§ 'If an Area or District Health Authority, in the course of exercising any of its functions in relation to a child who is under the age of five years, forms the opinion that he has, or probably has, special educational needs, the authority shall—
- (a) inform his parent of its opinion and of its duty under this section; and
- (b) after giving the parent an opportunity to discuss that opinion with an officer of the authority, bring it to the attention of the appropriate local education authority.'.—[Mr. Carter-Jones.]
§ Mr. Speaker
With this it will be convenient to discuss new clause 2—Duty to notify parents about relevant support organisation.
§ Mr. Carter-Jones
I wish strongly to support new clause 2. I understand that new clause 1 will have a fair wind from the Government. I want the House to note the date—10 June 1981. Is it not a sad reflection on the House that we have had to wait until 1981 to place on the statute book a simple provision which everyone believes should have been there for a long, long time? The new clause provides:'If an Area or District Health Authority, in the course of exercising any of its functions in relation to a child who is under the age of five years, forms the opinion that he has, or probably has, special educational needs, the authority shall—(a) inform his parent of its opinion and of its duty under this section.'That would be a normal action to expect under any circumstances, but we are having to enact a law to enforce it.
Many hospitals may be upset by that provision. I ask them not to be upset. If they have carried out that practice, good luck to them. They have our full blessing. The new clause aims to deal with the arrogant people in the medical profession—thank goodness they are in a minority—who do not accord that right to parents. I praise all hospitals who give parents that right.
The new clause also provides that an authority should(b) after giving the parent an opportunity to discuss that opinion with an officer of the authority, bring it to the attention of the appropriate local education authority.'.Those two provisions are all that the clause contains. I understand that the Government will look favourably upon it. I am not a parliamentary draftsman, and the clause had been drafted by an expert. He may have the legality correct, but much of the morality and real thinking is missing. I wish to spend a few moments speaking directly to the Secretary of State. Apart from granting us the new clause, I ask on behalf of all hon. Members and of parents outside that when he writes the guidelines to the Act he ensures that the spirit behind the new clause is enshrined in them.
413 One thing is certain—if a child under five is born with a handicap but receives no attention until he goes to school, he will experience a double handicap. In many cases of sensory difficulties it is possible to reverse the trend and prepare the child for when he starts school so that he will not suffer from a double disadvantage.
I wish to read a letter from a constituent to show the importance of the new clause. She is not a feckless person, but a woman who has had four children, the fourth being born with some form of handicap. She is a professional lady and a councillor. She should have known her way around these matters. However, with a newborn baby she found herself in difficulties. Many mothers will find themselves in a similar position. They need our help. My constituent has given me permission to read part of her letter. She says:There were many moves I had to make to get my child monitored for handicap and these took a long time. Many mothers would feel at a loss in this situation and vital remedial attention could be neglected at the optimum time.I would therefore urge you to exert whatever pressure you can upon the Government to recognise the social, economic and practical reasons for careful screening of children of pre-school age.I repeat that my constituent is not a feckless person. She would say that she could cope in all situations, excepting this. She needs help and advice. I shall return to that theme when I speak to new clause 2 in the name of the hon. Member for Isle of Ely (Mr. Freud), who regrets that he cannot be present.
The education and training of a handicapped child cannot begin too early. He has to be taught skills that an ordinary child spontaneously picks up during his early years, such as speech and movement. I stress the words "speech and movement". Early stimulation and experience are vital for the handicapped child to ensure that his handicaps do not trap him in frustration and boredom.
Often a spastic child cannot be diagnosed for a few months. He will have difficulty in some of the muscles and the tendency is to exercise the strong muscles and to neglect the weaker muscles. Unless he receives physiotherapy treatment quickly, he will suffer further handicap and damage. Physiotherapy should begin during his first year to help him make correct and useful movements. I am not using the esoteric language of the academics; I am trying to use the simple language of ordinary people dealing with their own children.
Left to himself, a spastic child will choose the easiest way and use the strongest muscles, thus letting the weakest ones become useless. Contraction and tension of the muscles could develop and cause a secondary handicap which, when the child goes to school, could be a tertiary handicap, which would make his position even worse.
Some children have speech difficulties. Speech therapy should begin early. It is essential to encourage correct muscular control through correct voicing, breathing, sucking, swallowing and blowing. The child then moves to babbling and, gradually, the introduction of syllables and words until finally simple phrases and sentences are reached. The speech therapist can help so that when the child starts school he does not face the embarrassment of difficulty with communication.
I find it dreadful that I am asking, in June 1981, for such provisions to be incorporated in legislation. It is a matter of right for everyone which should never have been 414 overlooked. I understand that the Minister will accept the new clause—not, I hope, because it has no resource implications, but because it is the right thing to do. We should grant such a right, and that should be done here and now.
I come now to the child with hearing difficulties. Ordinary children acquire knowledge through hearing. A child who cannot hear needs to be taught, trained and made ready to receive education. The same happens with the sensory handicap of blindness. Much can be done for the sensorially handicapped, physically handicapped and mentally handicapped if we start now. It could be argued that such provisions are economically sound. However, I am not here today to advance an economic argument. I am here to advance what I hope is a sound, practical argument. We should provide for all handicapped children.
I wish to refer to new clause 2 standing in the names of the hon. Member for Isle of Ely, myself and other hon. Members. I accept that there is difficulty in drafting a suitable clause. However, I ask the House to remember my constituent—that able woman who knew the difficulties of administration and said that she needed help—and understand that the new clause attempts to say to her and others in a similar position "There are voluntary organisations that might be able to assist you with your problem."
The voluntary organisations in their specialties acquire a tremendous amount of skill, knowledge and experience, and they are able to offer that freely. In Committee the Minister told the hon. Member for Isle of Ely that there may not be facilities for voluntary organisations in all areas. In a superficial sense we could accept the reality of the Minister's argument. However, if he wants to sponsor and stimulate voluntary organisations he should give them a challenging task to perform. He should say to them "A duty is being imposed upon the local education authority and the area health authority. Therefore, they will have to consult you." I am sure that voluntary organisations such as MENCAP and the Spastics Society and all the organisations associated with the blind and the deaf would provide the necessary facilities.
I hope that new clause 1 will be accepted. I urge the Minister to write in the memorandum a note to the effect that we are thinking of neonates as well and that consultants have a responsibility to ensure that adequate training is given, and, wherever necessary, education, to allow the child to be a total child and overcome his handicap. I ask the Minister to reconsider new clause 2 and to ascertain whether there is a way in which the resources of voluntary organisations can be marshalled to provide help for specific handicaps.
§ Mr. Speaker
I have had an opportunity to reconsider amendment No. 2, which stands in the name of the hon. Member for Bedwellty (Mr. Kinnock). I have made arrangements for it to be put on the selection list to be called and to be debated and, if necessary, voted upon. It will be called after we have discussed new clause 8.
§ Mr. Neil Kinnock (Bedwellty)
On behalf of my right hon. and hon. Friends, and, I am sure the hon. Member for Caernarvon (Mr. Wigley), may I say that we are most grateful to you, Mr. Speaker? I am sure that our attitude will be shared by all those outside the House who are closely observing our proceedings.
§ Mr. A. J. Beith (Berwick-upon-Tweed)
The whole House will be grateful to you, Mr. Speaker, for the personal attention that you are paying to the Bill, which matters so much to a minority who are beset with serious problems.
I agree with everything that the hon. Member for Eccles (Mr. Carter-Jones) said about new clauses 1 and 2, the latter tabled by my hon. Friend the Member for Isle of Ely (Mr. Freud). We are considering the plight of those who have received news that will have the most serious and dramatic consequences for themselves and for the child of whom they will take care. In Committee many cases were quoted and examples given of the bewilderment of parents in those circumstances and the difficulty that they have with bureaucracy, even when it is operating at its best, let alone when it sometimes proves unresponsive and unhelpful.
In Committee my hon. Friend quoted two cases which were relevant respectively to the new clauses which we are now discussing. He referred to the parent of a spina bifida child, who said:Nobody tells you about your child; I still don't know the name of what is wrong with her, I've seen it written down on doctors letters but … you ask them at the school, and hospitals and they just say 'I don't know'".It is precisely to deal with that bewilderment that new clause 1 is on the Amendment Paper, and I welcome it.
My hon. Friend quoted someone who said:This terrible depression comes over you. If I could have seen someone I would have liked someone who had the same, or nearly the same, problem, the same kind of worry. A parent. Someone you could have really poured your heart out to and known that they could have fully understood."—[Official Report, Special Standing Committee; 2 April 1981, c. 475.]It is that circumstance that links new clause 2 with new clause 1 in these discussions.
The purpose of new clause 2 is to extend the informing function that is embodied in new clause 1—the responsibility on the area health authority to tell the parents and to take that a stage further and require the authority to tell the parents about support organisations, voluntary organisations, which may be relevant. I think that there was a general understanding among Committee Members that the Minister was hoping to meet that requirement as well as the requirement that has been met by new clause 1 when he replied to the debate in Committee.
I shall explain why I think that new clause 2 contains an important principle. The Bill is almost the only response to the Warnock report and there is much concern that this is legislation for integration without resources and without expenditure. We must all be conscious of the fear that the Bill will create expectations that will be little satisfied. That is exactly the fear that proved to have good grounds in the Chronically Sick and Disabled Persons Act 1970. However, we are discussing an area in which the Bill can achieve positive good and where it may be said afterwards, "At least in that respect our lot was improved", even if there turns out to be disappointment that, because of lack of resources, some of the other features of the Bill do not materialise effectively in the short term.
The Warnock committee stressed the importance of support organisations and the need for parents to know about them. It reported:Parents of children with disabilities or significant difficulties 416 should also be informed at an early stage about voluntary organisations and associations of parents similarly placed. These can offer support and encouragement to parents, give information about the different services available and, in many areas, provide pre-school opportunities for young children with disabilities.That is what parents most need. They want other parents to talk to, with whom they can share experiences.
It is essential for handicapped children to receive help as early as possible before school age. The hon. Member for Eccles said that much can be done before school age and that often it is not likely to be done if the parent is not in touch with other parents who have a shared experience. The social worker and the local doctor may have only limited experience of the handicap. It may be the only handicap of the sort that has arisen in the area for several years.
It is only through a specialist organisation that the parent is likely to be put in touch with the possibility of pre-school help for the child. That underlines the need for parents to be informed at the earliest stage about support organisations. At present it is a matter of luck whether they are informed.
If the handicap is well known, the relevant organisation will be known nationally—for example, The Spastics Society. However, the support organisations for less well-known handicaps are naturally much less well known although no less effective in the work that they do. The Warnock committee quoted the research carried out by the York university social policy research unit. It appeared that many parents of handicapped children had little contact with either statutory or voluntary organisations. That encouraged it to stress the need to give that
When the issue was raised in Committee by my hon. Friend, with the strong support of other members of the Committee, the Under-Secretary of State's response seemed to imply a willingness to try to meet my hon. Friend's case, although he expressed reservations about practicalities and drafting details. In his response to the principles of notification and the need for parents to be informed of support organisations, the hon. Gentleman left the Committee with the impression that the Government were anxious to meet the case and were prepared to try to do so. He said:I suggest that a clause be drafted for Report in the names of the hon. Member for Exeter (Mr. Hannam) and the hon. Member for Isle of Ely (Mr. Freud) and also the hon. Member for Eccles (Mr. Carter-Jones). The services of my Department and all of us will be given to make sure that we get a tight clause which will fulfil all the needs that we have mentioned."—[Official Report, Special Standing Committee; 2 April 1981, c. 478.]I welcome the effort that has gone into the drafting of new clause 1, and I am glad to see it on the Amendment Paper. However, the linking of those names and the tenor of the debate suggested to my hon. Friend and others that the Government wanted to meet both principles. Therefore, my hon. Friend took up the matter with the Department and the Under-Secretary in the hope of satisfaction, and withdrew the new clause.
The Minister replied that, after thought, he had decided that he could not meet that criterion or draft a clause that would embody the principle of giving details of the support organisations. I studied his letter carefully, and I do not believe that his arguments in that respect were convincing. He said:In the first instance, it is more often than not impossible at birth for doctors or midwives to know whether a child is indeed handicapped … Secondly, even when serious handicap is obvious to doctors at birth the news must be broken very carefully to the parents".417 It is obvious that both those statements are true, but to regard them as arguments against what my hon. Friend sought to do is to misread my hon. Friend's intention and the new clause. The intention was that as soon as the handicap could be indentified the information should be provided, and provided again after the parents had had time to absorb the full emotional impact of the news.
§ Mr. Andrew F. Bennett (Stockport, North)
Is it not dangerous that the Minister seems to be making a judgment that the needs of the parent are more important than the needs of the child? Although we should have compassion and concern for the parents, surely the needs of the child are paramount and we should ensure that the child gets the appropriate help as soon as is necessary.
§ Mr. Beith
The hon. Gentleman is quite right. I thought that we had passed that stage. New clause 1 is an attempt to make it clear that the House is not prepared to allow essential information to be withheld from parents because of the medical custom and practice that people should not be told the truth. Perhaps an element of it can still be seen in the reply that I just read, that it might be bad for parents to be given, in addition to the other things that they have been told, the details of the support organisations at that stage. That does not stand up as an argument. We do not seek to prescribe a form of words or a manner in which doctors should convey the information. We simply seek to ensure that parents are given the information.
The Under-Secretary's second argument against embodying this issue in the law is what he described asthe technical problem, of defining 'support organisation' in law. By this, we understand 'voluntary body', which has itself no status in law".The Under-Secretary went on to talk about the possibility of using "charitable status" as the basis, and enlarged on the technical difficulty of defining "support organisation".
I reject that approach. We are not talking about giving a large tax advantage to support organisations. We are not discussing something that can be abused and therefore requires the narrowest and tightest statutory definition. We are talking about the need to tell parents about organisations which we know exist, whose abilities and contribution we know well, and which the Department and the Department of Health and Social Services know well. There is no technical problem about identifying those organisations.
In a moment I shall come to the quality of those organisations, but the Minister is going down a blind alley if he supposes that elaborate drafting is needed to safeguard ourselves against calling something a support organisation that is not a registered charity, or whatever. We are discussing organisations which we, as laymen interested in the subject, know about and have no difficulty in defining.
§ Mr. Carter-Jones
Would it not be possible for an organisation, an umbrella such as RADAR, to have the authority to suggest an organisation? It is a reputable organisation, so could not the local authority ask it about the best place for getting help? RADAR, with its umbrella organisation, could do it.
§ Mr. Beith
There are all sorts of means by which this requirement could be met. The hon. Gentleman has 418 suggested a sensible way to do it. Parliamentary draftsmen should not be allowed to stand in the way of common sense. It is obvious to all of us what we are talking about and that it can be done. The difficulty of drafting an appropriate phrase may be insuperable if it involves complicated tax law, but it is not insuperable in trying to give practical help to people through voluntary organisations.
The Minister said that the third difficulty is thatLocal support organisations are not always well organised or uniformly good at providing the kind of support that we would all wish parents in this situation to have".That is a diplomatically worded paragraph, and we know what he means, but for parents in this situation almost any help is better than none. Even the smallest group of ill-organised parents who have a shared experience is better than no parents at all and nobody with whom to talk over the problem.
We all know the organisations involved in this sphere well enough to recommend the principle without any real fear that people will fall into the hands of organisations that are so badly run that they are a handicap or a problem. However, if it were a difficulty, there are ways round it. The Department could have a register of organisations and set criteria and standards if it felt that that was necessary. It could have a list of recommended organisations.
§ Mr. Carter-Jones
Surely nothing has been sacrificed, because the National Health Service has the right to choose the local organisations or national organisations.
§ Mr. Beith
Again I agree with the hon. Gentleman. The National Health Service has extensive experience of co-operating with voluntary organisations. Our NHS could not run without that co-operation. There is ample experience in every health authority of which are the reputable and reliable voluntary organisations.
Many representations have been received from outside bodies. When the matter was being discussed in Committee, the director of MENCAP wrote:Even if a local network is not perfect, many are and it would be quite wrong to deny parents the support of the relevant organisation, just because some of these organisations may not be able to cope with the situation".He said later:I would go further: should this clause be accepted all these organisations would be eager to extend their existing services and do their best to make the clause work satisfactorily.After all, what would make these organisations better but the involvement of more parents, so that every parent with that handicap in the family has the knowledge to join and take part in the organisations? Their finances would be stronger if parents subscribed to them. Their local effort would be stronger if more parents belonged to them. It would be in all our interests if they were strengthened.
Brian Rix wrote at the same stage, when the matter was being discussed in Committee, saying that changes along these lineswould be a considerable improvement on the present Bill and there appears to be no conflict … as far as these … proposals are concerned".The principle should surely have been accepted from the beginning. It is disappointing to many hon. Members that the Government have sought technical objections to exclude it from the parts of the Bill where in other respects they have been prepared to make improvements. I hope that the Under-Secretary will tell us today that he is prepared to find another way of meeting the objective. Otherwise, we shall have to return to the matter time after 419 time—for example, in another place—because it is generally understood that parents with this difficulty need the support of other parents and of voluntary organisations, and should be told about those organisations.
It is in the nature of large public bodies such as health authorities that requirements such as this are sometimes forgotten or ignored. We want to find a way of making every health authority realise that, just as it must inform parents about a handicap, so it must tell them what voluntary help is available to them. The Bill can do that without spending any money. At least let us achieve that much.
§ Mr. John Hannam (Exeter)
I support the speeches that have been made by the hon. Members for Eccles (Mr. Carter-Jones) and for Berwick-upon-Tweed (Mr. Beith). I particularly support new clause 1. As the hon. Member for Eccles was, I think, helping to land Concorde at the time, I moved a similar new clause on his behalf in Committee. It is good to see the hon. Gentleman present today, and I am glad that he has moved new clause 1.
The two new clauses deal sensibly with the problem of communication at the time of the discovery of handicap in a young child or baby. New clause 1 places the responsibility quite squarely on a health authority to inform the local education authority about a child with special needs. New clause 2 enables parents to be informed of the various support organisations that can help with the handicapped child. Together the new clauses provide a two-pronged process, in that the information will go from the health authority to the local education authority and from the health authority to the parent. We must not forget the importance of keeping parents fully involved and informed Some of the later amendments return to that theme.
MENCAP, the national society for mentally handicapped children and adults, has been particularly concerned about new clause 2 and feels that it should be accepted if possible. It has produced a great deal of evidence which shows how stress and unhappiness can be reduced after the birth of a handicapped child if help, advice, information and good counselling are made available to the parents.
Many clearly defined local organisations can deal with the different handicaps. I am sure that they would be willing to extend their services and help if that was required under the provisions of the new clause. All the evidence points, not to the sudden discovery of a degree of handicap, but more to a gradual unfolding of the degree of handicap, the extent of the difficulty and what should be done about it.
I therefore believe that, taken together, the new clauses will provide the necessary links between the multi-disciplinary teams that already exist and the education authorities, which will now have the new responsibility for assessment from birth.
We talked a great deal about good practice when we discussed this matter in Committee and about how it existed in certain areas but not in others. We said that we wanted to see that good practice spread throughout the country. The proposed changes to the Bill, many of which the Government have accepted, are designed to extend good practice as well as the activities of the multi-disciplinary teams in conjunction with the education authorities.
420 Again and again in Committee we stressed the need for the early provision of information to prevent later damage being caused, both psychologically and educationally, to children. I believe that the changes proposed in the new clause,s will improve the Bill, and I hope that the Government will accept them.
§ Mr. Alfred Morris (Manchester, Wythenshawe)
I understand that new clause 1 flows from exchanges in Committee about the need for the earliest possible identification of special educational needs. This is an important new clause on which I congratulate my hon. Friend the Member for Eccles (Mr. Carter-Jones) and the other hon. Members who put their names to it.
Like the hon. Member for Exeter (Mr. Hannam), my hon. Friend the Member for Eccles is an old hand in this field. He said that he was not a parliamentary draftsman. That may be so, but he knows a good clause when he sees one. What is more, he appears to be very happy with the new clause.
My hon. Friend's work goes back beyond the introduction of the Chronically Sick and Disabled Persons Act 1970, in the making of which, along with my right hon. Friend the Member for Stoke-on-Trent, South (Mr. Ashley) and other hon. Members on both sides a the House, he played a distinguished role. Then, as now, he was intensely concerned to ensure the closest possible working together of agencies, statutory and voluntary alike, that can help disabled people and especially disabled children.
A great deal of knowledge is locked away in statutory organisations that could be of value, sometimes of considerable value, to other statutory organisations. It is said that knowledge is power, but it can also be an important resource. And we waste resources if knowledge is not properly shared in the statutory sector. New clause 1 accepts that proposition and also sets in relief the importance of co-ordination between statutory authorities.
There are two reasons why co-ordination is important. The first is that if the disabled person is to receive the right help, in the right place and at the right time, the left hand of the Government must know what the right hand is doing. I refer to local government as well as to central Government. That is what practical help for disabled people is really all about.
The second reason why co-ordination is important is that, with resources that are always likely to be limited, we must make sure that they are used to best advantage. Only effective co-ordination within and between the statutory authorities, and between central and local government and all the voluntary agencies outside, can ensure that there is a minimum of duplication and waste. As I said, knowledge is about resources as well as power and, whatever else we may or may not be able to afford, we certainly cannot afford duplication or waste.
New clause 1 says that area and district health authorities should, where appropriate, provide information to local education authorities. I hope that the LEAs will not be selfish with information that may be of help to disabled people if it is made available to social services authorities as well or, indeed, to any other authorities. The more we can share information, the better we shall serve the interests of disabled people.
New clause 2 is also important. I want to give praise today to the Voluntary Council for Handicapped Children. The council's work under the leadership of Dr. Mia 421 Kelmer Pringle has been outstanding. She and her colleagues have provided an excellent service for disabled children and their parents.
The single-door policy is important in this respect. If a mother suddenly learns that her child is severely disabled, she can find the number of agencies with which she has to deal extremely daunting. The more that we can direct the parents of handicapped children to one person who can unlock all the other doors of agencies that can help, the more we shall see progress in this important area.
I commend the two new clauses to the House and I very much hope that they will be approved.
§ Mr. Andrew F. Bennett
Most of us found our experience in Committee frustrating and disappointing, because almost everyone involved with the Bill realised that the easiest way to make significant improvements in the education of handicapped and disadvantaged children was to allocate extra resources. But every time we pressed for extra resources we were firmly told that there were none.
That is particularly disappointing in respect of these new clauses, because these were two areas where we felt that we would get small but worthwhile concessions. I welcome all the implications that new clause 1 will be accepted. However, it is disappointing that the Government seem to have had a change of heart and have decided that they cannot give their full support to new clause 2. The Minister ought to give an undertaking that he will have a further look at this matter and at least introduce an amendment in the other place, because I am sure that he will be under considerable pressure to do so.
The Minister must consider the importance of giving people the opportunity for self-help by talking to someone who has experienced the problems, so that as a result of the shared experience they may learn to cope. Most of the people involved in the voluntary organisations at local level have experienced the problem either directly in their own families or through friends. Therefore, others can turn to them for sympathy, understanding and advice on how to cope with the difficult problems that they will face in the first few weeks. They can continue to get help and understanding from them over a longer period. It is extremely important that people should be given the information.
The Minister may say that in some areas there is no appropriate organisation. In a few letters of notification the health authority may have to say "We regret that in your area there is no local organisation, but there is a national body that you can contact". I suspect that if such information were given it would inspire these people to get in touch with others to ensure that in future the same problem did not crop up. In most localities where voluntary organisations have been established it has been because someone has experienced the problems of going it alone and has realised the advantage of sharing the experience with other people with the same problem. If this provision were incorporated in the legislation, even if in a small number of cases it had to be admitted that no useful information could be passed on, in the vast majority of cases it would give people help at a time when they badly need it. I hope that the Minister will have second thoughts.
§ Mr. Dafydd Wigley (Caernarvon)
I support the comments that have been made, from the background of my personal and family experience. I should declare an interest, although in the context of the amendment the interest is not directly relevant, because the circumstances of our two handicapped children are such that they have gone beyond the stage to which the amendments apply. In considering the amendment it may be to the advantage of the House if I refer briefly to my personal experience.
We have two severely mentally handicapped children. One was aged 3 and the other 2 when the information about their condition was made available to us. It had been impossible for the agencies of health, social services and education—although I exonerate social services and education, because they had not an involvement at that stage—to make the information known to us prior to that. I have reason to believe that it might have been possible for the agencies of health to have done so. Therefore, at the age of 3, when the educational process normally starts for a non-handicapped child, we had to contend with the education and other services necessary for handicapped children.
As hon. Members have said, it is a traumatic experience to find that one has a handicapped child. It is an experience from which one learns a lot. I agree entirely with the comments of the hon. Member for Stockport, North (Mr. Bennett) about the benefits that can accrue from shared experience at this stage. When parents find out for the first time that their child is handicapped there is a danger that they do not know how to react. They tend to turn in on themselves and perhaps pretend that they have not heard, or have misheard the information. Therefore, it is important not only that parents are told of the condition of the handicap of the child but that more than information is provided. There should be follow-up facilities to enable parents to discuss their difficulties with others who are experienced in the problems that will face them and to benefit from the experience of others, so that they can more easily face the difficulties that will be involved with their own child or children.
As has been said already, if a group or organisation does not already exist locally that is no good reason why the provision should not be included in the Bill. We found it necessary to set up in our area a parents' group from which, I hope, others have received benefit, as we ourselves benefited from it. That structure exists for the future. If there is a provision in legislation to encourage the establishment of such groups or associations it will be easier to ensure that parents who find out for the first time that they have a handicapped child are able to resort to them.
In the context of new clause 1 there are a few points to which I should like to refer in detail. There is the responsibility of the area health authority not only to pass on to the education authority and to parents the information that there will be a need, or a probable need, for special educational assistance, but to determine whether such a likelihood exists. Obviously the information cannot be passed on either to the parents or to the local authority at the earliest possible stage if the health authority has not done everything possible to determine whether or not there is a likelihood of there being a special need.
In the broadest context of the term, that means that there is a need for screening not only from the age of upwards but prior to birth, so that any handicap or 423 potential handicap can be identified at a very early age. Such is the condition of our two handicapped children that their educational potential may have been greatest in their earliest years. Such children may hit an educational peak, then a plateau, and then a stage of decline. That decline may have set in by the age of 5. Therefore, it is necessary to identify the problem at the age of 0, 1 or 2 in order to take the maximum benefit from the educational potential at that age, so that it can be consolidated before a decline sets in. Unless that is done the opportunities will have been lost.
There is a need for information to be transferred. The only real help that we had when we had to face the special educational needs of our children was from a third party, who had no greater status than that he happended to be a friend of the family and my political agent. This was in the first few weeks after the 1974 election, when I became a Member of Parliament. My friend had the good sense to press us strongly to get in contact with the education authority about special educational needs. Even when one knows that one's child is handicapped and one has been told by doctors that he is likely to need special education at a later stage, one is still likely to say "Let us try him in an ordinary school in the hope that the forecast will not materialise and he will develop like other children." Parents of handicapped children need guidance and help from the experience of others at that critical stage to make the right decision. The decision may go against the grain at that time, but with hindsight parents will identify it as having been the right one.
There are two important points. First, there is the responsibility of health authorities to identify positively those who need help. I take it that the words in the new clause 1,in the course of exercising any of its functionscover that. If it is within the scope of the Minister's portfolio, I should like him to confirm that. Secondly, there is the need for a positive initiative, in the most relaxed and sensitive way, to give parents the information under paragraph (a) of the new clause. It is important not only that the information is given but that there is then the triggering off of teamwork to bring together the health authority, doctors, nurses, the specialist, the paediatrician, the social workers and the educational input, and that there is a named person to whom the parents can turn.
§ Mr. Carter-Jones
May I bring up the term "multi-disciplinary team" which we threw around in Committee? Is the hon. Gentleman asking the Minister to include in the guidelines the essential need for a multi-disciplinary team to assess the needs of the under-five child and say what action is to be taken?
§ Mr. Wigley
I am. I am aware of the comments made on this point in the Warnock committee's report. I do not see how the intentions of the clause, which I understand the Government are likely to accept, can work properly without the existence of a multi-disciplinary team. It is necessary for the proper functioning of the clause and for all the responsibilities under the Bill and other legislation. There is a crying need for it, and for the parents involved to be able to relate to a person who puts them in touch with a team that is aware of the various aspects of the difficulties faced by the child. I welcome the hon. Gentleman's intervention. It underlines the point that I am coming to—the need for the parents to be able to relate to people with expertise in the various facets of the problem.
424 There is need for a positive initiative by the local authority. We have identified the handicap, we have informed the parents and discussed it, we have a support mechanism for those parents and, we have informed the local authority of the problem. There then needs to be a positive lead from the local authority. It is so easy for the parents to sit back and avoid facing the reality of the problem. Therefore, the local education authority must take a more positive line in making suggestions, giving the parents supportive help, and making facilities available in addition to those made available for ordinary children where such "hang-ups" do not exist.
Those three aspects are important. If the benefits that will come from the thinking behind the clause are to be fully realised, the suggestions that I have made need to be accepted.
§ Mr. Frank Field (Birkenhead)
I shall come to the powerful theme of the speech of the hon. Member for Caernarvon (Mr. Wigley), but I first congratulate my hon. Friend the Member for Eccles (Mr. Carter-Jones) on the way in which he introduced this important clause. I am sure that he will forgive me if I concentrate most of my attention on the comments of the hon. Member for Exeter (Mr. Hannam). To sum up his contribution—several hon. Members have touched on the theme of it—if we are to prevent handicap from becoming more serious we have to act quickly, and that is what the clause is about.
My hon. Friend the Member for Eccles reminded us of the importance of the period before birth. I want to remind the House of the importance of the period of birth and the days after birth. As a result of the work done by Geoffrey Chamberlain, we know that a child who does not breathe within the first three minutes of birth will begin to suffer irreparable damage to the central nervous system. At that point it is necessary to take action to limit, if not to overcome, the handicap. The spirit of the clause takes on that information. Let us learn as soon as possible and then try to act to minimise the effect of the handicap.
There are two parts to the clause. First, there is the duty to inform parents and, secondly, there is a duty on the area or district health authority to inform the local education authority. We are now in the later stages of our discussions on a major Bill dealing with the education of handicapped children and young people. Will the Under-Secretary tell us what a local authority will be able to do under the Bill that it could not do before for parents who have a handicapped child of whom the authority will be informed by the area and district health authority.
New clause 2 is designed to help parents and, by helping parents, to help handicapped children. It is about telling those parents of the other organisations and voluntary bodies that will be able to help them. In his reply to my hon. Friend the Member for Bedwellty (Mr. Kinnock) on 26 May the Under—Secretary gave two reasons why the clause would not work: first, because there is no uniform network of support throughout the country, and, secondly, because voluntary bodies are not the right bodies to give parents the news about the handicap of their child. I hope that the Secretary of State is clear, from all the contributions that have been made, that no one wants voluntary bodies to give that information to parents.
We are saying that parents who have been through the trauma of realising that their child is handicapped have a 425 knowledge that no one else has, and that that knowledge should be shared with parents who find themselves in the same position. To argue that that cannot be done over the whole of the country is profoundly anti-Tory. The Minister is posing the Utopian solution—when we have a perfect way forward, we will adopt it. That is the argument that we normally expect to hear from the Opposition, not from the Government. The argument from the Conservative side is usually "Let us build on what we have and improve as we go along". That is good, old-fashioned, Tory sense.
It is surprising that the Under-Secretary of State should say that in his letter. I am sure that he had a copy of the letter that MENCAP distributed to Members of the Committee and to other hon. Members who were interested in this subject. The association said that to start by giving this special responsibility to voluntary bodies might improve the service that they can give. The association has also said that it has no wish to have the responsibility of telling parents the first news about the handicap of their child.
I understand that the Government smile on new clause 1, but have doubts about new clause 2. We want the Under-Secretary of State to think carefully about the arguments that have been put in the debate. That is what I intended to say before I rose to my feet. We have now had the benefit of hearing the hon. Member for Caernarvon, who made a powerful contribution of a kind that few of us could have made. I hope that on the basis of that contribution alone the Minister will say that the Government will examine this idea and perhaps report more favourably in another place. If he cannot give us that undertaking, we shall press new clause 2 to a Division.
§ The Under-Secretary of State for Education and Science (Dr. Rhodes Boyson)
We have had a good debate. There was also a good debate in Committee on the various factors in the Bill. All members of that Committee were concerned about what was happening to children below the age of 50. There was also much concern about the 16 to 19-year-olds, but were particularly concerned about the children in the former group.
Everyone who has spoken today has done so with genuine concern. I quote as an example my hon. Friend the Member for Exeter (Mr. Hannam). The hon. Member for Birkenhead (Mr. Field) gave me a little lesson on Toryism. I am always prepared to learn. The idea was that we do not wait for a utopian society, but progress step by step. I commend to the House the Government's attitude, which is completely within that philosophy. We must not go too far at the beginning. We must not put at risk the advances that we are making. We must create a climate of opinion that will take us on further. When I listened to the hon. Member for Birkenhead I realised how much of what he said was the Government's philosophy in the clauses that we are discussing.
Because of the debate in Committee we said that we would consider the matter and see what we could do for children under the age of 5. Reference has been made by the hon. Member for Berwick-upon-Tweed (Mr. Beith) to that debate and to what I said.
I said: 426New clause 2 is nearer to what we can accept than new clause 1 … The Government have no objection to the principle or to the new clause imposing on health authorities a requirement to a inform both the parent and the local education authority at the earliest possible time and, one trusts, with the degree of compassion that was mentioned by the hon. Member for Isle of Ely this morning, of the special needs of that child."—[Official Report, Special Standing Committee, 2 April 1981; c. 478]New clause 1 says that the parent and the local education authority must be informed. I do not think that anyone would disagree with that sequence of events. It is basically the duty of the health authority to break the news first. The hon. Member for Caernarvon (Mr. Wigley), who spoke so feelingly and sensibly on the matter, will agree with me. This is a considerable advance on what existed before, when there was a large gap. We have tried to do what we can to cover that gap.
The local health authority must notify the parents if there is a handicap. The hon. Member for Caernarvon asked me for an assurance that that was part of the duties of the local health authority. That is so and I shall reply to that point. It is not a duty for that authority to screen all children. However, the Bill will make it a duty, if the child crosses its path, as it were, or if the authority examines the child. Once that happens the authority will have a responsibility to see the parents and to inform them and the local education authority. The hon. Member for Birkenhead asked what difference that made. Having received that information, it is the responsibility of the local education authority to do something about it.
That responsibility did not exist before. We shall see how far that responsibility goes. There is now a difference of onus of responsibility. The authority is informed, because the risk is that in the bureaucracies that build up in our society, in large bodies, one section has information and another has not. This attempt was within the philosophy towards the Bill and was agreed by both sides of the Committee, as I am sure it will be agreed here.
There are two factors. The parent is particularly important. We have enshrined far more powers than previously in the Bill. Secondly, we have said that the local education authority can now do something about the matter.
If the House accepts new clause 1, which I commend, our Department will consult the Secretary of State for Social Services on the content of post-legislative guidance to ensure that health authorities appreciate the provisions of that clause—which applies not only to children between the ages of 2 and 5 but to small babies—and the ramifications of what is being done. That matter was raised by the hon. Member for Eccles (Mr. Carter-Jones). The hon. Member for Isle of Ely (Mr. Freud), who is absent today on other duties, spoke to me about the matter. He was involved, as well as the hon. Members for Eccles and Exeter. We helped with the drafting so that an advance could be made.
The Government cannot accept new clause 2 as it stands. There are two factors in new clause 2. The first is that it is proposed that it should be the duty of the National Health Service to acquaint the parents of a handicap at birth of or on identification of the handicap. No one objects to the identification of the handicap. There may be a difference of opinion about the timing. The second factor 427 is that the NHS shall acquaint the parents of the existence and whereabouts of a support organisation after six weeks, in writing.
Therefore, the first factor is the question of the parent being informed almost at the point of birth. The second factor was referred to by the hon. Member for Stockport, North (Mr. Bennett). That factor is informing the parents about the support organisations that are available.
§ Dr. Boyson
The clause refers to informing the parents about those organisations after six weeks, in writing. One cannot inform the parents of that unless they have been informed about the handicap in the first place. Therefore, the first point is subsumed. The clause specifies the time of identification. It does not leave it to the sensibility of the health authority to do that as soon as possible, which I am sure would be the view of most hon. Members.
Despite our respect for the support organisations and the good work that they do, we do not feel that the local education authority or the health authority should be tied down to provide that information. We feel that in cases where that is advisable, that will be done. When drafting a Bill, there is always a risk of over-legislating. Time and again the local education authorities have raised the matter of the amount of legislation in the Bill. There is nothing to stop a local education authority or the health authority informing parents about support organisations at the moment. That practice could be developed. We do not feel that it is necessary to put it in legislation. The clause says that the Nation al Health Service must acquaint the parents of the handicap and of the whereabouts of the support organisation at a certain time. That is what we disagree about.
With regard to timing, if the mother is suffering from post-natal depression I do not believe that the enforced time of information bound to apply under new clause 2 would be ideal for the parents to be acquainted of the handicap. I shall return to the question of timing, because timing is specified in new clause 2. The hon. Member for Birkenhead suggests that I should take it out, but at least I am talking about information being given at a certain time, which is in the clause.
There should be flexibility in building on a better practice. What we have done in accepting new clause 2, which I trust the House will accept—[HON. MEMBERS: "New clause 1."] I meant to say new clause 1. I was brought up on the tables and I immediately move on from 1 to 2. Before the House becomes too alarmed or too enthusiastic about that, I shall rephrase it. I hope that the House will accept new clause 1.
§ Mr. Kinnock
The hon. Gentleman has just informed me of what he is doing. At 8 am, when we have gone right through the night, he usually sounds as if he is on his 163 times table.
I wish to ask the hon. Member about some matters concerning new clause 2. Does his rooted objection arise solely because of timing? Would he be prepared to consider another form of amendment that removed the problem of trying to specify the time too closely?
428 My second point arises specifically from what he said. While mothers suffer post-natal depression, even in the event of producing children who have no obvious handicap of any description or any special educational needs, physiologically and psychologically, fathers do not. Fathers are extremely important in the process of post-natal adjustment to the difficulties that may arise for new parents as a consequence of having a child with obvious needs.
Thirdly, had we been able to rely on local education authorities, area health authorities or any statutory body, to ensure that parents knew of the support organisations, hon. Members would not have gone to the trouble to table an amendment specifically requiring that the duty be laid. Is the hon. Gentleman not aware, first, of the importance of support organisations and, secondly, of the need, without over-legislating, for a system that will ensure that the necessary information reaches parents likely to be affected?
§ 5 pm
§ Mr. Carter-Jones
I asked whether the hon. Gentleman could show in the guidelines the requirement that the information should also refer to neonates. He agreed, and at the same time nodded. We should have that gesture on the record and in the guidelines. Will he give a firm undertaking that in the other place a subsection (c) will be added to new clause 1 to the effect that the authority shall also be responsible for informing parents of the whereabouts of voluntary organisations? It would overcome the difficulty. The guidelines would cover neonates and deal with the six-week period, and new clause 1(c) would cover the other point. I trust the hon. Gentleman. The House would accept an undertaking from him.
§ Dr. Boyson
I gave way to the hon. Member for Bedwelty (Mr. Kinnock) and then to the hon. Member for Eccles, as I know that everyone has the best interest of children and parents at heart. We shall consider the suggestion of the hon. Member for Eccles before the Bill goes to the other place to see whether it should be a duty on health authorities to inform parents of local support organisations, but I cannot say more than that.
§ Mr. Carter-Jones
The other assurance that I should like is that the guidelines will contain a reference to neonates, which will meet the six-week argument. A neonate could be a newly born child, without definition of time.
§ Dr. Boyson
The hon. Gentleman is naughty. He pushes me further and further. He is a greater expert on neonates than I. I had to draw on my classical education to analyse what the word meant. I had never before used it, so I had to practice how to pronounce it. I can go no further than my assurance that we shall consider his suggestion about support organisations. Later guidance involves other Departments. We consulted the Department of Health and Social Security before the clause was drafted, so we had its full co-operation.
§ Mr. Field
Will the hon. Gentleman state clearly what he is offering? He has said that he will look again at new clause 2 before it goes to the other place, so what has been said this afternoon to lead him to believe that it is worth 429 while to reconsider? We do not want to miss the chance to vote on the new clause and then find that nothing happens.
§ Mr. Beith
The hon. Gentleman is moving to a position that we might all find acceptable. He left the Committee and the voluntary organisations with the clear impression that he welcomed the principle of informing parents, and he has addressed himself today to legitimate arguments about timing. The new clause is tabled in the same form as in Committee, because so far the hon. Gentleman has not been able to use the Department's drafting skills to incorporate the principle, which he is prepared to accept, in new clause 1. There is an opportunity in another place to include the principle in the ramifications of the Bill in a clear form. That is what we all seek, and I do not believe that the hon. Gentleman will argue against it.
§ Dr. Boyson
The last thing that I want to do is to mislead the House. Apart from my sense of honour, we shall all meet again tomorrow.
I give an assurance that before the Bill goes to the other place we shall see whether we can include in new clause 1 a provision that local health authorities have the responsibility to inform parents or local support organisations when they inform them of the child's handicap. I do not believe that we shall disagree about timing, and the hon. Member for Eccles made a suggestion about that.
I was asked why I had given the undertaking. It is a non-party Bill, and we are not trying to bulldoze it through the House. We have tried to get the Bill right, within financial and other restraints. Hon. Members on both sides of the House have been helpful this afternoon, and from their experience hon. Members believe that the matter may be of greater importance than we originally thought. Accordingly, it would be remiss if we failed to respond.
I commend new clause 1 to the House, and, although I cannot commend new clause 2, I have given an undertaking to look at the matter before the Bill goes to another place.
§ Mr. Carter-Jones
This has been an interesting and rewarding debate. Sometimes there is a bonanza and one gets a large piece of salami. At others, it has to come slice by slice. We have won a slice today. My hon. Friend the Member for Birkenhead (Mr. Field) tells me that our debate will be read and noted in the other place. I accept the Minister's word. He is an honourable man.
§ Question put and agreed to.
§ Clause read a Second time and added to the Bill.