Health and Social Care Bill

Lord Touhig Excerpts

Tuesday 11th October 2011 Lords Chamber

[Lord Touhig]

My Lords, people with autism routinely struggle to access the health services that they need. Consequently, outcomes for children and adults with autism are poor. I wish to focus my remarks on how I see the Bill affecting them.

It is a fact that 70 per cent of children with autism also have one or more mental health problems, yet research by the National Autistic Society shows that child and adolescent mental health services are failing to improve the mental health of two-thirds of children who access their services. A third of adults with autism say that they have experienced severe mental health problems because of the lack of support. People with autism are often disadvantaged in accessing health services as their needs are not properly recognised and understood by professionals.

In a debate in this House on 1 March, I pointed out that 80 per cent of GPs who were audited by the National Audit Office said that they needed additional guidance and training effectively to support patients with autism. Research conducted by the National Audit Office into public spending on autism found alarming gaps in training, planning and provision across a range of services.

The National Autistic Society tells me that it has some concerns about elements of this Bill, but it also sees an opportunity to address long-standing inequalities. Based on its briefing, I would like to share some ideas so as to be constructive about the Bill and to leave the Minister with some questions to answer.

One of the best ways to resolve structural and data problems is to establish specialist autism teams within the local authority area or GP consortium. The adult autism strategy for England, published in April 2010, recognised that where things were working well in a local area this was often as a result of the development of such a team. It recommended that the new bodies look at the models of teams that have been established and consider developing one locally.

I share the warm welcome that the National Autistic Society has given to the drive towards joined-up working, but I also share its concerns about how such teams will be commissioned and funded in the future. How will the NHS Commissioning Board oversee the commissioning of specialist autism services? How will the Government and the NHS Commissioning Board incentivise GP consortia to work with the local health and well-being boards to ensure the setting up of specialist autism teams, such as the Liverpool Asperger Team, which has been shown to be very cost-effective?

Currently, several specialist autism teams are jointly funded by PCTs and local authorities. But if 80 per cent of the commissioning budget sits with consortia while the health and well-being boards are responsible for the commissioning of joint services, there is a worry about major budgets held by GPs who may not decide to commission services whose primary benefit in the short and medium term will be to local authorities. That commissioning problem could become more complicated when a health and well-being board has a number of consortia in an area.

The NHS Future Forum recommended that wherever possible there should be coterminosity between local authorities and GP consortia. However, there will still be a number of GP consortia within a local authority area, so mechanisms will be needed to ensure that the consortia and the health and well-being boards can work together effectively.

Currently, the proposal is that a health and well-being board can send back a commissioning plan to GP consortia if it believes that it needs revision. However, there is no mechanism for resolving disagreements between these boards and the consortia. Do the Government agree that an arbitration service may be necessary to help resolve conflict between the consortia and the health and well-being board?

More, the National Autistic Society has significant concerns that unless GPs and others on the GP commissioning consortia are given the necessary support, they may struggle to commission the right services for people with autism. Do the Government agree that quality standards need to be at the heart of commissioning decisions made by GP consortia? What progress has the health department made to ensure that autism is part of the core training for doctors—an issue which we have debated for a long time? How do the Government intend to ensure that autism training is available to GP consortia?

We all know that autism is a complex disability, and many professionals will not have sufficient understanding of the needs of that group, nor of what services are necessary to meet those needs. As such, they need guidance, training and, of course, robust data. The Department of Health is currently conducting a review of the social care data that it asks local authorities to collect. For the first time, it is considering including data on autism. That is essential to ensure that local areas have adequate data on the needs of the people with autism, so that they can plan to serve them effectively. What progress is being made on that review of social care data and including autism in those data?

To conclude, let me say a few words about three key areas: guidance, training and data. On the question of guidance, NICE’s proposals to develop two quality standards on autism, along with the NICE guidelines on autism, if followed and implemented fully, will help the commissioning consortia to commission the right services for people with autism. That is certainly most welcome.

As for training, the document Fulfilling and Rewarding Lives, the strategy for adults with autism in England, commits the health department, working with the General Medical Council and the Postgraduate Medical Education Training Board, to ensure that autism is part of the core training for doctors. That, too, is welcome, but becomes even more urgent as GPs take on a more strategic commissioning role, if the Bill goes through as it is.

Finally, data collection and planning for people with autism is currently very poor. Only 20 per cent of joint strategic needs assessments even mention autism, let alone ensuring that services are planned through the process. We must do much better than that. One of the biggest problems that health and well-being boards and GP commissioning consortia will have will be assessing need, to obtain robust data and ensure that they are available. It is therefore crucial that data collected by those bodies must be broken down by multiple disabilities such as a child with autism, epilepsy and depression. That, in turn, needs to be supported by the NHS outcome frameworks to incentivise that and ensure that it works.

I have posed a number of questions to the Minister, and I have no doubt that he will want to discuss those with officials. I am quite happy for him to write to me later and, probably, to put a letter in the Library.

People with autism often do not have a voice. We can be that voice. We can make sure that the Government listen, understand and respond to their needs in this massive shake-up of the National Health Service. I am encouraged in this Chamber to believe that we will not let down people with autism; we will be the voice of those who do not have a voice of their own.