Autism and Learning Disability Training: Healthcare Professionals

Hannah Bardell Excerpts

Monday 22nd October 2018 Westminster Hall

[Daniel Zeichner]

The hon. Lady makes a fair point. Training needs to be provided to all staff, but absolutely, those who are not exposed to such people are a particular issue.

My comments so far have been decidedly non-partisan, and I hope Members from across the House are able to support most of what I have suggested. However, before concluding, I must make some observations about the staffing pressures that affect our public services—particularly changes to student nursing bursaries.

We have heard in the House many times that the current financial settlement for student nurses is insufficient given the intensity of their courses. I and many others believe that nursing students need bespoke financial support if the Government are to meet their commitment to growing the nursing workforce. Those students need support for living costs to incentivise a wider range of applications. There are many ways that can be done—through universal grants for students in recognition of their placements, means-tested grants to maintain diversity or targeted support for parents and carers, as many nursing students come to university later in life.

Since the coalition Government came to power in 2010, specialist areas such as learning disability and mental health nursing have been the worst hit by the wider staffing crisis. Those specialties struggle to recruit, since mature students are particularly likely to choose them. The Royal College of Nursing reports that there are 40.5% fewer learning disability nurses—2,176 fewer full-time equivalent nurses—today than in 2010. Despite Government claims, the removal of the NHS bursary in England failed to increase the number of nursing students. Recent data shows that the number of students accepted on to nursing courses in England has fallen by a further 4% in the past year, and by 8% since student funding was removed in 2016.

Intelligence from RCN regional networks indicates that directors of nursing across England are escalating concerns about course provision. They are concerned about the stark regional variation in course provision for learning disability nursing—particularly the risk of course closures in the south of England—which may exacerbate existing regional workforce supply disparities. The huge workforce pressure risks poorer care for learning disabled people. A commitment from the Government to encourage students into learning disability nursing may improve standards of care and patient safety.

[Hannah Bardell (Livingston) (SNP)]

The hon. Gentleman is making an excellent speech. Does he agree that, while Brexit dominates much of our time in Parliament, we must we also have the opportunity to debate and get into the granular detail of important issues such as the one he highlights?

[Daniel Zeichner]

I am grateful to the hon. Lady for making that point. We could probably find favour across the House and across the country for moving on from some issues at the moment, but she is absolutely right—such issues are very pressing and probably of huge importance to most people, especially when failure to address them leads to the kind of tragedy we have heard about.

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[Tulip Siddiq]

I absolutely agree with my hon. Friend that the issue is not confined to the healthcare services. It crosses borders, and she made an effective point about the police and others dealing with the challenges of autism that arise in everyday life.

[Hannah Bardell]

On a similar point, does the hon. Lady agree that staff in the Department for Work and Pensions should also be trained? Some of my constituents have not have positive experiences of the welfare system. I know that the staff have a difficult job, but often people are marginalised because of a lack of understanding.

[Tulip Siddiq]

Similar things come up in my surgeries. People come in and complain bitterly about the way they have been treated, simply because they have not been understood by service providers, whether at the Department for Work and Pensions when they needed social security, or elsewhere.

I would like the Minister to address how she will ensure that those with learning disabilities and their families will be treated as equal partners in setting targets for success and in deciding whether change is happening in the right way. How does she anticipate that all healthcare professionals, and not just a few, will get good quality learning disability training, and how will the challenge of resourcing that be met? We have heard Mencap’s estimate that 1,200 people with learning disabilities die every year because of an avoidable lack of access to good healthcare: it was pointed out earlier in the debate that it seems more deaths are of young people, which is shocking. I hope that the Minister will address that situation, which is simply horrifying. I hope that, in addition to answering my specific questions, she will explain how her Department is accelerating its efforts to reduce that figure dramatically in the coming months and years.

I pay tribute once again to Paula McGowan and those seated in the Public Gallery today, because I know it has been a difficult campaign so far.

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[Mike Wood]

The hon. Lady is right, and if I may give a quick plug, the all-party parliamentary group has done some important work with the National Autistic Society on precisely the issue of autism, employment and education. I understand it will be published shortly and I hope it provides a focus for a future debate.

[Hannah Bardell]

Following on from that point, does the hon. Gentleman agree that people with autism and additional support needs have a huge contribution to make to our economy and society? As someone who has had a number of people on work experience, they have helped me to see the world in a different way. I am sure the hon. Gentleman will have seen “The Curious Incident of the Dog in the Night-Time”; when I went to see that in the west end, it was a turning point for me in understanding the world and a little window into how people with autism see it.

[Mike Wood]

The hon. Lady is absolutely right. That enormous employment gap is a tragedy in terms of not only the lost opportunities for those people directly affected, but the wasted opportunities for the many employers who could be benefiting from the skills of people with autism and other learning disabilities, and for wider society, which is losing the contributions that they can make.

Finally, I will touch quickly on the issue of mental health. Autism is not a mental illness, but we know that people with autism are much more likely to be affected by many mental illnesses, particularly anxiety-related illnesses, than the general population. We need to ensure that the new framework is properly embedded across mental healthcare as well as physical healthcare, so that our mental health services can ensure that people with autism get the proper services they need. Far too often, people with autism find not only that their condition means their mental health problems are not properly diagnosed at an early stage, but that, if diagnosed, their condition can interfere with their receiving the appropriate treatment in a way that might be expected elsewhere.

We must ensure that autism is one of the four clinical priorities right across the healthcare system and that the training our healthcare professionals receive reflects that. Only then can we start to address the healthcare inequalities that we see in this country and, hopefully, try to ensure that there are fewer repeats of the terrible stories we have heard this afternoon.

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[Hannah Bardell (Livingston) (SNP)]

It is a huge pleasure to serve under your chairship, Dame Cheryl. I know that other hon. Members have said this, but the work that you have done in this area, and the work of others in this Parliament, is hugely important, and its importance has never been more obvious than today. I have no direct experience other than the constituency cases that I mentioned earlier, but the level of emotion and empathy in the Chamber today is raw. As chair of the all-party parliamentary group on deaths abroad and consular services and assistance, I have recently taken evidence from families who have lost loved ones abroad, albeit in different circumstances. Hearing about the circumstances of Oliver’s death, and knowing that his mother and his family are here to listen to the debate, only highlights the importance of doing something and doing it well. There can be no greater endeavour for a parliamentarian than to right a wrong by taking an experience that has been devastating or traumatic, or resulted in someone’s needless death, and trying to turn that experience into a positive—into change that will mean that others do not suffer in the same way.

The hon. Member for Cambridge (Daniel Zeichner) opened the debate with an excellent contribution. He took us through the details, of Oliver’s death, as the hon. Member for Kingswood (Chris Skidmore) did, and I have to say that although I had read some of the details, I was not aware of just how devastating and difficult what happened was, how complex Oliver’s needs were and how badly he and his family were let down.

We must be very careful, because we live in a blame culture. We live in a culture in which, when things go wrong, the finger is pointed. We all know that NHS staff, in whatever part of the UK, do their very best, but there have been failings and the lessons must be learned. Oliver’s death cannot be in vain. I therefore hope that the Minister will detail what she plans to do and give Oliver’s family and us all a sense that there will be change. I have no doubt that the UK Government are very much behind the wish to change the system.

The hon. Member for Hampstead and Kilburn (Tulip Siddiq) talked about the work being done in her constituency through the Treat Me Right programme and the impact that that has had in north-west London. I want to mention briefly the Beatlie campus in my constituency of Livingston. The Beatlie School sits at the back of my mum’s fence, and the building in which it is housed was my old primary school. When it shut, that was a great trauma for the local community, but it fills me with great pride that it is now a school that supports children with additional support needs: autism and a range of issues. Recently, it was awarded a Gold: Rights Respecting award by UNICEF. Its headteacher, Carol Robbie, and her staff do an incredible job, so I want to pay tribute to them.

The hon. Member for Dudley South (Mike Wood) spoke about his experience of being a governor of a school that supports children with additional support needs. Many of the speakers today, including my hon. Friend the Member for Central Ayrshire (Dr Whitford), have talked about the need for a tailored but collaborative approach. That is particularly important. In Scotland, we have championed partnership working in many of our local authorities, and we have particularly done so in West Lothian.

The point has been made that it is not just healthcare workers who should be trained but people who will be coming into contact with those with additional support needs, including in relation to autism. That is incredibly important. Whatever area we are talking about, whether it is housing, welfare or whatever, staff need to have proper and appropriate training, as do businesses. The debate has been very much opened up, and we must look at the improvements that need to happen across the board, not just for NHS staff.

The Scottish strategy for autism was published jointly with the Convention of Scottish Local Authorities in 2011, and our Government in Scotland committed £13.4 million over four years to improve the lives of autistic people and their families and carers. A review was published in 2014, and I will just share some of the findings. There was the development of a menu of interventions, which meant a guide to help autistic people and their families and carers to identify available advice and support, and a mapping exercise, which sought to map out and better co-ordinate local services. That coincided with £35,000 for each of our 32 local authorities to encourage local and national organisations to develop projects to improve the delivery of local autism services. In my constituency, a number of organisations have benefited from that.

[Ian Austin in the Chair]

In 2015, the strategy was refreshed and reframed into an outcomes approach, and it has had a significant impact on each local authority in Scotland and their services. We are not perfect, but we have done a significant amount and we are absolutely dedicated to ensuring that whatever an individual’s needs are, they are properly catered for.

I pay tribute to the hon. Member for Sheffield, Hallam (Jared O'Mara). It is hard to know how to respond to his speech, because it was so powerful and so necessary. He spoke not only about autism and his needs, but the way that this place is structured. We have said it many times—I will never forget that feeling of anxiety the first time I sat in Prime Minister’s questions. It was so alien. I witnessed such boorish and unbelievable behaviour—I have never seen anything like it in my life. It is not a natural environment for anybody. It fills me with great sadness that we have not been able to move on and that he still feels that he cannot attend Prime Minister’s questions. I am glad that some reasonable adjustments have been made. The brave and direct way that he spoke about his experiences will be shared, and I give him my commitment that I will share it on social media and beyond, because I think it is incredibly important. If we are going to be truly diverse in this Parliament and make better decisions for the people across these islands, it is vital that we have Members with different needs, abilities and perspectives, and the hon. Gentleman has epitomised that.

I cannot imagine what Oliver’s family’s experience has been like. What Paula and her family have done takes incredible bravery. I wish them well with their campaign, which we will carry in our hearts. I hope we will all play our part, and that the Minister will give Oliver’s family positive words and actions, to ensure that nobody ever again goes through the experience that he and his family did.