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The noble Viscount, Lord Colville, who I am delighted to see in his place—almost every other hour he is elsewhere in the building chairing the Crossrail committee—tabled an amendment in Committee which would have retained the ability to specify exemptions by order, but set out those circumstances that the orders must address on the face of the Bill. We thought that was a sensible approach, and we have therefore brought forward an amendment which will have that effect. The amendment will set out four exemptions which must be specified in the order. I do not need to set out what the exemptions say as they are in our amendment.
I have spoken to the government amendments but there is another one in the group. I beg to move.
7.30 pm
Baroness Hamwee: My Lords, Amendment No. 43 stands in my name. I pause to see whether the Government will accept it. I see the Minister shakes his head. It is similar to points that the Government have accepted, acknowledging the position of local authorities and providing for consultation with them. That explains the amendment. I hope that the explanation carries some force. I do not want to spend a long time on it.
I welcome the matters that the Government are putting into the Bill regarding exemptions. An acknowledgement of consultation would be an appropriate step. I welcome the government amendments in the group. On delegation, the Government are absolutely
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- “the effect of this amendment could be considerable for the resources of the LBRO and may bring into doubt their ability to meet the demand for adjudications and/or dealing with the (potentially large) number of references it might get under this process”.
I would welcome comment from the Minister on the resources point.
On Amendment No. 42, I cannot restrain myself from noting that we now have a provision that the Secretary of State “shall” do something. Amendments to change “may” to “shall” normally come from the Opposition Benches. The Government may find it is quoted back at them on other occasions.
Paragraph (b) in Amendment No. 44 states that the application of a section would be “wholly disproportionate”. I stumbled slightly over “wholly”; it is not something I would have expected to see in legislation. That seems to be more the language of conversation or rhetoric. Given that there is reference to proportionality elsewhere in the Bill, I wonder whether there is a particular significance in this.
Baroness Wilcox: My Lords, I speak against government Amendment No. 41. That amendment removes the ability of the Local Better Regulation Office to delegate its functions under Schedule 4 to another person as it considers appropriate. Perhaps I may jog your Lordships’ memories back to day three of Committee. Noble Lords will remember that that aspect of the Bill was debated by the noble Lord, Lord Cope, and by the noble Baroness, Lady Hamwee. The noble Lord, Lord Jones, answered the debate at col. GC 249 and, in his usual sympathetic style, agreed to review this part further and to look at “delegation”, “responsibility” and “function”.
The Government’s proposed solution is to remove that paragraph from Schedule 4. It is an unsatisfactory solution as, while it addresses the point made that the Local Better Regulation Office should not be able to delegate or discharge its responsibility to another, at the same time it now makes the reverse possible, as the Local Better Regulation Office could now not delegate at all. The noble Lord, Lord Jones, said that this provision is,
The Local Better Regulation Office is a small body and the arbitration role that it undertakes under Schedule 4 has the potential to become burdensome, to skew the resources away from other tasks and not take advantage of expertise in other organisations capable of ably assisting.
The Trading Standards Institute and the Chartered Institute of Environmental Health, as mentioned by the noble Baroness, Lady Hamwee, have expressed their concerns about this amendment and the impact it could have on the Local Better Regulation Office to engage with organisations such as themselves and the Local Authorities Co-ordinating Office on Regulatory
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My question to the Minister is: are the Government able to reconsider and to provide an amendment that addresses the concerns that were communicated in Committee without removing this paragraph completely and frustrating the clear intention that the Government had here?
Viscount Colville of Culross: My Lords, I do not want to make any criticisms. On Amendment No. 44, I just want to say a word of gratitude to the Minister. There are two lessons to be learnt from this amendment, which the Government, at my suggestion, have been good enough to accept. If one knows the criteria in advance, whereby some particular function will be used, one does not need delegated legislation. We have far too much of it. Just look how easy it is to put it in the Bill. I am very grateful to the noble Lord for ensuring that this will be in the Bill and that we do not have to endure even more subordinate legislation.
My other point relates to what the noble Baroness, Lady Hamwee, said. Paragraph (b) in the amendment is quite important. I do not mind whether it is “wholly disproportionate” or just plain “disproportionate”. If it does not matter, there is no point in involving massive bureaucracy. There is a great advantage in the noble Lord bringing forward an amendment that ensures that there will not be an imposition of bureaucracy on local authorities for quite minor matters, so I want to say thank you.
Lord Bach: My Lords, I am very grateful to the noble Viscount, although I am not sure that I am quite so grateful to the noble Baroness opposite or to the noble Baroness, Lady Hamwee.
Amendment No. 43 in the name of the noble Baroness, Lady Hamwee, would require the Secretary of State to consult local authorities before laying an order that would set out the exemptions to the primary authority requirements in Clause 27. We are sympathetic to the intentions behind the amendment. As the House will know, the Government’s code of practice sets a high standard for consultation relating to any new area of policy development. This is important not least in the interests of better regulation, which is the subject of this Bill.
Noble Lords will be aware that, as was said in Committee, the Government have recently reviewed their processes of consultation and will revise their code of practice shortly. I assure noble Lords that any use of the order-making powers in Clause 28 will be subject to consultation and will clearly need the input of the experts working with practitioners from local authorities as well as from businesses to get the details right. However, an explicit statutory requirement to that effect is unnecessary. The spirit of the noble Baroness’s amendment is agreed to, but it does not need to be in the Bill in this instance.
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The noble Baroness invited me to refer to the phrase “wholly disproportionate”. That relates to orders that the Secretary of State is required to make. Proportionality is a fine balancing test and often it is not crystal clear whether contact will be proportionate. Where contacting the primary authority is wholly disproportionate—a stronger test than merely disproportionate—there must be an exemption. That is what the provision does.
The noble Baroness also asked about resources. Under Clause 12 and the memorandums of understanding, we expect LBRO to make arrangements for sharing resource and expertise on arbitration issues. The answer to the noble Baroness, Lady Wilcox, is that, although we have taken out that part from the schedule, there is under Clause 14 the right for LBRO to do anything that,
- “it thinks necessary or expedient for the purpose of, or in connection with, the exercise of its functions”.
That can include seeking advice from a national regulator when arbitrating. I also point out that, under paragraph 5 of Schedule 4, LBRO must consult the relevant national regulator and may consult other persons it considers to be appropriate when arbitrating. By removing part of the schedule, we have not made it impossible—in fact, it is still very possible—for LBRO to consult.
On Question, amendment agreed to.
Schedule 4 [Enforcement action: references to LBRO]:
Lord Bach moved Amendment No. 41:
On Question, amendment agreed to.
Clause 28 [Enforcement action: exclusions]:
Lord Bach moved Amendment No. 42:
On Question, amendment agreed to.
Lord Bach moved Amendment No. 44:
“( ) The Secretary of State shall in particular under subsection (1) prescribe circumstances for the purpose of securing that section 27(1) to (4) shall not apply—
On Question, Amendment agreed to.
Lord Bach: My Lords, I beg to move that consideration on Report be now adjourned. In moving the Motion, I suggest that Report begin again not before 8.44 pm.
Moved accordingly, and, on Question, Motion agreed to.
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Autism: National Strategy
7.44 pm
Lord Maginnis of Drumglass asked Her Majesty’s Government what progress has been made in the development of a national strategy for autistic spectrum disorder; and what consultations they are having with the three devolved Administrations.
The noble Lord said: My Lords, I am grateful for this opportunity to speak about autism and am grateful to noble Lords who indicated a willingness to support me. I take this opportunity to thank all of them, especially those who manage to get in on this short debate.
I do not intend to speak about methodologies beyond declaring that my personal experience is that progress for more of those who are on the autistic spectrum can best be made through an eclectic approach; there is no easy, one-size-fits-all solution. Behavioural aspects, sensory difficulties and communication problems must be addressed together. Neither should aspects of co-morbidity be treated separately. We must get away from an approach that labels children and laboriously moves them from what I call one silo to the next.
That is why I want to ask the Government to rethink the provision and planning of autism services and to work to establish and accommodate within a national strategy the best of what is happening in England, in Wales, in Scotland and in Northern Ireland. The voluntary sector within the three devolved entities has found it beneficial to come together with the Irish Republic to establish an autism co-operative: the Celtic Nations Autism Partnership. However, the United Kingdom as a whole and we in this Parliament have an obligation to better manage procedures. Autism services are currently a postcode lottery. Those on the spectrum, their parents/carers and their siblings deserve better. Autism is a family issue.
I was asked in September last by Michael McGimpsey, the Health Minister in Northern Ireland, to chair an independent review of autism services. Without prejudice to what the review team will present within the next month, I want to define some of the shortcomings within our current system. In December 2002, Hall and Elliman published a report entitled Health For All Children—sometimes referred to as Hall 4—in which they endorsed screening and surveillance reviews of babies by health visitors soon after birth and then at roughly monthly intervals until 13 months. Thereafter, they advised only optional contact with parents and “assessment where required” at two years, with nothing further until three to five years.
Now I ask: “assessment where required” by whom? Is that by a first-time mother, with no baseline against which to make her judgment, or by parents in denial that something is not quite what it should be with their child? In Northern Ireland, a previous Chief Medical Officer issued an instruction based on Hall 4, which was:
“Formal universal screening for speech and language delay, global development delay, Autism, and post-natal depression is not recommended”.
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I stick my chin out: she and Hall 4 were wrong on this point and that guidance should be amended at once.
There is an irrefutable need for early identification of autistic tendencies, which can be evident when a child is between 18 months and two years. Such identification needs to trigger immediate intervention services concurrent with immediate early assessment and diagnosis. No longer should we have waiting lists that, according to the last Written Answer I received, can be anything up to three years. Those vital three years can never be retrieved. They will be crucial as to whether those with ASD achieve the best possible life outcomes or are destined not to reach their potential.
My number one proposal is that a two-year structured home visit by a health visitor must be put in place and the current two-year optional visit, with better purpose, must be put back until 30 to 33 months. Let me try to define, in real terms, what that involves. Available epidemiological data suggest a prevalence of ASD of around 90 per 10,000 births. With roughly 750,000 births per annum in the United Kingdom, that means about 6,750 children may come on the ASD register each year. Allowing for initial incorrect suspicion, adding, say 25 per cent, we will have closer to 8,500 children referred for specialist assessment and diagnosis. My review group has calculated that specialist diagnostic services will require about 18 hours per child, on average—some more, some much less.
In terms of scoping out diagnostic/assessment service capacity, additional capacity must be factored in because of, first, the backlog of cases currently on waiting lists and, secondly, the potential cohort of older, as yet undetected, cases that are still to arise and present to services; we also—thirdly—need provision to cater for Asperger’s syndrome, which can become apparent in those between five and 10 years of age. On that basis, our review has identified an immediate need to have 13.3—forgive the 0.3—whole-time equivalent specialists for our 1.75 million population in Northern Ireland; for the UK, we would be looking at a figure of around 480 whole-time equivalent specialists.
Should we achieve a situation where we effectively cater for every child as efficiently as is humanly possible through early identification, early assessment and early intervention, I could not promise any reduction in specialist services—there is a huge deficiency in adolescent and adult services. However, I do not have time to deal in detail with transitional services and the transfer of meaningful data across departments. Primary education will necessitate teachers and classroom assistants who are “autism aware”. Some, in both these areas, are outstanding, but too many are, bluntly, “unaware”. In my 23 years in the classroom, I would have been one of the latter.
But I have a good news story. I have, during the past six months, visited teacher training colleges the length and breadth of Ireland to discuss what is needed in respect of autism-specific modules. In the true spirit of cross-community co-operation, the principals of our two colleges, St Mary’s and Stranmillis in Belfast, have responded with a working
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I hope that others will refer to transition and data transfer in a more comprehensive manner than I have time to address—I refer to the transition to secondary and tertiary education and the transition to adolescence and adulthood, where, invariably, those with disability are currently left to fall off the precipice at 18 years of age.
Much can be achieved by a better-directed use of current capabilities and resources. But if we are to have equality of opportunity for those with ASD, we must systematically begin to organise along the lines that I have just outlined. We must have a proper blueprint for action that is properly benchmarked, so that there is accountability within every administrative sector and sub-sector—especially, but not exclusively, within health and education.
My number two proposal would be that, if we cannot achieve consistency and efficiency by persuasion, the Government must legislate specifically for autism. I hope that that will not be necessary.
During my research I have found the most caring parents, the most dedicated individuals within the health service and an enthusiastic voluntary sector—probably the best informed and most aware element of all—but each is searching, competing and despairing as it tries to function in a chaotic system in which government departments are yet to enforce cohesion. There is neither cross-cutting nor co-ordination. Sub-sectors must stop protecting their precious little corners and operating in silos.
I do not want to overrun my time; I simply ask the Minster whether the Government will study our comprehensive review of autism services and seek to give us leadership on this vital issue. Perhaps we could then have a longer and more detailed debate as we plan how quickly and effectively we can move forward.
7.54 pm
Baroness Gale: My Lords, I thank the noble Lord, Lord Maginnis, for securing this important debate on a national strategy for autism.
Autism is no respecter of national boundaries. Its impact is felt by families, carers, people with autism and those who work with them. It is clear that the more we can work together at a cross-national level to share our ideas, policies, skills, experience and knowledge, the greater the chance we have of meeting the challenges of autism that we face within our own nations.
It is therefore highly commendable that the national charities of Wales, Scotland, Northern Ireland and the Republic of Ireland have formed the Celtic Nations Autism Partnership. This Celtic partnership takes a strategic approach to autism within the voluntary sector and serves to engage with the devolved Governments in the UK on autism far more effectively than ever before.
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May I bring to the attention of noble Lords the capacity-building towards autism, which is currently being undertaken in Wales? In Wales today, 60,000 people are affected by autism—that consists of those who have autism, their families and those who work with them. The Welsh approach to autism is very strategic.
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