Children and Young People: Restrictive Intervention

Debate between Norman Lamb and Cheryl Gillan

Thursday 25th April 2019 Commons Chamber

[Norman Lamb]

I thank all hon. Members who have contributed to this debate, which included some powerful contributions. The personal testimony from the hon. Member for Berwick-upon-Tweed (Anne-Marie Trevelyan) was telling, because the wonderful news is that her son is now at university. The Minister should note that, because not only will early intervention and positive behaviour support being embedded in the entire system give people the chance of a good life, but the state will save a fortune. That is why it is so important.

We need the guidance. It needs to have teeth and to be backed by proper accredited training and by mandatory recording and reporting across the system. The Government need to get on with that now, because we must end the scandal of children not being protected from abuse in the way that adults and those in health settings already are. It is unacceptable that children in residential schools and in other settings are not protected. As the shadow Minister said, the guidance must be comprehensive. There is no justification for leaving out some settings, such as mainstream schools. The guidance should apply to everyone.

Question put and agreed to.

Resolved,

That this House calls on the Department for Education to urgently issue guidance on reducing the use of restrictive intervention of children and young people; and further calls on Ofsted to change its guidance to inspectors to recognise the importance of seeking to avoid the use of those interventions with children and young people.

[Dame Cheryl Gillan (Chesham and Amersham) (Con)]

On a point of order, Madam Deputy Speaker. I seek your guidance because Buckinghamshire County Council passed a unanimous motion this afternoon asking for High Speed 2 to be paused until the notice to proceed, which has already been delayed to the back end of this year, has been approved. This is a significant request because such notice cannot be given until the management capability, the affordability of the contract and the robustness of the already-discredited business case have been proved.

My county and my constituency are suffering daily disruption and catastrophic environmental damage, and we have not even seen the detailed design of this project. There are continuing complaints about poor communication by HS2, and the urgency of this matter is that there is news that machinery has already arrived in the county to start destroying a very large number of mature oak trees.

Madam Deputy Speaker, I want to know whether you have had any notice from the Secretary of State for Transport that he will make an urgent statement justifying this environmental vandalism, and whether there are any opportunities, when there are such serious doubts, for this project to be halted. What powers do we have in this House to bring about that halting or pausing of the project?

Transforming Care Programme

Debate between Norman Lamb and Cheryl Gillan

Thursday 5th July 2018 Commons Chamber

[Norman Lamb]

The hon. Gentleman makes a really important point, and I totally agree. I said at the start that this is not a great demand for a whole load more money. However, some up-front investment is needed, not only in establishing the facilities in the community, but in training people in the community, and I will come back to that in a little while.

[Dame Cheryl Gillan (Chesham and Amersham) (Con)]

I add my voice to others in the Chamber in saying that I am very grateful to the right hon. Gentleman for securing the debate, and I hope to catch the Chair’s eye to make a contribution on autism. Does the right hon. Gentleman agree that when it comes to financing and co-ordination, a lot can be learnt from the National Audit Office report from 2017 that looked specifically at progress in the transforming care programme? Does he also agree that it is quite worrying that the NAO said that it was concerned about the programme’s overall progress and whether it would achieve value for money? One of the problems that it pointed out was that some of the local partnerships were

“struggling to put in place appropriate accommodation quickly enough”,

which had led to delays in people coming out of hospital and perhaps not the correct co-ordination to provide the services that are so desperately required by this vulnerable group of people.

[Norman Lamb]

I thank the right hon. Lady for her intervention, although it was a bit freaky, because I was about to come on to the National Audit Office report. She is absolutely right in identifying the criticism that it made of progress on this programme.

Let me deal with the numbers involved. As I said, the commitment was to close between 35% and 50% of in-patient learning disability and autism beds and to provide alternative arrangements in the community by March next year. The document, “Building the Right Support”, mentioned getting 2,600 beds down to between 1,300 and 1,700 beds, which is a very significant drop. Hitting the minimum drop that the Government committed to of 35% would involve the closure of 922 beds. Of that total, 531 still need to be closed in what is now a very short space of time.

The latest data, from the end of May, shows that there are still 2,400 people in institutions, 41% of whom are over 50 km away from home. I ask hon. Members to think about what that means. Many of those families are not wealthy, and some people are themselves disabled. If their loved one—their child—is put in an institution a long way from home, it can sometimes be impossible to maintain contact. Just imagine—all of us—what that must mean to people to lose touch with their vulnerable child. It is not acceptable, but it persists today, and according to that latest data from the end of May, the length of stay is still over five years. There has been very little change in the length of stay. Perhaps most troubling of all from that latest data is that the number of children in in-patient beds has more than doubled. For goodness’ sake, this programme is about moving away from institutional care, yet between March 2015 and May 2018, we have doubled the number of children in institutions. This is intolerable and in a little while, I will come back to why that is not necessary if things are done properly.

I find myself in a horrible position of expressing anxiety about closing the rest of those beds by March next year, but it is important for the Minister to note that there is a real fear on the part of families and the organisations that represent them about a big risk in a head-long dash to close beds by the deadline in cases where many people have complex needs. Some people in units that have been earmarked either for closure or reductions in beds, apparently defined as “impacted sites” in the system, will not be going home but will have to be shunted somewhere else in the country. Of course, a move for someone who has very complex needs can be massively destabilising. If this is done in a hurry to meet a target because there has been a failure of the programme to date to prepare community resources, it will be a disaster for the individuals involved. For those able to live in the community who are still in institutional care, there is a massive concern that not enough has been done to develop community services or train the workforce. We have to avoid the risk of discharging people only to readmit them weeks or months later.

I mention the really shocking case of a young lad called Eden. He has been failed throughout his life, from childhood into adulthood. He has been in hospital for more than 10 years. His mother, Deb, is desperate. She constantly fights against the system, which does not listen to her. He is in a hospital in Norfolk, and they live in London. She has long journeys—a 10-hour round trip or something of that sort—to visit him. She is not wealthy. Eventually—I visited Eden in that hospital—she got him home to a facility near their home in west London, but because arrangements had not been made properly by the local authority to have the proper support services in place, within weeks he was back in that institution again. That individual has been horribly failed by the NHS—by the system—and it is wholly unacceptable.

The consequences of the failure to get people out of institutions include, as I said, the loss of contact with family. Care behind closed doors often involves unacceptable practices, hidden from view. I mentioned Fauzia earlier, who was admitted to St Andrew’s hospital in Northampton—she was a child of 15 at the time. Her family asked me to go and visit her. It is an unusual thing for a Minister to do, but I decided to go at the invitation not of the institution, but of the family. I went to see her and she was living in what I would describe as “a cell”. This is a 15-year-old girl. She suffered from the constant use of force—restraint—and she was being put into seclusion in another room that was completely bare, with concrete walls. She had a tiny exercise yard. This girl was in there for over two years. It was really shocking—a total abuse of her human rights. She had no life at all, yet from the day that she was discharged, when we finally got a review undertaken, there has been no more restraint. She went to a brilliant place called Alderwood, also in Northamptonshire. The people who work there have never had to use restraint against her, because they have been trained, crucially—the right hon. Member for Chesham and Amersham (Dame Cheryl Gillan) will know about this—in how autism affects the individual, which so often does not happen in big institutions.

I visited Fauzia at Alderwood. She has a very happy life. She is outdoors much of the time, happy and contented—still very complex, but not in the horribly alien environment that she was in in St Andrew’s. St Andrew’s is receiving a fortune in Government money—taxpayers’ money—in many cases to treat people using the wrong model of care, trapping them in this institution. It has invested in a very substantial new unit. It may be smart—I am told that it is—but why are we making this investment in new in-patient facilities when children should not be going into hospital, unless there is an absolutely exceptional circumstance?

I also visited Josh, who I mentioned earlier. He had been in a hospital in Birmingham that had cared for him well, but he was far away from home. He has now made a substantial improvement and is developing brilliantly. He has a life again, and he is happy with his family. It is inspiring to see what people are doing to support individuals in those community settings.

What have the Government done to assess the progress of this programme? The Department of Health commissioned an independent review of transforming care partnerships, allocated £1 million to it and put it out to tender, but I am told that it has now been pulled and will not go ahead. Why? I understand that it might be because NHS England is also, bizarrely, commissioning an independent review, but we have only had provisional results from that. When will we know more? Those provisional results are disturbing. They show that, in quarter 3 of 2017-18, only 35 of the 48 transforming care partnerships had intensive support services to look after adults 24/7 in their own homes across the whole area of the partnership. Those services are required by the Government’s document, and they are critical to ensuring that people can be safe at home, yet only 35 out of 48 partnerships have them in place.

Only 23—less than half—of the partnerships had intensive support services for children and young people, so it is little wonder that we have seen a doubling of the number of children going into institutions. Only 19 had adult community forensics services across the whole area, and only 14 had children and young people’s community forensics services across the area. There is no detail at all yet about what the services that are in place actually consist of. All we have is a tick-box exercise to show whether there is a service in place. As the hon. Member for Ipswich (Sandy Martin) rightly identified, there is so much missing from community support that would enable people to be safely discharged and return home.

The National Audit Office report, to which the right hon. Member for Chesham and Amersham referred, made a pretty damning assessment in 2017. It questioned the credibility of the transforming care partnership plans and highlighted the fact that care and treatment reviews were not taking place as promised. Those reviews are supposed to be carried out for every individual in in-patient care every six months, yet, as of May this year, only 54% had had one in the past six months, and 390 patients—16% of the total—had not had one for more than a year. Why not? If the programme is being properly implemented, with proper national leadership, surely those reviews should happen in every case, every six months.

The NAO made the case that money was not transferring quickly enough from hospitals to the community and that there was still no effective mechanism to guarantee that that would happen. It identified an absence of workforce plans for community provision and found that most transforming care partnerships did not intend to produce such plans until 2019. Well, how the hell are they going to meet the target of this dramatic reduction in beds by March 2019 if they do not produce workforce plans until that time? That is completely the wrong way round.

[Dame Cheryl Gillan]

I happen to agree with the right hon. Gentleman. Does he expect the Minister to be able to tell us what has happened to the extra £2 billion of investment that the Government have made in social care services since March last year? It seems to me that something is not quite right about the co-ordination in this area, because the money is going in but the outcomes are not coming out at the other end.

[Norman Lamb]

I agree, and I suspect that the social care system as a whole is under considerable strain. The Government have chosen to produce a Green Paper only on the older people element of social care. They are not looking at the position of younger adults with disability. The right hon. Lady is absolutely right to say that we are not seeing the outcomes that we absolutely need to see.

Importantly, the NAO focused on the proportion of people with learning disabilities who are in paid employment. We need to take a holistic view. This is not just about whether someone is in a hospital bed or in the community. We need to empower people, as far as possible, to live the kind of lives that the rest of us take for granted. The report highlights the fact that only 5.8% of people with a learning disability are in paid employment. However, some local authorities have up to 20% employment rates in that area, which shows what is possible. [Interruption.] Madam Deputy Speaker, I am moving towards the end of my speech. I heard a cough, and I note the point that you are trying to make.

Before I finish, however, I want to highlight the fact that there are good things going on. I want to ask the Minister a number of questions. Some areas of the country do this really well. They include Salford, Hertfordshire, Ealing and Bristol, and there is a brilliant community service in my own county of Norfolk, which is run by an immensely inspiring woman called Melanie Bruce. She previously worked in institutions, but now takes the view that very few children ever need to go into hospital and that, if they do need to do so, it should be for only a very short time. The community service is called Starfish, and I have written to Simon Stevens saying that that model should be applied everywhere. In the past year, among the group of people in the Starfish programme, there has not been a single admission to hospital. That shows what is possible, rather than the doubling of the numbers that we are seeing elsewhere. I also want to mention Shared Lives Plus, a scheme in which someone with a learning disability or with mental ill health goes to live in a family. The families are paid for the support that they give, but the scheme treats the person as a human being and an equal citizen, rather than putting them in an institution. That is what is so important.

I will end by asking the Minister some questions. What will happen after March 2019? Will she commit to an improved successor programme that learns lessons from the last seven years and actually fulfils the promise of the transforming care programme, with a focus on implementation and inspiring effective national leadership? Will she confirm that those other programmes in NHS England, which are vital for people with learning disability, will continue and that the same national focus will be maintained or indeed enhanced? What assurances can she give that this programme of work will continue as an absolute priority beyond March next year?

Given the slow progress to date on closing beds and the stated plan to close 922 beds by March, what evidence does the Minister have that new community support is available to support the safe discharge of those people? Can she guarantee that there will be a close focus on every single case, to avoid the risk of neglect? Will the Government establish a new workforce development fund to ensure that there are enough staff with the skills to deliver the right care in the community?

What actions will the Minister take to guarantee the pooling of money and the shift of resource from hospitals to the community? Will she address the conflict of interest of clinicians making decisions when they are employed by organisations that earn their money from keeping beds occupied? How will the Government ensure that all in-patients receive a care and treatment review every six months, instead of the failure of delivery that we have at the moment? What steps are the Government taking to improve data on in-patient numbers so that we can bring to an end the two unreconciled data sets that we still have, years on from when the NAO complained about this in the first place?

How will the Minister ensure that progress is robustly and independently monitored and scrutinised? When will the independent evaluation be published in full? How do the Government intend to learn from the areas of really good practice to deliver an approach based on early intervention and crisis prevention? Will she ensure that, from here on, children will be central to the Government’s programme? If we can prevent children from going into institutions in the first place, we can change their lives completely. We can rescue them from a life in an institution.

Finally, will the Minister discuss with the Prime Minister the case for a cross-departmental ministerial taskforce to drive progress and show that all parts of Government are doing their bit to meet people’s full range of needs, given the importance not only of where they are but of employment, housing, education and the criminal justice system? This is a story of the awful neglect of people’s human rights, and of people in this country here and now being treated as second-class citizens. This really does have to end, and we owe it to the families sitting in the Public Gallery today and their loved ones to do far better by them in the future.

World Autism Awareness Week

Debate between Norman Lamb and Cheryl Gillan

Thursday 28th April 2016 Commons Chamber

[Mrs Gillan]

Absolutely. It is clear that, despite the best intentions of the Government, getting such a diagnosis is still crucial, as my hon. Friend says.

[Norman Lamb (North Norfolk) (LD)]

Will the right hon. Lady give way?

[Mrs Gillan]

I will give way for the last time, because I must make some progress.

--- Later in debate ---

[Norman Lamb]

May I join in with the overwhelming tributes that have been made to the right hon. Lady for the work that she has done on this incredibly important subject? I do not know whether she saw the in-depth report in The Economist a couple of weeks ago. It reported that a Swedish study has found that the cost of lifelong care for someone with autism could be cut by two thirds with early diagnosis and treatment. Again, the moral case and the economic case for this are overwhelming.

[Mrs Gillan]

I agree. NHS England should collect, publish and monitor key information on how long people are waiting for diagnosis, and how many people are known by their GP to have autism. It should also ensure that waiting times standards on mental health, which are currently in development, reflect national guidance that no one should wait longer than three months between referral and being seen for diagnosis. The Government must share this commitment and ensure that NHS England meets its aims. Timely access to an autism diagnosis should be written into the Government’s mandate to NHS England.

I want to touch on autism and mortality. A recent Autistica report highlighted distressing findings from research in Sweden. The research found that autistic people, taking the population as a whole, have a lower life expectancy than the overall average. The research from Sweden shows that autistic people are at risk of dying younger from almost every cause of death. On average, this is 18 years earlier than the general population. For autistic people with a learning disability, the gap is even larger. The research shows that autistic people with a learning disability in that country die on average 30 years before their time. It also shows that autistic people who also have a learning disability are more likely to die early from epilepsy, and that those without a learning disability are at greater risk of suicide. It is worth remembering that the Swedish healthcare system is different from ours, but given the seriousness of those research findings, it is vital to find out whether they also apply in the UK, and if so, to understand the reasons for that. The Autistica report calls for this to be investigated as a matter of urgency, and I urge the Government to heed that call.

I want to comment briefly about the autism hospital passport, which has been endorsed by the Department of Health. The passport is designed to help people on the autism spectrum to communicate their needs to doctors, nurses and other healthcare professionals. It has been developed by Baroness Angela Browning in collaboration with the NAS. The motivations for starting the project were simple: when it comes to healthcare, the passport enables people on the spectrum and their families to have a much better experience of their interaction with the health service and to gain better, more timely and more fitting healthcare at the right time and in the right place.

I want to touch on various areas that I hope other Members will pick up, so I now turn to education. In specialist schools—the NAS is about to open a new one in the Epping forest area, supported by the Anderson Foundation—we have no fears about teachers’ ability to understand autism. But the training that teachers receive on autism has to be looked at carefully. Nearly 60% of children who responded to a survey said that the single factor that would make school better for them was if teachers understood autism. Teachers agree, and they want that training. A 2013 survey by the NASUWT found that 60% of teachers believed that they did not have enough training in autism. I am aware that work is going on to develop a new framework of core content for initial teacher training courses, but we need to make sure that no teacher enters the classroom without the tools they need to support those in their charge.

An intervention touched on employment, so I turn now to what children on the spectrum want after they leave education. They want the same things we all want out of life: stable, secure and fulfilling opportunities that allow them the same opportunities to lead independent lives. However, currently too few people on the spectrum enjoy the opportunity to find a job to help them maintain that independence. The Government have pledged to halve the disability employment gap—that was welcomed by Members on all sides of the House—and we await the Government’s White Paper, to be published soon; we also note recent assurances from the Secretary of State for Work and Pensions that that is a key priority for him. However, research by Scope has shown that the disability employment gap has remained static over the past year. Clearly the Government cannot rely on an improving economy alone to fix the issue. More will need to be done to close the gap.

The autism employment gap is even worse. The latest data indicate that only 15% of autistic adults are in full-time paid work at all and that 26% of graduates on the autism spectrum are unemployed, by far the highest rate of any disability group. The NAS hears from autistic people that the Government’s mainstream generic programmes do not feel relevant to them and are not addressing the specific and long-term needs of people with autism.

More autism-specific programmes are needed. Research shows them to be more successful. For example, research into one specialist support scheme found that 70% of adults found work when supported by autism professionals. The all-party parliamentary group on autism plans to return to that work later this year. In the meantime, I have several questions. Will the Government’s disability employment White Paper include proposals for ensuring that people on the autism spectrum can access specialist support? Will the Minister report on progress by condition in seeking to halve the disability employment gap, so that low employment rates of people with conditions such as autism can be specifically tackled? Crucially, will he ensure that the new work and health programme records whether someone on the programme is on the autism spectrum?

Autism touches so many areas of Government work that it is difficult to address them all today. For example, I have not discussed social care, mental health issues or benefits. I know many colleagues want to speak and so I do not want to take up too much more time. In summing up, I return to public awareness. Survey after survey of people on the spectrum tells us that better understanding of the condition among both the public and professionals would be the one thing that would help them to feel more secure and allow them to have fulfilling lives. People on the spectrum are reasonable, and do not expect an ordinary member of the public with no knowledge of the condition to be aware of technical details about the diagnostic criteria for autism. However, they feel that just a little more understanding, compassion and awareness would make all the difference to their lives. If we see a child having a meltdown in a supermarket or an adult acting a bit differently on a train, we should stop and think for a moment. They may be autistic, and need our kindness, not our judgment.

I thank all the organisations that have contributed to the knowledge of Members here today, in particular those charities and groups with whom we work closely, including the National Autistic Society, which provides the secretariat for the APPG, Ambitious about Autism, Autistica and the Children’s Services Development Group. I also thank the many individuals who have got in touch with me, and with all other Members here, in the past week. I hope that together we can improve the lives of those with autism and make some real progress in this area.

--- Later in debate ---

[Norman Lamb (North Norfolk) (LD)]

I have done it already, but I will do it again because everyone is doing it: I congratulate the right hon. Member for Chesham and Amersham (Mrs Gillan) on her leadership on this matter. What she has been involved with, and what we are all involved with as a society, is learning how to understand autism much better and recognising that we fail people badly through our ignorance of the potential and capacity of people with autism to lead fulfilling lives and to contribute massively to society. The hon. Member for Livingston (Hannah Bardell) and the right hon. Member for Clwyd West (Mr Jones) made the point strongly that there is much that people with autism can do in the employment sphere. They can be fantastic employees, contributing a great deal and leading fulfilling lives, but we often fail them. Also, it costs the Government and the economy a great deal when people with autism end up depending on the state because we have failed to provide them with the necessary support early on. That is the big challenge.

[Mrs Gillan]

I notice that we have just been joined on the Front Bench by my hon. and learned Friend the Member for South Swindon (Robert Buckland), who was my predecessor as chair of the all-party parliamentary group on autism. I want to pay tribute to the work that he did. I also want to stress that in bringing in the Autism Act 2009 and in securing this debate today, I was supported by many other Members across the House. It was not just me on my own; it was a real team effort.

[Norman Lamb]

That brings me nicely on to my next point, because I was going to say that this is not one Government’s responsibility; we all have to learn and understand more. The article in The Economist made clear the strong economic case that if we invest in diagnosis and early intervention, we will save a fortune in lifetime care. As we learn, the Government have to respond. That is the challenge. This Government, because they are here now and because new learning can lead to improvements, have a responsibility to respond.

Oral Answers to Questions

Debate between Norman Lamb and Cheryl Gillan

Tuesday 25th November 2014 Commons Chamber

[Norman Lamb]

Inexplicably, when the last Labour Government introduced access and waiting time standards, they left out mental health. That was an extraordinary decision, and it drives where the money goes. The introduction of mental health waiting time standards next year, for the first time ever, will help to achieve equality for mental health. We have also published a vision of the next five years explaining how we will secure genuine equality for mental health, which is something that the last Labour Government did not achieve.

[Mrs Cheryl Gillan (Chesham and Amersham) (Con)]

The Minister will know that the statutory guidance of the adult autism strategy in England is the keystone of the provision of services under the Autism Act 2009. The updating of that guidance is now imminent, and concern has been expressed to me about the draft wording produced by the Department. Can the Minister assure me that the Department does not intend to weaken the requirements for local authorities to provide services for people with autism and their families?

[Norman Lamb]

I am delighted that my right hon. Friend has become chair of the all-party parliamentary group on autism. She has fought for many years to secure a fair deal for people with autism. I am grateful to her for alerting me to the issue that she has raised, and I shall be sure to look at the guidance. It is absolutely not the intention to water down guidance for local authorities in any way.

Adult Autism Strategy

Debate between Norman Lamb and Cheryl Gillan

Wednesday 5th March 2014 Westminster Hall

[The Minister of State, Department of Health (Norman Lamb)]

I congratulate my right hon. Friend the Member for Chesham and Amersham (Mrs Gillan) on securing the debate, but more particularly on her brilliant work over the years to secure the 2009 Act and the strategy that followed it. I know from my ministerial role that she continues to show an interest and pursue the case for change, and that is incredibly valuable.

Ministers are normally under pressure to respond to requests for meetings, but although I have not had one today, I would like to offer my right hon. Friend the chance to come to the Department, before we reach the final point of the refreshed, revised strategy, to discuss where we are going with it. My hon. Friend the Member for South Swindon (Mr Buckland) spoke passionately as well. I was with him yesterday at a meeting of his all-party group on autism, and he should be part of the discussion. Other Members are welcome too—that would be very valuable.

[Mrs Gillan]

rose—

[Mr Buckland]

rose—

[Norman Lamb]

I will give way to both colleagues, but first to my right hon. Friend the Member for Chesham and Amersham.

[Mrs Gillan]

I thank the Minister for his generous offer. He took the thought out of my head, because I was going to ask whether my hon. Friend the Member for South Swindon (Mr Buckland) could accompany me, alongside someone from the National Autistic Society. That offer will be taken up, and communities across the country will appreciate that. Even if the Minister is unable to meet all the demands we have set out today, it is important that he can set out a path forward, so that we can achieve what we have been asking for across the board, so I thank him for his offer.

--- Later in debate ---

[Norman Lamb]

The hon. Gentleman makes a good point. I was going to come on to give an example of that. Sadly, we have also heard from many people with autism, and their families and carers, that things have not yet changed enough, or at all, for them. Gaps in provision or waits for diagnostic services continue to be reported. As my hon. Friend the Member for South Swindon made clear, diagnosis is the start of what can then happen; it is a condition precedent to an improvement in someone’s life, and is of course not enough in itself. Many people have told us that they have skills to offer employers that they cannot use. That is totally frustrating for them, and a waste for the individual and for the economy, as my right hon. Friend the Member for Chesham and Amersham made clear.

[Mrs Gillan]

The Minister has slightly moved on from the point that I wanted to make, but I will make it nevertheless. Will he also look at an initiative that the NAS and I took in my constituency with some parents of children who have autism? I brought them together with the clinical commissioning group in a non-crisis atmosphere, because most of the contact with parents and families with autism happens when they are in crisis. We held a meeting in my office in a non-crisis environment and it was helpful to have an exchange in a calm atmosphere about the issues and problems faced by those individuals and families. They were able to put those across to the CCG and the local authority, which meant that the professionals were then so much better equipped to know what such families and individuals are facing, and to give them the help and assistance that they require. Will the Minister also look at that as a model to roll out across the country?

[Norman Lamb]

I would. Bringing people with autism and people who use services together with those who are commissioning the services is a necessary condition for any good commissioning, but far too often it does not happen. As my right hon. Friend has demonstrated, there is a role for us here: we can act as local champions to bring people together and put pressure on institutions to change attitudes. I very much share that view.

We are in the final period of finalising the update to the strategy and are giving active consideration to ideas that others have contributed, such as the innovation fund, which my right hon. Friend mentioned, to help develop good practice, and an autism awareness scheme to help local volunteers and community groups. Autism should not be seen as an add-on to services or work programmes, and with well over half a million people on the autism spectrum, everyday services will already be seeing or in contact with many people who have autism. Thinking about and engaging with those people more effectively and making reasonable adjustments or adaptations to existing services will lead to better outcomes for people and a better use of public resources, as other hon. Members have said.

Monday was NHS change day. I was made aware, via Twitter, of a short video about a doctor’s pledge to ensure that instructions given to patients are clear and not ambiguous. The video followed a girl called Lucy who has autism. After a consultation in a room in a hospital, she was told to wait outside A and E, and so went outside the building, because she had taken the instruction literally, and sat waiting for hours outside in the cold in the car park, left entirely on her own. I encourage hon. Members to watch it: it lasts about 30 seconds and was distributed via Twitter. That simple and straightforward pledge, made by a doctor who recognised that there had been a complete failure by his service, will help to raise awareness within the service and increase understanding of autism. The hon. Member for Stretford and Urmston (Kate Green) made the point that this is not just a matter for the NHS; other organisations such as banks and other financial institutions have a responsibility to see how they need to raise awareness among their staff.

Many of the changes under way in public services, such as increased personalisation and choice for individuals, are essential to giving people with autism the right kind of support. Support for people with autism may not require huge budgets to achieve improvements, and much can be achieved with a degree of creativity, flexibility and determination.

This issue is relevant not only to health and care, however. Again, we can draw a comparison with the dementia situation. The Prime Minister’s challenge on dementia is about how not only health and care services but society need to change, and how we need to raise awareness across society. The same applies for people on the autism spectrum. It is about changing people’s lives, both where they live and where they work. We know that so much more could be done to promote autism awareness, but our society is becoming more aware of autism. We hear about local schemes to make parts of the community more accessible and welcoming to people with autism. For example, as was referred to earlier, cinema screenings are being made autism-friendly by simple adjustments such as having the lights on low and the volume turned down.

Services based around low-level interpersonal support, such as buddying schemes, have enabled adults with autism—including people who do not qualify for support from their local authorities—to participate in different social and leisure activities and have promoted social inclusion. The example of the special showing of a musical in London is a good demonstration of an organisation prepared to go the extra mile to make life enjoyable for people in those circumstances. Exactly the same can be done for adults as for children, as my hon. Friend the Member for South Swindon said.

The Care Bill also puts a duty on local authorities to develop preventive services for people within communities. The shadow Minister and I have been devoting a lot of our time to the Care Bill. It is great and groundbreaking legislation that puts a focus on individuals’ well-being and happiness. If we can change the way in which organisations such as local authorities behave towards people with care and support needs, so as to focus on their well-being and not the needs of the institution, we can effect real change.

The Children and Families Bill will bring significant improvements to the transition of young people with autism from school, through college and into adult life—a point made by the shadow Minister. It will introduce education, health and care plans for people from nought to 25, which will put greater emphasis on long-term outcomes for young people. We know that caring for someone with autism can be extremely rewarding, but it can also be incredibly challenging, both emotionally and financially. The changes to carers’ assessments that will be introduced if the Care Bill becomes law will ensure that many more carers can get support.

It is also important to improve training on autism for front-line public service staff, a point raised several times in our debate. Since 2010 we have worked with a range of organisations to produce a comprehensive set of resources for staff in the health and care sector. Health Education England has a role to play, along with initiatives from the royal colleges, such as the Royal College of General Practitioners, whose adoption of autism as a clinical priority from April this year is very much to be welcomed. The regulations to support the Care Bill will also require community care assessors to be suitably trained—again, an issue raised in our debate. Having autism-aware police officers, courts and probation services can make a great difference. The existing statutory guidance made it clear that autism training should be available to all staff working in health and social care.

To plan effectively, local authorities need access to data on numbers and needs that are as comprehensive as possible. From April this year, as an outcome of the zero-based review of adult social care data, they will have to record a person’s primary reason for support and any health conditions that person may have, including autism. That provides a basis for possible future measures on autism in the adult social care outcomes framework.

A key challenge for many older adults with autism is that they will have had significant support from their families, but as families age that becomes less possible. We are considering how to build on the recent NAS report that followed work by the House of Lords autism and ageing commission.

As we have heard, most people with autism want to work, and have skills and talents that would be incredibly useful in the workplace. The policy paper “The disability and health employment strategy: the discussion so far” outlines a more personalised and tailored approach to employment support for disabled people, including people with autism. As well as challenging negative behaviours and attitudes, the Disability Confident campaign launched last year by the Prime Minister is designed to help employers who are unsure about the benefits of employing disabled people.

Adults with autism are entitled to benefit from all the Government’s wider initiatives to get working-age people into employment. The Department for Work and Pensions is aware that more can be done to help people with autism make the most of those programmes and of themselves. Only this week, the DWP held an event with my Department and the NAS, for people on the spectrum and for employers, to improve people’s experiences in applying for jobs at the jobcentre and with employers.

We are only at the beginning of the journey to improve all aspects of the lives of people with autism, including when they are seeking employment or are in education, as well as the support they get in health and social care. We need to continue with concerted action and commitment both nationally and locally to make a difference. The update of the 2010 strategy will mark the next step in that journey, but there is still a long way to go.