I am grateful to you, Mr. Speaker. for the opportunity to bring before the House the importance of the early diagnosis of deafness where it exists in children. My attention was drawn to this problem by Mrs. Kathy Robinson of Marske, which is just outside my constituency of Redcar. However, in the past few weeks I have received moving letters from many other parents with similar tales to tell.
Ever since her own sad experience, Mrs. Robinson has sought to draw public and parliamentary attention to this problem. She has written many articles on the subject and she is writing a book that will tell the story, which is confirmed in many of the letters that I have received. It is a harrowing tale.
Mrs. Robinson's elder daughter, Sarah, was almost three years of age before she was diagnosed and classified as profoundly deaf. That meant that she had never heard her mother's voice. She had no concept of simple, basic words or sounds such as Mum or Daddy. She was, in a way, a prisoner of silence. Apart from the savage irony of the tinnitus sounds in her head, she has heard nothing.
It was small wonder that Sarah was troublesome. She would scream and beat her head against the wall. She often refused to go to bed. It was three years before she was diagnosed as deaf. Sadly, her younger sister, Joanne, was similarly afflicted, although not so severely, and her condition was not diagnosed until she was nearly two years of age. We can only try to imagine the awful pressures on the children and the strain on the parents, devoted as they are.
The strains were not eased by the long fight to enable Sarah to attend the local school, which her parents, after much careful thought, decided was in her best interests. Their wisdom has in her case been confirmed by events. I am glad to say that the two girls live a happy and normal school life. They have many friends who take them for themselves as people. They take their deafness for granted and have learnt to communicate with them readily. Most important, they accept the girls for what they are, as individuals.
The girls now feel that they belong. I hope that the Under-Secretary of State's colleague in the Government who is responsible for special schools will take note of what I have said. Not all parents have been successful in this part of their struggle for a normal life for their children.
I congratulate my hon. Friend the Member for Redcar (Mr. Tinn) on initiating this timely debate. He referred to the considerable importance of integration for handicapped children, not least for deaf children. Integration was one of the principal themes of the International Year of Disabled People, for the good reason that without positive steps to integrate the handicapped they are doubly disadvantaged by, first, their disability and, secondly, by social exclusion from their peers.
As my hon. Friend has said, not all parents have succeeded as Sarah's did in achieving educational integration for their children. I honour them for their dedication and their recognition that exclusion from the society of able-bodied children compounds the handicaps of disabled children when they leave school. Very sadly, the Education Act 1981, which was based on the Warnock report, was not backed by the resources to carry Mary Warnock's recommendations into full effect. It was an Act without any resources.
I have a deaf child. My daughter was born deaf, but I was one of the lucky ones, because my wife was afflicted with rubella and we knew that there was a risk of deafness. As a result, we had the advantage of early diagnosis, treatment and education. There is not the slightest doubt that if the diagnosis is not made early the critical ages of one, two and three, when the right instruction can be given, are missed. The children are often treated as backward. They miss the educational opportunities which would help them to speak and learn to read and write. I am grateful to the hon. Member for Redcar (Mr. Tinn) for bringing forward this debate and I hope that the Minister will take full account of the problem, which calls for action.
I am grateful to the hon. Member for Gordon (Mr. Bruce) for his contribution. It is important to diagnose deafness at the earliest possible opportunity so that the marvellous early months of a child's development are not completely bereft of the aural communication with others which was denied to Sarah and which we know to be important. By the time deafness is diagnosed, it is at present probable that three valuable years will have been lost. From six to 12 months is the age during which a baby develops many information-processing abilities—to use the modern jargon. I am sure that the Minister fully recognises the need. The doubts that I have are about the manner in which his Department proposes to meet the need and the extent to which we are currently failing to do so.
My anxiety is increased by the fact that only half of all the children discovered to be suffering from deafness are diagnosed by their third year. The consequence is that the uphill struggle towards communication and understanding is made even more difficult and the child's adaptation to his or her environment is unfortunately and, I believe, unnecessarily delayed. That is surely the measure of the challenge. I ask the Minister not merely to confirm his commitment — I believe that we can take that for granted—but to demonstrate by action his determination to meet the challenge. We want to hear his proposals.
I am disturbed also by the disparity in the provisions made by responsible authorities in different parts of the country. The senior clinical medical officer for audiology in the community child health services in Liverpool told me that they had been able to reduce the age of diagnosis to under two years, and in the majority of cases to under one year. That is most encouraging. I give full credit for it, but what about the other areas? Will the Minister give us detailed information to enable us to assess the performance of each authority? I do not expect him to provide it tonight, but I trust that he will promise to do so in the near future. We are surely entitled to know the facts. The public in each area are entitled to know how well or badly their authority is performing. That must be the least that the Government can do.
I should like the Minister to do rather more than that. Legislation in this area might not be acceptable to him, but the Government have not usually been reluctant to put pressure on local authorities, so why not a little pressure in this worthy cause on any health authority found to be lagging? In 1981 the Health Visitors Association conducted a survey which, like an earlier one in 1977, showed, among other things, a lack of standardisation in nearly all aspects of screening. There was variation in the age when the screening took place and in the training given to those responsible for the screening. Those disparities exist between regions and within regions. Will the Minister consider some way of enforcing an accepted, standardised procedure? Many people will be anxious to hear and be interested in his answer.
What troubles me most is the fallibility of the present screening tests. I note with concern the finding by the National Deaf Children's Society in a survey that no fewer than 41 per cent. of hearing-impaired children were not correctly diagnosed at their first screening. It is not much use having early screening, for which I am asking, if it is inaccurate. I should be glad to have the Minister's views on the auditory response cradle, which can detect impaired hearing at a very early stage. Evaluation studies are going ahead. When does the Minister think they will be completed? Again, however, a doubt arises. The value of early diagnosis from more precise and dependable techniques operated by skilled personnel is considerably eroded if there is subsequent delay in back-up procedures. At present it can take several months before diagnosis is followed by supportive action. I ask the Minister seriously to find ways of shortening that time lag.
I ask the Minster to consider ways of inducing, persuading and even if necessary pressurising parents to keep appointments that have been made for their child to be examined. I am told that there are a woefully large number of broken appointments. Persuasion is preferable to compulsion, but I hope that the Minister will be prepared to consider a sanction, perhaps the withholding of child benefit, when parents deliberately fail to give the health of their child the priority that it deserves.
The Minister has paid close attention. I am grateful to him for that. I am sure that he will be sympathetic in his reply, but the many parents of deaf children who wrote to me will want more than sympathy. We all want effective action, and we look to the Minister to provide it.
I am grateful to the hon. Member for Redcar (Mr. Tinn) for raising this subject, because it is important. It is my first appearance at the Dispatch Box with the duties of Minister responsible for the disabled. I hope that it will be encouraging to the many deaf people and people with deaf children that my first three engagements as Minister have been with organisations concerned with the problems of deaf people.
Last week I attended a reception here, with the right hon. Member for Stoke-on-Trent, South (Mr. Ashley), for the launch of a directory for the disabled, published by the Charities Aid Foundation. On Saturday morning I had a fascinating time, partly on a boat on the Thames, with a large group of deaf people who worked together with many people from ITV and BBC who produce programmes with subtitles and so on for the deaf. It has given me, even in a short space of time, greater insight into the problems that underlie those that the hon. Member for Gordon (Mr. Bruce) has personally experienced, and which the hon. Member for Redcar and the right hon. Member for Manchester, Wythenshawe (Mr. Morris) touched on. Therefore, I welcome this opportunity to speak tonight.
I am conscious of the work that the hon. Member for Redcar's constituent Mrs. Robinson has done, in the light of her unhappy and distressing personal experience. Her work in publicising and helping to understand the needs of deaf children has been much appreciated by my Department and by many others. Departmental officials have contacted Mrs. Robinson and they have been much impressed by what she has done. They suggested that she should work with one of the voluntary organisations such as the National Deaf Children's Society which has special expertise in this sphere thereby making the most of the valuable contribution that she has made.
I do not want to underestimate the vital importance in screening all children for hearing defects at an early age and to ensure that action is taken quickly to diagnose, assess and treat any child in whom a hearing loss is suspected. Just as my Department is grateful to Mrs. Robinson for her work as an individual, so are we grateful to the National Deaf Children's Society for its recent report called "Discovering Deafness". Unfortunately, the National Deaf Children's Week, during which the Society had hoped to focus more attention on this topic, took place during the first week of the general election campaign, so attention by politicians and the public was somewhat distracted. I am pleased that we have this early opportunity after the election to discuss the subject. I welcome the chance to acknowledge the contribution that has been made during the years by the National Deaf Children's Society and the other voluntary organisations that are helping the public to understand the needs and problems of hearing impairments in children and that of their parents.
The hon. Member for Gordon (Mr. Bruce) said that the early detection of hearing loss is essential because of the implications that such a loss has on a child's emotional, social and language development, and therefore there is an imperative need, wherever possible, to counter that damage at the earliest possible moment. That is why, along with the National Deaf Children's Society, I welcome what has already been a significant improvement in the services in recent years. In saying that, I do not intend to say to hon. Members or to the public that there is any room for complacency, as there is not. We must ensure that the improvements that have taken place, as acknowledged in the survey by the Health Visitors Association, to which the hon. Member for Redcar (Mr. Tinn) referred, not only must be maintained but built upon. The Government have given much attention to this topic. "Care in Action", which is the Government's handbook on the policies and priorities for the health and personal social services, and was published in 1981, stressed the importance of health promotion and preventive medicine programmes. It is not easy to ensure adequate coverage in community health service programmes, but hon. Members will be pleased to know that take-up of these preventive child health services continues to improve at an encouraging rate.
The Department stresses the importance of the early detection of hearing loss. In 1980 the Department's paper entitled "Prevention in the Child Health Services" stressed screening for hearing impairment as an essential element of health surveillance. The Department has also endorsed the recommendation made to it in 1981 by the former Advisory Committee on Services for Hearing Impaired People that as a minimum all children should be screened at about eight months old and during the first year at school.
I am pleased that health authorities appear to have adopted a policy of screening all children for hearing loss at about the eight or nine month stage, although in some instances further progress can be made in implementing that policy.
Auditory screening tests on very young children are difficult to perform and we must accept that in the present state of the art, they are not always completely successful. The Department's paper on "Prevention in the Child Health Services" emphasised the need for health visitors to be appropriately trained to carry out screening tests of hearing and vision.
As the hon. Gentleman said, a comparison between surveys conducted by the Health Visitors Association in 1977 and 1981 showed that the provision of routine screening for the under-fives and the training of health visitors to carry out such screening improved considerably between the two dates. There is no doubt, however, that the provision of adequate training is still an area of concern and one to which we must continue to give attention pending developments in new screening techniques.
As the hon. Member for Redcar also said, for some time there has been interest in and speculation about the possibility of detecting hearing impairment at the neonatal stage. As the hon. Gentleman and other hon. Members will know, there has recently been a most interesting development in this area. With the help of Government funds, a device has been developed to test the hearing of newly born babies. The Linco Bennett auditory response cradle uses a computer to analyse the baby's response to sounds delivered automatically. It is still at the research and evaluation stage and it will take some time to evaluate it properly because the number of children involved is relatively small so that the period necessary to build up a sufficient sample for a proper evaluation will be quite long. At present there are three such cradles.
Yes, indeed. There are three such cradles already in place and we hope to have a further eight installed shortly, four financed from Department of Industry funds as the techniques involved are of interest to that Department, and four from DHSS funds. I hope that that will give us more experience and allow us to speed up the evaluation process about which the hon. Gentleman is rightly concerned.
Talking of funds, my hon. Friend the Member for Redcar (Mr. Tinn) rightly placed strong emphasis on the importance of educational integration for Sarah. He wanted more children who are profoundly deaf to be integrated into mainstream education. Does the Minister accept that that is impossible unless more resources are provided for the purposes of the Education Act 1981? If as Minister with responsibility for the disabled he has co-ordinating responsibilities between Whitehall Departments, what action is he taking to secure more resources for that purpose?
I was intending 10 touch on the importance of the Education Act 1981, but at this moment I must resist the right hon. Gentleman's assumption that all progress depends on finding additional resources. Of course it is always possible to do more with additional resources, but I believe that is a defeatist approach to assume that nothing can be done within existing resources by education authorities in this matter and health authorities in others examining their own priorities and gearing the way in which they provide services to deal with the problems that the right hon. Gentleman rightly stressed.
I do not seek to resist the importance attached to this by the right hon. Gentleman and indeed Mary Warnock, to whose work in preparing the report which led to the Education Act 1981 I pay tribute. In this as in many other matters with which a Minister with responsibility for the disabled or indeed any Minister in any Government has to deal, it is always helpful to be able to find additional resources. I do not deny that, but I must resist the common and, in my view, rather defeatist assumption in some quarters, especially among the Opposition, that no progress can be made without additional resources and that it is not possible to achieve some of the objectives that we all seek by examining the ways in which existing resources are used.
Will the Minister comment on the reconsideration taking place in my area? I understand that Grampian regional council is considering reversing or partly reversing the decision to provide funds for the integration of the Aberdeen School for the Deaf with the Linksfield Academy because the local authority feels that the needs of 60 children compared with the needs of the greater number of children who do not have this problem require it to reconsider committing funds for the integration of the two schools. That suggests that local authorities are finding it necessary to cut back in this area.
The hon. Gentleman will not expect me to comment off the cuff about a local education authority, especially one in a part of the country where my right hon. Friend the Secretary of State for Scotland has a particular responsibility. I shall certainly draw to the attention of my right hon. Friend what the hon. Gentleman has said, and no doubt he will take note of it.
I had mentioned the importance of securing the fastest possible evaluation of the new Linco Bennet auditory response cradle to which the hon. Member for Redcar referred, and I hope that it was encouraging to him to hear me say that the Department hopes shortly to increase the number of those machines.
In view of the interventions. I must curtail much of what I had hoped to say this evening about the provision of aids once the screening has been done and the diagnosis made. The National Deaf Children's Society report drew attention to disparities between the regions. Our officials are in touch with the society and have asked it for the evidence that it has on, for example, the regional variations in the provisions of hearing aids and in the provision of peripatetic teaching or other educational support. We shall do what we can in the light of those discussions on the evidence produced by the society.
We expect health authorities to accord priority to the provision of aids to children, and in recent years we have extended considerably the standard range of hearing aids available under the National Health Service. We must still improve the range of aids suitable for young children, and I have no doubt that modern micro-electronic technology has an important part to play in that. In this connection, the Department has asked the Medical Research Council to consider the needs of young children in the context of work on design requirements for aids.
It has been a common theme in the speech of the hon. Member for Redcar and in the interventions by other right hon. and hon. Members that one of the most important issues affecting all children, including those who are deaf and disabled, is their education. Those matters are, in the first instance, for my right hon. Friend the Secretary of State for Education and Science, but I am sure that he would agree that for children suffering from a significant loss of hearing early identification is critical, and the sooner that intervention and education begin, the greater the likelihood of positive and lasting benefit. The Education Act 1981, the remaining provisions of which came into force on 1 April this year, opens the way for educational arrangements to be made without delay wherever they are required. The Act follows the concept recommended by the Warnock committee of making, where necessary, a multi-professional assessment of a child's educational needs as a whole rather than concentrating on his specific disability. Section 10 of the Act places a duty on health authorities to inform the local education authority when they form the opinion that a child under the age of five has, or is likely to have, special educational needs. In the case of the hearing impaired child, that will enable the education authority to take early action, where appropriate, and thereby to minimise some of the consequences of the impairment.
I have taken careful note of the comments of right hon. and hon. Members tonight, and I shall bear them in mind and draw them to the attention of my right hon. and hon. Friends at the Department of Education and Science. I hope that it is of some comfort to Opposition Members to know that I was a member of the Committee that discussed the Education Act 1981, that my hon. Friend the Minister for Social Security was then the Under-Secretary of State for Education and Science responsible for piloting through the Bill, and that the Minister's Parliamentary Private Secretary, the hon. Member for Rugby and Kenilworth (Mr. Pawsey), who is sitting behind me, was also a member of that Committee. Hon. Members need have no doubt about our interest in and enthusiasm for seeing the principles of that Act carried through into reality, not only for deaf children, who have been our special concern tonight, but for all the disabled children whom the Act was designed to benefit and whose interests I shall advance in my new job.
Question put and agreed to.
Adjourned accordingly at twelve minutes to Eleven o' clock.