Special Educational Needs and Children’s Mental Health Services

Debate between Layla Moran and Maria Caulfield

Wednesday 9th February 2022 Westminster Hall

[The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)]

It is a pleasure to serve under your chairmanship, Ms Fovargue. I thank my hon. Friend the Member for Newbury (Laura Farris) for securing this important debate on special educational needs and children’s mental health services. As we can see by the number of Members who have attended the debate, this is clearly a significant issue across many parts of the country. Unfortunately, the Minister for Care and Mental Health, my hon. Friend the Member for Chichester (Gillian Keegan), is unable to be here today because she is self-isolating, so I will do my best to answer hon. Members’ questions. I am sure we can follow up on anything that I am not able to cover in my remarks.

I thank the hon. Member for Sheffield, Hallam (Olivia Blake) for sharing her personal experience, which illustrates some of the struggles that people face. She outlined the positives and negatives in her remarks. I also thank my hon. Friend the Member for Bury North (James Daly) for sharing his son’s experience, which is unfortunately not uncommon.

My own postbag reflects many of the comments that have been made in the debate. Children are often not getting the help and support they need at the early stages, which often leads to more difficult interventions later that could have been avoided if the support was in place. The collaboration locally between health and education is often not where it should be. I am here not to deny any of the remarks made in debate, but to set out what is being done to address these issues, which have been in place for many years. I agree with my hon. Friend the Member for Bury North that funding is not necessarily the only factor here; it is also about how services are brought together. As my hon. Friend the Member for Newbury said, it is about accountability for how those services are delivered.

In March last year, we published the covid mental health and wellbeing recovery action plan, which includes £31 million to improve autism and learning disability services. There is £42 million to continue funding projects to support young people and families with special educational needs. There are funding pots available, but we are hearing that they are not making it to the families who need them or to the services being provided. In the short time that I have, I hope to be able to set out how we aim to resolve some of those issues.

The demand for services has increased. There is no doubt that the demand for CAMHS, ADHD assessments, autism assessments and diagnosis has increased over time, but waiting times are also dismally short of where they should be. According to the National Institute for Health and Care Excellence, which provides evidence-based guidance on many of these areas, children and young people who are referred for an autism diagnosis should have a diagnostic assessment within 13 weeks. We have heard from many colleagues, including my hon. Friend the Member for Newbury, that it takes around two years. My hon. Friend the Member for Bracknell (James Sunderland) cited three years. Of course, my hon. Friend the Member for Bury North cited his son’s experience, and the hon. Member for Vauxhall (Florence Eshalomi) also spoke about this issue. We can see that it is a problem across the country.

For ADHD diagnosis, NICE guidelines do not recommend a specific waiting time, but they set out recommendations for how services should support and manage children who need a diagnosis and their families, for how such children should be supported through education, and for general support as well. We want every area of the country to meet NICE guidelines but, sadly, that is not happening in many places. To make sure that we get on top of the situation and reduce the delays, we want to work towards providing an assessment within the recommended 13 weeks in order to deliver a timely diagnosis—not just so that they get a diagnosis, but so that the interventions are there to help and support young people and their families.

There are three key areas where I think we can improve things. The SEND review, which was touched on a couple of times in the debate, is a joint collaboration between the Department for Education and the Department of Health and Social Care. It is in progress, and we expect its findings to be announced fairly soon—I am talking about weeks, rather than months. Following the recommendations from that, a Green Paper will be published. It will follow a 12-week period in which I encourage all Members to take part in the process and to highlight many of the experiences that we have heard today. We have talked about the funding that is being announced, but often that goes to health and does not get into schools. I met representatives from one of my schools only last week, and the joined-up working locally between education and health just is not happening. That reflects the point made by my hon. Friend the Member for Newbury that accountability for who is responsible for doing what, and the joint working, is currently not happening.

[Layla Moran]

Will the Minister comment on access to funding for third-sector organisations, which are often more expert at offering advice and support that families need?

[Maria Caulfield]

Absolutely. Services are commissioned locally. Part of the issue is that there is no accountability for when services are not commissioned. The funding that is put forward needs to look at all service providers, and the third sector is often well placed to provide those services.

To touch on long waits, NHS England is working to ensure that CAMHS have embedded diagnostic pathways for autism and ADHD as a core part of their work. A sum of £13 million is going in to improve those pathways and identify those at risk of crisis; £2.5 million of that funding will test different approaches to diagnostic pathways and ensure that they are backed by research and are evidence-based. In addition, NHS England wants to develop a single point of access to ensure that referrals are triaged, and that individuals do not stay on lengthy waiting lists. We have heard today of the difficulties caused by not having a single point of access. I have met families in my constituency. As the hon. Member for Oxford West and Abingdon (Layla Moran) said, we are the last refuge and point of contact when they cannot get anywhere else.

We know that school settings can provide an invaluable opportunity to identify autistic children early in life. We are investing £600,000 in significantly expanding an autism early diagnosis pilot in Bradford. That will test at least 100 schools over the next three years to assess whether new approaches to achieving a faster diagnosis can be rolled out across the country. The early findings from that pilot are positive. Education staff report that they are better able to identify children and put in place the support they need to thrive in education. Local areas will look to upskill mainstream staff to better identify children’s needs. In Manchester, a project to support early identification and diagnosis in young children involves health visitors identifying those who show signs associated with autism and fast-tracking their assessment, with additional post-diagnostic support for families.

The issue for many years has been the lack of a national strategy, but that is changing. What we want, when pilot studies show good initial results, is to roll them out across the country. In the next year, on top of the £1.5 billion spent in the past two years, we are providing an additional £1 billion of high-needs funding for the education of children with more complex needs. The aim of that funding is to reduce waiting lists and variations in practice, make navigation pathways less complex, and improve the speed and quality of diagnosis.

Those points tackle some of the issues around waiting lists, but accountability was the main thread of the introductory remarks of my hon. Friend the Member for Newbury. At the moment, no one is held accountable locally if services are not commissioned. The integrated care system will be put on a statutory footing from 1 July, if the Health and Care Bill goes through on time, and ICS boards will be the accountable bodies for commissioning services. Their chief executive officer will be the accountable officer for the NHS locally and will be responsible for bringing those services together and will be accountable if that is not happening.

Since November 2019, NHS Digital has reported on waiting times for autism assessments, trying to ensure transparency in how services are delivered and highlighting areas where improvements are needed. It is incredible that, up until now, we have not had the data to hold people’s feet to the fire when services are not provided.

Bullying and Harassment of MPs’ Parliamentary Staff

Debate between Layla Moran and Maria Caulfield

Wednesday 17th July 2019 Commons Chamber

[Maria Caulfield (Lewes) (Con)]

It is a pleasure to welcome this report and to speak in support of it. It is reassuring that the report shows that the majority of staff who responded have not experienced any harassment or bullying, but it is absolutely unacceptable that any of them have; we should really have a zero-tolerance approach.

As many Members have already said, one of the most shocking things I found as a newly elected MP was that there was absolutely no support or training in taking on staff. I had worked for many years in the NHS as a research sister, leading a team and being responsible for the staff of the team. I had had extensive experience of advertising for staff, interviewing and recruiting; doing staff appraisals and staff development; taking on disciplinary proceedings and dealing with conflict management within the team; looking at the staff budgets; looking at sick leave and maternity leave; looking after the temporary staff; and doing the payroll returns each month. I was therefore pretty experienced in staff management, but if I had not been, how on earth would I have learned how to take on a team of staff and look after them? We elect MPs on the basis that they will be good constituency MPs and good legislators, who bring their knowledge to this place when we make laws. We never give a moment’s thought as to whether they will any good at employing and supporting a team of people.

Language is important. It is not by chance that we do not have a staffing budget, but are termed to have an “expenses budget” for staff. In any other institution or big workplace, we would not treat our staffing budget as an expense. That demeans the staff we employ. It suggests that they are seen as a little bit extra, an add-on, of no real significant structural value to the team. That term should be changed. It should be a staffing budget, which has procedures, policies and guidelines for how it is managed. The current term is unacceptable.

When I was a nurse with a team of staff, I had protected time to look after them. I had protected time to do their appraisals and training. I had other professionals to ask for support. I could phone up the HR department and say that I had someone going on maternity leave and had forgotten how to do the paperwork, and could ask for up-to-date guidelines? I could contact the payroll department if I wanted to look at giving someone a pay rise, or if someone needed to take sick leave. I had senior managers. If I was having a difficult time, I could ask for their support and some guidelines. We get none of that as an MP and we wonder why we run into problems.

My big difficulty with the report, which makes some excellent recommendations, is that it does not go far enough. It is all about dealing with bullying and harassment. We need to encourage a culture of staff welfare, because by the time we have got to bullying, harassment and sexual misconduct, it is far too late. From day one, or when a person is even applying for a job here, there should be policies and procedures that safeguard their welfare. If they are then employed, those structures and processes would be in place.

[Layla Moran]

I recognise much of what the hon. Lady is saying, but there is a Members’ HR service which has been dealing very professionally with some issues in my office. That service is available, although not enough. It should be much more structured in the way she suggests, but it does exist. I want to take a moment to thank the staff for their work; they probably just need a lot more resource.

[Maria Caulfield]

I have used that service, and its staff do provide a fantastic service. The point is that as an MP we have to approach them and know that their services are available. I recommend them to any MP because they are fantastic, but they are not available to staff. When I was working in the hospital and I had an issue, I could go to the HR department whether I was a team leader or an ordinary member of the team. That is the difference. Our staff do not have access to that wonderful support, advice and experience which could make a huge difference. The report recommends that they do have access to it.

I agree with my right hon. Friend the Member for Basingstoke (Mrs Miller) that MPs should remain as 650 small individual businesses, but changes do need to be made. We are treated as if we have autonomy over our staff, but there are some subtle things in the way that stop us. For example, I have a south-east constituency and my staff budget—it is not an expense, it is a budget—is £11,000 less than that for a London MP. Some of my staff live in London and some live in the south-east, which is as expensive as London. Some have to commute to London, spending £4,000 or £5,000 to do so. As I have £11,000 less in my budget, I cannot pay them as much or I cannot take on an extra member of staff. My small team, which does the casework and everything else that other staff members do, is under extra pressure from day one because they have the same workload as a London MP but without the same financial recognition. How is it fair that from day one the staff of non-London MPs already feel the pressure of being in a smaller team or of being less valued financially, while doing exactly the same work?

I have an office manager to whom I delegate responsibility for looking after some of the other members of the team: taking on appraisals, looking at staff leave, conducting staff training and working with them. Most of my staff work in the constituency office. They do not work in Parliament, so they cannot nip to the office next door in Norman Shaw North and say, “I have a difficult case; can we get some advice on it?” They are completely isolated as a team, and my office manager has the responsibility for looking after them. We have had members of the public come into the office in tears because we are the last port of call when the jobcentre has let them down, when they cannot get their housing benefit or when they have been made homeless on a Friday evening. They often land in tears in my office, and my staff, many of whom have just left university and do not have a huge amount of life experience, have to pick up the pieces.

Ultimately, I am responsible for my staff, but I am not there every day of the week. My office manager has to support them as a team. What training and support is available for those staff? I cannot do it all as their employer, so it is incumbent on the House of Commons to help MPs to provide that support for their staff—whether that means the senior staff who are delegated to look after them or the junior staff who have to do some very difficult work on a daily basis.