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The fourth aspect is community care assessments. It should go without saying that they should be person-based. It was a long time ago that I first heard the term “holistic care” mentioned—well over 25 years. I see the Minister nodding. We share a professional background, and I am sure that at times she, like me, could weep at the lack of progress. Care assessments must be person-centred, which means that they must be carried out by those with the training necessary to assess the needs of people with autism. I ask the hon. Lady to affirm her understanding of the need for appropriate training for people who undertake community care assessments.
On the publication of the strategy and guidance, I was moderately amused to see in the National Autistic Society’s briefing that the Department of Health had said that it was standard to stagger the publication of strategy and guidance. I always hate it when I read that anything is standard, or that “that’s what we always do”, because an opportunity to do things differently might be overlooked. Perhaps the Minister will explain the policy, as I may have missed something obvious. Will she do what she can to ensure that strategy and guidance are published together, and if that is not possible, will she tell us why not?
In that context, it would be useful for many of the people who will read or who are watching the debate if the Minister gave us some idea of the dates of publication. We need to know that as soon as possible. We frequently hear from local authorities and various health agencies that they are still waiting for the statutory guidance. That is terribly frustrating. Often, local authorities want to get on and start fulfilling their commitments under new legislation, but the guidance is slow in appearing.
My hon. Friend the Member for Tiverton and Honiton mentioned silos. That is my penultimate point, and the subject is a bee in my bonnet. We talk about partnership working, attend joint meetings, make joint appointments, and believe that in doing so, we have achieved joint working. We have ticked the box on working in partnership, but real joint working is about getting out of those silos. Only then can we make the difference. The silos have to go. Government at all levels are desperately resistant to moving out of their bunkers and sharing budgets, experience and the benefits of cost-sharing.
As with commissioning, if we have our eye on the needs of the population for which we are trying to provide services, there should be no reason why we cannot break down the walls between Departments. Will the Minister spell out the measures that her Department will take to ensure that the strategy can be developed and implemented jointly with other Departments, particularly the Department for Work and Pensions?
John Bercow: My hon. Friend is making an admirable speech, but in referring to the DWP she prompts me to highlight an issue often mentioned but as yet not resolved—the off-putting complexity of the application form for disability living allowance. Does my hon. Friend agree that it would help if the Government looked at that again? It is true, to be fair, that the form has been substantially shortened over recent years, but I think I am right in saying—I have some personal experience—that it is still 52 or 54 pages long, and it does not lend itself to speedy completion by people who are not used to having to provide essay-style responses to testing questions.
Anne Milton: My hon. Friend makes yet another excellent point. If I recall correctly, my hon. Friend the Member for South-West Surrey (Mr. Hunt), who is not in the Chamber today, introduced a ten-minute Bill on exactly that point a couple of years ago, when he was shadow Minister for People with Disabilities. He pointed out the huge complexity of some forms, which would defeat many of the brightest of us. If we assess people’s needs, and one of their needs is to access services and benefits readily and easily, simplification of the forms must inevitably follow.
Finally, the Secretary of State must keep the strategy under review if we are to hold the present and future Governments to account. To review the strategy, we need to monitor and we need indicators. It would be useful to know from the Minister what indicators will be used to determine when a review of the strategy is necessary, how the Department intends to monitor the progress of the autism strategy, and whether a named individual within the Department of Health will have responsibility for the successful implementation of the strategy at local level. I hope that the Bill will be passed today. Having made huge progress, it is crucial that all the energy and enthusiasm are not lost. What we need is real drive to make sure that, if passed, the Bill starts to produce results at the front line.
Rather like the Oscars, thanks are due all round for the cross-party working, and a cheer for the parents and families who hold together the care of their small children, their teenagers, and their younger and older adult children while we at every level of government have moved painfully slowly in developing proper services to support those families. Those unsung heroes are often wrung out, exhausted and have developed their own health problems, both physical and mental, as a result of their never-ending caring responsibilities.
Whatever our party politics, whatever our background, I have never doubted that all hon. Members came to the House to make a difference. Many of us have struggled at times to make the difference that we thought we could make, if only we found the way of doing it. We often have the opportunity to help individuals with their tax credits and their battles with the many Government agencies and with the local council, but to make a difference throughout the country is not easy. I hope that, today, Parliament has made a difference not only to the 500,000 people with autism, but to their families, friends and carers.
11.30 am
The Parliamentary Under-Secretary of State for Health (Ann Keen): I thank the hon. Member for Guildford (Anne Milton) for her warm words and encouragement and hope that, through my speech, I can address all her points.
I am so pleased and indeed proud to speak to this Bill. I sincerely apologise on behalf of the Minister of State, my hon. Friend the Member for Corby (Phil Hope), the care services Minister, who has played such a key role in its progress. He is very disappointed and sorry that other business prevents him from being here today, but I shall be sure to pass on to him the very kind remarks about his commitment that were made in all parts of the House and, in particular, by the hon. Member for Chesham and Amersham (Mrs. Gillan).
I pay tribute to the hon. Lady. She should be proud of her achievement in introducing the Bill. Her determination to drive it forward, while recognising the need for a realistic and collaborative approach in Committee in order to obtain the ends that she seeks, greatly impressed my hon. Friend the care services Minister. In addition, I recognise the efforts of the hon. Member for Tiverton and Honiton (Angela Browning) in her tireless work to promote the needs of people with autism before the Bill was introduced and since, including her active participation in Committee.
I have the highest regard for the hon. Member for Tiverton and Honiton, because prior to entering Parliament we both had a health background, and we both know how we have struggled to bring our knowledge to the forefront in this place when it has not always wanted to listen. I suppose that we now have to put Devon county council on warning, as this debate has managed to do; the way in which the hon. Lady managed to put across the reality of the misdiagnosis of mental health problems will never leave my mind. I hope that that goes not only for people in the House today but for health professionals outside. She gave an example in which she asked, “If this were a cardiac condition, how would it be managed if it were misdiagnosed?” That was absolutely accurate and to the point. I know that many Members from all parts of the House have the highest respect for her, and after the debate I look forward to perhaps chatting to her about how we can continue to work together.
The Government, like the hon. Members for Chesham and Amersham and for Tiverton and Honiton, are committed to taking action to improve services for people with autism. We are determined to see true, transformational change and a real improvement in their quality of life. Our means for achieving that is the development and publication of an adult autism strategy. The full publication of a consultation on the content of that strategy began in April, and that in itself indicates our commitment.
As Members present know well, my hon. Friend the care services Minister made it clear on Second Reading that, although we shared the principles set out in the Bill, we could not support it in the form it took at that time. That is why in Committee, my hon. Friend tabled the amendments that have made the Bill what it is today. The hon. Member for Chesham and Amersham has eloquently made the case for this Bill, and the figures that she quoted are a powerful testament for the need for action in this area.
I have no ministerial responsibility for this area of care, but since knowing that I would be present today and having been privileged to be a part of taking the Bill forward, I have learned a great deal. Even though I am a former health professional with more than 28 years’ experience, I know that we can still learn a great deal and it has been a pleasure and privilege to learn more on this subject.
The National Audit Office’s recent report on services for people with autism provides further evidence of the needs of people with high-functioning autism and Asperger’s syndrome, and of the types of service and good practice that already occur in some areas. Senior officials from the Department of Health, the Department for Work and Pensions and the Department for Children, Schools and Families appeared before the Public Accounts Committee earlier this week, as has been mentioned, to
give evidence on the NAO’s findings. The hon. Member for Tiverton and Honiton took that opportunity to press for continued action to improve services, especially on the diagnosis, assessment and understanding of autistic spectrum conditions, and I trust that she and other members of that Committee were reassured that we take the issue seriously not just in the Department of Health, but throughout the Government.
My hon. Friend the Member for Erewash (Liz Blackman), who spoke with her usual honesty and passionate feelings on the subject, raised the issue of how important local leadership will be to the implementation of services, and I am pleased to say that there will be representatives of the Association of Directors of Adult Social Services on the external strategy reference group.
Clause 1 places a duty on the Secretary of State to prepare and publish by April 2010 a document setting out a strategy for meeting the needs of adults in England with autistic spectrum conditions. By improving the provision of relevant services by local authorities and the NHS, the Secretary of State will be required to keep the autism strategy under review and will be able to revise it. He will have a duty to consult and seek the participation of such persons as he considers appropriate in preparing and revising the autism strategy.
That consultation process has already begun, so clause 1 also contains provisions to ensure that the consultation will fulfil the Secretary of State’s duty, even though it will have not only begun but ended by the time the Bill comes into effect. Similarly, my hon. Friend the care services Minister has made it clear that our intention is to publish the autism strategy by the end of this year. Therefore, the clause also contains provisions to ensure that doing so fulfils the Secretary of State’s duty to publish a strategy even if the Bill has not come into force at the time of publication.
Of course, publishing an autism strategy is only the beginning of the story. The hon. Member for Mid-Dorset and North Poole (Annette Brooke) ended her contribution by saying: although we have packed and started the journey, how will it end? I hope that, with her knowledge of young people and children, about whom she so often speaks, we will be able to complete the journey together.
To that end, clause 2 places a duty on the Secretary of State to issue guidance by 31 December 2010 to local authorities, NHS bodies and NHS foundation trusts for the purpose of securing the implementation of the autism strategy. Some Members may ask why there is apparently such a gap between the deadlines for the strategy’s publication and for issuing the guidance on its implementation, and I shall return to that point later.
Clause 2 also sets out some issues that guidance should cover as a minimum. It requires the Secretary of State to keep the guidance under review and to consult the NHS and local authorities on preparing it and, if the Secretary of State proposes, on revising it. On the strategy itself, there are also provisions to cover the possibility that the consultation on the guidance may begin before the Bill comes into effect, and to ensure that such a consultation fulfils the Secretary of State’s duty under the clause.
Clause 3 is of particular interest. On Second Reading and, indeed, elsewhere, my hon. Friend the care services Minister gave clear commitments that the guidance on
the implementation of the autism strategy will have the necessary bite to drive real transformational change. The clause puts that commitment into action. It specifies that the guidance is to be treated as section 7 guidance under the Local Authority Social Services Act 1970, meaning that local authorities will be required to exercise their social service functions in accordance with the guidance. Case law has established that that means more than just taking account of the guidance. A local authority that failed to comply with section 7 guidance without a really compelling reason for doing so would be acting unlawfully.
For NHS bodies, there is no existing provision equivalent to section 7 of the LASS Act. In order to create the same obligation on NHS bodies to act in accordance with guidance issued under clause 2, clause 3 also specifies that, for the purposes of that guidance, NHS bodies are to be treated as local authorities. That means that their functions in relation to the provision of relevant services are social services functions under the provisions of the LASS Act. That means that NHS bodies will be bound by the guidance to the same extent as local authorities, which also means that the case law that has established the status of section 7 guidance as being more than just advice to be taken into account will apply equally in relation to NHS bodies.
I should add that these provisions will not apply to NHS foundation trusts. Although the Secretary of State is required by clause 2 to issue guidance to NHS foundation trusts, they are not covered by clause 3 because the definition of NHS bodies set out in clause 4 does not include NHS foundation trusts. That means that foundation trusts will be expected to take the guidance into account in planning and providing services for adults with autistic spectrum conditions, but they will not have the same duty to act under it as local authorities and NHS bodies. This reflects the greater autonomy of NHS foundation trusts.
Liz Blackman: In Committee, we had a good debate about this issue, and the Minister reassured everybody that although foundation trusts do indeed have autonomy, when PCTs were commissioning their services they still acted under the guidance, which was incorporated in the commissioning process. That gives reassurance that the guidance will, to a degree, stretch into foundation trusts.
Ann Keen: I thank my hon. Friend; using the knowledge that she gained from being on the Committee, she has clarified that point.
The remaining clauses deal with the matters that one would expect to see in any Bill: definitions, extent, application and so on. I do not propose to go through them in detail, but I would just draw the House’s attention to the commencement arrangements in clause 6.
John Bercow:
I certainly have no desire to strike a discordant note; as I said, I admire the way in which the Government have taken this matter forward. However, I am a little concerned by the idea that whereas there is a duty to act on the part of the local authority, the responsibility of a foundation is merely to take something into account. It seems to me that it is quite easy for an organisation to say, with a nod and a wink, “I’ve taken
it into account, and I’m now pursuing the policy that I want to pursue.” There is real concern out there that taking into account must also mean translating into practice.
Ann Keen: The hon. Gentleman, whose earlier contribution demonstrated so well his commitment to the subject, raises the “nod and a wink” approach. I believe that when the Bill goes through the other place, it will be so strong that a nod and a wink will not be involved: foundation trusts will be there to deliver best practice.
John Bercow: I am grateful for that, and I am reassured.
Ann Keen: As I said, I do not propose to go through all the definitions in detail. [ Interruption. ] I think that Members are indicating that they are relieved about that. However, I would like to draw the House’s attention to the commencement arrangements in clause 6.
Liz Blackman: Just for a bit of clarity, let me point out that, in Committee, the Minister of State, the hon. Member for Corby (Phil Hope), explained that this is handled through the contracting system. He said:
“Yes. The Bill does not apply to foundation trusts for the reasons that I have just given—wider policy and so on—but if a PCT is contracting with a foundation trust, as I said earlier, the obligation of the PCT as an NHS body to ensure that it is carrying out its statutory duties is, therefore, handled through the contracting process. I emphasise that the NHS foundation trusts have more autonomy in the system, which is why the Bill cannot directly apply to them in the way that it may apply to other NHS bodies.” ——[ Official Report, Autism Public Bill Committee, 13 May 2009; c. 38.]
I hope that that clarifies the point.
Ann Keen: I thank my hon. Friend, and I hope that the hon. Member for Buckingham (John Bercow) is content.
Ann Keen: We are here to please.
As I said, my hon. Friend the Minister of State wanted to be present, so he has asked me to say the words that he would have said had he been here. I therefore need to make some progress, if hon. Members can bear with me.
It is a further mark of the Government’s total commitment to the autism strategy, and the improvements that will flow from it, that we have chosen to provide for the Bill to come into force automatically, two months after Royal Assent is given, so no commencement order will be needed.
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