Health: Learning Disability and Autism Training

Lord Addington Excerpts

Monday 10th February 2020 Lords Chamber

[Lord Addington (LD)]

My Lords, there is an unpleasant familiarity about this debate. Anyone who has been here for any length of time has heard these issues raised before. The similar issue has also been raised—the noble Lord, Lord Sterling of Plaistow, beat me to it in mentioning the Department for Education—that if you are not trained to deal with something, you will not deal with it. You will go back to your original training because that is what is in your DNA and you will refer to it straightaway. If you are told that that is not the way—“You’re a professional, you know better”—you will fight against it. Thus the tiger parent, who has often been helping this person out for so much of their life, is in a situation of conflict. This has been a rich thread running through most of the examples of things going wrong: somebody who knows how this individual behaves is not being listened to in delivering the help.

There is nothing new about this, nor anything particular to the health service about it—it is just that you get dramatic results from the health service. You do not get long periods of decline in medical health; mental health care might normally have a slower drip, but it is there. The person involved often has to be trained to listen to those outside. That will be one of the steps forward. As has been said, different levels of training will be required for the first to be efficient. Just having an awareness programme delivered online or in person will not be enough. You will need expertise to come in and help with that situation, because anybody who has trouble processing information and giving it out, which both of these groups have, will be a problem.

The medical profession works by talking to you often—allowing you to know what is happening and allowing you to explain the problems. The Minister will have come across communication problems with those who are deaf. Their problems are different, but there is a similarity in the general thrust of what is going forward. If we value these people as fully as the law tells us we should, we have to make sure that this communication is facilitated and that people know they have to do it. The senior nurse and doctor involved need to know that it is not a slight on their professional conduct to get somebody else involved. It is the same in teaching and other areas. You have to make sure that they understand when they have to get support and help in. If they do not do that, it does not really matter what else you write down. If they do not realise that they have to reach out, they have problems.

As has been said, we need to hear from the Minister what the structure of progress is for making sure that this happens more frequently. It is an excellent idea that all new staff be started on this programme, because that cements it as something that is there and solid. CPD can then start to pick up some of the rest of it, provided the structure is in place. I accept the caveat that you must have a decent training programme in the first place, because there is no point wasting your time with bad training. What are we doing there? How will we start this and make sure that we say it is a requirement? This is the big question, and I would like the Minister to answer it today.

If we are to carry on developing a programme that allows people to interact quickly, we need a starting point. It would also help to have some idea when the Government think they will have good coverage across the board, or at least enough knowledge for someone who has not received this training to ask where they can get the help and support, call in somebody else and not have it seen as a slight on them, because this will take resources and occasionally slow down the process. Pretending that it will not happen will help nobody. Can we get something to go through on this?

If we go on pretending that once you are trained, you are fine—I think it has been agreed on an intellectual level that this cannot happen—we will achieve very little. The rate of progress will be very much slower than it should be. Can we get an idea of the time structure for making sure that everybody knows that it is okay to ask for help and support, and that if something is identified then there are processes that have to be gone through and accessed? What duty is there to make sure that you have read clearly and understood what may be a note on paper or in a file somewhere telling you what process to go through? This is a very odd thing, because the Minister will say, “Of course you’re supposed to understand it”, but what training is there to say, “By the way, do it and ask for help”? These things will all come together.

It will never be easy, because you have to tell someone to change their behaviour, and there will always be entrenched resistance to that. Look at us: we do not like being told that we get things wrong and have to change—there may be one or two noble Lords here who do, but I know that I certainly do not. However, we have to do it occasionally. This problem is further exemplified in this field in so far as it was once said to me, “Once you know about an autistic person, you know about one autistic person.” There is a huge number of patterns and variations in that field: those who hate to be touched and those who are huggers, for example. That is a pretty basic difference in patterns of behaviour between two people who are supposed to be in the same group.

Can we get some idea of the progress structure? We have already heard that we have enough information to do better things, even if they are not perfect. Can the Minister give us an idea of start dates, progress dates and when information will come down to those who have not been taken into this that they must refer to those who have? If we do that, we have the start of fundamental change to the system. If we do not have that, we will just have bits of good practice and will see the horror stories coming through here at a slightly slower rate. Surely we do not want to aspire to that.