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I read with interest the references in the Committee Hansard to section 7 of the Local Authority Social Services Act 1970, and the hon. Member for Tiverton and Honiton drew our attention to the fact that it was ineffective and not actually implemented. I congratulate the Minister, who clearly took that on board and adjusted
the way in which the guidance should be applied to NHS authorities. That struck me as a landmark in the debate.
We have started the journey. We have the luggage and the map, but will we reach journeys end? It is such a long journey. The NAO found that 74 per cent. of local authorities do not have a commissioning strategy for adults. Some 80 per cent. of GPs told the NAO that they needed additional training and guidance. This is a huge problem and we must not underestimate how much needs doing. Training is necessary across the board.
Hon. Members have mentioned Jobcentre Plus, and it is my experience that even when a young adult is provided with a contact at Jobcentre Plus who is said to have had the relevant training, communication is still difficultthat is probably the politest way to put itfor whatever reason. I have seen some of the e-mails that have resulted, and the dissatisfaction. Communication is a two-way process, and it is difficult, but we need so much more training. We know that more young adults could be in work, and those who are not in work need to access benefits and not get into financial problems because their benefits have been cut off following their failure to fill the forms in on time. We also need cultural changes and the resourceswe should not pretend that resources will not be necessary. As has been pointed out, some of the proposals in the Bill mean investing to save. Unfortunately, local finances do not always work like that, because the money is not available in the year when the investment is needed. I would like the Government to take that on board. There has to be longer-term financial planning for local authorities, health services and all others who are involved.
We have rightly raised expectations with this Bill, but as well as raising expectations and making these excellent proposals today, we all have a duty to continue to work on a cross-party basis at all levels of government and to encourage all relevant services to work together. We can do better and we must do better.
John Bercow (Buckingham) (Con): It is a pleasure and a privilege to follow the hon. Member for Mid-Dorset and North Poole (Annette Brooke), with whom I have been pleased to work as a co-conspirator for improved childrens and young peoples services for an appreciable period of time. Today is a very important day. It is one that we should mark, that we should celebrate and that we should regard as the springboard to greater things.
I begin my hopefully brief remarks by apologising again for my late arrival in the Chamber. I was detained in my office for a short period on other matters, but I certainly did not want to miss the opportunity to be present today.
Most of the substance of what is in the Bill has been covered and I do not think that it will benefit from further repetition. I want to say a few thank yous, and to underline what I think is important about the issue and this place. First, thanks, of course, are due to my hon. Friend the Member for Chesham and Amersham (Mrs. Gillan), who has piloted the Bill through the House with the combination of eloquence, skill and patience for which she is renowned in all parts of the House. That was a considerable feat, because at first the
Government were not keen on the idea of the Bill. My hon. Friend, with good-humoured insistence, kept it up, pressed the case and would not take no for an answer. She was absolutely right to adopt that approach.
I want to pay tribute to the Government, too. I always felt that the Government had good intentions in this matter. I did not subscribe to the rather tedious, old-fashioned, boring and partisan view of some people that the Government were out to scupper the whole idea. The issue was about how to achieve the objective, not whether to do so. As someone who has worked with the hon. Members for Erewash (Liz Blackman), for Burton (Mrs. Dean) and the Under-Secretary of State, I know that the Government are serious about these matters and that they have done a considerable amount on the subject. That is an issue of public record.
It is obvious that, if we work together, we maximise the chance of progress. What is more, we do what the country expects us to do as Members of Parliament, which is to recognise when an issue has a salience and urgency that completely dwarf and diminish the significance of the partisan battle. People out there in the country who have an autistic child or know someone who does could not give a tinkers cuss whether it is a Labour Government who agree to the passage of such a Bill, a Conservative Administration, a hung Parliament or a grand coalition. Many of them, frankly, could not give a tinkers cuss about party politics at all. Even if they do, the significance of the issue is far more important to them.
Mrs. Gillan: It is such a shame that my hon. Friend was not here for the opening speeches, because I was able to make the point that this House has been acting at its best in a cross-party way. Had he been here, he would have been able to hear that. That has been the special thing about all the people who have been intimately involved with this Bill and who have personally made contributions to it.
John Bercow: I am extremely grateful to my hon. Friend and I would have greatly enjoyed hearing her speech. I have never doubted her commitment to work on a cross-party basisafter all, she was the one offering to do so. However, there are always cynics who do not necessarily think that it is a good idea. It makes sense and we have benefited from it.
As far as the media are concerned, and perhaps I can conclude on this point, I think it was the late Enoch Powell who said that politicians complaining about the media are like sailors complaining about the seait is a completely pointless and fruitless activity. Doubtless that is the case, but it is sad that when we work together in a concerted, principled and effective fashion it gets no attention or coverage. The media are just not interested. What a shame. They ought to be. We have done the right thing
John Bercow: My hon. Friend is saying from a sedentary position that she made all these points in her speech. I am sure that she did, with great eloquence. I have already explained why I was not here and have apologised for the fact. There is no harm in underlining the strength of opinion on this matter.
Let us go forward in a spirit of togetherness and determination to make things better. I think that we all agree that this subject is important. I sometimes make the point that politics is, in one senseand perhaps only one senseanalogous to a market place. Just as in a market place, huge numbers of products compete for custom, so, in the field of politics, huge numbers of issues compete for attention and priority. On the basis that people of good will can fairly readily forge consensus about what needs to be done on the issue of autism, the challenge then is to catapult the issue from the back of opinion formers and decision makers minds to the forefront of their minds and, having so catapulted it, to keep it there. I think that my hon. Friend the Member for Chesham and Amersham and others have succeeded in achieving that objective today.
Anne Milton (Guildford) (Con): I was always aware of the danger that this mornings speeches would sound a little more like an Oscar ceremony than anything else, and I am afraid that I will only add to that. None the less, I say to my children and to my colleagues that when one does something well, one should be proud of it. It should be used as an opportunity to understand better how one can do things better in future. I therefore want to associate myself with all the comments made by my hon. Friend the Member for Chesham and Amersham (Mrs. Gillan). This Bill has indeed shown Parliament at its cross-party best, sharing and joining together in a drive to improve the lives of people with autism. At a time when people are so angry with politicians, this Bill is not only a huge landmark for people with autism, their families and their communities, but might be a small chink of light for Parliament itself.
I also want to pay tribute to my hon. Friend the Member for Tiverton and Honiton (Angela Browning), who has been a voice on this matter for a long timesince long before I ever arrived in the House. I pay tribute to the all-party group, the National Autistic Society and many others, including Ministers. The Government, having originally resisted the Bill, have swung all their efforts behind it and have been remarkably and notably gracious in their retreat.
I want to take this opportunity to pay tribute to Surrey county council. It is one of those councils that everybody loves to hate, but it is cited in the Department of Healths consultation document as an example of good practice:
The County Autism Group and autism lead have developed a network of 80 ASC champions across services in all sectors in Surrey. These champions have six months training and mentoring and then help cascade this training to their team. Champions are supported to network and share good practice across services. Assessment of this process showed that it had led to positive outcomes for individuals...In addition, the county group and autism lead have supported Surrey County Council and Surrey and Borders Foundation Trust to jointly develop an ASC training pathway with different levels of training for staff in different services.
The danger today is that, having highlighted the huge lack of services and huge amount of unmet need, we will lose the small pocketsthere are somewhere there is good practice and where innovative approaches are being taken.
The hon. Member for Erewash (Liz Blackman), who openly admitted a change of mind, paid significant tribute to others, but I want to pay tribute to her for graciously changing her mind and throwing her weight behind the Bill. She referred to many statistics, and I will repeat some of them because they cannot be mentioned too often. There are more than half a million people with autism in the UK, and they struggle to gain access to the services they need. Outcomes for such people are extremely poor: only 15 per cent. of adults with autism are in full-time work, almost half still live with their parents, and more than a third have developed serious mental health problems. A lack of ready access to services has a huge impact, not only on them but on their families and carers. As many Members have said, the parents often worry about their childrens future, when they will no longer be able to support them. Older parents carry around a huge burden, worrying what will happen to their children when they die.
Some 70 per cent. of children with autism have one additional psychiatric illness, and almost half have two or more. A quarter have self-harmed or have suicidal thoughts. If we look at the rise elsewhere in the number of children who self-harm, we see that the figure is likely to increase. The figures are truly shocking. If we spill out a load of figures, there is a danger that people will get figure-blind, and their eyes will glaze over. If we have any members of the press still sitting in the Press Gallery, I ask them to take note of some of the figures and to take them on board.
The Bill, as amended by the Government, puts a duty on the Secretary of State to introduce a strategy for improving outcomes for adults with autism, accompanied by statutory guidance for local authorities and NHS bodies. We hope that, if the Bill is passed, it will be a catalyst for huge progress in meeting the needs of the countrys adults with autism. In many instances, the Bill as amended goes well beyond the original measure. It is in that regard that the cross-party working, and the efforts of my hon. Friend the Member for Chesham and Amersham and many others, have been so effective. We are talking about access to diagnosis, needs assessment, transition planninga crucial area, and one of many areas where people may fall through the holes in the netstrategic planning and support services, and local partnerships and co-operation.
I should like to highlight six or seven key issues. When the Minister sums up, I hope she will address some of the issues on which there remain questions in some peoples heads. On data collection and the need to identify people with autism, the National Autistic Societys comparison showing how hard-to-reach groups become easy-to-ignore groups was quite haunting. The key point is that groups of people can no longer be easy to ignore. They might remain hard to reach, but we can no longer ignore them.
Does the hon. Lady not agree that the many people who have high-functioning autism and have never had a diagnosis will be extremely difficult to
identify? I am sure that there are data that could help local authorities, primary care trusts and the like to try to make a diagnosis, and to try to identify such people. It will be tricky to do so, and real, proactive commitment is needed, but it is important that we do so.
Anne Milton: The hon. Lady makes an excellent point, and, as she rightly says, some of the groups of people whom we are talking about are very hard to reach. That is where training and raising community awareness comes in; I will mention training later. If we look back 20 years, we realise that there are many issues that we, as a community and as individuals, simply were not aware of then. That can change, and it is important that it does, so that friends, neighbours, colleagues and those whom people with autism meet can recognise that a person has unmet needs, and can perhaps alert such a person to the fact that they can present themselves to the appropriate services to ensure that they can live their lives to the full. The Bill ensures that can happen.
We have heard that only 9 per cent. of local authorities are keeping any record on that pointonly one in 10. It would be useful if the Minister assured the House that there will be a particular focus on identifying those whose autism is not already known about. The danger is that local authorities, in a rush to demonstrate that they are complying with the legislation, will pick up the group that they already know about and run with them. We need that focus, and a word from the Minister on that point would be helpful.
John Bercow: To build on the point made by the hon. Member for Erewash (Liz Blackman), does my hon. Friend the Member for Guildford (Anne Milton) recall that TreeHouses Constructive Campaigning parent support project research found that teachers and other staff had not been adequately trained, or trained at all, and still did not recognise the condition of Aspergers? I am thinking of a quote from the TreeHouse research, in which a teacher said to a parent, I dont believe in Aspergers syndrome. Of course, it is a matter not of belief, but of fact.
Anne Milton: I thank my hon. Friend for that intervention. Of course, it is pretty shocking when one hears of a teacher saying that, but one will hear the same story from families and charities working with, say, children with epilepsy. Children with epilepsy will have absences, will be low academic achievers, and may well be 12, 13, 14 or 15 before anybody realises that they were not just staring out of the window vacantly or failing to pay attention, but had epilepsy. We hear that time and again. I do not want to wander too far from the subject before us, Mr. Deputy Speaker, but bear with me for one moment while I say that there is a need to raise awareness within the teaching profession, and many other professions where people come into contact with children with a multitude of different needs. People in those professions should be alert to conditions such as epilepsy, and should signpost children and their families to possible diagnosis. However, today we are talking about autism.
As my hon. Friend the Member for Chesham and Amersham said, joint strategic needs assessment is a terrible mouthful. One of these dayssoon, I hopewe will start simplifying the language that we use in
government, at all levels, so that ordinary people can understand it. The joint strategic needs assessment must include and mention the needs of people with autism. It would be useful if the Minister confirmed that the statutory guidance will specify that the JSNAs should account for the needs of people on the autistic spectrum.
I should like to say a word about commissioning. Nowhere in the NHS or in local authorities have we really got to grips with commissioning, because the starting point tends to be the services that are available. We decide where those services should be placed, not so as to provide the very best service for specific groups, but so as to serve them as best we can, or hopefully serve them, at any rate. That is the wrong way round. The joint strategic needs assessment will be a crucial tool in commissioning the right services. One must first assess the needs, and then provide the services to meet those needs. That can mean a significant change in services. One of the reasons that does not happen is that it can be very uncomfortable for service providers, as it can mean big changes; it can mean reshaping how services are set up and delivered.
Mrs. Gillan: I thank my hon. Friend for the contribution that she is making, from the Front Bench, on behalf of the party to which she and I belong. I was struck by a National Audit Office report in which a consultation was carried out that referred specifically to the services that were available. About two thirds of respondents to a survey of local authorities and NHS bodies felt that the services available were limited. An adult with autism who responded to the consultation said:
My local social services department does not provide any autism-specific services, so these services are not at all flexible to my needs.
He was referring to supported accommodation, employment, recreational and social activities, and general support such as advice and advocacy. There is a great need for attention to how services are commissioned and how we identify the needs of people with autism.
Anne Milton: I thank my hon. Friend for re-emphasising that important point about the gap between the group of services available and the unmet need. The two are not necessarily in line with each other. If commissioning is done well, what a rocky ride that can be for government at all levels, but we will never get commissioning right in any area of local government or in the health service until we start from the needs of the population that we are trying to serve. Proper needs assessment is necessary to build a platform on which to develop services that dovetail and produce the results that we want to see.
My hon. Friend the Member for Buckingham (Mr. Bercow) referred to the training of staff. Only 15 per cent. of people with autism are in full-time work, so the training of staff in Jobcentre Plus as personal advisers and disability employment advisers will be crucial. That training, as we have already said, needs to go much wider80 per cent. of GPs said that they needed more training and guidance. Increased awareness of autism among accident and emergency staff and across the community will mean that people with autism are recognised and empowered, and have equal access and opportunities. It would be useful if the Minister confirmed that professionals who have particular responsibilitylet us start therefor supporting adults with disability will get specific training to help them support adults with autism.
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