Care Bill [Lords]

Robert Buckland Excerpts

Monday 16th December 2013 Commons Chamber

[Mr Robert Buckland (South Swindon) (Con)]

When I say that it is a pleasure to follow the hon. Member for Lewisham East (Heidi Alexander), that is not a mere formality; it really is a pleasure, and it was fascinating to hear the family experience of her late grandmother in Swindon. As the Member of Parliament for some other members of her family, I was particularly interested in, and concerned to hear, that story. Clearly there is a measure of consensus about the progress that the Bill allows us to make. Although I understand and appreciate her concerns about the process that was successfully challenged in the courts in relation to her local hospital, and the detail in respect of clause 118, I do not think, with respect to her and to the Opposition, that that is sufficient for the reasoned amendment to pass tonight. I say that because I think of the thousands of families like hers who, over the years, have had to wait for change and for politicians to come up with a decision. We have procrastinated and prevaricated, and had review after review, so surely time is now up and decisions have to be made. That is why this Bill comes not a moment too soon.

I want to address an aspect of the Bill that has been dealt with by other Members: the care of adults with learning difficulties, and especially with autism. I speak in my capacity as chair of the all-party group on autism. I also declare an interest as the parent of a child who one day might fit some of the criteria of the Bill and as the parent of a young carer. I say with enthusiasm that I welcome those provisions in the Bill that relate to the assessment of young carers. They were very much part of a cross-party campaign with which my right hon. Friend the Member for Sutton and Cheam (Paul Burstow) and the hon. Member for Worsley and Eccles South (Barbara Keeley) were involved. A necessary change was made to allow young carers’ rights and needs to be assessed as well. Let us not forget that while this Bill makes its way through this House, the Children and Families Bill is making its way through the other place. We must ensure that both Bills dovetail in a way that is truly effective. In particular, I am thinking of the provisions of the Children and Families Bill that extend the education, health and social care plans to those young people between the ages of 18 and 25. We must ensure that the social care aspects of this Bill dovetail properly with the needs of those young people, because this Bill affects adults from the age of 18 and onwards.

This is a hugely important Bill, and I want to address it in the context of the Autism Act 2009. That groundbreaking legislation was passed in this House with all-party support and following the work of my right hon. Friend the Member for Chesham and Amersham (Mrs Gillan). I pay tribute to all Members, and former Members, who played their part in that legislation. As a result of it, an adult autism strategy was passed in 2010, which committed both national and local government and the NHS to improve the lives of adults with autism.

However, here we are in 2013, and there is still some way to go to meet the aims of that legislation. The strategy is currently under review. Ahead of that review, the National Autistic Society launched its “push for action” campaign, which identified some of the most important barriers to implementation and outlined the key challenges that adults with autism continue to face. Some of those challenges can be met by this Bill.

I am particularly pleased with clause 2, which places new duties on local authorities to prevent the needs for care and support from developing in the first place. Change in that area for adults with autism has been slow and patchy. A third of adults with autism who responded to a survey by the National Autistic Society said that they developed serious mental health problems because of a lack of services. Support at a low level can allow people with autism to become more independent, work, socialise and take part in their communities. At the same time, it can prevent an escalation of care needs.

Back in 2009, the National Audit Office found that providing such low-level services is cost-effective and helps people to avoid the use of in-patient mental health care, which costs between £200 and £300 a day. The NAO said that if just 4% of adults with Asperger’s syndrome or high-functioning autism are identified and supported, that would become cost-neutral over time.

I am glad that the right hon. Member for Stirling (Mrs McGuire), who is no longer in her place, referred to the Deloitte economic model, which quite clearly shows that for every pound spent to support people with autism and other disabilities, there is an average return of £1.30 for central Government, local government and disabled people and their families. Clear duties that prevent mental ill health are essential if we are to make the aims of the adult autism strategy a reality and to save money. I would be grateful if my right hon. Friend the Secretary of State and the Government ensured that local authorities’ understanding of prevention is wide ranging and includes the very types of low-level support that can make this prevention aspiration a reality.

Let me turn now to the existing duties of local government and the NHS. I welcome the Bill’s intention to bring together in one place statutory guidance on care and support. However, the statutory guidance that was published as a result of the Autism Act is slightly different. As opposed to the Care Bill, the 2009 Act also places important duties on the NHS. I want to ensure that those duties on the NHS are not unintentionally omitted from this Bill.

There is still much progress to be made with regard to the duty to develop a diagnostic pathway for adults with autism. I am happy to say that in Swindon the local social enterprise SEQOL has already done that, and has developed an important diagnostic pathway, which is also followed up by meetings with and assessments by clinicians. That has resulted in adults as old as 50 and above being diagnosed with autism or Asperger’s for the first time. The issue of what happens next will be key if we are to make this Bill, and the good intentions behind it, work for people with autism.

A common problem reported by families of people with autism is that far too often the person carrying out the care assessment does not sufficiently understand the condition or how to communicate effectively with someone on the spectrum. I am therefore encouraged by the recent amendment to the Bill to enable regulations that will specify where community care assessments should be carried out by assessors with specific expertise. Assessments for adults with autism must be covered by those regulations, because that will reinforce the obligation already placed on local authorities by the Autism Act and the statutory guidance to train those who carry out community care assessments. The NAS found that, at the moment, only just over half of local authorities have specialised training available for their staff, so, quite clearly, more work needs to be done to deal with that.

The right to advocacy is essential to enable people who find it hard to communicate to exercise their rights. I pay tribute to the work of the Swindon advocacy movement, which, as a result of its efforts and funding from the local authority, is now extending advocacy to adults with autism and Asperger’s, who have never had that support before. What often makes us parents lie awake at night is the question of who will speak for our children when we are gone. Who will be there to carry out that advocacy? This service is essential to provide peace of mind to parents and carers of sons and daughters with autism who will outlive them. My hon. Friend the Member for Newton Abbot (Anne Marie Morris) mentioned the definition in clause 68 of “substantial difficulty”. This debate on Second Reading is about the principle of the Bill. I am sure that we will be able to iron our further details when the Bill goes to Committee. None the less, I commend it to the House as an overdue attempt to address the concerns of real people in our communities, and to help people with disabilities, including autism, lead fulfilling lives.