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Jonathan Reynolds (Stalybridge and Hyde) (Lab/Co-op)
I appreciate having been able to secure the debate. I thank the Minister and shadow Minister for their attendance, and am grateful to the other MPs present. A lot of people watching the debate on the Parliament website might not be aware that we all had a late night last night, debating the finer points of the Finance Bill, so I am grateful to hon. Members for turning up. I also thank the National Autistic Society for providing me with statistical information. I remind the Chamber that I have declared an interest in the subject of the debate, as the parent of a child with autism.
I want to discuss the experience of many families with autism; their feedback on the support provided by child and adolescent mental health services, or CAMHS; and problems of communication, misdiagnosis and the training of CAMHS professionals. I will then make the case for more specialist autism support and ask the Minister a number of questions.
Autism is a serious, lifelong, disabling condition that affects how a person communicates with and relates to other people. It is a spectrum disorder that affects each individual differently. Some people with autism can lead independent and fulfilling lives with little support, while others need specialist support throughout their lives.
People with autism have said that, to them, the world is a mass of people, places and events of which they struggle to make sense, and which can cause them considerable anxiety. In particular, understanding and relating to other people and taking part in everyday family and social life may be harder for them, while other people appear to know intuitively how to communicate and interact with each other. Approximately one child in 100 has autism.
Autism is not a mental health problem, but a recent study by Professors Simonoff and Charman found that 71% of children with autism have a co-occurring mental health problem, and 40% have two or more. Such problems include serious conditions such as depression, anxiety disorders and obsessive-compulsive disorder, which can be debilitating without the right support. Seven out of 10 children with autism develop such conditions, which is far too high a figure. However, with the right support from people who understand autism, such children can have mental health as good as any other child’s. Unfortunately, that support is often unavailable in our society.
Children with autism find it difficult to understand the world around them. They may not understand social cues and expectations or be able to identify patterns and routines in their lives. Help with understanding what to do in different situations or what happens next in a sequence of events, or with coping with changes in routine, can make a big difference, but without such support, children with autism can become anxious or frustrated.
Children with autism are also less likely than other children to have strong social relationships. One Office for National Statistics study found that 42% of children with autism had no friends, compared to 1% of other children. Children with autism may act in unusual ways, or may try to fit in with their peers in socially inappropriate ways. Other children may ridicule or bully them as a result.
Difficulties at school and elsewhere may affect the self-esteem of children with autism. An inability to express their feelings can lead to escalating emotions or leave them unable to deal with experiences such as loss or grief. A supportive educational setting that works for the child, in partnership with mental health services, can be crucial to maintaining emotional well-being and preventing mental health problems from developing, yet the NAS found that 34% of parents said that a delay in accessing the right support at school had had a negative impact on their child’s mental health, and that half of children with autism are not in the kind of school that their parents believe would best suit them. Awareness and consideration among the general public also play a part. Whether in shops and restaurants, on public transport or in the park, children with autism and their parents can face intolerance and lack of understanding that can cause considerable stress and anxiety.
It does not have to be like that. Most of those difficulties can be overcome with the right support for children with autism and their families. Children with autism can live happy, healthy, fulfilled lives, do well at school and reach their full potential. Everyone in society must take some responsibility for making that happen.
I intend to concentrate on the support that children with autism and their families receive when mental health problems develop. According to Government-commissioned research conducted by the university of Durham, one child in every 10 who accesses child and adolescent mental health services has an autism spectrum disorder. That amounts to more than 10,000 children a year. Such children are often extremely vulnerable and in dire need of support that works for them. Another ONS study for the Government found that 25% of children with autism either self-harm or have suicidal thoughts. Their families are desperate for skilled help that can improve their children’s mental health and quality of life.
The NAS has been carrying out in-depth research on the subject since last summer, as problems with CAMHS were being mentioned consistently through its helpline and regional offices. When NAS members were surveyed on the organisation’s campaigning priorities, 99% rated improving CAMHS as either important or very important. The NAS held focus groups with parents and one-to-one interviews with children who had experienced CAMHS, followed by a mass survey of parents. It also visited several CAMHS sites and spoke to professionals and clinical directors.
Through its research, the NAS has found that, sadly, most children with autism and mental health problems are not getting the service that they need from CAMHS. According to the NAS survey, CAMHS fails to improve the mental health of two thirds of children with autism. We must improve on that.
One young woman said of her experiences as a nine-year-old accessing CAMHS that
“when I went in to the meeting I was miserable and depressed. When I came out I was suicidal. I was trying to throw myself out of my windows and hang myself… It took me several years to recover and I didn’t ever want anything to do with them.”
The NAS consistently heard from professionals, parents and children that, despite the huge proportion of children with autism in the system, understanding of autism among professionals is generally poor. Only half of parents feel that CAMHS staff have a good understanding of autism, and fewer than half think that CAMHS staff know how to communicate properly with their child.
To work successfully with a child with autism, a CAMHS professional must have a good understanding of autism. Autism is a communication difficulty, so the professional must generally adapt how they communicate, which requires a good understanding of autism. With respect to some children, that involves speaking more clearly and directly, while others have limited or no verbal communication and may need visual cues to help them to make sense of and communicate their feelings. A child with autism is likely to take longer than other children to trust the professional and communicate openly.
Professionals may also have to adapt their explanations to be less abstract or hypothetical and relate more directly to the specifics of the child’s situation. For example, if a professional works with a child with autism to deal with a certain situation in a classroom setting, the child will usually struggle to generalise, applying the same techniques at home or on the school bus. The professional will have to work through each situation in turn, which is not necessary for other children.
Children with autism can also struggle to explain difficulties that they are not currently experiencing. One child said:
“They need to be there when things happen, because when I went to see the doctor at our local CAMHS I never felt bad and couldn’t talk about what had been hard because it wasn’t happening then”.
When professionals are given the time and training to get to know the child and their family, understand the child’s autism and how they communicate best, and adapt their approach accordingly, outcomes are greatly improved. However, a professional who does not understand autism is unlikely to make such adjustments, leading to a breakdown in communication and making effective intervention extremely difficult.
When a child with autism also has a mental health problem, it is crucial that the right support is provided for the right diagnosis. If a child is wrongly assessed, the wrong support will inevitably follow. Practitioners who do not have a good understanding of autism can misdiagnose children as a result, leading to inappropriate or unsuitable interventions. Without a sound working knowledge of autism, some behaviours that are common in children with autism can easily be interpreted as mental health problems. For example, autism-related personal obsessions, rituals and routines can lead to a false diagnosis of OCD. Peculiarities and fads about what a child eats can come across as an eating disorder. Sleeping difficulties or an aversion to human touch can wrongly lead to suspicions of abuse-related trauma.
The NAS found that some children who had been diagnosed with autism were wrongly undiagnosed by a professional who was convinced that their behaviour was symptomatic of a different condition. Other children’s mental health conditions were overshadowed by their autism, when professionals were unable to distinguish the symptoms of mental health problems from autism-related behaviours: if the CAMHS team focused on autism, mental health issues were ignored. Some parents said that the professionals they met considered conditions such as anxiety disorders inevitable and unavoidable side-effects of autism, rather than as the separate, treatable conditions that they are.
Many of the professionals told the NAS that they wanted more opportunities for professional training and development, so that they and their colleagues would be better able to work with children with autism and mental health problems. Many children with autism receive either inappropriate support or no support at all because the right support simply does not exist in their area. Some CAMHS professionals told the NAS that their waiting lists for children with autism were much longer than those for children without autism, and that, because so few staff had autism training, the vast majority lacked the skills to treat children with autism, so those children were left waiting for the handful of staff with sufficient autism expertise.
Charlotte Leslie (Bristol North West) (Con)
As chair of the all-party group on autism, I congratulate the hon. Gentleman on securing this debate on an immensely important subject. The NAS has done fantastic work raising these issues with colleagues. What training did CAMHS staff receive under the previous Government and does he think it was adequate? If not, what improvements might be made?
Jonathan Reynolds
I am grateful to the hon. Lady for her intervention, and I acknowledge her work and expertise in this field. I approach this subject primarily as a parent, so I am happy to say that more needs to be done. I am not making this a party political issue between this Government and the previous one. I am trying to highlight the issue and, I hope, move forward together, across the House.
I wish to identify some good practice relating to the hon. Lady’s question. Dudley primary care trust operates an autism clinic that focuses on diagnosis and assessment, and has the specialist expertise to assess complex autism cases. The clinic takes a “broad apprenticeship” approach to training new staff, which gives them the opportunity to observe specialists and more experienced clinicians assessing children from behind a one-way mirror.
After new staff have watched several assessments, they progress to shadowing colleagues and then to taking the lead with children with autism, with support from a specialist. Finally, they are able to work alone and train new starters themselves. They learn through practical experience, rather than theory. The clinic also shares its expertise more widely and trains external agencies. For instance, it trained a group of specialist autism teachers and key workers to provide social skills training to children, meaning that social skills training could continue once a child had left CAMHS, making it far more effective than if it had been delivered once and then discontinued.
There is clear evidence that a good understanding of autism is vital to delivering an effective service to the high number of children with autism in the CAMHS system. All professionals working in CAMHS must have their training needs relating to autism recognised and addressed. In “Fulfilling and rewarding lives”, the Government’s recently published strategy for adults with autism, there is a commitment for
“all NHS practitioners”
to
“be able to identify potential signs of autism, so they can refer for clinical diagnosis if necessary… but more importantly so they can understand how to adapt their behaviour, and particularly their communication, when a patient either has been diagnosed with autism or displays these signs.”
The same strategy commits the Government to working with the General Medical Council and various professional bodies
“to improve the quality of autism awareness training in their curricula.”
What action do the Government intend to take to ensure that the NHS training objectives made in the autism strategy, “Fulfilling and rewarding lives”, are met, so that all CAMHS practitioners receive some basic training in autism?
Dr John Pugh (Southport) (LD)
The hon. Gentleman has made two distinct points so far: that mental health problems can be masked by autism so that a person who really has mental health problems may be seen only as having autism, and that autistic behaviour can be misdiagnosed as a mental health issue. Surely that is a very tricky situation for any diagnostician to be in.
Jonathan Reynolds
Yes, it is difficult. To be clear, my point is that the prevalence and frequency of co-occurring mental health problems with autism require CAMHS professionals to have specialist training. Without that support, there can be misdiagnosis, which can lead to the situation that the hon. Gentleman referred to.
Does the Minister agree that, given the high proportion of children with autism who access CAMHS, all CAMHS professionals should receive some autism training?
I have explained how a basic knowledge of autism among all CAMHS staff is essential to ensuring that appropriate interventions are delivered to children with autism, but that alone is not enough. Providing mental health support to a child with autism is a specialist skill. Research has found that when an autism specialist has been involved in the support of a child, the outcomes and service satisfaction both improve dramatically.
The NAS found that parents who reported that their child had received support from a professional specialising in autism were twice as likely as those whose children had not to agree that CAMHS had improved their child’s mental health. They were also four times as likely to say that a good understanding of autism by mental health professionals had positively influenced their child’s mental health. However, only two in five parents say that their child has had such support.
Mr John Leech (Manchester, Withington) (LD)
I congratulate the hon. Gentleman on securing the debate. As a parent of an autistic child, does he support the idea that children on the autistic spectrum should be educated in special schools, or are such children better off in mainstream schools?
Jonathan Reynolds
Speaking as a parent, we must recognise that this is a spectrum disorder. Therefore, children with autism are in different situations and have different symptoms, and each requires a response particular to them. Generalisations of the kind that the hon. Gentleman asks about cannot be made. Each parent and professional would, in respect of the support that they had, have to make the decision based on what was best for that particular child.
The professionals who spoke to the NAS stressed the importance of specialist autism expertise when dealing with a child with autism and mental health problems. They explained how in many cases a specific skill-set is required to treat these children and that without that specialist knowledge it can be very difficult to effect any real improvement. They felt that specialist expertise was often required to get a real understanding of how the child’s mental health problems related to their autism, and how they would need to adapt the interventions they provided to take account of the child’s autism.
Although basic autism knowledge will help a professional to communicate better with the child and understand better why the child displays certain behaviours or symptoms, greater expertise is often needed to make a positive difference to the child’s mental health. That is because many therapies and interventions rely on thought processes and communication techniques that do not make sense to children with autism, and only skilful adaptation from a specialist can make them relevant and useful. Children with autism often will not gain any benefit from treatment that is applied in the standard way. Indeed, such treatment can make things worse.
Again, we should recognise good practice where it exists. West Berkshire has a social communication team that provides home and community-based assessment and intervention for young people with complex diagnostic issues or needs that cannot be met by local services. That team works with children with autism and a co-occurring mental health disorder. It takes a multidisciplinary approach, incorporating speech and language therapists, two clinical psychologists and a psychiatrist. The team is also part of a wider multidisciplinary group that provides services for children with autism in west Berkshire. The team recognises the need to adapt therapies to account for autism. Psychologists divide their time between diagnosis and follow-up appointments, and provide behavioural and mental health interventions.
Pat Glass (North West Durham) (Lab)
I have worked in this area for many years, with many children and CAMHS services. I have found across the country that there is massive inconsistency in the quality of CAMHS services, but there is absolute consistency in the lack of those services for children. Quality is variable throughout the country. Although the services that my hon. Friend is talking about are at the upper end of the scale, for many children they simply do not exist.
Jonathan Reynolds
I am tremendously grateful to my hon. Friend for her intervention. She has great expertise in this and other matters, and in another capacity was responsible for the education system that I went through. I hope that I am not letting her down.
Following on from that, as so many children who access CAMHS have autism, what action will the Government take to ensure that specialist autism support is available to all children with autism and mental health problems? To take up what my hon. Friend has said, I think we would all agree that one matter that always arises when we talk to parents and campaigners is the inconsistency in service delivery across the country. For every example of innovative or positive practice, there are often many examples of children with autism and mental health problems facing inadequate or non-existent provision.
Local commissioners are supposed to plan services based on the needs of the local population, but it seems that in many instances commissioners are unaware of either the number of children with autism and mental health problems in their area, or that those children need specific support from people who understand autism, or both. When commissioners fail to recognise and address the needs of children with autism and mental health problems, those extremely vulnerable children and their families do not receive the support that they need. Commissioning is a local exercise, but there is no doubt that direction from the Government at national level can make a huge difference to what is commissioned.
Previous Government directives—for example, the national indicators, Care Quality Commission inspections and the national service framework for children—have instructed commissioners to prioritise specific areas of CAMHS, such as age-appropriate in-patient wards for teenagers, early intervention services, and services for children with a learning disability. Those directives drive commissioning in those areas, and lead to greater availability of services and greater consistency across the country.
The National Autistic Society has provided strong evidence that CAMHS are failing children with autism, and that results for such children can be greatly improved by improving autism understanding and specialisms within CAMHS. We know that only 10% of CAMHS provide targeted support to children with autism. Surely, there is a strong argument for the Government to prioritise the commissioning of services for children with autism.
Ten thousand children with autism access CAMHS each year. Given that the mental health of two thirds of children with autism is not improved by the support that they receive, that is a huge waste of NHS resources when we can ill afford such a waste. Furthermore, when children with autism receive services that do not work for them, or receive no support because none is available, their problems escalate and become more complex. Not only does that mean that it is much harder for families to cope; it means that, ultimately, those children are much more expensive for the NHS to treat. A relatively short period of appropriate therapy from an autism specialist at an early stage could prevent a child from needing a long stretch in an expensive in-patient unit.
If commissioners were given more guidance and direction to help them to commission the right services for children with autism in the first instance, we could stop wasting money and stop wasting lives. What action will the Government take at national level to ensure that the right services for children with autism are commissioned locally across the country?
Mr Joe Benton (in the Chair)
Order. The debate lasts only one and a half hours. Several hon. Members have indicated that they would like to speak—I will do my best to call them all—so perhaps they will bear that time limit in mind, and that I propose to start the winding-up speeches at 3.40 pm.
Annette Brooke (Mid Dorset and North Poole) (LD)
I congratulate the hon. Member for Stalybridge and Hyde (Jonathan Reynolds) on securing this debate, and providing comprehensive coverage of the vital issues. I also congratulate the National Autistic Society on its “You Need to Know” campaign, because we must make services work better for people with autism. An important aspect of that is to make CAMHS services throughout the country work effectively for children with autism.
I have been contacted by constituents asking me to support the campaign, and I want to begin my brief contribution by describing some of their experiences, because they illustrate all the general points that the National Autistic Society makes. One constituent wrote:
“I first realised there was something wrong with Jon’s development at the age of 2 but was told by my Health Visitor that I was comparing him to his older exceptionally bright brother and that he was fine. I continued over the next 2 years to say that ‘something wasn’t right’ until she eventually agreed to get his hearing checked—he wasn’t interacting with me, seemed in his own little world and wouldn’t even respond to his name. His hearing was fine so she referred him to a speech therapist as he didn’t talk much but after a few weeks of attending, he was discharged saying he was ok. It was only once he’d started school that he was referred”—
to the local hospital—
“But the consultant…decided that Jon must have a form of epilepsy as he would ‘switch off’ in the playground and was oblivious to his surroundings. He did months of tests but they revealed nothing”.
Eventually, Asperger’s syndrome was diagnosed, and my constituent went through years of seeking help. She continued:
“I have no idea what or how to access services which may or may not be available to Jon especially CAMHS. He is 17, 14 stone and 6ft 3, and can have tantrums like a 2 year old—just as sudden and just as violent. I asked my GP if there was some kind of Anger Management course available to him or if he could see a psychologist that could help him. He said I would have to see Jon’s consultant”.
And so it went on. My constituent believes that training is needed across the board for GPs, nurses and psychologists, as well as with direct CAMHS services.
Another constituent who works with children and young people with autism said:
“I feel that many health professionals are unaware of the battles faced by those living with autism. I have often found those from outside agencies quite hostile towards our clients…not realising that they need to be treated differently from neurotypical people. Most of these students have diagnosis in other things such as Obsessive Compulsive Disorder, ADHD and Pathological Demand Avoidance and attachment disorders.”
They say that it is
“hard to find people with the right expertise to deal with these disorders as they usually have not dealt with people with autism before, leaving these other diagnoses untreated. Add this to the fact that the provision for all of these services usually drop away once a person with autism reaches 19 and are transferred into adult services and it seems we are failing those with a diagnosis”
of autism.
Another constituent said:
“My experience with CAMHS for Sam has been quite negative. We saw an ASD Nurse Specialist from CAMHS for about 6 months. He knew very little about autism, in fact he used to borrow books on autism from parents”.
Another constituent wrote:
“We are consistently told by professionals that they are severely overstretched which from personal experience and talking to other parents leads to very few families receiving adequate support…Maybe if money was invested on these children as they deserve…then they would be more likely to develop into functioning adults who are able to contribute to society in a positive way rather than developing into adults with mental health issues who are totally reliant on the state.”
Those four experiences sum up many of the issues that we are debating.
Autism is not a mental health problem, which makes it difficult for people to access appropriate services. As we have heard from the hon. Gentleman, a large proportion of children with autism have mental health problems, which may develop because of the symptoms that they express and subsequent interaction with other people. They may become more socially isolated at school because of their characteristics. The problem snowballs if the symptoms of autism are not identified early, and the child’s journey does not include trained people who understand its complexities and varieties.
Mr Mark Williams (Ceredigion) (LD)
The debate is rightly concentrating on the inadequacies of CAMHS, but my hon. Friend knows of my interest in teacher training and teachers’ awareness of identifying the characteristics of autism. There is understandable frustration among teachers at the lack of training facilities and opportunities available to them.
Annette Brooke
My hon. Friend and I, along with many others, have worked hard on education, and we are slowly making progress. Today’s debate takes us further afield because we have to get the whole package right for children with autism.
Being mindful of the time, Mr Benton, I would like to touch on two issues. First, I would like to emphasise the need for training for CAMHS professionals, which is vital for all the communication issues mentioned by the hon. Member for Stalybridge and Hyde. The issue is not straightforward, which means that there must be training; there must be flexibility, patience, skill and understanding. The local CAMHS commissioning process is designed to identify and address skills gaps in the local work force. What steps will the Government take to ensure that such gaps are identified and addressed with regard to autism?
I have been involved with the Every Disabled Child Matters campaign, and one area of concern that we have identified is the falling apart of services for disabled children during the transition period. There is a lack of forward planning for the transition, starting about age 14. That is particularly true for children and young people with autism, because they are likely to require ongoing mental health support and to need a smooth changeover between children’s services and those for adults. One issue that I have with children’s trusts is that in some local authorities, there is a great dichotomy between children’s and adult’s services. The best local authorities manage the transition well, but there is the potential for people to fall through the gap. How do the Government intend to ensure that CAMHS and relevant adult services work together to plan appropriate ongoing support for children with a mental health problem and an additional disability, such as autism, and for all young people who require ongoing mental health support?
Cathy Jamieson (Kilmarnock and Loudoun) (Lab/Co-op)
I, too, congratulate my hon. Friend the Member for Stalybridge and Hyde (Jonathan Reynolds) on securing this important debate. Hon. Members who know that I come from north of the border may wonder why I choose to speak on a matter that essentially relates to devolved issues in Scotland. However, in a number of areas, we have to look across the UK, and the National Autistic Society has a facility—Daldorch House—in my constituency, which has become a centre of excellence in the local area and is looked to by a number of local authorities, not just in Scotland but across the UK, for advice on how to approach work with young people with disorders on the autistic spectrum.
I have taken an interest in this subject over many years, and I first came across young people with disorders on the autistic spectrum 30 years ago as a young art therapist. It is fair to say that there have been a number of positive moves both in recognising the range of issues that people face, and in looking at different ways of working with people and the different services required. Despite all those improvements, all of us as elected Members of Parliament will come across people in our constituencies who still have to battle, fight and almost scream from the rooftops to get the services that they need for their children.
One difficulty that people often face—I certainly experienced this as the Minister responsible for education in Scotland when I tried to introduce legislation that should have provided additional support for learning—arises because parents are suspicious of any change, as they feel that it might lessen the rights of young people, rather than give them increased rights to education and other support.
This morning, I received in my e-mail inbox a piece of correspondence from a constituent, which I think sums up how much further we still have to go. The parents were writing about the needs of their teenage son, and the difficulties that they have encountered in finding appropriate educational placements. Their son is already in a school but, according to the parents, that school does not have the necessary skills and experience to cope with him and does not want him there for reasons of health and safety. Another school has been identified in the local authority area, and although it has the skills and expertise, it does not have enough support staff to take the teenager on. The parents are extremely worried about the impact of budget cuts that are already being made in the local authority, with learning support assistants—and others—being made redundant.
As a result, those parents told me that they do not know whether any schooling will be available for their son after the summer break. They have been advised by both schools that they are unlikely to hear anything from the education authority until two days before the start of the new school term. All hon. Members who are aware of the issues surrounding education for young people with disorders on the autistic spectrum will know that that is an unacceptable way to deal with young people who require support and preparation, and for their parents, who need to know what is going to happen.
I am conscious of the time, but I want to say that we must work to identify who these young people are. Every local authority and health board has a responsibility to identify young people with disorders on the autistic spectrum and put in place appropriate support packages. I am concerned that we are not doing enough to recognise that those young people will grow into adults, and at some stage will require not only support to enter further education or employment and all that goes with that, but support with the ageing process. At some stage, there will be a significant number of people approaching their elderly years who are diagnosed as having a disorder on the autistic spectrum. We have not done anything to look at that issue.
It is important that parents receive support. Everyone who has been the parent of a teenager knows that it is a difficult time. I used to joke that my son disappeared into his bedroom aged 14, and came out a better person aged 17. [Hon. Members: “Too early!”] Perhaps I was lucky. For people who have teenagers with disorders on the autistic spectrum, it is a difficult enough period. The added pressures and the support that parents require have not been adequately recognised.
We must pay attention to the number of people who end up in young offenders institutions and prison systems but who probably, had their condition been picked up at an earlier stage, would have been diagnosed as being somewhere on the autistic spectrum. I have also raised that issue in a Scottish context. When people are in a place such as a young offenders institution or prison, we should be able to identify the problem, get them the appropriate help and support, and look specifically at how we can help them in the future.
I am grateful for the opportunity to make a brief contribution to the debate. When the Minister responds, perhaps she will say something about what the Government are planning to do about the transition from education into employment, and about the specific issue of how we can provide support for people as they go through the ageing process and inevitably require a degree of support from the state.
Mr Robert Buckland (South Swindon) (Con)
Thank you, Mr Benton, for giving me my father’s name. Robert Buckland is my true name. I am grateful for the opportunity to speak in this debate, and I congratulate the hon. Member for Stalybridge and Hyde (Jonathan Reynolds) on an excellent and comprehensive analysis of the report from the National Autistic Society, which many of us have read and found extremely useful.
I declare an interest because, like the hon. Gentleman, I am the parent of a child on the autistic spectrum. My experience, although initially negative, is something that I have decided to try to be positive about, again like the hon. Gentleman. Having had the honour of being elected to this place, I regard it as my duty to raise those experiences, talk about them and do whatever I can to advance the cause of children, young people and adults with autism, the autistic spectrum disorder and Asperger’s syndrome.
The “You Need to Know” campaign touches on an issue that all of us, whether Members of Parliament, parents, professionals or members of the public, may have experienced in recent years, as the extent of the diagnosis of autism has dramatically increased. A group of individuals and their families feel utterly isolated because their experiences have, in the words of the hon. Member for Mid Dorset and North Poole (Annette Brooke), resulted in their having to scream and shout from the rooftops, bang on doors and adopt behaviour that they might never have contemplated at the beginning of their journey. I simply ask the eternal question: why does it have to be like this? Why on earth are we still in this position in the second decade of the 21st century? The National Autistic Society was founded nearly 50 years ago. Medical research on, and analysis of, the condition that we now know as autism began as long as 70 years ago. I appreciate that the calls on the public purse are immense, but progress on this issue is too slow, and that is betraying an entire generation of children and young people.
Provision for the transition from youth to adulthood is—I hesitate to say this, but I will press on none the less—nothing short of scandalous. The excellent provision in the education and children’s services sector suddenly vanishes when the young person reaches the magic, or should I say tragic, age of adulthood. Time and again, I have met constituents who are crying out for the help and support that they thoroughly deserve, but who are not getting it. They understand and are conscious of the fact that they are increasingly a burden on our society, but it should not be like that. They should not be a burden on the rest of us; they should be making a valuable and meaningful contribution to our society. We should not forget the talents, idiosyncrasies and amazing abilities of children and young people with such lifelong conditions. I talked about the initially negative experience of learning and understanding that one’s child has autism. As I said at the beginning, however, the positive aspect of such conditions must not be forgotten. These children and young people are not a burden; they add to the mosaic of human experience, and we need to understand and embrace that as we address the questions.
I know that we have touched on this point in the debate, but we should not forget the position of parents and carers of young people with autism. All of us with experience and knowledge of the position of parents and carers will understand that the pressure on them is often intolerable. They often need support and access to mental health services themselves if we are to avoid some appalling scenarios. In one appalling case in south Wales recently—I will not go into it, because it is sub judice—a parent was detained under the Mental Health Act 1983, and a young child lost his life. In the second decade of the 21st century, that is unacceptable in any book.
Hon. Members have eloquently outlined the need for training, and I need not repeat what they have said. Professionals who are outside this place, or who may be present, will say that they are doing all they can with limited resources to deal with the huge variety of problems they are presented with as paediatricians in the national health service or as mental health practitioners. I understand that resources are tight, but as has been said—I make no apology for repeating it—there is huge potential for saving money by intervening early and recognising problems. In these times, when finance is understandably the Government’s paramount consideration, is that not a strong and persuasive argument for supporting provision?
Mr Russell Brown (Dumfries and Galloway) (Lab)
My hon. Friend the Member for Stalybridge and Hyde (Jonathan Reynolds) mentioned west Berkshire. As a result of the pressure that I and others in my locality have put on our local health board, we now have an integrated ASD network, with speech and language therapists and a whole host of professionals. The hon. Gentleman has hit on the central point: early intervention, with good, sound, solid professionals working together as a team, will make the difference. That can save money in the long term, but, more important, it can alter the quality of life for young people and their families.
Mr Buckland
I thank the hon. Gentleman for that important intervention, which leads to the point that I was about to make. We could spend hours in a chicken-and-egg argument about whether mental health conditions precede autism. Let us not forget that autism is often accompanied by physical disabilities and a range of other conditions, so it is a complex area. Similarly, mental health problems will accompany autism in some families for hereditary or genetic reasons, so it is probably not worth getting into the chicken-and-egg argument.
There is, however, no doubt that a number of young people who present themselves to CAMHS will have had an imperfect or late diagnosis of their condition, and I am afraid that my personal experience in that respect has been rather negative. Experienced paediatricians, whom I will not name, because they are distinguished in their field—one in particular is very distinguished in the medical-legal field—told me that diagnosis at two or three was not possible for autism and ASD. I was a mere layman in those days, and I had not made the journey that I have now, so I accepted what I was told at the time, but I learned later that it was not the case. If that attitude is still prevalent, we have a problem. I do not want to criticise health care professionals, who do a wonderful job, but the point being made by the National Autistic Society is that we need more training, awareness and understanding. That is all we ask for in this debate.
The hon. Member for Mid Dorset and North Poole asked the proper question about transition provisions. We now have the Autism Act 2009, and we await the statutory guidance, which is all-important in fleshing out the bones of the Act. The guidance is key, and we need the Government to give a clear steer in it as to how we manage the transition from childhood to adulthood. That is a key time, but there is, as I have said, a scandalous dislocation in provision, which needs to be dealt with properly.
As the hon. Member for Dumfries and Galloway (Mr Brown) so eloquently said, we need to look at key intervention at the earliest stage. A lot of the mental health conditions that accompany autism can be avoided through early intervention, which would mean that there was less pressure on CAMHS and less of a crisis in the key early and mid-teen years.
I know that other hon. Members want to contribute, so I will finish on this point. We have seen some excellent examples of provision, and west Berkshire has been cited. In authorities such as mine in Swindon, the PCT and children’s services are integrated and work very well. They are starting to do the outreach work in CAMHS in the primary sector that will help to identify problems and improve early intervention. However, although that integration is all very well, the question, which the hon. Member for Mid Dorset and North Poole posed, is whether there is proper integration with adult services. Therein lies the problem, and more work needs to be done.
I am grateful for being allowed to contribute to the debate. I hope that this will be the first of many contributions that I make on the subject in the years ahead. I thank you for allowing me to speak, Mr Benton.
Mr Andrew Smith (Oxford East) (Lab)
I, too, congratulate my hon. Friend the Member for Stalybridge and Hyde (Jonathan Reynolds) on securing this important debate and on his well informed and persuasive speech. It is encouraging that the debate is so well attended and that it is informed by the personal experience of parents of children with autism.
Like other hon. Members I have received a number of representations from constituents in support of the National Autistic Society “You Need to Know” campaign. I applaud the work of the society and its supporters in raising the profile of the needs of children and young people with autism and of the importance of ensuring that there is proper diagnosis and support from CAMHS, GPs and other health professionals for the 70% of children with autism who also have mental health issues.
My hon. Friend set out both the range of difficulties that young people face as they go through life and the opportunities that are opened up by the right skilled help. I want to raise a couple of points that I think are important. The first is the interaction between autism and mental health and the number of young people who are not in education, employment or training. An interesting Audit Commission report on re-engaging young people—published today, coincidentally—includes an analysis of the characteristics of young people in the NEET category, and shows for example that whereas young people with either learning difficulties and disabilities or one or more special educational needs statements comprise 10% of all young people, they comprise 23% of young people who are not in education, employment or training for six months or more. It does not give figures specifically on those with autism, but the proportion will be significant—not counting, of course, those who have not been properly diagnosed. That is an important issue.
One of the key recommendations of the Audit Commission report is that local councils, especially with the transfer of 16-19 funding, and all the existing and coming pressures on local budgets, need to understand the nature of their local NEET population and to target their support appropriately. I urge that understanding the extent of autism and mental health difficulties among those young people should be a key part of the analysis and of the supportive action that needs to be provided by health, education and training professionals.
Another point that I would like to stress follows from the comments of the hon. Members for Mid Dorset and North Poole (Annette Brooke) and for South Swindon (Mr Buckland): it is the importance of improving and joining up support for young people with autism as they move into adulthood, which is understandably a particularly stressful time for the individuals concerned and their parents. Certainly in my area in Oxford, although there is still some way to go, there have been welcome improvements in support for children and young people in education. Parents have praised to me the work done by Oxford and Cherwell Valley further education college. However, as youngsters become adults it can be an especially uncertain time, when the prospects for work, other meaningful activity, further training, social relationships and housing become problematic, and their parents are getting older. There needs to be a better joined-up approach between health, social services and housing providers so that there is a coherent system of support. As the Audit Commission report recommends, there is a need for better co-ordination between Connexions and Jobcentre Plus, and better handover arrangements as people move forward and look to the possibilities of work.
At a time when local council budgets face huge cuts, it is all the more important that we should speak up for the needs of those young people, which have so often been misunderstood and neglected in the past. They must not be marginalised in the battles for funding ahead. One crucial point from the Audit Commission report is that early intervention and the right early support not only make a huge difference to people’s quality of life, but, as the hon. Member for South Swindon said, can save big sums of public money in the long run. The report illustrates that fact by contrasting the example of a young man with Asperger’s who gets the right support and ends up with a life in work, and one who does not, and ends up with a life on benefits.
I would be grateful if the Minister let us know what guidance and support will be given to local councils, health authorities and others on relevant matters so that young people with autism and their families can face the future with more confidence, and in particular what action the Government will take to ensure that CAMHS and adult mental health teams work together so that there is the right continuing support.
Dr John Pugh (Southport) (LD)
I want to add a few footnotes to the excellent introduction to the debate by the hon. Member for Stalybridge and Hyde (Jonathan Reynolds), who set out the major issues carefully and meticulously. Mental health and autism cropped up emphatically in debates on the Mental Health Act 2007. We were then largely concerned with the treatment of young people, including making treatment specific to them, rather than putting young people into adult accommodation or the like, or giving them adult services when juvenile services would be appropriate. While recognising that that was not always possible, I pay tribute to the campaign by YoungMinds for adolescents to receive adequate, full treatment no matter what their condition or mental health.
I pay tribute to the work done on the 2007 Act by the hon. Member for East Worthing and Shoreham (Tim Loughton), who has gone on to greater things, and to Baroness Browning, the former Member for Tiverton and Honiton, who was a champion of autistic people in this place and who pioneered the work that was taken on by other hands as the basis for the private Member’s Bill that subsequently became the Autism Act 2009. Off the back of the 2007 Act, I carried out my own research on provision for children and adolescents and wrote to every PCT for which I could obtain a name. I wanted to focus particularly on adolescent mental health provision, rather than childhood provision, and on waiting times. I accept the point that all the hon. Members who have spoken have made about the critical nature for families and, obviously, patients, of waiting times—the time between a suspicion that something is wrong and getting a diagnosis and treatment. Those are of course different things—one can get an early diagnosis but be slow in getting treatment.
It is not surprising that that issue is crucial during adolescence, when huge hormonal, physiological, social and personality changes are happening. That is a stage in life when, often, psychotic and other disturbances first become evident. One of the more depressing passages included in the Library debate pack deals with that fact. It states:
“Mental illnesses are the chronic diseases of young people.”
It continues:
“It is a curious paradox that better physical health in young people has been accompanied by steadily worsening mental health.”
That is indeed what the national statistics show, and it is why early intervention matters, because if it is successful and efficacious it means someone does not have a life of ongoing suffering and disturbances.
My inquiries of the various PCTs unsurprisingly produced patchy results, in accordance with the well-documented contributions made by other hon. Members. There was a general variation in standards, which I think people might expect, and which has been vouched for today, but what disturbed me more was the lack of clarity about who was responsible for the standards. My inquiries were passed from PCT to CAMHS and back. People did not seem clear about who would carry the can if provision were less than adequate. The implication is that for people using the services no one is ultimately responsible; that is the nagging feeling.
Another feature that cropped up in my research was an apparent lack of dedicated facilities and expertise in many places, and a recognition that although in some places there were adequate facilities for children, facilities for adolescents were wholly inadequate. There is no excuse for that state of affairs in relation to Asperger’s syndrome and the autistic spectrum, because what is required for progress is very clear. Certainly, early diagnosis is required, but the National Audit Office report that I have seen—which I think Baroness Browning did something to trigger—clearly stated that specialist autism teams were the way forward, coupled with good integration, and so on. That is all known, but hon. Members have reported that across the country none of it has been perfectly accomplished.
May I make a personal constituency point? I increasingly receive complaints from parents of children who are mildly autistic but are now being excluded from services because needs must—there are pressures on local authority resources, as the right hon. Member for Oxford East (Mr Smith) illustrated. That is profoundly depressing, because the result is that people who could progress to independence and, in later life, manage far better for themselves and not become problems as adults are not making progress at the key point at which they could be making the progress necessary to become independent of parents and institutions.
My conclusion and, I think, the conclusion of the whole debate is that we are confronted with a situation in which there is a known complaint, a known solution, enormous support from the voluntary sector and clarity about what is required, but on the statutory side there is a somewhat ham-fisted response. Getting that ham-fisted response removed and replaced with something better is the thrust of the debate.
Roger Williams (Brecon and Radnorshire) (LD)
It is a great pleasure and privilege to contribute briefly to the debate. I congratulate the hon. Members for Stalybridge and Hyde (Jonathan Reynolds) and for South Swindon (Mr Buckland) on making contributions based on their personal and family experience of this matter. Many of us have not had that experience and our comments come from a different level of understanding. However, the message that I get from the debate is that given the level of understanding and competence that there is for this condition, there should be much better training for the professionals involved and much better working together and co-ordination between those professionals—between people in the medical profession, between people in education and between people in social services.
Some of the things that I shall say may seem a little cold and uncaring, but although the diagnosis of autism and the triad of impairments—the three conditions that lead to a classical diagnosis of autism—have been established, we have since realised that this is a spectrum condition. Every child, every young person—and every adult, for that matter—is an individual and their needs are different.
I first became aware of this issue a long time ago, when I became a governor of a special school at about the time that Baroness Warnock produced her report that changed our attitude to the education of children with special needs. The idea was that every child should have the support appropriate to them. We have moved on a long way: at that time, autism was hardly ever talked about, and I did not really have an understanding of it. Our knowledge has moved on a lot and improved, and professionals have a much better opportunity to use it. My point this afternoon is that we still need to do more fundamental research on the condition. What causes it? Is there a genetic element to it? Is there an environmental element? Is there a social element? At the moment, we just do not have the necessary understanding of those issues, and unless we can understand them, the way we intervene will not be as effective as it should be.
The other day, I was at the Hay festival, which is in my constituency—if anyone wants to attend, they will be very welcome—at an event with Simon Baron-Cohen, who is a researcher at Cambridge university. He was looking at personality disorders and then autism. Obviously, autism is not a personality disorder, but the issue of empathy is relevant. People with personality disorders are unable to relate to other people, and there is an element within autism of finding it difficult to understand the nature of a person’s response. The good news was that that gentleman, doing his research, felt that there were ways in which the research could be used to ensure that interventions and the way autism is treated are more successfully dealt with and lead to great improvements in the quality of people’s lives.
My message to the Minister is therefore: please, in all this, do not forget the fundamental research that is essential if we are to make progress. Yes, make use of the knowledge that we have, but do not think that that knowledge is comprehensive, because it can be improved and then the lives of people with this condition will be improved as well.
Pat Glass (North West Durham) (Lab)
I thank my hon. Friend the Member for Stalybridge and Hyde (Jonathan Reynolds) for securing the debate, which has been excellent. I do not disagree with anything that I have heard, nor do I intend to repeat any of it. I shall concentrate on the areas that I have the most concerns about.
We have come a long way in recent years and there have been improvements, particularly in education, but we must not be complacent and there is still a long way to go. The two areas that I have the greatest concern about are transition, which I shall come on to, and diagnosis. This refers back to the issues of child and adolescent mental health services. In my experience, far too many children still receive a diagnosis that is less related to their symptoms and difficulties than to who they are and where they live. I still see too many cases in which clinicians go down the route of attention deficit hyperactivity disorder or EBD—emotional and behavioural difficulties—first, because of the family and where they live. That means that those children and their families do not gain access to the diagnosis, services and provision that they need. That is one concern, and it relates to what I said in an intervention about the quality and consistency of CAMHS across the country. If people look at the issue geographically—on a map, as I have done—they will see hot spots of certain diagnoses, and sometimes around certain clinicians. Those issues need to be addressed.
Everything that I have heard today about transition, particularly transition in the early years, is absolutely correct. If we get that right and provide access to the right services—good, well co-ordinated provision—the mental health of those children and their families will be much improved, outcomes will be much improved and we will save money in the long run. Transition in the early years is crucial and will save us money in a time of austerity.
The transition at the other end is also an issue. A lot of emphasis has been placed on that in recent years, but in my experience that has been about the process—the right forms filled in by the right people, and the right people being at the right meetings at the right time. For the families, the process can be fabulous, but if there is nothing to transition on to, it is a disaster for them.
When I was in my former role in education, we recognised that there was almost a time bomb here. Children are going through the education services and coming up to the adult services, but those services are not there for them. Will the Minister consider the issues of diagnosis and quality of provision across the country to ensure that a child’s diagnosis is right and not based on the family’s circumstances or socio-economic grouping? Will she also consider transition in relation to the quality of provision, not just the processes, forms and meetings?
Mr Mark Williams (Ceredigion) (LD)
I thank the hon. Member for North West Durham (Pat Glass) and my hon. Friend the Member for Brecon and Radnorshire (Roger Williams) for the speed with which they spoke. I intended to make a bigger contribution about some of the good precedents and good practice that we have experienced in Wales, in the hope that the Minister might have a look at that, but I shall just highlight the launch on 28 June by the Welsh Assembly Government of their new child and adolescent mental health strategy and the work commissioned by the Assembly Government from Professor Sue Leekam of the Wales Autism Research Centre. It is undertaking evaluation of the assessment and diagnosis of children with disorders on the autistic spectrum, which will analyse and strategically examine CAMHS provision and many of the inadequacies of that, particularly in professional training, which we have heard about from hon. Members.
I wish to highlight also the work being undertaken by the Betsi Cadwaladr university health board, which operates in north Wales, to develop a register for children and young people with autism. I applaud what the hon. Member for North West Durham said about the lottery of service provision, but the strong message is that we must identify the extent of the challenges that face the nation. The problem was not addressed by previous Governments; I hope that it will be addressed by this one.
I end with a brief anecdote. We have heard some powerful stories this afternoon. My earlier intervention about teacher training was deliberate. I spent 12 years in the classroom and I always realised that, even as a professional, I was sometimes failing the children in my care. The problem of the little girl who used to wander around the playground with no friends should have been addressed, but teachers are not often equipped to do so. The fact was that when we told her, “Don’t touch the hot boiler in the corner of the room,” we knew that she would probably end up touching it and burn herself. I should have been equipped to deal with the many problems that that girl presented.
However, there are huge opportunities, which is a point that was made strongly by the hon. Member for Stalybridge and Hyde (Jonathan Reynolds) and others. If we create the right environment—a nurturing, caring and enriching environment—in our classrooms and in our health service provision, people on the autistic spectrum will be able to make a huge and valuable contribution to society.
I am sorry for speaking so quickly, Mr Benton, but thank you for allowing me to contribute.
Barbara Keeley (Worsley and Eccles South) (Lab)
It is a pleasure to serve under your chairmanship again, Mr Benton, and I congratulate my hon. Friend the Member for Stalybridge and Hyde (Jonathan Reynolds) on securing an important debate to which many hon. Members have contributed.
I pay tribute to my hon. Friend and to those parents—we heard about them again today, and our debate has been enriched—who have campaigned for vital improvements to services. As of yesterday, 136 Members from all parties, including my hon. Friend and, I expect, others here today, had signed early-day motion 160, which highlights the fact that 10,000 children with autism use child and adolescent mental health services every year. It also highlights a survey showing that using such services will not improve the mental health of two thirds of those children. As my hon. Friend said, the children are not getting the support that they need.
Children with autism are particularly susceptible to developing mental health problems, and many Members mentioned the fact that there is a range of reasons for that. Such children may experience social isolation, and 70% of children with autism struggle to make and keep friends, compared to 10% of other children. Children and young people with autism also find it challenging or impossible to express how they are feeling. The struggle to communicate causes frustration and anger, which can lead to mental health problems.
With the right support given at the right time, many of those problems can be prevented. Given that one child in 10 who accesses child and adolescent mental health services has autism, that should be a priority for the professionals in that service. However, only just over half the parents surveyed by the National Autistic Society thought that staff working in CAMHS had a good understanding of autism. Many of the professionals to whom the society spoke felt strongly that there were not enough training opportunities—many hon. Members touched on that point. Professionals need to develop their clinical expertise in order to work with children with autism and mental health problems. There is good experience of that happening up and down the country.
The high number of children with autism, coupled with the lack of skilled professionals, leads to many children being seen by professionals who are unable to meet their needs or simply being turned away. I have some questions for the Minister; I may be repeating some of them, but it will not hurt to do so. Will the Government ensure that all child and adolescent mental health professionals are provided at least with basic autism training, so that they can meet their duties to make “reasonable adjustments” under the Disability Discrimination Act 1995 and provide services that meet children’s needs? How will the Government ensure that specialist autism support is available within CAMHS?
As we have heard, autism is a complex disability. When mental health problems arise in children with autism, they are harder to recognise, evaluate and treat. Professionals need a good working knowledge of autism to do those things. Providing mental health support to children with autism is a specialist skill, and research conducted by the National Autistic Society found that if an autism specialist is involved in the support of such children, outcomes and service satisfaction improve dramatically. Indeed, those parents whose children had received support from a specialist in autism were twice as likely as those whose children had not to agree that the child and adolescent mental health service had improved their child’s mental health. Sadly, coverage is not good, and only two in five parents say that their child has had such support.
Specialist autism support is vital. We need to adapt therapies and interventions so that they are effective. Skilful adaptations will obviously make them relevant and useful to children with autism. Many Members spoke of the importance of early intervention. Autism specialists can also help other professionals to develop their skills, and they should share their experience with schools and social services.
The subject of commissioning was mentioned by a number of Members. It is particularly important, given the radical changes that the Government have indicated that they wish to make to local commissioning. The way services are commissioned locally for children with autism and mental health problems is clearly important.
Commissioners obviously need to know how many children with autism live in their area, how many of those children also have mental health problems and how local services are working. They need expert advice on what is needed to deliver the right mental health services. They then need to use those data to plan the right services for the children. If the commissioning changes that have been signalled are to be made, it is important to take those factors on board.
Commissioning must also take account of CAMHS waiting times, rates of return and family outcomes for children with autism. Specific local pathways should be developed for the mental health support of children with autism. Parents and children affected should be involved in the commissioning process, together with front-line professionals.
The Labour Government introduced a vital new duty, which came into force in April 2010. Children’s trusts now have to plan to meet the needs of children with special needs and disabilities. That represents a significant step forward. What action will the Government take to build on Labour’s work, to ensure that services are planned and commissioned at the local level so that every child with autism and mental health problems starts to get the support they need? How will the Government ensure that parents and young people are involved in the development of services to ensure that they meet local needs?
We know that the number of children with learning disabilities and of children with autism who use such services are similar. It is clear from improvements to services for children with learning disabilities achieved under Labour that having the right measures in place does make a difference, which was mentioned during the debate. As my hon. Friend the Member for Stalybridge and Hyde said, the Labour Government achieved improvements to services for children with learning disabilities through the 2004 national service framework. That highlighted the importance of providing adequate child and adolescent mental health services for children and young people with learning disabilities.
Specialist training, the adequate resourcing of learning disability specialist support and access to specialist in-patient support were also recommended. As we heard, a specific indicator was recommended for local authorities to rate themselves on their provision. As a result, specialist support for children with learning disabilities more than doubled between 2005 and 2007. In 2010, two thirds of primary care trusts rated themselves four out of four for their provision of CAMHS for children with learning disabilities. Based on the improvements for children with learning disabilities made under Labour, I urge the Government to commit themselves to achieving the same benefits in the coming months and years for children and young people with autism.
I shall speak briefly about early intervention. As was said by my hon. Friend the Member for Dumfries and Galloway (Mr Brown) and my right hon. Friend the Member for Oxford East (Mr Smith), putting support in place early makes a big difference in the long run. It can help to prevent difficulties from escalating into mental health problems. Over recent years, there has been a strong focus on improving support for children with autism and improving the emotional well-being of children with autism in schools. I hope that that continues.
The autism inclusion development programme has helped to improve teacher training. The social and emotional aspects of learning programme has helped pupils at school to gain emotional and social skills, and has helped them with self-awareness and managing their emotions. The early support programme has helped families of disabled children under the age of five to get co-ordinated support and information early, so that problems do not escalate.
Hon. Members touched on the fact that Labour initiatives, such as the Every Child Matters agenda, also helped to ensure that agencies work together, which is important in providing support to our most vulnerable children. Parents at the Every Disabled Child Matters reception in the House yesterday wanted assurances from the Minister that schools would continue with the initiative. They felt that they had created the initiative, and that it was not just a Government thing.
Government leadership over recent years has made a significant difference to aspects of the mental health system for children. In today’s debate, we are asking for similar action for this other group of children. We must continue to prioritise children and young people with autism because they are among some of the most vulnerable people in our society.
The Minister with responsibility for care services, the hon. Member for Sutton and Cheam (Mr Burstow), spoke about the campaign to make good mental health for children with autism a reality:
“There is no doubt that these changes can happen, where there is a will on the ground to make them happen.”
I hope the Minister confirms that the Government have that will, as many hon. Members from all parts of the House have shown that they have in the debate today.
The Parliamentary Under-Secretary of State for Health (Anne Milton)
I congratulate the hon. Member for Stalybridge and Hyde (Jonathan Reynolds) on securing both this debate and his seat. The subject is of huge importance to him, and he brought with him his invaluable personal experience, as indeed did the hon. Member for Manchester, Withington (Mr Leech) and my hon. Friend the Member for South Swindon (Mr Buckland). Those personal experiences are crucial to the debate, as are the contributions from those who are experienced in the provision of services. This debate is vital, and I will ensure that all the representations that have been made today are fed back into the policy process. Time is short, but I will just say to the hon. Member for Worsley and Eccles South (Barbara Keeley), who speaks for the Opposition, that some of us were fortunate enough to have listened to and participated in debates on the Autism Act 2009, promoted by my right hon. Friend the Member for Chesham and Amersham (Mrs Gillan), as it made its passage through the previous Parliament. At the time, there was an increasing dislike of and disillusionment with politicians, so I mention that measure because it showed this place in its very best light. It was about cross-party working and building a consensus. It was a genuine attempt by Members from all parts of the House to work together to improve the lives of others—in this instance it was the lives of those with autism. I pay tribute to Angela Browning, the former Member for Tiverton and Honiton, who was sometimes a lone voice calling for services for people with autism. She, too, brought her own personal experiences to the debate thereby helping to raise us to the next level.
I echo the comments made by the Minister of State, Department of Health, my hon. Friend the. Member for Sutton and Cheam (Mr Burstow), at the recent National Autistic Society reception. He said that the standards of care highlighted by the society in its “You Need to Know” report are unacceptable. He was grateful to the society—as indeed we all are—for its tireless campaigning, and was struck by the particular contribution of the young campaigners group. I am sure that he would pay tribute to them were he able to be here today.
The coalition’s programme for government makes it clear that we are committed to supporting the most vulnerable and to tackling health inequalities. There is strong consensus on what needs to be done to improve the emotional well-being and mental health of children and young people. More work is needed on prevention, early diagnosis and early intervention. Those are the key things that are needed by people with autism and mental health problems. We need better integrated working and more evidence-based approaches. The work force must be developed, and, crucially, we must do more to tackle stigma for people not only with autism but with mental ill health.
The National Advisory Council for Children’s Mental Health and Emotional Wellbeing report earlier this year reinforced the scale of that challenge. It called for action to strengthen leadership, build a confident and skilled work force, improve commissioning and ensure real participation by children and young people in service development. For me, commissioning is a vital part of that. It has never been done that well, but there is a general acceptance of the fact that if we improve commissioning, the services will then follow. As has been mentioned during this debate, there are examples of best practice, which we need to be able to transport to other areas. We need to consider all those issues to get the services that we want.
The Government have also promised to deliver measures in “Fulfilling and rewarding lives: the strategy for adults with autism in England”. There are many areas in which improvement in adult autism services will yield benefits for children’s services, such as developing local autism teams, improving access to diagnosis, better planning and better commissioning of services. As several hon. Members have said, raising awareness of the issue and improving skills in the work force should go much wider than just those working in the autism field, and should include teachers and sports clubs and all those who are involved with young people.
Our focus must be on improving the quality of services that we provide to all children. We must ensure that no one suffers the indignities and difficulties that are sadly all too common. I am referring to the frightened young person who is restrained by police because crisis services were not available; the child who feels isolated and frustrated, only to find that health care staff are not trained to help or able to understand them; the parents who desperately want to see an improvement but feel let down by services that do not treat their children as people with individual needs; and parents who are desperate, isolated and at the end of their tether. That is why it is so important to improve the standard of care across the board.
We must plan and build on the work that has been done on integrating services so that local partnerships can work together to deliver what we want. It will require incredible commitment from local NHS providers to engage with the work force to resolve difficult issues such as training and service design. Improving the reach and quality of child and adolescent mental health care means looking carefully at the different services that make up the whole picture. I am referring to universal services that play a pivotal role in promotion for all children and young people; targeted services that provide early interventions for vulnerable children and young people; and specialist services, which the hon. Member for Stalybridge and Hyde mentioned, for young people with complex, severe or persistent needs.
Anne Milton
I am sorry, there is no time. I already have far too many questions to answer. If hon. Members feel that their questions have not be answered or addressed, I urge them to write to me and I will make sure that we respond.
Barbara Keeley
When there have been a great number of questions, it is more usual for the Minister to agree to write to us rather than expect us to write to her.
Anne Milton
I am sorry for that error. I thought that I said that I would write. I thank the hon. Lady for raising that.
I have only two minutes left. The hon. Member for Stalybridge and Hyde said that staff working in child and adolescent mental health services should have the necessary values, competences and skills. That is vital. The coalition document made it clear that we are committed to supporting the most vulnerable and to tackling health inequalities, and we will make more announcements about public health. Appropriate tier 4 child and adolescent mental health services should be available to all children who require them, including children with autism. There are a number of other vital issues, including diagnosis and transition. I am proud of my own field, which was highlighted by the previous Government, for some of the things that they achieved on transition. I should also like to pay tribute to Sara Truman, who has done a huge amount of work with the National Autistic Society.
We have not touched on the health outcomes for people with autism and mental health problems, but if we look at them we will find that they are truly shocking. Parents and carers carry a huge burden. There are many issues that we have not covered, including respite and research. We still do not understand why people get autism. We also need to look at those children who are not yet diagnosed. There are significant challenges that will require real commitment and buy-in from the staff who work hard in CAMHS across the country, but I am greatly encouraged by the number of contributions here today and by the amount of expertise that is sitting here. There is a role for Government to play. I hope that hon. Members appreciate that we cannot provide all the answers—