Balniel
I am glad to hear the hon. Gentleman's explanation of his contribution to the debate.
I have not had the good fortune, while I have been speaking, of having the presence of die Parliamentary Secretary to the Ministry of Health, but we have the good fortune of the presence of the Minister of State, Department of Education and Science, the hon. Gentleman the Member for East Ham, North (Mr. Prentice). So far, my criticisms have been directed to the Ministry of Health, but I hope that the Minister of State will not feel too complacent about that. There is cause for concern that so little research has been undertaken by his Department into the teaching of the mentally handicapped and the learning processes of the slow learners.
§ Mr. Hamling
Would not the hon. Gentleman also agree that there is a great shortage in the E.S.N. schools, which come under the Department of Education and Science?
§ Lord Balniel
The hon. Gentleman has made a criticism that is perfectly justified. I was, however, going to make a number of criticisms on a rather different point—but also concerning these schools which fall fully within the responsibility of the Department of Education and Science. Of course, the estimates of the number of children who need special educational help vary according to the criteria one takes as a diagnosis.
My right hon. and learned Friend the Member for Huntingdonshire referred to the 1 per cent. of children in need of very special help. If one takes other criteria the figure is about 10 per cent. of children, that is, if one includes children who, in normal classes, are rather more backward than the average. Between the seriously disturbed and those mildly backward, there is a whole range of slow learners needing special help.
When the Minister of States comes to examine the expenditure of his Department on research into the learning processes of slow learning children he will be very depressed. We in the National Association for Mental Health regard 1744 research into this as being of the very highest priority and are now embarking, with the University of Manchester, in setting up an Institute of Special Education to research into the learning processes of slow learners. I hope that the Minister will agree that this is an extremely valuable contribution.
§ The Minister of State, Department of Education and Science (Mr. R. E. Prentice) indicated assent.
§ Lord Balniel
I see that he does assent to that proposition. Perhaps I might therefore point out to him that we are embarking on the raising of £250,000 to finance the project over the next 10 years—and if he assents to the general proposition I hope that he might be able to back his good will by a financial contribution. If he does so, he will be pioneering a new cause because it will be almost the first financial contribution made by his Department to this kind of research.
If the responsibility is transferred from the Ministry of Health to the Department of Education and Science it may not, however, be an unmixed blessing for the children concerned. The lot of educationally subnormal children in the E.S.N. schools is not altogether a happy one. Before we agree to it we should expect a considerable improvement from the Department of Education and Science in the subsequent care of the children and adolescents when they leave the E.S.N. schools and go out into the world in the subsequent care of the children to earn a living.
Last year, I asked for some information about how these E.S.N. children hold their own in the outside world and I was astonished to hear that no record is kept of the subsequent employment or unemployment of the 20,000 children leaving the special schools. My impression is that the work done by the Department of Education and Science to adjust the E.S.N. children to help them lead a happy life in the outside world is in some ways less satisfactorily undertaken than the similar work done by the Ministry of Health.
There is just one further predicament lying before us in supporting the Motion. In the junior training centres, they are able to keep children over the age of 1745 16. What matters to the mentally handicapped child is in no way the date on his birth certificate. What matters to him is the mental age which he manages to attain. If the transfer of responsibility is to take place, then the Department of Education and Science will have to take on its shoulders full responsibility for children who have reached the physical age of 16, but who are still far below the mental age of 16.
I apologise for having kept the House so long. In conclusion, I would say that the mental hospitals for generations have been the Cinderella of our health services and although we are moving away from this they still remain in many respects the Cinderella of the National Health Service. The hospital schools, in their turn, are the Cinderella of the mental hospitals. If the hon. Member for Woolwich, West has done anything in contributing to an improvement in their status, he has served a very worthwhile purpose by moving this Motion.
§ 1.30 p.m.
§ Mr. David Weitzman (Stoke Newington and Hackney, North)
My hon. Friend the Member for Woolwich, West (Mr. Hamling) has used his good fortune in the Ballot to great advantage and is certainly to be congratulated upon it. There cannot be many subjects which call for more study and attention than that of mentally handicapped children. Indeed, it is a sad reflection on our civilisation that countries are ready to spend large sums of money on so-called defence while little is expended on research into the problems of the child. It is estimated that more than 25 million working days are lost to the national economy because of mental disorder, and the figure must include many who are mentally handicapped children.
There are two other aspects which may be even more important. First, the retarded child, the victim of an affliction fo the brain to some degree, is still a child. He has all the normal child's need of loving care and encouragement. It needs more than the normal child, not only protection, but special education and training. That should be essentially the obligation of the State and we must ask ourselves whether the State discharges that obligation as it should.
Secondly, there are the parents, an aspect of the matter which has been 1746 mentioned but not developed. We know that such a child—my hon. Friend the Member for Halifax (Dr. Summerskill) mentioned this—may be born into any family, intelligent or unintelligent, rich or poor. But the child is not accepted by an ordinary school and is shunned by society as being different. The parents must suffer considerable personal sensitiveness, often due to misunderstanding as to the causes, and often because of unkind neighbours. Can we do something in the training of such a child to alleviate that?
I became personally interested in this subject by association with a foundation called the Ravenswood Foundation. This is a voluntary body established by trust deed for the lifelong care of mentally handicapped children and young persons. It runs a residential school for boys and girls from four to 16 and a training centre for boys from approximately 16 to 20. It has a permanent settlement for both sexes for continued and lifelong care and a special unit for children and young persons in the more severely handicapped categories and for those suffering from physical as well as mental disability.
Of course it is only one of a number of such voluntary institutions. Although maintenance grants are made by the local authorities, these institutions largely depend on contributions made by the public. I often think that it is disgraceful that there should be annual appeals to raise the large sums of money required for things of this kind. Institutions like the Ravenswood Foundation naturally suffer because the specialised staff training which is required on a continuous scale is clearly beyond their means.
When the Education Act, 1944, was passed, the mentally handicapped were deemed to be ineducable. It is true that there are special classes in some ordinary schools for the subnormal and special day and boarding schools provided by local authorities which cater for what are called the educationally subnormal, the E.S.N. Those two categories come under the Department of Education and Science. But the rest, the S.S.N., the severely subnormal children, according to the administration of the Act are ineducable and therefore come under the Ministry of Health and are dealt with, 1747 as we have heard, in training centres, hospital schools and so on.
The assumption that a child should be classed as ineducable and ought to remain so has gone. Much more is now known about the so-called severely subnormal child. He can no longer be called ineducable. There has been mention of different degrees of mental handicap, but the very fact that degrees are mentioned shows that every child is able to be educated to some extent, and it is fair to say that such children can no longer be called ineducable. Experience at the Ravenswood Foundation has made that abundantly clear.
We know that there has been a tremendous advance in our knowledge and methods of treatment and it is surely illogical that within the limits of their limitations these children of all categories should not have the fullest possible benefits of education, and these should be provided by the Department of Education and Science.
I am told that one health authority in Birmingham has delegated responsibility for training centres from the health to the education authority and that other authorities in Gloucestershire and Berkshire have at least one special school and a training centre brought together under the headmaster of a special school. The health authorities build delightful training centres, but these require to be staffed by qualified teachers with special training. Many figures were quoted by the noble Lord the Member for Hertford (Lord Balniel). It is clear that most of the staffs of these training centres are totally untrained. It is true that the situation has improved in recent years, but I understand that the majority are still untrained. I am told that there is a year's course which is provided by the National Association for Mental Health and that one in five have taken the course. The Ministry of Health itself has recently set up a central training council with approved courses, but again this is a mere fleabite.
The real weakness is obviously the need for the training and provision of teachers. If training centres were brought under the Department of Education and Science, it would be the duty of the education authority to provide 1748 properly trained teachers in these centres. In many cases, children wrongly diagnosed, or even borderline children who had improved, could be transferred. The National Union of Teachers and the Guild of Teachers of Backward Children and many members of the medical profession have protested at the system which denies to these children fully qualified teachers. In many cases, the children would benefit and parents would feel that their children were not being treated as second-class offsprings.
I lend my wholehearted support to that part of the Motion which says that responsibility for all mentally handicapped children should be the concern of the Department of Education and Science. I emphasise that no menially handicapped child should be deemed to be ineducable. Every child should have the best attention under a properly qualified teacher and that should be the obligation of the State carried out by the appropriate Ministry, the Department of Education and Science.
Even in approved schools, which come under the Home Office, where there are undoubtedly many backward and maladjusted children, I am informed by a probation officer with considerable experience that he had never met a teacher who had taken any educational course equipping him to teach such children. If this is so it is a scandalous affair. Even with respect to such children the Ministry of Education and Science ought to play its part. In the Motion my hon. Friend says:…that improved educational opportunities are the key to the proper development of these children…".This is clearly so. In education generally a great deal remains to be done by the Ministry for E.S.N. children and the subnormal in special classes.
Adjoining my constituency is the Edward Seguin Secondary School, a very well-known special school headed by Mr. Segal, who founded the Guild of Teachers of Backward Children. It is an excellent school. I have discussed this problem with Mr. Segal, and I understand that since 1950, when one-year diploma and supplementary courses for teachers in these special schools were introduced, 1,100 teachers have benefited. There is still a great deal to be done. The Guild produces a publication each 1749 year in which many recommendations are made. We know of the tremendous scope for research in this matter. Indeed, the establishment of a chair of research at one of our universities ought to be considered. I hope that the Ministry will look carefully at the criticisms and recommendations made by the Guild in conference and in its publications.
I want to turn now to that part of the Motion which says that:…subsequent training and employment…should be the responsibility of the Ministry of Labour…".There is an urgent need for more sheltered workshops. The Ministry has ample powers under present legislation, but these powers have not been exercised. It has done an excellent job under these powers for the disabled, but authorities have paid lip-service only to the needs of the mentally handicapped children, particularly when they leave school and try to obtain work. A number of speakers have commented about the travesty in doing all that one can in the care or attention given to these children until they reach the age of 14 or 16; and then when they look for work, there is no real assistance. Nothing is provided by the Ministry; there are no courses by local education authorities to assist these children to adjust themselves to working life. Figures are not available but I am told that the experience of the National Association for Mental Health leads it to believe that mentally handicapped children are failures in the employment market, or that they constitute problems for the mental health department of local authorities. Enough special help is not being given. There should be flexibility between the school and the employment situation.
More experiments might be tried to introduce children gradually to working conditions while still at school. I gather that this is being tried out at a number of schools, and I am told that such an experiment is being undertaken at the Slough Training Centre and hostel with excellent results. This should be closely watched by the Ministry. I understand that there is nothing to compare with it in America and that it is an experiment which is evoking world comment. A factor of paramount importance is that there should be officers in the employment 1750 of the Ministry of Labour specially trained to deal with the problem of mentally handicapped children. Industrial rehabilitation units do not at present seem to be of much help to the school leaver who comes from a special school. I hope that the Minister will wake up to this problem.
The terms of the Motion are clearly justified. Every person must have a deep regard for the welfare of the child, and a still deeper regard when that child is mentally handicapped. I hope that the time has arrived when, with the advance in science and medicine, and the better methods in education, something will be done for these children in the manner outlined in the Motion.
§ 1.45 p.m.
§ Mr. David Mitchell (Basingstoke)
We were all moved by the compassion with which the hon. Member for Woolwich, West (Mr. Hamling) moved this Motion. How right he was to say that the needs of the mentally handicapped child are the responsibility of the whole of society. It seems that it is the mark of a civilised society, as well of a Christian society, that a community should accept responsibility for those who are helpless, to see that they do not also become hopeless.
I would like to draw the Minister's attention to the problem associated with the parents at the time of the identification or detection of a mentally handicapped condition in their own child. I am disturbed at the way in which sometimes, at that point, nothing is said to help the parents immediately with the problems they face. When parents are informed that they have a mentally handicapped child it is a shattering piece of information, and terribly disturbing. They tend to recoil within themselves and to shun society. They look inwardly and in some cases, quite wrongly but understandably, wonder whether they are at fault and to blame.
It is important that the parents should be quickly put in touch with the specialist services available, and with other parents who have similar problems, as well as with those who can show them that this is not a hopleless and helpless situation which is their immediate and perfectly natural reaction. There is a weakness in the system here in that after parents are told the news they go away and 1751 suffer the most frightful pangs of unhappiness and misunderstanding. It is then that they ought to be passed quickly and swiftly from the doctor or clinic to the specialised services which can help them tackle their problem.
§ 1.47 p.m.
§ Mr. Reginald Freeson (Willesden, East)
I would like to pursue the point made by the hon. Member for Basing-stoke (Mr. Mitchell) before going on to deal with other aspects of the subject. I agree with him that this is of vital importance, and in a sense it points the need to encourage, to a far greater extent than at present, grass-roots activity in local communities by getting local branches of the National Society for Mentally Handicapped Children, given the fullest possible backing, to work closely with the local health authority and educational services. While this has been said often enough, particularly in recent years, it still remains a fact that there is an element of dichotomy, of division, between the parents' organisations or, perhaps, the society I have mentioned and the local authority, not because of ill-feeling but because it is felt that they are of a different type.
It is not always sufficiently accepted by personnel, whether they be representatives or officers at local level, that parents who take the responsibility of joining such organisations commit themselves to an interest ranging beyond that of their own children and attempt a serious understanding of the problems and difficulties involved. This is of vital importance. It is by drawing in organisations of this kind at local level that much greater support can be given to the parents who suffer this shock if they have not been sufficiently prepared for the difficulties which they will experience as the years pass.
I wish to make a few points which I hope will be taken as an attempt to be practical. Today many tributes have been paid to the work done by the voluntary organisations and to the dedicated staffs operating particularly at local authority level and at other levels through the hospital services. I echo all the tributes paid to both the voluntary organisations and the full-time staffs. But we have, perhaps, in recent years particularly, been too ready to pay 1752 tribute both at national and local level and have tended to provide too little practical support for die work of the voluntary or independent organisations and the staffs concerned. They are not getting the backing that they should from local authorities and the State.
This failure can be summarised by the terms "shortage of staff and facilities" and "lack of research and planning". While I fully support the need to expand the activities and financing of these services at national level, a great deal more attention should be given to a proper evaluation of needs in local communities by councillors, officers and Members of Parliament so that the proper kind of planning can be made well in advance to provide comprehensive services in this field as well as in others.
I come more and more to the view that one of the major failings in making provision for this kind of social need is not just that people, whether they be ratepayers or taxpayers, are unwilling to provide the resources but that they do not give sufficient study in depth to the needs in the communities to provide the basis for the proper planning of services. I should like later to illustrate this by a notable example of which I had experience in my county recently.
There is no doubt that the number of mental welfare officers and other suitably qualified officers—psychiatric social workers and specially trained teachers—should be increased. There is a need to provide additional facilities for training. This is the responsibility of both the Government and local authorities. Basic training is needed for the professional posts involved. This requires to be undertaken particularly in industrial training and among the sheltered workshop staffs in the schools which have been discussed today.
There is a dire and, it seems, continuing shortage of qualified social and mental welfare workers who are the only people, apart from the independent organisations, who can, full-time, begin to give reality to the great amount of talk which we have heard about the ideal of community care. We cannot have community care unless we are prepared, both at national and local level, to train and pay for the workers who are required to provide the services needed in local districts and boroughs.
1753 There is a need to provide hostels, training centres, day centres, sheltered workshops in schools. It has been underlined in the debate that provision of these things is increasingly being made. An hon. Member opposite stressed that far too little is known of the need in the various localities, particularly in the major urban concentrations. If we have no idea of the need for which we should provide, it is not possible to undertake proper planning for these facilities. It is impossible to undertake the proper site-searching in heavily built-up areas and to get architectural staff on the job of designing the necessary buildings, of getting the right training facilities put in hand locally, regionally and nationally for staffing the buildings when they have been provided after the sites have been found on the basis of the research in the local areas which can be undertaken to show where the need is.
There has been a notable example of this failing in my district. I do not believe for a moment that it is an isolated example. I should like to describe an experience which I had before I became a Member of the House and while I was leader of my local council. Five years ago a London borough, which acted in co-operation as far as it could with the country welfare authority, which was then Middlesex County Council, wanted to give effect to an idea mooted by the county welfare authority to provide a sheltered workshop in an industrial training centre for the mentally handicapped—and an excellent idea it was, too. A dispute arose between the borough, which was the delegated education authority, over the desire of the county to take over a non-conforming factory which was projecting into a school site on which the local borough wanted to see a new school built.
There was a good deal of protracted argument which went to Ministry level before it was resolved that this factory should not be used because to do so would be harmful to future school development plans. The local borough proceeded, as it had been offering to do for some time, to submit, as alternatives, the sites of non-conforming factories which it was prepared to buy under its planning powers on which could be provided the accommodation which the county welfare authority had insisted time and again 1754 was urgently necessary. We did not doubt this. We wanted to see it done.
I will cut fairly short the story of what happened over a period of five years. The London government reorganisation took place. The health and welfare powers of the Middlesex County Council, which ceased to exist, were transferred to the boroughs and my borough became the local health and welfare authority. It proceeded to discuss the possibility of this sheltered workshop or centre in a factory which had been purchased under planning powers.
Two months ago, it was decided that in all probability the centre was not necessary in the borough. I saw the minutes appear in the council papers. I saw the medical officer of health and asked him how it was possible that when a county health and welfare authority had for five years insisted that this kind of provision was urgently necessary, it was now discovered that it was not necessary and that provision could be given in centres in other districts outside the borough.
I found that there was not even a file of papers from the health and welfare authority, the old county council, to the new borough supporting the case for the centre. It had been a desirable idea to provide such a facility in the borough. There had been five years of argument, some of it very strong argument, before certain sites were taken out of the hands of the county, only to find at the end of that time that there were no facts and figures or research and no basis had been provided for the strong arguments which had been going on for five years.
I am not concerned at this stage to go over the rights and wrongs of whether the facilities should have been provided or should yet be provided within my borough. What I am concerned about, and what I "exploded" about when I saw the medical officer, is that no research had been undertaken. The whole thing has been going on for years on the basis of guesswork and nice ideas. This is disgraceful. I do not believe that it is untypical of what is going on in other parts of the country. This underlines the comments that have been made during the debate that there is a failure to establish information and understanding of needs in depth in the localities, and particularly in the heavily built-up areas. There is need for far more information to 1755 be collected locally, and between Departments nationally, as a basis of policy-making and for building programmes, otherwise we shall have wasted time and effort by officers, not to speak of the waste of buildings and staff facilities.
Having given that illustration following my comments about shortages and the need to expand, I should like to deal with one or two other points. It is clear that there is a need, as has been stated time and time again today, to transfer the services which are educational to the Education Ministry and to the local education authorities. Let us, however, be careful not to conclude that if this were done we would find all the answers for provision in this field coming our way.
It remains a fact that even within the existing education service, provision for the mentally handicapped child is to a large extent the Cinderella of the education service. It is not simply the Cinderella within the Ministry of Health and local authority services—it is largely the Cinderella within the education services. Some of the provision which is made physically, as well as the difficulties with staffing and the overall shortages in many areas, is deplorable and would not necessarily be answered or resolved quickly by transferring the service to the Education Ministry, although I favour this idea.
Undoubtedly, the idea of junior training centres being treated other than as part of the school service is fundamentally wrong. They should be brought under the education authority. Health officers are responsible for supervision in the home. No one would suggest that there is need for the whole of the services which come under domiciliary care and help to be taken out of the hands of the local authority health and welfare departments and put under the administration of the local education authority. There is, however, need for much closer co-operation and integration and for much more effective use of staff which is in short supply. Whether or not we transfer the school side of the service to education, this need of close integration and co-operation between the various kinds of social workers and instructors and/or teachers will continue to be a vital priority.
1756 One must also not overlook the fact that even were we to transfer the services to education, there would continue to be a need for expanding the work of the independent organisations and the welfare staffs within the community. I think of such things as encouraging guardianship societies which can assist in looking for individual homes where children can be put into care and deal with the difficult problem of finding suitable foster-parents for children who are mentally handicapped. There is also the difficulty of children who not only suffer from mental abnormality but also have a physical handicap and who need special treatment and care in special care units. While it may be argued that these should continue to remain under the administration of the health and welfare services, it is desirable and necessary that increasingly they should be attached to the training centres, which could be more appropriately termed and administered as schools. Very frequently younger children can be accommodated in that kind of special care unit and so avoid hospital admission and the institutionalisation to which hon. Members have referred.
The provision and staffing of these units requires much more generosity than in the past, and much more generosity than, perhaps, local authorities or the State have considered necessary. It is not always a question of people not wanting to do certain things in public service as much as of being unaware of the need. When, suddenly, people find that a need exists, there arises a division and an antagonism between local public authorities as well as the Departments, on the one hand, and the individuals, for example, in the voluntary organisation of the independent bodies which are unnecessary and are based largely upon misunderstanding rather than deliberate ill-will towards the provision of the service which is shown to be necessary.
In my view, it is not sufficiently understood by many people that the staff of these units in the services suffer much greater physical and mental fatigue than the staffs of many other of what might be described as the more normal social services. The physical and mental work of caring for these children is far greater than at first sight appears and makes it much more necessary to provide a 1757 better ratio of staff than is the practice normally. In addition, if we continue to maintain the present levels of staffing ratios in the services we will continue to encourage staff wastage. The staff continue to leave because of strain. This adds to the difficulties with which we are all faced.
These are some of the points which come to my mind, not as one who has studied these matters carefully but as somebody who has had experience at local authority level and has become more and more concerned as the services have been transferred to the boroughs, within London at least, in recent times.
These are some of the points of need which I am glad to have had the chance of adding in this debate. They illustrate the main issue with which I started: the need for comprehensive provision, research and planning in support of the pioneering work of such organisations as the national societies and of the devoted staffs. There is this need to replace, as we must, the inadequate ad hoc approach of which we have had far too much in this field in the past.
§ 2.10 p.m.
§ Mr. George Wallace (Norwich, North)
I shall not attempt in any way to bring into this debate any expert knowledge, because I have none of this subject, but I have a very intense sympathy with the Motion and give it my strongest possible support.
I join in the chorus of praise which has been accorded to my hon. Friend the Member for Woolwich, West (Mr. Hamling) for raising this vitally important issue, and not only for his having done this but for his very balanced, informative and human speech.
I feel that the most vitally important point in the Motion is the need to improve educational opportunity for these children, particularly those able to remain at home. That is of the utmost and primary importance. Without doubt, if that were done it would ease the burden of very many parents and certainly lay the foundation for subsequent training and possible employment.
I am particularly pleased that the Motion stresses that the facilitiesshould conform to a minimum standard not lower than that obtaining in the best authorities.1758 For it is very true that in this field there is far too much variation in standards between one area and another.
We may even take a look abroad, and in this connection I am very pleased to see the hon. Member for Wokingham (Mr. van Straubenzee) in his place, because he and I had the privilege recently to visit Malta as members of a Commonwealth Parliamentary Association delegation. He, of course, was one of the most popular members, with a distinguished county background. We were given an opportunity to see the new centre established for mentally handicapped children in the island. It is situated on a beautiful site and has fine modern buildings in separate units dealing with different types of children.
The standard of teaching, as far as one could judge, was very high indeed, and, as usual in this type of work, there was a dedicated staff. The canteen facilities were of a very high order, and around the whole place was a bright and cheerful atmosphere. It is true that the finances and even some of the food come from United Nations Agencies for this type of work in Malta, and, of course, we should be proud of that, but, even so, comparing the very poor facilities available in some parts of this country with the very fine facilities now established there I could not help feeling in my heart the force of the old saying "Charity begins at home", and while we are very busy establishing good facilities abroad we must, of course, also see to it that we have equally good facilities here.
I join in the appreciation of the work of voluntary societies in this field, an appreciation expressed by so many hon. Members, because not only do they do the day to day practical work, but help in research and the urging of reform. Here I should particularly like to stress the valuable work carried out in my area by the Norfolk and Norwich branch of the National Society for Mentally Handicapped Children. Nothing has made a greater impression on me than the Christmas party, which I attended, organised by that branch. For these children, handicapped as they are, to have come together socially in such numbers and being so obviously happy in the enjoyment of their party, was itself an impressive object 1759 lesson in what can be done, particularly with the co-operation of parents.
In passing, I note that this branch has refused to be involved in a national bingo scheme whereby 2d. in every 1s. subscribed is devoted to the National Society. This refusal, of course, is typical of Norfolk independence and the county motto of "Do different". Not for one moment do I attack these schemes to raise money in a general sense, but I do feel that more of our national resources should be devoted to this work as well as others, and that, therefore, there should not be so much tendency to gambling instincts to provide these vitally important services.
At the same time, I feel that whatever extension of help we can secure through the Government for the invaluable work carried out by the voluntary societies should be encouraged and assisted. For let us be under no doubt whatever that, whatever expansion takes place in the State scheme in the near future, there will always be work for these societies to do.
I come to the particular point made by the hon. Member for Basingstoke (Mr. Mitchell), dealing with the first news given to parents of their child's handicap. I see that he has been promoted to the Opposition Front Bench. I congratulate him. Voluntary societies can be immeasurably helpful, because this help through sharing of experiences among parents can be given best by such organisations, to which so many parents belong. It is true to say, from my own experience, little as it is, that no parent need bear the burden alone provided he is aware that such societies exist, and provided also, of course, that he is aware of the address of his local branch. As we strive to improve the lot of the children the need of parents, particularly in the early days, should not be overlooked, and I hope that as our schemes are extended there will be provision to take care of the need of the parent as well as that of the child.
§ 2.17 p.m.
§ Mr. Laurence Pavitt (Willesden, West)
This has been an extremely interesting debate and it seems that a number of themes have run through it. One of the most common has been the 1760 one with which I wish to start, as it seems every speaker has started with it—congratulation to my hon. Friend the Member for Woolwich, West (Mr. Handing), and—tinged with envy—congratulation to him also on his name coming out of the hat twice in so short a space of time when so many of us who have been here longer have not had such success.
I would congratulate him on two grounds. One is the compassion of the Motion which strikes a chord in every quarter of the House. I rather feel that we are sometimes inclined to make this kind of speech and to exhibit this kind of compassion feeling a little bit smug about it. I hope that when we discuss this matter we shall realise that we are not just trying to do good to the mentally handicapped children but that in society we have a responsibility which we are trying to face up to, and that we are not only givers of compassion and that these children should receive it, but that society itself thinks so and feels this need—for, if it does not, our society will be a very sorry place indeed.
I congratulate my hon. Friend, too, because I feel that this is the Parliamentary equivalent of storming the Bastille, for my hon. Friend seeks to get from the empire of one Ministry a chunk to pass within the boundaries of another Ministry. I know from my own experience that whenever one tries to do this one always finds a tremendous amount of resistance on the part of the Ministry which is to lose part of its empire, though not so much reluctance on the part of that Ministry to which perhaps it might be given.
One of the themes running through the debate has been the question of research. I am pleased to see the Minister of State for Education and Science here, and I hope that his attention will have been drawn to some of the comments which have been made on research into the problems of the mentally handicapped child—and, indeed, into mental health altogether.
I should like my hon. Friend to have a look at the Medical Research Council's budget, because he will find that recently there has been practically nothing spent on innovations. The amount spent is invariably for a person who is given the task of watching something else going 1761 on and reporting back. There is a considerable lag in work on the subject, because the Medical Research Council does not wish to innovate difficult things, but if research is innovated elsewhere it is prepared to put aside a sum of money and allocate a research grant in order that it shall be watched and assessed. However, what is needed is not just assessment, but some innovation.
I am not quite so wholehearted in my support for a complete transfer of responsibility to the Minister of Education. In the main, my hon. Friend the Member for Woolwich, West is quite right in the case that he has put. It is incontrovertible that education has to be given over a much wider range than it is being done at the moment. However, in my view, the care of the child and of the complete overall personality of the child is the task of the Minister of Health. One does not simply deal with the educational facet, the physical facet or the mental facet. Whatever degree of personality the child has, he or she must be dealt with as a complete being. What has come out during the debate is the number of varying forces, public, voluntary, Departments and Ministries, which all have a finger in this one poor child's pie.
We need to be able to use the services of the Ministry of Education and ensure that Her Majesty's Inspectors are just as much seized of the importance of educating the mentally handicapped as they are of their other tasks, not in order that the Minister of Education shall add another section to his Department, but in order that the mentally handicapped child shall have the best possible educational service available.
A point which has been made frequently during the debate is that one treats not only the child, but the child and its environment and certainly the child and its parents and the circumstances in which he finds himself. We talk glibly of child guidance, but, as one hon. Member opposite has already pointed out, it is very often a case of parent guidance. The present system is that a psychiatrist sees the child, and then probably a psychiatric social worker from the local health authority sees the parents. Then, quite separately and divorced entirely from the other two, a psychologist will carry out the 1762 necessary testing and assessment to decide the child's future.
In pointing to the three Ministries involved, the essence of the speech of my hon. Friend the Member for Woolwich, West is that we must find ways and means of getting away from the tripartite approach into a combined operation whereby, even if responsibility rests ultimately with the Ministry of Health, we can ensure that all the services needed are working wholly together.
Looking at the needs of the mentally handicapped child causes me to wonder if the Parliamentary Secretary can tell us how far the Underwood Report about the number and level of staffing of child guidance clinics has been implemented. The Report is now rather ancient history, but I have the feeling that we still have a long way to go to reach even the standards that it recommended in those days. Another point with which I presume he will deal is the increase that there has been in providing additional training facilities to secure qualified staff. We had a very interesting contribution from the hon. Member for Hertford (Lord Balniel) on the amount of work being done by the National Association for Mental Health, but I should be interested to know what has been the increase in training facilities from all sources in the light of what my hon. Friend the Member for Halifax (Dr. Summerskill) said about the likelihood of one in every hundred children being born mentally handicapped.
The Ministery of Health has recently been given instructions that there shall be priority in the hospital service for geriatrics and for mental health, but the last figures that I saw were that at the beginning of 1964 there were 370 beds available for children—in other words, approximately eight for every million of the population—and 157 beds for adolescents. At that time the Ministry responded rapidly, as has already been stated during the debate, and said that there should be something like 20 to 25 beds per million. But it would be interesting to know from the Parliamentary Secretary how far we have gone towards the target since the beginning of 1964. What is the number of beds now available for mentally handicapped children and adolescents?
One very important point which I should like to underline came from my 1763 hon. Friend the Member for Halifax when she said that we frequently try to attach a label to mentally handicapped children and say that a child is mentally retarded or educationally subnormal. But there is an infinite gradation of the qualities that a mentally handicapped child may possess. There are not just those who are educationally subnormal or those with an intelligence quotient of 50 or 55. There are cases with other handicaps as well as mental ones. For example, there is an excellent school at Penn, in Buckinghamshire, for those who are deaf as well as mentally retarded.
If we are to give the right educational facilities for which my hon. Friend the Member for Woolwich, West, presses in his Motion, we must provide a catchment area much wider than that of the local or county education authority. If we try to break down the figure to the specialty or, as we must, to the much smaller unit for those specialties, we will not find the expert teachers and qualified people that we want in those grades over a small area.
There is already a very good coordination between local authorities which enables an authority such as that in my constituency, for example, to send mentally handicapped children to a number of schools well outside the area, some under the Inner London Education Authority and some under other county education authorities. There is a certain amount of contact which enables us to know the facilities that are available. But I am afraid that that is totally inadequate. At the best, it is good co-ordination. At the worst, it is lack of knowledge and inability to find places. What we need is a kind of overall unit enabling us to break down the educational needs of those children into such forms that we can provide precisely the building structure and the qualified teachers to give them that which is needed. That means a fresh approach to the whole problem of teaching. The point has been made already about the need to bring standards up to something comparable with and even exceeding those of ordinary teachers. Because of the numbers required, it will need a very imaginative approach to find new ways of getting people interested who will be prepared to devote themselves and take the necessary training to do the job.
1764 Whenever there is a cry for more manpower or womanpower, the area in which everyone tries to fish is that of married women. From that source it might be possible to increase by a small percentage the numbers coming forward, but what we need is a completely fresh approach with a much wider attempt to bring in people who, at the moment, possibly have not considered it but who might, nevertheless, because of their sympathy and understanding, their backgrounds and personal knowledge, be made into the very teachers whom we so urgently need.
Crash training courses of the kind that the Ministry of Education found so successful between 1945 and 1947 are needed if we are to get the standards that we require in educating the mentally handicapped child today. The question is, where does the money come from? Do we find it through voluntary bodies, local authorities or the Ministries? How do we squeeze out of my right hon. Friend the Chancellor of the Exchequer or any other body the cash to give the service the kind of impetus that it must have.
I was interested in, and I should like to quote from, a comment in a pamphlet published by the Fabian Society, though not the one to which reference was made earlier today. Talking about mental health in general, and the needs of handicapped children in particular, it said:The financial implications of the developments outlined in this pamphlet will be at first glance, formidable…The salary bill for mental health might ultimately be doubled, as more doctors, nurses and ancillary workers become available…Against this we must set the credit side of the account Not only will many existing patients be returned to their homes who might otherwise end their days in hospital, but thousands more persons every year will be kept out of hospital and enabled to live useful and productive lives. Let us remember also that we have up to now been conducting our mental health services on the cheap. There is a good deal of leeway to make up.The author of that pamphlet, issued in 1958, is the present Minister of Health, and I hope that from time to time he will go back over his words and exert the maximum pressure on the Chancellor of the Exchequer to secure the kind of financial resources which are needed to deal with this problem.
1765 The Minister had issued instructions to all hospital regional boards that they must give priority to mental health and geriatrics, but I am certain that here, as in other aspects of health services, the tripartite structure in these two specialties is wrong. The fact that we divide out services between hospitals, local health authorities, and general medical services, affects the field of mental health and mentally retarded children more perhaps than any other sphere of our health service.
I want to see one direction to cover all the services for mentally handicapped children. Even if we cannot get the complete amalgamation of the tripartite administrative services within the National Health Service as a whole, I think that it would be very useful, in mental health at least, where so much overlapping can take place because of the responsibility of the different sectors of the Health Service, the Ministry of Health had complete control vested in one central mental health administration to see whether we can get in one speciality the prototype organisation which is needed to carry out effective work in other specialities.
This is an urgent matter which will not brook of delay. The speeches from both sides of the House have shown unanamity on the understanding of the problem, and compassion for those who are caught with it. Everyone has paid tribute to those who serve the causes which we have been putting forward during the debate, but this will mean nothing unless there is a sense of urgency to get things done quickly and unless there is the necessary financial power to achieve success.
§ 2.33 p.m.
§ Mr. Alasdair Mackenzie (Ross and Cromarty)
This has been a very important debate. The hon. Member for Woolwich, West (Mr. Hamling) is to be congratulated on raising such an important issue. I am very pleased to see the urgent concern felt and expressed on both sides of the House for the welfare of the mentally handicapped child.
The main purpose of the debate is to stress the need to transfer responsibility for the education of the mentally handicapped from the Ministry of Health to the Department of Education and 1766 Science. This is the position in Scotland, so there is a precedent for the change which the Motion seeks to bring about. I believe that we could get better and more uniform results if the Department of Education and Science were responsible for education, except in the case of physically as well as mentally handicapped children who need special hospital treatment, where special units would have to be provided.
It will be necessary to have a considerable number of these children taught in homes and residential schools, because in certain areas there are not a sufficient number of them to justify the employment of specialist teachers. It is very important that there should be a suitable environment for them. It is also important that many more residential schools are provide. They should be fairly small, so that they have a homely touch about them. The old and large institutions are obsolete for present-day requirements. It is very important that children should have individual attention to enable them to learn to do things for themselves, and to develop initiative, and it is quite clear that this cannot be done when they are taught in large groups.
Although we have made considerable progress in research in this field, far more needs to be done. Indeed, we seem to be falling behind some other countries in this respect. Even though, traditionally, in education we are far ahead of other countries, they seem to be doing more for the type of child about whom we are talking.
If we are to treat the backward child with the urgency which he deserves, we must regard this as a specialised subject, and the country must be prepared to spend a great deal more money on providing the necessary facilities to do this. Teaching this type of child must be a very painstaking task. It must require special skills. For the teacher who has a bent for this work, and who is able to achieve reasonable results, it must be a very rewarding task indeed, but people with this bent are very few indeed in relation to the profession as a whole. That being so, the State must be prepared not only to pay for the training of these specialised teachers, but to pay higher salaries than those paid to the teachers of normal pupils.
1767 Because of our neglect over many years, many parents have not yet realised what can be done for a mentally handicapped child. It is, therefore, vitally important that parents should be made aware of the advances which have been made through research and improved teaching techniques in recent years. We all know of the parental love and attachment of parents of handicapped children, and how they are sometimes reluctant to let them go out of the home lest they may not be properly cared for. We must change this attitude, however laudable it may be.
It seems to me that three things are necessary if we are to deal with this problem with the urgency it deserves. The Department of Education and Science must be prepared to take bold and imaginative decisions. We must have a sufficient number of dedicated men and women who regard it as their duty and responsibility to devote their talents to the needs of these unfortunate children. Parents must be prepared to trust those bodies with the social, welfare, and educational needs of their children. It must be made abundantly clear to parents who are expected to allow their children to go away from home that adequate facilities are available to meet their children's social and welfare needs.
Given these conditions, the future of mentally handicapped children seems to be brighter than at any time in the past. By calling attention to this great problem this debate has been very well worth while.
§ 2.40 p.m.
§ Sir Edward Boyle (Birmingham, Handsworth)
I should like to begin, as have other hon. Members, by congratulating the hon. Member for Woolwich, West (Mr. Hamling) both on his good fortune in the Ballot in this Parliament and in his choice of subject today. The speeches and the attendance in the House have shown how greatly hon. Members on both sides have welcomed the opportunity of devoting a day to this subject. It is possible that our debate will not attract so much attention outside as will the first 20 minutes of this morning's proceedings; none the less, it should be realised that hon. Members attach great importance to this subject and wish that
1768 they had more opportunities of discussing it.
In the circumstances, I rise relatively early, so that the Parliamentary Secretary will have the fullest opportunity to make a progress report to the House. We will not grudge him any time that he may choose to take to give us details of the latest position.
In considering this subject it is important to realise that we cannot make an absolutely hard and fast distinction between children who are mentally handicapped and children who are not—that is to say, when we are considering handicaps of all kinds we have to think in terms of gradations of severity and realise that all sharp distinctions are to some extent arbitrary and conventional. They exist for administrative reasons and not because of the nature of invidual children.
It may seem a fairly obvious thing to say, but it has taken our society a long time to realise this. That is precisely the reason why—as my hon. Friend the Member for Hertford (Lord Balniel) pointed out in his remarkable speech—we have only recently come to make progress in our provision for many of these categories of children.
My noble friend rightly pointed out that the very first voluntary occupation centre for the training of children dates from 1919, and that the first full-length training courses dated from 1945. I am not sure that we always realise just how primitive was our handling of the whole issue, not merely of mentally defective children, but of educationally subnormal children, before the Education Act, 1944. Before that Act, we used to speak of blind, deaf and "defective" children.
All children who had any form of educational or mental handicap were simply classified as defective. Only since 1944 have the various divisions of handicapped children been finally broken down. We now recognise that any measure of potential ability needs to be recognised and fostered. That is one of the main functions of all our social service organisations. We try to see that every child gets the fullest opportunity for his abilities and aptitudes to be fostered, however limited they may be.
In this context we cannot point out too often that, just as there is no sharp distinction between children who can take 1769 advantage of the traditional academic education, or some part of it, and those who cannot—whatever may be our views about the organisation of secondary education it is common ground that we cannot categorise children sharply in respect of the type of course that they are able to complete—so the same is true as between the lower end of the Newsom sector and educationally subnormal children. At the margin there is bound to be a great deal of conventional categorisation. The same is true as between the educationally subnormal and the mentally handicapped. That is why it is exceptionally important, whatever pattern of administration we have, to ensure that there is an overlap, and that the fullest liaison exists, so that children with similar degrees of handicap can receive similar opportunities.
I was very glad to hear hon. Members refer to the need for more research into the causes of mental handicap. My right hon. and learned Friend the Member for Huntingdonshire (Sir D. Renton), in his very moving speech, talked about the physical and genetic background, and the importance of having all cases properly recorded. I am sure that the whole House agrees about that. My right hon. and learned Friend was right to point out that today far more children survive with mental handicap than ever before.
It is also necessary carefully to consider the environmental background as well as the physical background. Increasingly, research is showing that these factors are inter-related, and it is interesting to note that on this question there is common ground between East and West, whatever may be our ideological differences in other ways. When I was in Prague last September I found much interest being taken in one aspect of contemporary sociology in Britain, namely, the effect of parental love and care upon intelligence later on. Of all the various aspects of the reaction against Stalinism, none is stronger in social science than the reaction against the idea that creches are suitable for all young children. I told them that from experience in Britain we equally realised that there are some families whose children ought to be taken from home for their education.
All these are important matters on which more research needs to be carried 1770 out, but it is surely true that, quite apart from the physical causes of mental handicap, we can find children between the age range of five to ten, and with mental ages as low as 18 months, in respect of whom at least a part of the trouble arises from a poor background, where there has been little to stimulate growth or expression. In other words, the home background as well as the physical background must be taken into account.
Although I cannot claim to speak with any special knowledge, I respectfully suggest that the hon. Member for Halifax (Dr. Summerskill) was right on laying stress on the vital ages between one and five. We should never forget that the earliest years of life play a very big part in influencing future personality.
I wholly agree with what has been said about the need for research, and repeat that we must train more researchers in universities. This is a matter of which the University Grants Committee is aware. If we want more research done by the Social Science Research Council—I shall not go into the question whether or not we should have a separate educational research council—we clearly need more departments in universities to train up researchers. This is a more important limiting factor today than the provision of actual money for research.
Today, we are dealing with a subject which is borderline territory between the Department of Education and Science and the Ministry of Health. These pieces of borderline territory involve subjects that we should discuss regularly in the House, because it is here that we are apt to make less rapid progress than we should. One of the troubles about industrial training, for a long time, was that it was borderline territory, between the Department of Education and Science and the Ministry of Labour. In the same way, we are today dealing with borderline territory between the Department of Education and Science and the Ministry of Health.
From my experience as Parliamentary Secretary to the Ministry of Education, as it was then called, I know just how important it is to have good liaison between education authorities and health authorities. My hon. Friend the Member for Devonport (Dame Joan Vickers) was 1771 right to stress the need for the fullest cooperation and the fullest possible interdepartmental discussion.
I remember seeing a quite normal-looking boy in a school who was in such a condition that it was impossible to speak to him. If one spoke to his neighbour he would sometimes answer, but it was impossible to obtain any direct response from him. He did not have a particularly low I.Q., but I can remember the extremely devoted and, I thought, very able teacher in charge of his form saying, "If we could just overcome this problem there is no reason why this boy should not do perfectly well in this school. On the other hand, he is proving so difficult that his handicap is having an effect on the whole class, so that it is possible that he will have to be categorised as 'ineducable'." The clear implication of the teacher's words was that, if the boy were declared ineducable, that meant that, from having been potentially a promising pupil of the school, he would be going outside the ambit of the school system altogether. I saw then, as never before, how important it is to have close co-operation between education and health authorities, to deal not just with categories of cases, but with individual cases; and how important it is to see that the files are kept in such a way that one can follow individual cases if they have to move from one Department to another.
The question is raised in the Motion whether we should not have a transfer of responsibility for the education and training of all mentally handicapped children from the Ministry of Health to the Department of Education and Science. I agreed with what my noble Friend the Member for Hertford said on this matter. I look on the Motion as an ideal—that is to say, the more we can discover about the potentialities of what we now consider to be ineducable children, and the more we can learn about how to cope with their problems, the more rapidly, I hope, we can advance towards this ideal.
I would not go all the way with this suggestion, because one has to face the fact that there is a considerable number of children who have to be categorised, for shorthand, as ineducable. That does not mean, as I say, that there is a sharp 1772 distinction between these children and all others.
I agree with much that my noble Friend said and his specific suggestions. But to transfer all this work to the Department of Education and Science would, I suggest, be to take too large a step. I agreed particularly with my noble Friend when he said, in dealing with mentally handicapped children, that we want to get away from what he called the "custodial approach"—that is to say, from any residual idea that these are simply defective children who must be looked after. In his rejection of the custodial approach, he went to the root of the matter.
A number of suggestions have been made with which I express my full agreement. First of all, I agree that we ought to recognise the numbers of children within the purview of the Ministry of Health's responsibility who overlap in I.Q. with those now in E.S.N. schools. Secondly, I agree with my noble Friend's suggestion that, where this happens, E.S.N. classes should be run in hospitals, that we should seriously consider these classes as being within the responsibility of local education authorities, and that qualified teachers should be provided for those suitable.
I cannot see anything inherently impossible about those in hospitals actually being identified as children suitable for education and coming within the responsibility of the local education authorities. Where this happens, these classes could be inspected.
Thirdly, I agree with those who—
§ Sir D. Renton
Before my right hon. Friend leaves this point, would he clarify his own view—we are very interested in his views—on the position of those children who are at the very lowest end of the scale, who nearly always have the dual handicap—mental and physical?
§ Sir E. Boyle
With regard to those at the lowest end of the scale, who present a problem with which no local education authority has the responsibility of coping, I did put my views in an informative during the speech of my noble Friend. It is difficult to say now that they should equally come within the ambit of local education authorities. Some children in hospitals could, if identification had happened differently have 1773 been in an E.S.N. school or perhaps in a school for children with some multiple handicap. I thought that there was a very strong case for my noble Friend's suggestion. But I would not at this moment suggest that the Department of Education and Science should have any responsibility for the sorts of cases of which local education authorities today have no experience. That is the distinction which I was trying to make.
Thirdly, there was the question of the need for more research into the learning process of slow learners. Surely it is of considerable importance that we should learn exactly how slow learners can achieve some degree of progress. We must consider here those whose mental age is substantially behind that of their contemporaries but who may yet be capable of catching up, to some extent, at their own pace. I agree that we should keep a record of all E.S.N. children going into the outside world. Perhaps this is a matter for liaison between the Department of Education and Science and the Ministry of Labour. I have been bothered by the tendency to forget a handicapped child when he finishes school.
In fairness to the Department, in the schools for the physically handicapped, children stay at school for one year longer than the normal leaving age of 15. Physically handicapped education goes on until 16. Even so, I feel that we ought to improve our arrangements for keeping in touch with what happens to handicapped children after they have left school. This must be a matter for all the Departments concerned.
The hon. Member for Fife, West (Mr. William Hamilton) said, fairly enough, that some of my noble Friend's remarks were critical of successive Governments. I take my full share of responsibility for anything which may not have been done. It is only fair to point out that my noble Friend would have spoken in exactly the same tone of voice were my party on that side of the House. I have heard no hon. Member make so much noise in this House as my noble Friend did on one occasion during the last Parliament when the Closure was moved on an Amendment to which he wanted to speak. His independence of thought is not a new tendency since his move to this side of the House.
1774 I express my full agreement with the hon. Member for Willesden, West (Mr. Pavitt) on the importance not just of staff in general, but of married women, perhaps with family responsibilities contributing to this work. Surely, when we are dealing with all aspects of education and all ranges of ability, we must realise that we shall be depending, to a great extent, on part timers. I hope to see more full-time staff and more well qualified staff in this world, but the hon. Member is right to say that part-time married women have a part to play.
We have had the pleasure of the Minister of State's presence today. He has courteously listened to a large part of the debate. I hope that he will forgive me for jogging his memory once again on the important issue of a superannuation scheme for part timers. In so many aspects of social work, working out a superannuation scheme for those doing almost half-time work is as important as the issue of a basic salary.
I would add a few suggestions of my own to those which have already been made. I hope that it is common ground among us all that we do not want to institutionalise mentally handicapped children. In this respect, surely, the same is true of children as of geriatrics. One of the most distressing things is to visit old people's homes or special schools where one feels a sort of institutional atmosphere.
The emphasis in the Department of Education and Science's special boarding schools for physically handicapped children, for those who cannot move about, has always been that the schools should not be institutionalised and the children should be encouraged to have photographs and personal things about the place. I hope that we shall firmly resist any suggestion of institutionalising children who are mentally handicapped. Obviously, we do not want to admit them into large centres for the subnormal and into large classes.
Secondly, I have always believed that, whatever the limitations of Government Departments, there is one thing that they can do better than anybody else, and that is to act as a clearing house for ideas and in spreading the results of the latest psychological studies and research. I hope that the Department of Education and Science and the Ministry of Health 1775 will see that all who are concerned with handicapped children know of the latest discoveries. With the extension of higher education, there is a great deal more research, and a great many more ideas are being thought of all the time in our universities and other institutions. One often quotes a paper like New Society because it is so symptomatic of our time. It could not have existed 20 years ago, giving anything like the same range of information as it gives today. I hope that Government Departments will keep all those working on the ground fully up-to-date with the latest information on this subject.
As for my third suggestion, I have no first-hand knowledge of this, but I wonder whether in dealing with the mentally handicapped there is not more scope for the nursery type of school. As I understand the present situation, children take a test at seven years of age which may determine whether they are educable or ineducable, and if they are ineducable they go to a junior training school. Is it not possible that children who are handicapped in this way should stay for some time longer in nursery school atmosphere? I am sure that there are a number of disabilities which could be more easily coped with and overcome in that atmosphere—children with no speech or with a wooden expression, or children who delight in anti-social behaviour. One can think of many outward signs of handicap which could be coped with more easily in the atmosphere of a nursery school.
Finally, with regard to each type of handicap there must be one particular Department which should be able to give information and answer the House on specific subjects. In this context, I take up what the hon. Member for Lichfield and Tamworth (Mr. Snow) said about autistic children. I am not sure that the hon. Member is quite correct in his definition of an autistic child. I understood that an autistic child is a child who treats people as things and has no sense of the difference between what is animate and inanimate, but this is a most difficult handicap about which we are learning more all the time.
I was a little bothered by an Answer which the Minister of Health gave on 28th July when he was asked 1776on the basis of the most recent estimates, how many autistic children under the age of 18 years there are in England; and what is their regional distribution.and he replied:I regret that such estimates are not available."—[OFFICIAL REPORT, 28th July, 1965; Vol. 717, c. 144.]Either the Department of Education and Science or the Ministry of Health—and this to some extent falls between the two—but preferably both should know what the numbers are. They should give the information to the House about the numbers and what is being done about these and other categories of children. To trace the provision being made for special categories is important and somebody in the Departments must take clear responsibility for this work.
The hon. Member for Willesden, East (Mr. Freeson), and particularly the hon. Member for Willesden, West spoke about the need for more money in connection with the mentally handicapped. I am glad that the hon. Member for Willesden, East specifically mentioned money for special schools. I hope that the sum allocated for special school building in the National Plan—the continuation of the annual figure of £4 million, the sum being stabilised at the present year's figure—will leave a little money for improvements and some replacements of the older schools. This is the first year in which some provision has been made for some special-school replacements in the building programme.
As the House knows—I shall not elaborate the point this afternoon—we on this side are extremely concerned about the balance of expenditure within the education service today. It is very suitable that we should be discussing the importance of buildings for the handicapped on the same day as an important senior vice-chancellor has once again expressed anxiety about the university building programme. All this points the need to work to a proper scheme of priorities for education expenditure.
One point which has run all through the debate has been the importance of our realising in the House that notions of what children can achieve are changing all the time. Children's abilities are not, as it were, fixed at birth. Whatever the range of ability, whatever the handicap, ideas of what children may be able to 1777 achieve are changing all the time, and it is right, as the years go on, that we should be more ambitious for every category of child and about what can be hoped for even for the mentally handicapped.
I agree with the hon. Member for Willesden, West when he says that, in our approach to this subject, we must beware of sounding smug, that is, if I understood him aright, beware of sounding as though feeling sympathetic about the subject it all that is required of us. It is right and important that our ideals should be soundly based, and that our hearts should be in the right place on this subject, but I hope that we realise, also, that progress in all the social sciences is partly a matter of putting in sufficient money where it will count most—putting the weight of effort where it is most needed; and is partly also a matter of patient observation and measurement—in other words, an exercise of all those qualities which are comprehended in our use of the term "social science".
I hope that the message will go out from the House that, in our whole approach to this subject, in the pattern of administration which we devise for it and in all the ambitions we have for these children, that we recognise that abilities are not fixed, that possibilities are open for the future, and that we have the greatest admiration in the House for all those who have done so much to make the picture today a good deal more cheerful than could have seemed possible 20 or even 10 years ago.
§ 3.7 p.m.
§ The Parliamentary Secretary to the Ministry of Health (Mr. Charles Loughlin)
I join the right hon. Member for Birmingham, Handsworth (Sir E. Boyle) in congratulating my hon. Friend the Member for Woolwich, West (Mr. Hamling) on introducting the Motion today. Not only has he done a service to the House but he has done a service to the community and a service to the children and the parents of the children about whom we have been so concerned today. This is, I think, one of those occasions when the House is at its best. All those who have contributed to the debate have done so out of a great fund of knowledge which has impressed me greatly as I have sat in my place on the Front Bench. Perhaps at this point I may take the opportunity to apologise to the noble 1778 Lord the Member for Hertford (Lord Balniel) for missing his speech which, I understand, was an exceptionally good one. It was the only occasion when I had a chance to go out and have some food.
As I have sat here, throughout almost the whole debate, I have become increasingly depressed, not about the speeches made or about the picture of the services or their inadequacies as it has unfolded, but about my growing awareness of inadequacy in this matter. One thing the debate has taught me is that the more one examines the whole range of persons coming within the designation of mentally subnormal, the less one inclines to a rigid attitude or what the noble Lord called dogmatism. I am sure that this reaction is the right one, and that the more sensitive and flexible our approach to the subject becomes, the better it will be not only for the implementation of the services but for the children and parents themselves.
In examining the problem one cannot separate the parents and the children. One hon. Member made a very short but very valuable contribution about the services rendered to parents when they were informed that their children were mentally subnormal. I sincerely hope that anyone charged with giving this information to a parent would ensure that if he could not do it in the correct way someone else would do it who could break the news in a gentle and kindly manner so that the parent would get over the psychological shock very quickly. I hope that it would also be ensured that the right kind of counselling service was available to the parent.
I pay tribute to the right hon. and learned Member for Huntingdonshire (Sir D. Renton), who has tremendous courage. From his coming to me about cases involving mentally subnormal people, I know that he has tremendous compassion. His attitude to the subject and the contribution that he makes cause me, the father of two normal children, to feel terribly humble. I assure him that I accept the normality of my children as a challenge to me to do everything I possibly can to help those who are not so lucky.
A number of ideas and suggestions have been put forward in the debate. 1779 I am sure that right hon. and hon. Gentle-men will accept that it will be impossible for me to express opinions about all the suggestions that have been made. But I assure the House that, in the same way as I said there should be complete realisation that dogmatism should be avoided, once the OFFICIAL REPORT is at my disposal I shall examine every suggestion to see whether an improvement can be achieved in the services at present available.
I have a tremendous number of questions to answer. At one moment I wondered how I should get through my prepared notes, and I went out of the Chamber and decided an order of priorities and split them up. Looking at the number of questions put to me, I feel that it would be well past four o'clock if I tried to answer all of them. I shall, however, make one or two comments on some of the contributions, and I think that some of the questions will be answered by the other remarks that I shall make later.
My hon. Friend the Member for Woolwich, West, in introducing the subject, made a speech of which I think he will rightly be proud on looking back in the years to come. I congratulate him not only on the construction of his speech but on the content.
The right hon. and learned Member for Huntingdonshire and the right hon. Member for Birmingham, Handsworth and others, referred to the degree of research being carried out. I accept—and this is typical of many fields both within and without the education and health services—that there is clear need for increased research of one kind or another. But, in the final analysis, the right hon. Member for Birmingham, Handsworth was correct in saying that the emphasis should be not so much on the need for increased research but on the need for more researchers.
A substantial amount of research has been devoted specifically to the problems of children. In the period 1960–64 more than 100 projects concerned with mentally sub-normal children were either initiated or completed. Most of the research into mental health is, however, aimed at problems common to patients in all age groups. The Medical Research Council seeks every opportunity of advance 1780 and supports research groups studying the relationship between organic and functional mental disorders and provides further assistance by extending research through schemes for research grants and training awards.
I am sorry that I cannot give the House the whole programme of research, but I assure right hon. and hon. Members that some degree of research is going on and that, generally speaking, we will see to it that, as far possible, it is extended. The right hon. and learned Member for Huntingdonshire referred to the possibility of a central register and local registers. The establishment of an "at risk register" was recommended to local health authorities in 1962 with the object of early detection of, and provision of services for, both physically and mentally handicapped people. Most local authorities have started such a register. Indeed, some have actually done so even before 1962, when the recommendation was made.
I am not too sure whether a central register would necessarily be an advantage because of the present division of responsibilities. A local authority is responsible for deciding whether children come within the scope of the Education Department or the Ministry of Health. I do not reject completely the idea of a central register but I am not too sure, so far, that it would have a value that would justify the work of keeping the statistics and the registration, which would increase the need for administrative personnel.
§ Sir D. Renton
I think that the best plan would be for me to write to the hon. Gentleman and explain to him the advantages and the simplicity of this suggestion and the benefits to be obtained in medical research.
§ Mr. Loughlin
There may be some advantages. I began my speech by saying that I was only too conscious, after listening to the debate, of my own inadequacies and I can assure the right hon. and learned Gentleman that if he can supply me with information or ideas on this or any other aspect of the problem which affects my Ministry, I shall be only too glad to receive them.
§ Mr. Freeson
My hon. Friend said that it was recommended in 1962 that local authorities should establish registers 1781 and he said that some, and possibly most, had started them. To what extent does his Ministry correlate the information from those existing registers? Would it not be a good idea to go part of the way to a central register by requiring local authorities to have such registers?
§ Mr. Loughlin
It crossed my mind when I was talking about the 1962 recommendation that not only should we recommend them but, even if we fell short of compulsion, we should take steps to ensure that in practice local authorities kept registers. I am sorry that I cannot give my hon. Friend the statistical information which he requires at this stage, but perhaps I shall be able to let him have it by post.
My hon. Friend the Member for Halifax (Dr. Summerskill) made her usual capable and very kindly contribution. She spoke of the experimentation in Soviet Russia. Much material has been published about what is happening in Soviet Russia. I do not want to criticise the Soviet Union any more than any other Government, for this is a matter in which it is more important to create a climate in which nations co-operate to the full rather than to be carping in any way. However, we are not too sure that the concept which Russia is now following, which is almost the concept that there is no such thing as mental sub normality, no matter what the I.Q., is correct. We have to have some reservations about the work which has been done. But that does not mean for a moment that we shall completely ignore what has been done in other countries. The hon. Lady the Member for Plymouth, Devonport (Dame Joan Vickers) asked about figures for the setting up of centres. I think that these figures are essential for the information of the House. My hon. Friend the Member for Lichfield and—
§ Mr. Loughlin
I am never very sure about that. They are two most beautiful towns and they each deserve as good a Member of Parliament as they both have at present.
§ Mr. Loughlin
I am not going to get involved any further in local history.
My hon. Friend the Member for Lichfield and Tamworth (Mr. Snow) referred to autistic children. The point was also taken up by the right hon. Member for Birmingham, Handsworth. Children who are described as being autistic do not form a homogeneous group. Research is going on into the ways of relieving the isolation of persons suffering from sensory defects, methods of retraining children with specific defects due to brain damage and into methods of educating children whose maladjustments appear to be emotional rather than organic. Research is also continuing into the treatment of children suffering from schizophrenia. These and many others may present as "autistic" children, but their treatments depend on the nature of the underlying cause.
My hon. Friend the Member for Woolwich, West referred to the Marlborough Day Hospital, and said that we ought to look at the possibility of extending the system involved. He went on to ask if I would study a paper which he would send to me. I should be very glad to receive the paper and, having read it, I will let him have my observations. The hon. Member for Hertford spoke when I was out of the Chamber, but I understand that he wanted to know whether figures were available for the number of trained staffs in schools in hospitals for the subnormal. I believe that he referred to the annual reports published by my Ministry and to the statistics contained in them. The 1965 statistics which will be published in the annual report are now available. These show that in September, 1965, 107 persons out of a total of 504 were qualified. That is, roughly, 20 per cent. The other point which the hon. Gentleman raised concerned the staff going on training courses. I assure him that the Ministry does not discourage hospitals from sending staff on training courses. In fact, we are very glad when they do so.
I should like to apologise to anyone whose questions I have missed, but there may be answers to them in my later remarks.
I turn to the debate as a whole and to the Motion. As the House is aware, administrative responsibility for services 1783 for mentally handicapped children is divided locally between education authorities and health authorities and centrally between the Department for Education and Science and the Ministry of Health. For mentally handicapped as for other adults the Ministry of Labour has responsibilities for vocational training, industrial rehabilitation, and employment, including sheltered employment for those who are capable of remunerative work.
The training and occupation of handicapped adults who are not capable even of sheltered employment are the responsibility of local authorities in either their health or welfare capacity under the general oversight of the Ministry of Health. The local health and welfare authorities are also generally responsible for a wide range of services which contribute to the health and social well-being of handicapped people of all ages, in addition, of course, to the specialist services provided in hospitals and the general medical services provided by general practitioners.
These arrangements are kept under review and adjusted from time to time to meet changing situations. The administrative arrangements for mentally handicapped children were one of many subjects reviewed by the Royal Commission on Mental Health which reported in 1957. This Commission recommended that responsibility for the training of children who are suffering from a mental handicap so severe that they are not suitable for education even in special schools should remain with the health authorities, but recommended various changes in terminology and procedure. Most of these recommendations were embodied in the Mental Health Act, 1959, which contains the present statutory provisions governing the responsibilities of local education authorities. The training of severely subnormal children who are not the responsibility of the education authorities is carried out by local health authorities and hospitals under the provisions of the National Health Service Act.
For handicapped adults, a thorough review of the arrangements for rehabilitation, training and resettlement was undertaken by the Piercy Committee which reported in 1956. As a result of 1784 its recommendations, the Disabled Persons (Employment) Act, 1958, was passed which made various amendments to the Disabled Persons (Employment) Act, 1944, which otherwise remains the basis of the provision of services for the disabled by or under the aegis of the Ministry of Labour. The other services for the mentally or physically handicapped are provided by local health and welfare authorities as part of their services under the National Health Service Act and the National Assistance Act.
That is the statutory framework. The services operated within it are constantly developing and changing in character and it is fair to say that within the last 10 years or so there have been fundamental changes of attitude to the training of mentally handicapped children and adults as the result of new knowledge and new understanding of the potential response to training and to new training techniques. I will speak about these in more detail presently. At this point, I should like to emphasise that these developments have taken place under the present administrative arrangements.
Our aim is that the services should continue to develop so as to provide the best possible service for the handicapped children and adults, and changes in the administrative arrangements should be made only if clear benefit to the service provided is foreseen from such a change. My right hon. Friend and my right hon. Friends the Secretary of State for the Department of Education and Science and the Minister of Labour are in close touch with the way in which the services are developing. We see no need for change in administrative responsibilities at present but we will watch the situation and will, of course, take account of the views expressed in this debate.
I do not think it necessary for me at this stage to go into the whole range of the services that are provided. The debate has shown that most hon. Members are fairly conversant with the type of services that we provide. Rather than survey them all, I should like to refer to the children who are more severely handicapped than the educationally subnormal and who are ascertained assuffering from a disability of mind of such a nature and to such an extent as to make them unsuitable for education at school".1785 These children are notified to the local health authority and their training then becomes the responsibility of the local health authority or of the hospital authorities, according to the nature and character of their handicap.
Reference has been made to our ensuring that children who are educated in hospitals develop to the extent that it is possible to educate them as educationally subnormal. That is what happens in practice. Not only does it happen, but where there are schools of this kind and there is a division between children who are educationally subnormal and those who are wrongly described as ineducable, there is, in practice, some degree of inspection by Her Majesty's Inspectorate even at the present time. I understand also that each child's case is reviewed at two-yearly intervals. Thus, where it is possible for a child to have developed sufficiently to take advantage of the educational facilities for the educationally subnormal, that position is already dealt with.
It may be argued that the situation is not considered sufficiently closely by certain hospitals or in certain regions. As the point has been put to us today, however, we will examine it closely to see whether the concept expressed in the debate can be extended.
§ Sir E. Boyle
This is a point to which several of us in this debate have attached importance. We are grateful to the Minister for the way he is assisting the House. Does what he has said mean that from time to time there will be regular inspections to see whether there are children in the hospital schools whose names should become known to the local education officer—somebody for whom provision should be made through the services of the local education authority?
§ Mr. Loughlin
Well, I want to give the assurance right now that I will make arrangements to see that this can be done—that is, I will make inquiries. The only qualification I am making—the hon. Gentleman is smiling—but the only qualification I am making, and the right hon. Gentleman appreciates this, is that I am the Parliamentary. Secretary and not the Minister; and this was what was exercising my mind when I was giving the assurance to the hon. Gentleman. Let 1786 me rephrase it: I will draw the attention of my right hon. Friend to his position and the desirability of ensuring that the suggestion of the right hon. Gentleman is carried out.
§ Mr. R. W. Brown (Shoreditch and Finsbury)
In view of what my hon. Friend has just said about the feeling that the people at the lower end of the scale could not be educated, will he not agree that, for so long as the education authority can get rid of the situation by putting them into hospital schools, and so long as we have the present staff situation at the lower end of the scale, with classes crammed, this is the easiest way out, and that so long as the Ministry of Health is responsible the Ministry of Education will be only too pleased to be rid of that situation?
§ Mr. Loughlin
I am not accepting that at all. It may be that it is a temptation, but I would not accept that the temptation is not resisted by any single local authority or any single local education authority.
§ Mr. Hamling
Is not that view in fact untrue, because pressure for this change comes from educationists and not from my hon. Friend's Department?
§ Mr. Loughlin
I said I could not agree with the suggestion, and, of course, my hon. Friend has now reinforced what I have said.
I am in somewhat of a difficulty because I have promised to sit down at a quarter to four, yet I do not want to let this debate go by without making some reference to training of staff who teach and train mentally handicapped children.
This is specialised work for which specialised training is needed. This was recognised by the setting up early in 1964 of the Training Council for Teachers of the Mentally Handicapped with the object of promoting the provision of training for the staff of local authority training centres and hospitals and to approve courses of training. Before this, the National Association for Mental Health had for several years been running pioneer courses, and all its courses have since been approved by the new Training Council. When the Training Council was set up the National Association was running four courses for teachers of mentally handicapped children, with an annual 1787 output of about 110 trained staff per year, and one course for the instructors of adults, with an annual output of 30 trained staff.
In the two years since the Training Council started its work it has approved another 11 courses which will be run mostly by colleges of further education. The first students will be graduating from these new courses this summer, and by next year, when all the 11 new courses will be turning out trained students, we expect an output of about 240 trained teachers of mentally handicapped children and about 90 instructors of adults. This output of trained staff should continue year by year, and increase with the approval of further courses. The Training Council now issues its own diploma to those who have received the diploma of the National Association for Mental Health and to all those successfully completing the present approved courses. We have made some considerable improvement in the number of teachers who are trained and available in this field. There has been the setting up of the framework within which we can increase the number of teachers over the next few years.
Perhaps one of the big criticisms that I have of some of today's contributions is that there seems to be a concentration on the idea that because a person is academically qualified as a teacher, that necessarily qualifies him to teach children who are mentally subnormal. I want to keep clear of that one, because I believe that there are additional qualities required for that work.
When I go to hospitals and centres for the handicapped and see the staff who are training and caring for mentally handicapped children, I marvel that they are able to do such a tremendous job of work. I marvel sometimes that they are able to do it at all, because very often they are working under conditions which they should not have to endure. They are working in a dedicated fashion without any thought of reward, and I pay my tribute not only to the teachers but also to the local voluntary organisations which are doing so much good work.
We have had a first-class debate today. I am only sorry that, because of time, I have not been able to deal with the subject more widely than I did. If there have been any inadequacies in my reply, 1788 I apologise to the House. My final word is to ask my hon. Friend, in the light of what I have said and of the promises that I have given to him, if he will accept the position that I have outlined and be prepared to withdraw his Motion.
§ 3.47 p.m.
§ Mr. Alfred Morris (Manchester, Wythenshawe)
My hon. Friend the Parliamentary Secretary to the Ministry of Health has expressed the view that the House has been at its best today. I wonder whether it has? There has been very little controversy, and there are certainly some hon. Members who think that the House is only at its best when we do our work in an atmosphere of controversy. For my part, I am happy there is such wide agreement on the needs of mentally handicapped children.
It is a pleasure for me to speak in support of a Motion moved by my hon. Friend the Member for Woolwich, West (Mr. Hamling), for he is a very close colleague and personal friend. He stood with me in the 1951 General Election, when we fought two adjoining Liverpool constituencies together almost as one campaign.
My hon. Friend has given the House the opportunity to reconsider its objectives in this important field. I like the insistence in his Motion that improved educational opportunities are the key to the proper development of mentally handicapped children, and that facilities for them should conform to a minimum standard that is not lower than that obtaining in the best authorities. I take some pride in the fact that my own authority, Manchester, is held in high regard for many of the provisions it makes for mentally handicapped children.
On the question of improving educational opportunities, anyone who has taught, as I have, both the very able and the severely subnormal child, knows that the ideal of equality of opportunity is not enough. We need to bias opportunities in favour of those who lack the physical or mental powers to compete from the basis of equality of educational opportunity. In my view, equality of opportunity is not very meaningful when applied to a child who derives from divorced parents and a broken home. In those cases there is often an emotional blockage to learning, which requires special educational help. This is even 1789 more true in the case of the child who is severely handicapped mentally.
If we desire social equality, we shall not succeed by making equality of opportunity the means of achieving it. Social justice requires the award of privilege to those suffering handicaps of the kind that we are discussing today. What is repugnant to many people is that too often privilege seems to be available to those who are least in need of it. For those who believe in the doctrine "from each according to his ability, to each according to his need," the Motion is one of real importance and deserves the unanimous support of the House.
I think that there are five improvements which we should re-emphasise at this stage of the debate. Manifestly, there is a need for much more, and much more co-ordinated, research. I agree with the hon. Member for Plymouth, Devonport (Dame Joan Vickers) and my hon. Friend the Member for Lichfield and Tamworth (Mr. Snow) that there is need of much more help from the research workers for the autistic child. I should also like to see more research into whether mentally handicapped children should be taught in special schools or in special classes of ordinary schools. There is dogma on both sides of this discussion, and I think that there is scope for much more research on a subject of such fundamental importance.
There is need for more research into the problems of retardation, that is the gap between ability and attainment. I am sure that our society loses a great deal because of this gap, and that any money spent on improving research into retardation would be well spent. It would indeed be a very wise investment.
I agree with the suggestion that there might be a differential increase in the family allowance in respect of the severely handicapped child of the less well-off family, and I hope that the Government will give both serious and sympathetic consideration to this point.
It is also important to stress the importance of preventive medicine in this field. There is need for much improved prenatal care for mothers. Preventive medicine is always the best, and I am certain that any expenditure here will be a useful investment in the field of reducing the incidence of the problem we are discussing.
1790 I should like to see more nursery schools built. The National Society for Mentally Handicapped Children recently held a conference at which it was emphasised that the problem of what is called "discovering" the educationally subnormal child was one of the most important problems to be tackled. Sub-normality is often detected only when children go to school. If we had more nursery schools it would much assist educationally subnormal children.
There should also be much more provision for further education for educationally subnormal school leavers. We should improve their educational opportunities both before the normal school starting age—through the provision of extra nursery school accommodation—and after the normal school leaving age, by the provision of extra facilities for further edcation. As well as these improvements, there is an urgent need for more sheltered workshops. If such improvements stem from this debate it will prove to have been an extremely important one.
§ Mr. R. W. Brown
Does not my hon. Friend agree that one point that he has not raised is the importance of training parents how to handle children? All the schools and nursery schools are of no value if, for the remaining 16 or 18 hours a day, parents are unable to cope with the problem of these children.
§ Mr. Morris
I recently heard a very moving speech at the Conference of the National Society for Mentally Handicapped Children. It was made by the parent of an educationally subnormal child from Altrincham and Sale in Cheshire. He was speaking, in the main, to other parents. And I am satisfied that most parents of educationally subnormal children are acutely conscious of their responsibilities. Where there is an emotional blockage to learning, resulting, for instance, from divorce and the breakdown of family life, the parents concerned bear a heavy responsibility for the damage that accrues to their children.
Dr. Simon Yudkin, an expert in this matter, has said that all children need to be accepted in society as worthwhile people. This will not happen until the generous spirit that has informed this debate also informs every official action 1791 in this field. We urgently need more action to help the less fortunate members of our society. A very distinguished predecessor of my right hon. Friend, Mr. Aneurin Bevan, said that any society should be judged according to the way in which it treated those who were most in need. I hope that our society will be held in ever higher regard for the manner in which it treats children like those whose problems we have been discussing with such compassion today.
§ 3.58 p.m.
§ Mr. Lewis Carter-Jones (Eccles)
I shall not have much time to speak before the debate ends, but I want to make one or two observations which I regard as significant. Had my hon. Friend the Member for Woolwich, West (Mr. Hamling) been lucky when he first stood for Parliament and been able to put down a Motion, I do not think that he would have chosen this topic. Only 20 years ago we would not have discussed this matter in the way in which we have discussed it today. That gives us a measure of the progress that has been made in those 20 years. This is the remarkable thing about today's debate, together with the fact that my hon. Friend wants power transferred from the Ministry of Health to the Department of Education and Science, which indicates the tremendous hope that he has for the future of this type of child.
I want to refer to the tremendous emphasis that is now laid upon the need for the continuation of education, and its control by the Ministry of Labour. This shows a tremendous degree of confidence in the ability of people to communicate with these children. If—
§ It being Four o'clock, the debate stood adjourned.