Adult Autism Strategy

Lord Bellingham Excerpts

Wednesday 5th March 2014 Westminster Hall

[Mr Buckland]

I entirely agree. It is time that we recognise that conditions such as autism are particular disabilities that open a gateway to specialised housing. Unless we deal with that, we will carry on down the failed route of institutionalisation. We can see the logical conclusion of that in Winterbourne View and other serious examples. The Minister has a passion to deal with these issues, and I know he agrees that independent, supported living in properly tailored, properly built housing—it does not yet exist in any great measure—is what is needed for adults with autism if we are to avoid the tragedy that I and other hon. Members see week in, week out, whether we are canvassing or in surgery. We see young people sitting upstairs in the family home, without a job and they do not know what to do. They have no support, and their families are at their wit’s end in knowing what to do. We have to do better than that, and they deserve better.

On interface with agencies—I was talking about criminal justice—in many police areas, we now have autism alert cards. That system works well in Wiltshire, which is the police force area in which I live. We relaunched our autism alert card only last week. It is a simple thing: a bit of plastic with next of kin details on it. Importantly, the card tells the reader that the person carrying it has autism. That should trigger a series of events happening and make the police aware that autism is a factor. If various support services and care services are needed, they can be brought into the package and the family and the support network can also be informed about the incident or problem that the adult is having. Those simple measures can make a great difference.

[Mr Henry Bellingham (North West Norfolk) (Con)]

My hon. Friend is being incredibly generous. Where do GPs sit in all this? He has mentioned awareness and the need for different agencies to work more closely together. Does he agree that GPs should be given more training on autism at medical schools?

[Mr Buckland]

In a word, yes. GPs would welcome it and it would, at a stroke, deal with a whole range of unidentified problems. With greater awareness among general practitioners, referrals can take place. Where there are existing diagnostic services, as there are in Swindon, they can be used and, as I have mentioned, SEQOL and other organisations in other areas can get to work, using the pathways and identifying the condition.

What is next? What else is needed? I am a great believer in advocacy services, and I can see their power in some excellent local examples. The Swindon Advocacy Movement has recently had more funding to extend its remit to help people with autism and Asperger’s. It is a wonderful organisation, with a one-stop shop in the centre of Swindon that gives support to adults with learning disabilities. Its motto is that it is not there permanently to do things for people, but to empower people to help themselves. With that little bit of help, support and advocacy, lives can be changed for the better, and I see that happening through its wonderful work.

We also have Discovering Autism Spectrum Happiness, a voluntary organisation set up by a group of like-minded individuals some years ago in Swindon. It is now working from the Pinetrees community centre, offering the Swindon autism information and advice service, which is an invaluable resource. It only started last year, and it has already reached out to more than 150 individuals with autism and their families. By its estimate, there might be a couple of thousand of people in the community who have not yet been identified. Through its support work and its network, it is giving advice and empowering people with autism. I had the pleasure of visiting it only two weeks ago to talk about some of the cases that it is finding and some of the cases that are coming across my desk. There is a lot going on in local communities, but there is much more that we can do on an overall strategy to identify best practice, to knit that together in a co-ordinated and coherent way and to give other commissioning bodies and other authorities a gold standard from which they can work.

The Minister knows that I am not into lowest common denominators or prescriptive measures when it comes to this sort of thing, because I believe in localism. There has to be, however, some standard to which all commissioning bodies should work. Like adults who are neurotypical, adults with autism should not be frightened or worried to move about. If they can move to another part of the country to secure employment, they should reasonably expect that autism services in their new town or city will be of a similar standard to where they have come from. When they have a family support network, the tendency is for people with autism to stay close to home, and in many cases that is not a bad thing at all. Bearing in mind the Winterbourne View example, bringing people with a disability closer to home and to their network is a good thing, but there will be many high-functioning people with autism who want to travel, want to move about and want to take that job at the other end of the country. Why can they not do that? At the moment, there is a fear that the support network that they might enjoy in Swindon would not exist in another part of the country. That is the function that the strategy could fulfil; it is an empowerment strategy, not some prescriptive “We know what is best for you, so we will tell you what to do” strategy.

On community autism awareness, I have talked somewhat about advocacy services and information, but I want to talk about the sense of isolation that many with autism and their families feel. In a survey conducted by the National Autistic Society, 82% of adults with autism said that they have days and 42% said that they have weeks when they do not talk to anybody outside their household. Just think about that for a moment. Some 72% said that they have been bullied or discriminated against. A survey by Ambitious about Autism found that 87% of parents and carers of people with autism felt unsupported by the community. Those are stark statistics, but some of the solutions are simple. Small adjustments are all that is needed to change things. In the supermarket, staff are often not trained to know how best to deal with individuals who have autism. In the hairdressers, a few sensory adjustments would allow someone with hypersensitivity to access those facilities. The cinema at Greenbridge in Swindon regularly hosts autism-friendly screenings for children and young people, which make all the difference in the world. Parents at those screenings do not need have to have eyes in the back of their heads or worry about whether their child will be seen as naughty or misbehaving. They can relax, secure in the knowledge that everybody around them is accompanying someone with autism. Such adjustments make a huge difference in the lives of not only the individuals who have autism but their carers and families.

Urgent and Emergency Care Review

Lord Bellingham Excerpts

Tuesday 12th November 2013 Commons Chamber

[Mr Hunt]

I think the right hon. Gentleman will find that some of the competition law powers that are being used and are causing Sir David worry were actually from the Enterprise Act 2002, which we are now looking at to see whether we can sort it out.

[Mr Henry Bellingham (North West Norfolk) (Con)]

Is the Secretary of State aware that hospitals in Norfolk have recently made it clear to MPs that one of the key drivers of a big increase in people going to A and E is the fact that many people are not going to their doctor? Does he agree that it is essential that the GP contract of 2004 is rewritten so that doctors provide that 24/7 cover? When will he be able to sit down with the BMA and make real progress to right a serious mistake that the Opposition made?

[Mr Hunt]

My hon. Friend speaks wisely. The most senior A and E doctor in the country, Professor Keith Willett, said that he thought that between 15% and 30% of the people attending A and E could be looked after in the community. This is a root cause of pressure. I am afraid that the Labour party needs to show some humility before it starts whipping up public concern about problems that it had a very big part in making. I am in the process of discussions with the BMA, and I hope my hon. Friend will not have to wait too long for some good news.

Oral Answers to Questions

Lord Bellingham Excerpts

Tuesday 16th July 2013 Commons Chamber

[Anna Soubry]

Let me first pay tribute to the work my hon. Friend continues to do in support of his hospital and his children’s heart unit. NHS England has told me that individuals and patient organisations have all been encouraged to engage with and contribute to the local review process. The feedback received will be used to help to inform the outcome of the review of children’s heart surgery at Leeds.

[Mr Henry Bellingham (North West Norfolk) (Con)]

6. What plans he has to meet the acting chief executive of the East of England ambulance trust to discuss that trust’s recovery plan.

[The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)]

The NHS Trust Development Authority is working with the trust to review its action plan and monitor progress in response to the findings of the recent governance review and the Marsh report. Ministers will keep the situation under review.

[Mr Bellingham]

Is the Minister aware that, in spite of the efforts and professionalism of front-line staff, the organisation has been badly led and has lurched from crisis to crisis? Does he have confidence in the new management team and the recovery plan? Does he not agree that the time might have come to break up this large organisation and move it into smaller units that are closer to the communities?

[Dr Poulter]

I thank my hon. Friend for that question and his diligent local campaigning on the issue. He is absolutely right that the Marsh review highlighted a failure of leadership at the trust and in the trust board as well as a disconnect between the front-line staff, who work effectively and well, and that leadership. We now have a new team at the top and we must give it time to respond to the Marsh report and put in place the right measures. I believe that efficiencies can be made at a back office and regional level, but there is a good case for ensuring that more localised data are presented about ambulance response times countywide.

East of England Ambulance Service

Lord Bellingham Excerpts

Tuesday 25th June 2013 Westminster Hall

[Mr Henry Bellingham (North West Norfolk) (Con)]

I congratulate my hon. Friend the Member for Witham (Priti Patel) on her characteristically candid and very well-crafted speech. She speaks for many of us in expressing those strong arguments.

Like my hon. Friend, I pay tribute to the paramedics, drivers and engineers—the people at the sharp end—because they have done a consistently good and professional job, despite poor leadership; they have not had the backing that they deserve. I also join her in paying tribute to the Minister’s ministerial colleague, Earl Howe, who has been very attentive to our concerns throughout.

Dr Marsh’s report is well researched and impressive. If the report has one compelling conclusion, it is that the crisis in the ambulance service trust is the consequence not of a lack of resources, but of a lack of leadership, vision and strategic direction. The comparisons that he draws with West Midlands Ambulance Service NHS Foundation Trust are pertinent, because it is a trust with a similar population base—the population is obviously more urban—that faces similar challenges, but it has met those challenges through strong direction and leadership throughout. That is why the West Midlands Ambulance Service NHS Foundation Trust is at the top of the pile. Unfortunately, our trust is down at the bottom.

I agree with my hon. Friend the Member for Broadland (Mr Simpson), who said in his important intervention that recently, over a number of years, a management culture has emerged in the East of England Ambulance Service NHS Trust that basically deems second best to be acceptable, and consequently action that should have been taken has not been taken.

If the trust was an alternative investment market-listed company that had gone into crisis mode, the non-executive directors would have resigned on principle; if the trust was a company listed on the main stock exchange, the directors would have had to resign. It is staggering that they have somehow decided that it is okay to cling on to their jobs and stay, despite the complete lack of oversight of corporate governance and the failure to adhere to the combined code. As I understand it—the Minister will correct me if I am wrong—the non-executive directors are responsible under the combined code in the same way as directors of public companies. The trust is obviously not a public company, but it has the same corporate governance rules. Notwithstanding the fact that it is a different organisation, the non-executive directors have that responsibility. If they had any integrity, they would offer their resignations.

I hope the Minister is able to tell us that she will advise the non-executive directors, with the approval of the Secretary of State, to resign before tomorrow’s board meeting. It is no good for the interim chairman, Dr Harris—there is a whole lot of management speak here—to review the board members’ benchmarking against leadership criteria, etc. What the hell does that mean? Basically, the board needs reconstituting, and it needs reconstituting very soon. Will the Minister give us some insight into what her Department is doing to try to bring new blood—people with real ability, not jobsworths who simply get recycled around one public board after another—on to such boards?

Just as the trust has fallen way down to the bottom of the league, King’s Lynn and west Norfolk is unfortunately lagging behind the rest of East Anglia. I find that very worrying. Obviously, I accept that, in remote rural areas, there are some hamlets and remote communities where it is physically impossible for an ambulance to reach a patient within the targets. We know that. There are some places in my constituency, and in the constituencies of many of my colleagues here today, where that is absolutely impossible, even with the best will in the world. There might be a coincidence in which, for example, an ambulance is going along a main road at a particular juncture, but achieving the target may well be impossible, so it is even more important that the targets are met in the towns and bigger communities, where it might be thought perfectly reasonable to expect ambulances to get to a call within the target time in 95%-plus of cases. Unfortunately, the targets are not even being met in the towns in my constituency.

I have been given permission by my constituent Mrs Delna Barrett to refer to her case. Her husband, Chris, had been suffering from Parkinson’s disease for some 20 years. He stopped breathing in a restaurant in Hunstanton, which is the second-largest town in my constituency, and it took the ambulance more than 20 minutes to arrive. Despite numerous resuscitation attempts, he died in hospital two days later. We do not know whether, if the ambulance had arrived within the target time, he would have had a better chance of surviving. The family are not criticising the paramedics or the staff, but the bottom line is that the ambulance did not arrive within a reasonable time.

We know that many difficulties are caused by the problems at A and E, to which my hon. Friend the Member for Witham alluded in her excellent speech, and we know that those problems have been around for quite a long time. There certainly are problems at the Queen Elizabeth hospital in my constituency, and there are problems at the Norfolk and Norwich hospital, where at one stage back in March all 17 of the trust’s ambulances were tied up waiting outside. All that is well documented, and it is not entirely within the purview of this debate, but we cannot consider the problem of the ambulance trust in complete isolation; we must consider out-of-hours services and out-of-hours cover.

Very often, individual family events bring home to us the different parts of the health service that are perhaps in need of improvement or are examples of best practice. Some 20 years ago, I was staying with my mother near King’s Lynn, and at about four in the morning she banged on my door and said that she was dying. She was in the most appalling pain—absolute agony. My mother is a war veteran who was in the Women’s Royal Naval Service. She is a very tough person, and she never complains about anything. She told me that she was in complete agony and could not move. I rang the local doctor, who came out within 20 minutes. He said, “You have kidney stones, and I am going to give you an injection that will put you asleep until tomorrow afternoon. I will then come back and we will take stock of the situation.” He gave her some more injections the following afternoon. The stones were broken down, and she did not even have to go to hospital.

If my mother knocked on my door now, what would I do? Obviously, I would dial 111 or 999, but so risk-averse are all those call centres that she would undoubtedly have gone into A and E. I would not have been happy with any advice from someone who did not know her medical records. The key to her treatment by the local doctor was that he knew her medical records and understood that she might be prone to that problem.

We must sort out the out-of-hours cover. We cannot go back to what we had before, when each doctor’s surgery provided out-of-hours cover, but the idea of co-operatives and mergers between GP practices to provide cover and ensure that the people who deal with patients out of hours understand their medical records and are prepared to provide service is key to sorting out the problem. Otherwise, given that the population in some parts of the country is growing, that people are living longer and that many more people have challenging illnesses and a multiplicity of problems, more and more people will have out-of-hours difficulties. Unless we sort out the out-of-hours service, we will have more and more problems.

[Mr George Howarth (in the Chair)]

Order. The hon. Gentleman is straying somewhat from the theme. I realise that it is a related matter, but he should return the discussion to the ambulance service.

[Mr Bellingham]

I shall do so immediately, Mr Howarth, as that is the topic of the debate. However, I wanted to put it into that context, because we cannot consider the ambulance service in isolation.

In conclusion, there is a great deal of concern throughout the region, but we take the view that the problem can be solved through new leadership if management get a grip, put common sense first and, above all, bring out the best in the people at the sharp end, who serve our constituents and take great pride in doing so. Those people set high professional standards. Given the right management, they will do the job to a high standard and give our constituents the ambulance service that they deserve. This is a turn-around situation. I wish the interim chairman and chief executive all the best in sorting out the problem. However, they require the Minister’s assistance and support, and her first step must be to grip the decision of the non-executive directors. She must then work closely with the management team to ensure that the trust is turned around for the benefit of our constituents, who deserve better.

[Several hon. Members rose—]