Plenary, 19 Jan 2006

Meeting date: Thursday, January 19, 2006

Official Report 727KB pdf

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Communication Impairment

The final item of business is a members' business debate on motion S2M-3245, in the name of Nanette Milne, on communication impairment. The debate will be concluded without any question being put.

Motion debated,

That the Parliament notes that there are an estimated 250,000 people in Scotland who have communication impairment; recognises that communication impairment can affect every waking moment of a person's life and that those affected by communication impairment, by definition, are not easily able to speak up about their needs, and believes that the Scottish Executive should take immediate steps to support quality social action research in order to develop a comprehensive and coherent framework for action on communication impairment in Scotland.

I have brought the motion before the Parliament on behalf of the short-life working group on communication impairment, or CI, as communication impairment is also known.

I am grateful for the significant cross-party support that the motion has received. I also acknowledge the drive and enthusiasm of Kim Hartley and her colleagues in the Royal College of Speech and Language Therapists, as they doggedly strive to improve life for all those who have communication support needs. Kim is in the public gallery along with some of her colleagues. With the permission of the Presiding Officer, I extend a warm welcome to them.

Many people in Scotland suffer from impaired communication; there are probably around a quarter of a million of them, although there are no accurate figures, because many have not been identified. If the estimated numbers are right, the average Scottish constituency will have about 3,000 affected people.

People with CI have difficulty understanding the spoken and/or the written word and/or other non-verbal means of communication. They find it hard to express themselves and to find the language to communicate in a meaningful, appropriate or socially acceptable way. Of course, that affects their ability to interact with other people.

The number of people with hearing and visual impairment and their needs are quite well known, but there are many more with communication support needs, which arise from a wide variety of medical and physical conditions, such as strokes, head injuries, motor neurone disease, multiple sclerosis and other neurological conditions, autistic spectrum disorder, dementia, mental illness, cerebral palsy, stammering and some cancers. All those conditions and more can result in communication difficulties to a greater or lesser degree.

Sufferers often feel discriminated against. Service providers and others who do not understand their difficulties might react with anger or scorn, or might ignore them altogether. They find it difficult to ask for help and are sometimes looked on as being incapable. They face discrimination by employers, who often have no understanding of CI or how people can be supported to cope with it and who find it easier not to employ people with problems in the first place or to pass them over for promotion when they are employed. If an employee has a stroke that leaves even a mild speech impairment, it is often easier to write him off, rather than cope with his needs. As a result, many people with CI do not achieve their potential either in education or employment and have varying degrees of difficulty accessing and benefiting from services.

Most services are delivered through speech or the written word, including helplines and online services. Staff are not trained in alternative methods of communication and exclusion is the result for people who need them. There is a lack of awareness and understanding and little support is on offer, other than to those who are visually impaired or hard of hearing.

My encounter a couple of years ago with a constituent who has severe dyslexia first opened my eyes to the problems that people with CI experience. That man, who is now in his 40s, has had difficulty with communication for most of his life, but his condition went undiagnosed until seven years ago. Prior to that he found it hard to get employment and, as a result, experienced significant bouts of depression, which badly affected his lifestyle.

My constituent came to see me because of on-going problems in accessing public services because of his inability to read and write. Council, national health service and Government offices all tried to communicate with him by letter and he, in common with many people in the same boat, simply cannot cope with that. Only last week he spoke to the local press in Aberdeen to highlight his problems. Now a cancer patient, he missed a recent hospital check-up, because he could not read the reminder about his appointment. He lives alone and, naturally, does not want strangers to see his medical correspondence, but he says that his repeated requests for voice messages have been ignored.

Public bodies such as the national health service know that they have a duty under the Disability Discrimination Act 1995 to contact patients by alternative means if they are known to have conditions such as dyslexia, but that message does not always get through to those who work with patients. Raising awareness among staff is an issue that needs to be addressed.

How can we help these people? Many resources are available to assist communication, but awareness and use of them is patchy. That must be improved. There is a need for good practice guidance on dealing with communication impairment for health, social care and other staff.

Although CI is common among all priority health care groups, there has been no attempt to generate a comprehensive, inclusive approach to identifying, prioritising or delivering the communication support that is needed.

The Scottish Executive has made significant financial investment in British Sign Language and English interpreters and, recently, in creating accessible general practitioner services for people with hearing difficulties, but there has been no investment in support or research for other groups with communication support needs.

Comprehensive research is needed to identify the number of people with CI and to find out from them what they regard as the priorities for change. There is a need for a Scotland-wide communication strategy to deliver appropriate support to everyone with impaired communication, so that they have the same opportunity as others to enjoy a good quality of life.

The CI action group presented a research proposal to the minister last August, which he welcomed enthusiastically before passing it on to the social research unit. However, five months later, there has been no response from the unit. I urge the minister to press the SRU for some concrete proposals regarding this important issue.

I hope that the debate will help to put CI on the map, will highlight the exclusion that is experienced by people who suffer from it and will lead to a better understanding of their needs.

Kim Hartley and her colleagues are doing their very best. The CI working group is giving what support it can. We now await the minister's response and look to him to ensure that the necessary research is supported in order to develop a proper strategy for action on communication impairment.

I congratulate Nanette Milne on securing this important debate and offer my apologies for the fact that I will not be able to stay until the end of it.

Nanette Milne has made a clear call for action. Usefully, the motion is specific in what it calls for. I await with interest the response from the social research unit. I hope that it will come soon. Perhaps the minister will be able to shed some light on when we are likely to get that response.

I want to highlight a case that was brought to my attention recently. It concerns a young child with communication support needs. The child was due to start school but the parents and the school had concerns about the school's ability to provide the necessary support. The parents were concerned that the child was just not ready for school and needed more support, particularly speech therapy, before they started school.

Agreement was reached that the child would delay starting school for another year, to allow speech therapy to continue. However, when the parents sought continuation of the nursery place for a further year to allow the child's pre-school education to continue, it was denied and the child was left in limbo for that year, between pre-school education and school.

That case highlights the need for joined-up services in the pre-school and school systems. It also shows that there should be more flexibility if we are to meet the needs of children with communication support needs. Although there was agreement that going to school at that particular time would probably have been a negative experience for the child and the school, the parents were somewhat shocked that there was no back-up to ensure that the child's educational needs were met at an appropriate level.

The parents feel that the lack of support through the system—the child is a bit older now—has left the child with communication difficulties that they would not have had if the appropriate support had been in place through the school years. What is being done to ensure that such children have the support that they require?

I want to make a plea on behalf of speech therapists. They are still too thin on the ground. We do not have enough of them to ensure that people who require speech therapy get regular access to it. More must be done to address that shortage. I would be interested to hear what the minister has to say about that issue. If I miss the minister's response, I will read what he says in the Official Report.

I thank Nanette Milne for securing this debate. Members will be aware that a short-life working group has been considering this issue. I would like to thank all members who have shown an interest in that.

I, too, put on record my thanks to Kim Hartley and her colleagues for the support that they have offered us and the awareness raising that has been carried out, which highlights the need for research. I will come back to that if I have time.

We tend to think of communication impairment as a health issue, but it is much more than that. It impinges on every aspect of life and it is not just for the health service to make provision to help people who have communication impairment. To help members understand communication impairment, I will give a couple of examples from opposite ends of the spectrum. One is obvious, but it is something for which there is still underprovision; the other is perhaps less obvious.

My first example will be familiar to anybody who was at the cross-party group on mental health yesterday. We focused on mental health and deafness. We heard from the Scottish Council on Deafness and Deafblind Scotland that there is no dedicated mental health provision for deaf people in Scotland. The only dedicated service is provided on an outreach basis from the unit in Manchester, which may discontinue. There are no dedicated mental health officers in our social work departments who are themselves deaf or who have expertise in working with deaf people.

Being able to communicate directly—not through an interpreter or a family member—with the professional who is dealing with them, whether it be their general practitioner or a specialist, is crucial to deaf people with mental health problems. This is an area in which everybody understands the needs of deaf and deaf-blind people—they are quite obvious—but there is still underprovision.

For my second example, like other members, I will talk about a case from my own experience. It is a success story. In my days as a school doctor, I was involved in the case of a child whom I knew from the age of two right up to his teens, when I left that job. The child's intelligent and intuitive mother recognised when he was still at pre-school age that his communication was a bit different from other children's and had him referred for speech and language therapy. He was eventually diagnosed as having an autistic spectrum disorder, Asperger's syndrome.

Because the child was diagnosed before he went to school, extra support was put in place when he went to school. His primary school experience was characterised by a lot of support. When he was transferred to secondary school, the transition was handled successfully. He was phased in gradually and visited the school on in-service days, when there were no other pupils there, to familiarise himself with it.

In secondary school, there was an individually tailored programme of social education for him, in recognition of the fact that learning at the pace at which his peer group learned would not do. A child on the autistic spectrum must have very targeted skills training, and that was done. When I last knew him, he was a well-adjusted and terrific boy who was very academically able. He had a concrete understanding of language. For example, he did not realise that when the teacher said, "It's time to put your books away," that meant, "Put your books away." He needed a direct command or instruction that was clear and explicit, rather than an inferred instruction.

If the child's condition had not been diagnosed so early, before he went to primary school, and if he had just sat there not putting his books away when the teacher said, "It's time to put your books away," he would have been seen as a disobedient child. Similarly, if he had not had a carefully managed transition to secondary school, he would have found it far too stressful. He would have failed in secondary education and he would have acquired the mental health problems that lots of young people with autistic spectrum disorders have. He would not have done nearly so well. At the age of eight, he had a reading age of 12, he was academically able and he had a terrific vocabulary. Anyone would have thought, "Where is the communication disorder?" unless they looked closely for it.

I bring that case up because we know that among our young offenders there is a high incidence of poor educational attainment in reading and writing. I wonder how many of those young people have additional communication disorders and how many of them have had speech and language therapy assessments. Whenever anybody in our society has a problem, we should think about communication issues, which go much wider than somebody having a stroke and losing their speech or people being deaf or deaf-blind. There are lots of much more subtle communication disorders—language disorders—that adversely affect people's lives.

I have given examples from opposite ends of the spectrum, but there are many more in between. Nanette Milne listed some of them, such as strokes and neurological diseases. They all give rise to the same problem. The ability to communicate with our fellows is, essentially, what makes us human, and the isolation that results from the loss of it is frightening. I therefore support the plea for research into this area to assess the extent of the problem and the unmet needs. These are people who, quite literally, do not have a voice.

I ask everybody please to be patient. That is also the request that the British Stammering Association makes. It applies when we speak to all people who have a communication impairment. Many of us hesitate before we speak, but simple, everyday conversations that people have to enter into to buy a newspaper or to ask for milk for their coffee or tea can become frustrating and difficult experiences for a person with a stammer.

I, too, thank Nanette Milne for lodging the motion and want to talk about the needs and experiences of people who stammer. Like Eleanor Scott, I thank colleagues from all parties and the individuals and organisations that are represented on the communication impairment working group for their efforts to date. Our targets are clear: we want to raise awareness of communication impairment and improve services. We hope to do so by mapping the needs of people with communication impairment throughout Scotland in order to inform a national strategy. I should add—as Nanette Milne did—that we have so far been encouraged by the minister's response. I hope that we hear more in a similar vein today.

I want to concentrate on stammering partly because I was privileged to attend an event yesterday at which the British Stammering Association—with Executive support—launched a series of CD-ROMs and associated materials that are to be distributed to all our schools. The event brought to my attention the extent of the difficulties that young people with stammers face in our schools. The event was encouraging—even inspirational—because the CD-ROMs contain the testimony of young people who believe that they cannot talk as well as their peers can, yet they talked about their experiences so vividly that they provided a lesson in communication. Their willingness to describe their feelings made the CD-ROMs memorable. I hope that they will be a good resource for our schools.

What has been their experience? Unfortunately, many young people experience isolation, loneliness, frustration and anger. The lack of understanding and knowledge of, and sympathy towards, stammerers among teachers as well as among pupils can be damaging to the self-confidence and self-esteem of the individual concerned.

Much still needs to be known about stammering. It has been estimated that it affects about 1 per cent of adults, but 5 per cent of children—some 59,000 people—in Scotland. It affects boys more than girls—the ratio is about four to one—but we do not know its exact cause. It affects people of all abilities, from all walks of life and from all cultures and social groups.

The huge variation in support that is available to stammerers in different schools, local authorities and health boards is perhaps the most worrying issue. Many of us have highlighted to the minister our concern about the lack of speech and language therapists—there are acute shortages in some parts of the country—but it is worth pointing out that even in their disciplines, stammering is given a low priority.

Overlooking people who stammer is easy. In fact, I was told yesterday that individuals often go to great lengths to hide their stammer. The easiest way is not to talk. Because they have been overlooked, they have missed out in the allocation of resources—that is directly reflected in the number of specialist speech and language therapists who deal with stammering.

The British Stammering Association and others who work in communication impairment have done a lot in recent years to raise awareness about the needs of people who stammer, but there is no doubt that we could achieve a lot more if the minister and the Parliament took the lead in highlighting the issues that are involved. More support, greater understanding and specialist services are needed. In the meantime, the message to all members and to everybody who does not have a stammer is, "Please be patient."

I thank Nanette Milne for initiating the debate, which is welcome.

We should think about the figure in the motion, which states:

"there are an estimated 250,000 people in Scotland who have communication impairment".

Research is needed to identify the number of people who are affected—we may find that that figure is not accurate. We also need to find out what those people think the priorities for change should be. We should consult in order to move forward.

A broad range of people are involved. Ken Macintosh rightly spoke about stammerers, but the range includes people with an autistic spectrum disorder, people who have had strokes, people with dyslexia and people with cerebral palsy. A strategy to deal comprehensively with that broad range is needed. We must ensure that we have enough speech and language therapists to provide the necessary services. They could act quickly for a stroke patient or identify the child with autistic spectrum disorder before they start school, so that a strategy that will make a difference for that child can be put in place. Key people who can identify who is in need, assess them and help with future planning must be available. Without that, the support is useless.

A communication strategy for Scotland is definitely the way forward. We must ensure that everyone gets an equal opportunity. We should not have a postcode lottery that means that whether people have access to speech and language therapy and to the appropriate education depends on where they live. Most members have experience of recognising a situation that is wrong and asking how it can be put right. What is to be done with the hearing impaired child who is afraid of isolation and therefore adamant that he does not want to go to the mainstream school, even though its hearing impaired unit has a good reputation? He is afraid of isolation because he knows that none of the pupils will be able to communicate with him. Some of the teachers will be trained to communicate with him, but no child will be. How do we remedy that?

We need to speak to the people with communication impairments to find out what we can do and how we can work round the problem so that the child in my example feels happy going to the mainstream school. We want to ensure that the child does not have to go to court to be allowed to attend a school for the deaf. In a mainstream school, a child with autistic spectrum disorder may stand yards away from the other children in the playground. He is included because he is in such a school, but he is excluded in many other ways.

There is much to be done to train people to accept and understand the difficulties of communication impairment. I have said before that if fiscals and the police do not understand the difficulties people with an autistic spectrum disorder face, there may be more problems in the criminal justice system as a result. Eleanor Scott rightly pointed out that many young people need to have their problem identified and need support. I would like to say to Nanette Milne that the strategy in the briefing paper is excellent. I hope that the minister will respond positively to it.

I congratulate Nanette Milne on bringing the motion to the chamber. I also thank the cross-party group for its work, and I would like to make a slight apology for not so far making time to attend its meetings. I fully intend to go on a day when I am not doing something else, which is rare.

From my assessment of the problem and from what we have heard so far, it immediately struck me that there is a huge need for training at all levels. That is particularly true for public servants, including medical and educational professionals. It really struck home that there is a problem with discrimination. People with communication support needs are ignored, actively avoided, thrown out, insulted or put under pressure by impatient and angry service providers. If people look at the problem from that perspective, they begin to see that it is not minor but extremely serious. There is therefore a real need for training for all public service providers.

I ask the minister to speculate on how on-going training could be provided and how advice and information could be given to public service providers using the facilities and money that we already have to hand, rather than say, "We cannot afford to do that at the moment".

I also ask the minister to point out that what we need is simply the application of existing legislation rather than the invention of new rules and regulations. Legislation on equality, human rights and disability should already be familiar to public service providers, but it is clear that many of them are unaware of how the requirements of such legislation affect them in their dealings with people with CSN.

As I said, there is a lack of awareness and understanding of what can and should be done to support people because of a lack of training and information. We lack co-ordinated, comprehensive, inclusive planning that covers everyone. Co-ordination and training are needed. All the problems have been outlined by the cross-party group and by the Royal College of Speech and Language Therapists. The big need is for training, although we also need more advocacy and assistance.

I was struck by the French research that suggested that 78 per cent of clients who were screened in a mental health unit suffered from some form of speech and language problem. Clearly, if that figure of nearly 80 per cent applies as a rule, we must ensure straight away that advice and assistance are given to all mental health service providers. By linking such providers with specialists who can assist people who have mental health issues to deal with their speech and language problems, we could assist about 80 per cent of all those who have a mental health problem. That is a very simple sum, so the Executive does not even need to carry out further research but could address the issue forthwith.

Training and education on communication impairment are also needed in prisons. There are many reasons why people in prison should receive far more help with education, but the research that has been brought to our attention suggests that many problems can be a result of communication impairment. More could be done through the education service in prisons to help prisoners, who may have a variety of communication problems that, at the moment, are not identified either before they enter prison or while they are in prison.

I thank the Presiding Officer for giving me this chance to speak and I congratulate Nanette Milne once again on securing tonight's debate on her motion.

I apologise to Nanette Milne and everyone else that my mobile phone went off during her speech. That is one form of communication that we can all do without at times. I also congratulate her on securing the debate.

As Nanette Milne mentioned, an estimated 250,000 people in Scotland suffer from a communication impairment. I use the word "estimated" because, unlike deaf or deafblind people and people with hearing or visual impairments of other sorts for which figures are available, no accurate figures exist for people who need communication support. We desperately need the research that has been carried out to be taken further, as such information is essential for developing a framework to address the needs of people who have a communication impairment.

Communication impairments can affect anyone. People can develop a form of communication impairment—such as a stammer, which Ken Macintosh mentioned—after suffering head injuries in a car accident or after suffering a stroke. It is very sad that not enough support is provided to help such people.

Like Ken Macintosh, I want to raise the issues that affect people who have a stammer. We need only imagine what it would be like to be unable to communicate properly such that, in attempting to communicate, one became a laughing stock. That is the impression that people have of those who have a stammer and that is very sad indeed.

We perhaps need a policy whereby people are made more aware of certain types of communication problems. If we had that, people would perhaps not be ridiculed or become the butt of jokes in the way that we see happening all too often on television and in the media. The issue of communication impairment should be looked at rather than laughed at.

Basically, if we had more speech therapists for people with stammers and other forms of communication impairment, that would go a long way towards rectifying the problem. I hope that the minister will take on board the need for more speech and language therapists. If we started with people at an early age, we could do something to help them. Such help is sadly lacking, as has been mentioned time and again.

When people with a communication impairment access education and health services, they are sometimes looked on as being incompetent. However, as Eleanor Scott mentioned, the mental health services that are provided in Scotland are not guaranteed to meet the needs of such people, especially those who are deaf or deafblind.

There is a petition before the Parliament that seeks some form of unit for deaf and deafblind people who have mental health problems. At the moment, some of those people get no help whatever when they have a mental health problem, whether they are in Aberdeen, Glasgow or anywhere else in Scotland, because there is no dedicated service for them. I hope that the minister will look into that.

The issue of employment has been mentioned. If someone with a communication impairment goes for a job, they are sometimes not given the job or given a lowly job. They are looked on as being less intelligent than others, but I am sure that if people were educated about their impairment that would satisfy the employer as well as other employees. We must address that issue.

Much has been said about the inquiry into how many people suffer from communication impairment. As Nanette Milne and others have mentioned, the social research unit has produced figures on that. It would be helpful to know from the minister when proposals will be brought forward. I know that the Executive has been considering them for five or six months. I plead again for more speech therapists and for language therapy services to be made available.

I congratulate Nanette Milne warmly on her motion and the recognition that she seeks for communication impairment. I also welcome the on-going work of the Equal Opportunities Committee in its disability inquiry and look forward to the publication of its report in May 2006.

Like Ken Macintosh, I would like to make relevant points about stammering. After all, Demosthenes, one of the greatest orators of all time, had a stammer. We are told that he got over it by practising with pebbles in his mouth. I would not for a moment suggest such treatment today, but it is suggested that it worked for him. I suspect that there may be other logical explanations.

Stammering affects a surprising 1 per cent of the adult population. Around 60,000 children, young people and adults in Scotland are affected by stammering, but many have not met anyone else who shares their experience. Specialist speech and language therapy services to meet their needs are, alas, far too limited. The sense of isolation that is commonly experienced by persons who stammer is compounded by the geography and population spread of Scotland. Many people who stammer try to avoid revealing their difficulty, which can have a profound impact on whether they enter further education and on their social relationships and career choices. However, in many cases stammering can be and is completely resolved if it is treated during pre-school years. Early identification and referral to speech and language therapy are the key.

Since January 2004, the British Stammering Association Scotland has been effective in raising the profile of stammering and making a real difference to those who have this communication problem, which affected such great men as King George VI and Aesop, of Aesop's fables. The British Stammering Association offers support and promotes awareness of stammering. Its hard work is admirable.

I end with the words of one of my constituents—the chairman of the Edinburgh stammering support group—who summed up the hurdles that people with stammers face and the steps that we must take to address those problems. She wrote to me:

"People who stammer often face ignorance, teasing and stereotyping from the general public and in the entertainment media. We are commonly misunderstood or overlooked in education, by employers and by health service providers when allocating their resources. Skilled speech and language therapy services for people in Scotland who stammer are woefully inadequate. I support this call for research and the development of a communication strategy for Scotland that will benefit all people with communication impairments, including people who stammer like me."

I, too, strongly support the call for research and the development of a communication strategy for Scotland.

I commend Nanette Milne most warmly for the excellent motion that she has lodged, which will be to the benefit of all those with communication support needs. We look forward very much to hearing from the minister, who we hope will give an extremely positive response.

I congratulate Nanette Milne on securing the debate and recognising the achievement of the Parliament's short-life working group on communication impairment and the communication impairment action group in bringing these issues to our attention. Like Mrs Milne, I pay tribute to their work and welcome their members to the chamber this evening. I acknowledge people's depth of feeling about the need to raise awareness of the full range of communication impairment issues and to increase support.

Nanette Milne has advanced the view that comprehensive research is required to achieve those objectives. The Executive takes seriously the needs and experiences of all people in Scotland, including those with communication impairment, and we will undertake research in this area to help us to understand and to improve people's life experience. However, we should acknowledge that, although many people are comfortable with the term "communication impairment", some prefer to use the wider phrase "communication support needs", which recognises that, although people are sometimes able to communicate well, they might have difficulty because the right support is not available for them. The Executive is already delivering a range of measures to support people with communication support needs and to ensure that they are able to access services and have their voices heard. I will highlight some of those measures in response to points that have been raised this evening.

Shona Robison referred to children who have communication difficulties. As members know, the Education (Additional Support for Learning) (Scotland) Act 2004 establishes a statutory framework for meeting the needs of all pupils who require additional support for learning, regardless of the factors that have given rise to them. That legislation, which covers all forms of communication impairment, places duties on local authorities and national health service boards to meet those needs; however, I am aware of the situation to which Shona Robison referred and acknowledge that there is still much to do in that area.

The Executive also core funds the communication aids and language learning centre at the University of Edinburgh, which provides specialist expertise in technology for children who have speech and communication difficulties. More generally, two projects funded through the children, young people and families unified voluntary sector fund are relevant to the points that have been raised in the debate. In fact, Ken Macintosh mentioned the first of those projects, which was launched yesterday. The Executive awarded £145,000 to the British Stammering Association to issue CD-ROMs that will provide teachers in Scottish schools with a significant best practice and guidance resource for managing stammering in the classroom. Furthermore, in response to Nanette Milne's points on dyslexia, I should point out that an award has been made to the transition dyslexia project.

Eleanor Scott and Robin Harper both highlighted the issue of mental health and hearing impairment. Last year, the relevant guidance was reviewed to draw together key advice, guidance and considerations into a clear, unambiguous benchmark document for agencies to use in designing services for people with a sensory loss who also have a mental health problem. A short-life group worked on the matter, and new guidance has recently been issued.

Before I deal with the issue of research, I will touch briefly on other Executive measures. We fund the operations of the Scottish sensory centre, which is a national organisation aimed at supporting those involved in the education of deaf and visually impaired children and young people.

As for stroke, which was mentioned by Nanette Milne and Rosemary Byrne, we are improving the organisation of stroke services through the development of managed clinical networks. If a communication impairment is identified, specialist assessment and treatment are available from speech and language therapists. Moreover, the Scottish advisory committee on stroke recently agreed to gather figures for aphasia. I know that campaigners on this issue have been concerned about the lack of information in that respect.

As far as learning disability is concerned, we are continuing to implement "The same as you?", which recommends a person-centred approach to meeting each individual's needs. Communication is fundamental in allowing that to happen.

Notwithstanding all that, we acknowledge that the current position lacks the strategic and comprehensive approach that the motion calls for and that we must understand the nature of communication support needs across all sectors. As Eleanor Scott and other members reminded us, that is an issue not just for the NHS. As the motion points out, communication impairment can impact on every waking moment of a person's life and affect their experience of the education system, the justice system, transport and employment. Research will help us to understand the full impact of the issues and develop a more comprehensive approach.

A key feature of the research that we will commission will be the inclusion of direct consultation with people who have communication support needs. That was one of the factors that attracted me to this proposal; it is something that I know about from other policy areas. From my experience in the health portfolio, I know that we are trying to get more and more involved in listening to the people who use the service and in learning from them to develop appropriate services. Rather than going through service providers or umbrella groups, we will want to ensure that we reach and involve people who have communication support needs—although some of those people might not be accessing services at present. Only by doing that will we be able to understand their experiences and needs. More generally, our strategic disability working group has already been considering how we can improve our consultation with those who are hard to reach. We are delighted that the communication impairment action group has been participating in that working group and has been working with us to help us to develop a more inclusive approach to communication impairment.

Any new research will not stand in isolation because the Executive has already undertaken some research to examine some of the issues and experiences of people with communication support needs; there is an existing evidence base that goes well beyond that. Notwithstanding that, we want to broaden our understanding of the issues and ensure that we are able to identify and meet the needs of those with communication support needs across all areas of their lives. I have therefore asked my officials to develop a specification for research that will build on what we have already done and help us to develop a programme to tackle the very real needs that have been brought to our attention by the communication impairment action group.

Once again, I thank that group and the all-party group for the work that they have already done to raise awareness of this issue. I hope that the research will build on that and improve both awareness and the support that will, as a result, develop in due course. We will need to go out to tender for the research and we plan to do that in the near future.

Meeting closed at 17:52.