Augmentative and Alternative Communication Services
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The Minister of State, Department of Health (Norman Lamb)
I am really grateful to my hon. Friend the Member for Blackpool North and Cleveleys (Paul Maynard) for raising this issue, and for his work, together with that of colleagues, as a member of the all-party parliamentary group on speech and language difficulties. An occasion such as this is particularly valuable, as was the meeting that we had yesterday, in ensuring that Ministers focus on issues that might otherwise not get attention. I learned a lot from the meeting yesterday, and from my hon. Friend’s impassioned speech today. He clearly speaks with real authority on this subject. I was struck by his point about the lad who ended up with a PhD as a result of the support that these facilities can provide. He made the point very powerfully that they can change lives.
Augmentative and alternative or assistive communication is one of the more specialised areas of health and education provision. The number of children who will require support in this way is relatively small, perhaps less than 0.5% of the population, so it is important that we do not lose sight of them. My hon. Friend rightly made the point that the ability to speak and communicate is a pretty basic human right, and that it should be recognised as such.
Augmented communication has the potential to have a tremendous beneficial impact on the health and well-being of those whose condition places barriers between themselves and others, which until recently were insurmountable, and indeed, on their families and friends. Technological and therapeutic advances have in recent years revolutionised the support that can be given to those who have lost, or never had, the tools of speech and language that allow us all to interact and that are critical to development, to education, to work and to living one’s life. Augmentative and assistive communication—AAC—aids range from tools for paper-based communication to pretty sophisticated electronic equipment.
Support in the past has not always been of sufficient consistency and quality, and the Bercow review in 2007 and the subsequent work of the Communication Champion, Jean Gross, have helped to identify systemic improvements, culminating in a new approach to the commissioning of AAC that began just a few months ago. It is worth pointing out that the new system is in its very early days. I was pleased that my hon. Friend acknowledged that it had the potential to work effectively. It is perhaps understandable that we have not got it quite as we would want it to be, given the early stage that we are at, but I agree that it has enormous potential. There is significant clinical consensus behind the new approach, and I am proud to say that it has been developed from the new structures of commissioning that this Government have introduced into the NHS.
In April this year, NHS England took on responsibility for the direct commissioning of specialised assessment and the provision of augmentative and assistive communication aids for adults, children and young people. NHS England’s role as an independent national commissioner is particularly suited to the effective commissioning of extremely complex, yet relatively low volume, services of this kind. Let us bear in mind that the patients who require AAC aids have extremely complex needs and in many cases require bespoke equipment that has been designed for them. My hon. Friend the Member for Totnes (Dr Wollaston) mentioned the training involved in the use of such equipment. It could not feasibly be provided by small-scale local services. Assessment and provision is needed by specialised tertiary providers with their concentration of expertise.
Previously, we had no national commissioning of AAC services and improvement across the board was essential. There was no standard or nationally consistent definition of those services, which were the commissioning and funding responsibility of the NHS. The effect of that was variation in the organisations commissioning and funding specialised AAC services and, crucially, inequitable access to them. There was a mix of non-NHS commissioning agencies, including social care and the education sector, to which my hon. Friend referred, and charity and third sector funding agencies that were commissioning the assessment and provision of specialised AAC aids. It was haphazard, depending very much on where people lived. That was unfair to those in need, and far from ideal for commissioners or providers.
That has now changed. NHS England—committed to ensuring national consistent commissioning of high quality, equitable and effective specialised services—has worked with the expert partners on its clinical reference group for complex disability to develop for the first time a nationally consistent specification for specialised AAC aids, which was subject to public consultation. The specification has allowed a clear demarcation of the responsibilities of clinical commissioning groups in relation to less specialised AACs—around 90% of the total provision. The highly specialised services will be commissioned by NHS England. It will be an important role for NHS England to work to support CCGs in their commissioning of the less specialised end of the spectrum and to ensure that we build capacity rather than lose it, as my hon. Friend feared could happen. If we get this right, the potential of having this specialist team working nationally with local commissioners could be significant.
In implementing the specification, NHS England will draw on the recommendations of the Bercow review and the Government communication champion to consider, in particular, how best to ensure more consistent and responsive commissioning of AAC aids across England and the implications of meeting unmet need. We know from recent research from Communication Matters that there is variation in service provision across England—the postcode lottery to which I referred—and inconsistency in identifying, assessing and providing AAC services.
A key priority is therefore to ensure that commissioning arrangements for this specialised service are placed on a much more robust and equitable footing across England. NHS England is working with its clinical reference groups and area teams to identify areas where there may be inequalities and where additional resources may be required to bring about better access. The clinical expertise both embedded in the organisation and accessed through its close association and close partnership working with organisations such as ACE—Aiding Communication in Education—will be decisive in this. I met Anna Reeves of ACE yesterday, and I would like to pay tribute to the amazing work she has done in leading the case for much better access to these services. She has worked tirelessly in that regard and should be credited for doing so.
I would also like to acknowledge the potential benefits of clinically-led commissioning of services for children with special educational needs as part of new joint arrangements, which will also provide far more tailored support, focused on the health and lifestyle outcomes for the child, for the developmental needs of children who require AAC aids. The Children and Families Bill sets out a framework for a new integrated approach to meeting the needs of children and young people with special educational needs. This will include many children, potentially the majority, of children in need of AAC aids.
In brief, the Bill’s provisions will get clinical commissioning groups and local authorities—and, in some cases, the NHS Commissioning Board, where it is acting as a commissioner of services for a child or young person—to enter into joint arrangements to assess, plan and commission the services needed by children and young people with special educational needs. Each child’s improvement outcomes, and the services they need to deliver them, will be captured in the education, health and care plan, to which the relevant commissioners will contribute. That is a much more joined-up approach than we have ever had in the past.
The new arrangements will be introduced in 2014, Parliament allowing. Twenty pathfinder local authorities are piloting new approaches to integrated assessments and the plans currently. The amended Bill now includes a duty on CCGs to secure the services that they agree the individual needs and which comprise the education, health and care plan. We have specifically required in the mandate for the NHS—the Government’s priorities—the need for improvement, through partnership working, to support children and young people with special educational needs and disabilities, and for ensuring that children have access to the services identified in the agreed care plan. AAC support will be a significant part of these plans for many children.
NHS England and CCGs will need to work closely with local authorities and, of course, health and wellbeing boards, which will include the local authority director of children’s services and the local healthwatch. That is the vehicle for a consensual local identification of needs and a local strategy for meeting them. The health and wellbeing board must, as our guidance makes clear, have particular regard for hard-to-reach groups and those with complex conditions, which will require more specialised health services, as well as ensuring it has an in-depth understanding of more widespread health needs among the population.
Mr Andrew Smith (Oxford East) (Lab)
I congratulate the hon. Member for Blackpool North and Cleveleys (Paul Maynard) on initiating this important debate. In the allocation of resources and the approval of plans, what mechanisms for appeal will there be for individuals who feel that they have not been fairly treated, or indeed for areas that feel that?
Norman Lamb
There will be the potential to challenge and question to ensure that the individual is satisfied that their case has been properly heard, but I will also write to the right hon. Gentleman to fill in the details further to ensure that he understands the position fully.
Let me make a quick point about the historical budgets to which my hon. Friend the Member for Blackpool North and Cleveleys referred. To start with, NHS England has worked on the basis of the amount spent hitherto. It is important to say that work is very much ongoing on this matter, and it is absolutely recognised that it is important to get it right and to assess the level of need so that we can identify how much needs to be spend on it. This is not a done deal and he should not assume that this is the end of the story. He also made a point about organisations with great expertise which could be excluded from being able to play a part in this. I can reassure him that they will be able to bid to do work. He also made the point about loss of equipment on leaving school, and it is really important that that is avoided; that sort of thing is utterly crazy and we must ensure continuity. As he rightly said, this is a health issue and it must be recognised as such. He talked about the hub-and-spoke issue. The relationship between the expert team nationally and the CCGs has the potential to work well to build capacity within the system to improve the level of expertise available and to ensure a more consistent approach.
I hope that what I have said today provides significant reassurance to hon. Members about the robustness of the new approach to deliver AAC aids, not least in the role of NHS England in leading the development of expert service specifications and implementing them in a national programme of commissioning to deliver improved and responsive communication support. We are not complacent and, together with NHS England, we understand that more needs to be done to ensure absolute consistency across England, so that everyone who needs it has access to high-quality, equitable and effective AAC support. We have in place the right system to deliver that; my profound belief is that we will shortly be able to recognise NHS England, in this regard, as an exemplar of the effective design and commissioning of specialised services.
Question put and agreed to.