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Mrs. Lait: I realise that my hon. Friend is a true expert on autism. Will she perhaps describe the reaction of some autistic people when their routine is disturbed, and say how badly such a disturbance affects them?
Mrs. Browning: For the purposes of the debate, I am assuming that those people with autism who are in full-time residential care would not come within the remit of the policy. I am talking about those in the community. Some may be living independently; some may have supported living arrangements. The vast majority of adults in this category would be living with relatives. They are all different. Although certain common features might typify the response of a person with autism, every response will be different.
The Minister said that, in many cases, the interviewer would visit the person's home. The presence of a stranger who has come to talk to a person with autism, and to ask them questions in their own home, could be met with a range of reactions, no matter how experienced the interviewer was. It would not be untypical for an adult with autism to sit with their face to the wall during the interview, instead of looking at the person asking the questions. It is very important to emphasise--because this is what distinguishes autism--that I am not talking about people with a below average IQ. In autism and other conditions, such as Down's syndrome, there is often a high IQ. It is not that people do not have verbal skills. Some have very good verbal skills, but would resist using them and engaging in conversation in a stressful situation, such as an interview.
Another possible reaction is over-anxiety to please. The person would try to second-guess the interviewer, and try to give the answer that he or she felt that the interviewer wanted. It is very difficult for someone with autism to imagine a situation that is not within their personal experience so, when asked the straightforward question "What sort of work would you like?" it is not unknown for the person with autism to say, "I would like to be an astronaut." Such a case has been recorded. Such a response does not mean that the person is of low IQ; it is
simply that they may have seen a film that tells them what an astronaut does. They have understood it, and they have understood it sufficiently to give that answer. I do not know how many vacancies there are for astronauts, but that is not an untypical answer.
Unless interviewers have a great deal of experience, not just of interviewing, but of asking questions in a specific way, they will not receive a useful answer. The question "How do you feel about this?" is very difficult for a person who cannot conceptualise an answer. It is not simply a case of asking questions in a gentle or non-pressurised way; the work is very specialised.
In the previous Parliament, when I was Parliamentary Private Secretary at the Department of Employment, I took part, with the then Secretary of State, now Lord Hunt, in a pilot scheme co-funded by the Department of Employment--the supported employment scheme in London for people on the higher functioning end of the autistic spectrum. There was some success. I am not saying that no one on the autistic spectrum is capable of employment. I am simply telling the Minister that autism is different from any other developmental disorder.
In order to get people with autism into employment and in order for that employment to work--which is the key, as has been said--what happens when they have passed through the gateway is crucial. The people conducting the job interview need coaching. Someone must be present during the interview to be with the person being asked the questions. Once the person is in an appropriate job, they will need someone there to support them--not to do the job, because some people with autism have university degrees and can hold down very high level jobs. I know of several who have worked in the civil service. What I am saying is that someone will need to be in the workplace to sort out communications with other people there. That is invariably the challenge at work for people with autism.
There is a way around that problem if the Minister recognises not that some groups should be excluded from the opportunity to get into employment, but that a different approach would be the answer. Even if it worked in only one case in a hundred, that would be worth while. I am convinced that the top-down approach of the proposed structure and the compulsoriness of the interviews will make it less likely that more people with autism will become employed.
Although there has been much welcome emphasis and recognition of autistic spectral disorders among children over the past 10 years, a gap remains in recognition among adults. Adults, often living at home with parents, may be undiagnosed until long after childhood. Some may qualify for benefits such as severe disablement benefit. The Minister has talked of flexibility, and the Government must ensure that conditions misdiagnosed, or not diagnosed at all, are recognised in the benefits system through the gateway.
For an adult who has never worked, a situation affecting many, the simple physical discipline of holding down a full-time job can be difficult. Has the Minister considered such people? If they were successfully interviewed and it was thought that supported help could be given, the best first stage might not be a paid job, but a process of working towards paid employment through
voluntary work. That would certainly mean supported help; we cannot send people with autism out into the wide world. Many would have difficulty in finding their way to the benefits office for the interview on their own and on public transport. Such problems compound their difficulties with getting into work.
As a former Minister, I fully understand why Ministers are reluctant to make exceptions on the face of a Bill. However, the Minister has an excellent opportunity tonight to reconsider, on the basis of the information that he has heard about specific groups for whom the scheme could have a detrimental outcome despite its overall good intentions. He could consider how to adapt his scheme to accommodate people such as those with either developed mental disorders or mental health problems.
Those two groups are not, of course, exclusive. One difficulty that faces people with developed mental disorders is that they often have mental health problems on top of the disorders as they become adults. The nature of their conditions may lead to difficulties in adapting to adult life. This is a complex area, especially for those without specialist knowledge who will be asked to make judgments about whether the person sitting in front of them is behaving or reacting as he or she is because he or she has a developed mental disorder or an overlying mental health problem. In adulthood, the two often go together. Considerable expertise is required to unravel the suitable way to take such people forward.
Dr. Lynne Jones (Birmingham, Selly Oak):
This morning, I had the pleasure of a visit to Sandwell to see the pilot scheme for the new deal for disabled people. Despite the coincidence of its occurring today, the visit had been fixed up some time ago, and I met a group of people highly committed to helping disabled people not only to get back to work but to make progress towards a life in which they can feel they participate in the community. I had a strong feeling that they were doing an excellent job under the current arrangements, and I urge my Front-Bench colleagues who are devising schemes for the new gateway to listen to the experience of those people.
I was told that about 4,000 letters had been sent out, and around 400 phone calls came back. Those who sent the letters were at pains to ensure that there was no mention of any Government Department. The logo refers only to the new deal. For disabled people, receiving a letter from a Department is distressing and stressful. Many phone calls came from people who said, "Thank you very much for writing, and the scheme sounds very interesting. If only it had been available 10 years ago, it might have been useful to me, but I do not think that I am able to participate now."
The people who have responded did so voluntarily, and they are receiving an excellent service. Even so, interviewing people with disabilities such as mental health problems is stressful for staff. I asked one of the team, an occupational psychologist, what her work was. Most of it, she said, was in assisting the team dealing with disabled people. Sometimes it can be extremely stressful if a person who suffers a mental illness needs a lot of time.
I am concerned that we could, if we are not careful, throw out the baby with the bath water in this new scheme. If teams who interview people have to spend much of their time on enforcement rather than offering a
good service, the scheme could prove counter-productive. I believe that Ministers are well aware of that fact, and they have talked to the team that I met and to people who have experience on the ground.
A briefing sent to Labour Members in 1995 pointed out the insecurity that compulsion causes among disabled people. It said that changes from invalidity benefit to incapacity benefit meant
I shall vote with the Government tonight, largely because of the answer that I received to a recent parliamentary question about compulsion. My hon. Friend the Minister of State, Department of Social Security wrote that the requirement for compulsion
"more insecurity--both for existing claimants who might become ineligible for any benefit, and for anyone concerned about their long term security should they fall ill."
It referred also to the difficulty of having one test intended to cope with complex disabilities, particularly mental health disabilities. My Front-Bench colleagues are aware of those issues.
"will initially affect only the 12 Single Work-Focused Gateway pilot areas and will be introduced in ways that take account of individual circumstances. The evaluation of the pilots will enable us to consider whether to extend this approach more widely."--[Official Report, 31 March 1999; Vol. 328, c. 840.]
The Government are aware of the pitfalls and they will go about the process carefully. In so doing, I urge them to listen to the staff who will have to implement their policies and ensure that they are comfortable with having to implement whatever element of compulsion is eventually decided upon.
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