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11.03 am

Lord Freud: My Lords, I am delighted to rise for the first time in your Lordships' House in support of this Bill. First, perhaps I may place on record my appreciation to the staff of this House for their helpfulness towards me and my family. I am particularly impressed by the way in which the Doorkeepers thrust notes into my hand as I wander through the corridors. They clearly have a much better idea of where I am than I do.

Let me turn to the Autism Bill. I congratulate my honourable friend in another place, Cheryl Gillan, on championing this Bill and the noble Baroness, Lady Pitkeathley, on so ably introducing it in this House. I should like to take the opportunity to draw your Lordships' attention to the close connection with another Bill before this House, the Welfare Reform Bill. The underlying concept in that Bill is that, if we invest in a disciplined fashion in people who need help in making their way in the labour market, we all win-that is, the individuals concerned, society and the taxpayer. The autistic fit exactly into this paradigm. Indeed, when I was compiling my independent report on this matter two and a half years ago, autistic people were one group that I had explicitly in mind. With the right support, autistic adults can make an incredible

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contribution in the workplace. Many have an attention, a focus on detail and a sheer perseverance that can be invaluable attributes in particular jobs.

Two forward-looking employers-BT and Goldman Sachs-have programmes that allow people with autism to make this kind of contribution. BT has told me that autistic people are highly prized for their extraordinary facility with numbers. The tragedy is that, according to estimates provided to me by the National Autistic Society, only some 50,000 adults with autism, or 15 per cent, have regular work. The approach presaged in the Welfare Reform Bill would allow us to find the very considerable resources necessary to transform the lives of those adults with autism. It would do so despite the very difficult times that we are facing, when the economic pressures on spending will inevitably be severe. Properly organised programmes, managed with financial rigour, should allow the 15 per cent figure to improve dramatically.

With your Lordships' indulgence, I should like to take advantage of this unique opportunity to place some more personal remarks on the record. My family arrived here 71 years ago at a very difficult time for this country and the world. They escaped only because Sigmund Freud, my great-grandfather, was a well known figure. My father and grandfather were both desperately proud to join the Armed Forces of their newly adopted home. Indeed, my father parachuted back into Austria in 1945 as an officer of the SOE and single-handedly captured the enemy aerodrome of Zeltweg.

The descendants of Sigmund Freud have been accepted and have thrived in this country. I cannot remember a single occasion-not one-when I have been made to feel an outsider or that I did not belong here. That is a remarkable testimony to the tolerance and generosity of this country. I firmly believe that-perhaps with one or two exceptions-I would not have been able to make that statement of any other country in the world. While I would not presume to speak for all Freuds, who are a fiercely individualist group, many of them will, I know, join me when I place on record in this place and at this very difficult time my gratitude to this great country for all that it has done to nurture the Freud family and other families who have come here for freedom and to achieve their potential. I thank the House for its indulgence.

11.10 am

Baroness Tonge: My Lords, I congratulate the noble Lord, Lord Freud, on his fascinating maiden speech and I welcome him to the House. His remarks about people with autistic spectrum disorder in the workplace were extremely useful and we look forward to hearing more about that. He made several interesting references to his family. I was wondering what Sigmund Freud said about autism, but I do not think that the word existed in his day. I will have to look through my psychiatric text books, if I still have them, to find out what was the nearest word. I also loved the noble Lord's comment about not knowing where he is. I remind him that we are given a life sentence to this place, so before we die many of us will probably get to the stage of not knowing where we are. We must all look forward to it. I thank the noble Lord for his contribution.



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Over a year ago, on 19 March 2008 to be precise, the noble Lord, Lord Maginnis of Drumglass, led a debate on this subject. I spoke in the debate and, in a very full and informative reply, the noble Baroness, Lady Thornton, gave us reassurances that an enormous amount of work was going on and that various initiatives were already in place. She mentioned the Early Support programme, extra funds for the National Autistic Society and for the further involvement of TreeHouse-both of these are wonderful charities-programmes to improve training for teachers, and funding for the Autism Education Trust to improve teaching and social work. All this is making a difference. While nothing is ever enough, of course, tremendous progress is being made for children with autism. However, as the noble Lord, Lord Astor of Hever, said in that debate, enough attention is still not being paid to the transition years and adults with autistic spectrum disorder. This was the subject of a recent report from the All-Party Parliamentary Group on Autism.

I thank the noble Baroness, Lady Pitkeathley, for introducing the Bill so ably into this House after its passage through the House of Commons. It concentrates on the transition phase from school years to adulthood and the management of adults with autistic spectrum disorder. As someone who years ago as a local councillor and doctor and then as an MP battled to help individuals with autism and their families, I want to emphasise yet again the need for co-operation between health services, social services and education. I see that the noble Baroness is nodding in agreement. Co-operation is still a headache, but it was a nightmare in my day. I understand that the joint needs assessment that each primary care trust and local authority are supposed to have undertaken to assess the needs of people with autistic spectrum disorder in their area has not really produced much in the way of results. Only 21 per cent of PCTs have actually done these assessments and I hope that the Minister can explain to us why that is and how they are to be implemented.

I apologise because I must rattle through a series of questions, to which I know that the Minister will write with her responses if she cannot answer now. I want to put on the record during this debate how much I appreciate the efficiency, pleasantness and extreme speed with which the noble Baroness always responds to queries and other points raised in debates. I turn now to my questions.

Do we know whether each area has a lead person responsible for the joint strategic needs assessments to be made by PCTs and local authorities? Who is that lead person? We know that the planning of support and care for adults with autistic spectrum disorder needs to start well before the age of 18 when they leave formal schooling. Are we sure that each individual has a key worker in the run-up to reaching 18, someone with the right training to be able to identify individual needs and plan for the future? I am sure that this will be developed in the strategy, but how many offices of the Department for Work and Pensions up and down the country have in them professionals trained to recognise autistic spectrum disorder and able to advise people accordingly?



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A huge problem faced by adults with autistic spectrum disorder was mentioned by my noble friend Lord Addington in last year's debate. Some people do not have the condition recognised when they are children. As they move into adulthood, sadly, some end up in the criminal justice system and, even worse, can often go to prison. What are we doing to identify these people before they get into trouble? What happened to the national prevalence study that was announced two years ago? So far as I know, it has not yet seen the light of day. It would be useful to have the answer to that.

I think that two weeks must pass between the Second Reading and the Third Reading of a Bill, which means that there is little time for this Bill before the Summer Recess. I urge the Minister to try to persuade the authorities to ensure that it gets through before the Recess, or three months will be lost. Only a nod is required from the Front Bench. It does not take long and there must be a way in which we can do this so that we are able to take advantage of the Summer Recess to get going on the work. Perhaps I am asking for a miracle, but I am sure that the Minister will work on it. We need the publication of both the strategy and the guidance as soon as possible.

There is increasing interest in the diagnosis and treatment of individuals with autistic spectrum disorder. It presents a huge problem when it occurs and, without proper provision and support, it can create enormous stress in a family, sometimes leading to relationship break-up, which I have seen on several occasions.

On a very pragmatic level, the National Audit Office has found that simple interventions that occur early, whether for children or adults, can save huge amounts of money later on, so they are extremely cost-effective. People with autistic spectrum disorder deserve society's support, which must be properly planned through a strategy and with no more delays.

11.18 am

Baroness Verma: My Lords, I, too, join noble Lords in congratulating my noble friend Lord Freud on his very eloquent maiden speech. It is obvious that my noble friend will be an exceptional addition to your Lordships' House, to which no doubt he will bring great experience and wisdom. I thank the noble Baroness, Lady Pitkeathley, for introducing this important Bill. It is heartening to witness the high level of cross-party support that the Bill has received. The National Autistic Society has called the response by Members of Parliament "unprecedented". My honourable friend Cheryl Gillan is to be congratulated on her central role in bringing this Bill forward, and I am pleased to see her here today. I also thank the noble Baroness, Lady Pitkeathley, for setting out so clearly and eloquently its provisions in this House. I will of course have to repeat a number of points that have already been raised by noble Lords, but it is important to do so.

We all recognise the importance of supporting those suffering from autism in our society and the need to ensure that they can enjoy a quality of life that we would wish for ourselves. At Second Reading, my honourable friend Cheryl Gillan described some of the shocking detail of the lives of more than 500,000 children and adults with autism. It is worth repeating

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some of those statistics today. Some 42 per cent of children with autism have no friends, and the proportion rises to 75 per cent for adults, while 40 per cent of children with autism have been bullied or harassed. The number rises to 50 per cent among adults. This suggests that not only is there a failure to support and understand children with autism, but that this gets progressively worse as they grow up This is a story of exclusion and alienation that leads to unacceptable outcomes for people suffering from autism. Evidence shows that 27 per cent of children with autism have been excluded from school and that only 15 per cent of autistic adults are employed. We must engage with all the related partners to ensure that appropriate information and support is available to children right through to adulthood.

For a great many of us, it is self-evident that the Bill should enforce statutory requirements on the National Health Service and local authorities to look after people with autism, rather than only guidance. I celebrate the consensus that has been developed as the Bill has progressed. Earlier, in debates in another place, Phil Hope suggested that a Bill was not needed. Mr Hope's statement that,

seemed almost unbelievable coming from a Government characterised by a 12-year long addiction to legislation. It is therefore gratifying to see that this is no longer the Government's position and that the Bill has been approached in a real, meaningful fashion.

A good example of where specific guidance is necessary is in the statutory guidance for joint strategic needs assessments. Currently, only 21 per cent of all JSNAs include any mention of the needs of people with ASD. Thus the vast majority of local authority and PCT partnerships are failing to consider the needs of people with ASD. The Government have confirmed that good practice guidance will be published this year to help assessors identify the needs of people with autism in their areas. I do not think it is enough to produce only good practice guidance. Can the Minister confirm that statutory guidance will specify that JSNAs must take into consideration the needs of people with ASD? Can I press her for a further assurance that community assessments will be carried out by professionals who have received appropriate levels of autism-specific training? Can the Minister also assure the House that this will be part of the strategy and statutory guidance?

The timing of the publication of statutory guidance, set currently at no later than 31 December 2010, means however that there could be a possible nine-month time lag between that and the publication of the autism strategy. Would it not be better for them to be published together as this would aid local authorities and PCTs in working out which elements of the strategy will be in statutory requirements? Can the Minister say why there is this delay?

The statistics regarding the lack of local information about both children and adults with autism make for chastening reading. According to the National Autistic Society, two-thirds of local authorities do not know how many children with autism live in their areas. This

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in itself is worrying, but, sadly, it rates better than the fact that, in comparison, only two local authorities in the country know how many adults with autism live in their areas. This chronic lack of information makes any coherent approach to tackling the difficulties faced by those with autism quite impossible. If these numbers are not known, local authorities can, quite simply, not address the needs of people with autism in their areas as they plan their commissioning of services.

I am certain that we are all aware that such a situation is unacceptable. We on these Benches wholeheartedly support the Bill's aim to improve this information. On a more specific note, while I acknowledge the view in another place of Phil Hope that the details of improving the identification of adults with autism spectrum disorders will be determined during the consultation period, can the Minister inform the House of the steps that the Government will take to ensure that taking such measures will be proactive and focus particularly on those adults who are currently unknown to the services?

It is important that co-ordination between children and adult services offers a seamless transition for children with autism as they reach adulthood. If children with autism are to reach their full potential, there must be improvement in the support they are offered by local authorities and in the information that they and their parents are given. As the NAS has stated, 40 per cent of adults with autism live with their parents, relying on them for much of their support. This is a pernicious situation for these people and their families which can be alleviated with the proper support from their local authorities. A seamless transition requires a holistic strategy for people with ASD. How can the Government ensure that all relevant departments will participate? Will the support demonstrated by the DCSF for children with autism be built on by working effectively with the Department of Health and the Department for Work and Pensions?

We agree that this joint approach is vital for the success of the autism strategy. For better employment opportunities, it must be a key priority for this process. What measures do the Government intend to take to ensure that the DWP plays a central role?

It is reassuring that the Government have already begun work on the adult autism strategy in line with the duty the Bill will place upon the Secretary of State to introduce such a strategy. The Bill offers us a huge opportunity to positively affect the experiences of adults with autism. In its current form the statutory guidance provides for access to diagnosis, needs assessments, strategic planning of services and transition planning, and for local partnerships to meet the needs of adults with autism. The success of this guidance and of the strategy will surely depend upon the quality of their implementation. The implementation plan proposed by the Department of Health will be central to this. Can the Minister tell us whether the implementation plan is being consulted on as part of the strategy consultation? If this is not the case, what action is the Department of Health taking to develop a robust and practical implementation plan?

It is an indictment of the approach that has pertained in this country towards autism that over three-quarters of local authorities do not currently have an autism

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training strategy. Will the Minister assure the House that there will be appropriate guidance and training in local authorities?

It is encouraging that the Bill has provisions to ensure that statutory guidance includes the training of staff who provide the relevant services to adults with such conditions. "Relevant services" do not include such professionals as disability employment advisers. Can the Minister give assurances that these DWP professionals will have the training to enable them to support adults with ASD in finding employment, and how this will work in practice? Can she also confirm that the Government intend to provide appropriate training for all professionals with a significant role to play in supporting adults with autism? How will this be supplied? Is she able to outline whether any measures are to be put into place to ensure that appropriate housing, such as warden-controlled accommodation, will be available for adults with autism to encourage independent living?

It can make the difference between people with autism fulfilling their potential or remaining excluded from mainstream society. The National Autistic Society makes a valid point when it argues in its press release that,

The commitment from the Government to placing a legal duty on local authorities to collate and share data on disabled children, with autism as a specific category, is to be applauded.

Clause 1(4) requires the Secretary of State to keep the autism strategy under review and to revise it if necessary. This will require monitoring at local, regional and national levels. It will also require effective frameworks for evaluation and guidance. For this to be implemented successfully, it is important that there will be a designated person. Can the Minister say how the Department of Health intends to monitor the process of the strategy and what indicators will trigger a review? Will she commit to having a named individual within the health service who has a responsibility for successful implementation?

It is particularly pleasing that the interpretation clause of the Bill gives responsibility for both diagnosis and provision of support to local authorities and the National Health Service. It is crucial that there is no fudging of responsibilities or a lack of clarity. I am sure that noble Lords will offer the benefit of their great expertise to ensure that no opportunity to strengthen, clarify or improve the Bill is missed. I look forward to the Minister's response.

11.29 am

Baroness Thornton: My Lords, I welcome the opening remarks by my noble friend. I am extremely pleased that she is taking the Bill through the House, and I am delighted to be speaking to it today.

I add my voice to those welcoming the noble Lord, Lord Freud, in his place in the House. His fame-possibly notoriety-goes before him, and his maiden speech did not disappoint. I am sure that we will find him moving forward with great rapidity on his own Benches, and we can all look forward to that.



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I think the fact that many noble Lords stayed in their places to support my noble friend's opening remarks tells us how important the issue of autism is in your Lordships' House, and I am pleased to say that the Government have made clear their commitment to taking action to improve services for people with autism. Our means for achieving that is through the development and publication of the Adult Autism strategy, and most of my remarks will be addressed to adult autism. I shall make a few remarks about children and transition, as the noble Baroness, Lady Tonge, mentioned, but this is a most important discussion about adult autism. I pay tribute to Cheryl Gillan for bringing this forward in another place.

The full public consultation on the content of the strategy began on 29 April. I am pleased to say from the outset that the fact that the Bill will not reach the statute book until after the break, due to the procedures of the House, does not mean that work on the strategy and the work contained within the Bill will not begin. We are determined to do what we can, within the confines of what we can do, before the Bill reaches the statute book.

When the Bill was introduced in another place, the Minister for Care Services made it clear that, while the Government share the principles which underlined the Bill, we could not support it in the form in which it stood. That is why the Government brought forward the amendments that have made the Bill as it stands today.

Through the Bill, the Government are making clear that we will deliver what we have promised. The duty on the Secretary of State to prepare and publish a document setting out a strategy for meeting the needs of adults with autism in England by April 2010 is unavoidable. It is a mark of our commitment that we not only accept that duty but, indeed, that we proposed it.

We cannot pre-empt the consultation on the strategy, which will end in September, but with our external reference group we have identified the priority themes for an adult autism strategy. These are health, social inclusion, employment, choice and control, and training.

On health, we will identify the barriers to accessing specialist health interventions and mainstream healthcare services and propose action in the strategy to address this. On social inclusion, the strategy will address issues of employment for people with autism, as mentioned by the noble Lord, Lord Freud. That includes building on work to address the commitments in Public Service Agreement 16 to support more of the most socially excluded groups of people into employment.

We are commissioning work from the Social Care Institute for Excellence to publish evidence-based good practice guidance in September 2010 on enabling people with autism to have greater choice and control over the types of support they receive, and we will be working with professional bodies to take action on addressing the training issues. Skills for Care is carrying out a national consultation to create new knowledge sets, with the aim of publishing the basic competencies needed for workers who support people with autism. We have already made clear our intention to publish the final strategy by the end of 2009. We are happy to

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underline our commitment by setting ourselves a statutory timescale for this, with, of course, a sensible margin for flexibility.

In developing the strategy we are working closely with a very wide range of stakeholders-a term I hate, but I could not think of another one that encompassed the range of bodies with which we are working in terms of the voluntary sector and right across the spectrum. We want to hear from as many people as possible whose lives have been touched by autism, whether personally or professionally.


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