Hospice Funding

Robert Buckland Excerpts

Monday 22nd April 2024 Commons Chamber

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

It is a pleasure to speak in this debate, and I thank my hon. Friends the Members for Hastings and Rye (Sally-Ann Hart) and for Darlington (Peter Gibson), and indeed the Backbench Business Committee, for allowing us time to debate this issue. We have heard some powerful contributions today.

Any of us with friends or family who have gone through end of life care will know exactly how the hospice movement plays such an important part in ensuring that death is dignified and dealt with properly, and that the wider family considerations are at the heart of the way in which hospices support people in that position. This is about not just the bricks and mortar of those hospices, but their work in the community; what they do in people’s homes; how they offer domiciliary support; and how with a good plan, agreed between the various agencies of our local health services, death can be dignified and an experience that is entirely fitting, bearing in mind the obvious sensitivities that exist around this issue. We do not talk enough about death in modern society. We rightly talk a lot about sexuality and sex, but we seem to talk more about that than we do about death. The Victorians did it exactly the other way round, being obsessed with death and never talking about sex. We need to get the balance right and talk frankly about death.

As my hon. Friend the Member for Darlington said, this evening is not a time to debate assisted dying—assisted suicide, as I would call it—but it is a time to talk not just about the invaluable contribution of hospices, but the future of our hospice movement and how we strike a balance between the need to maintain their independence, flexibility and character, which reflects the local community they serve, and the support that it is incumbent on the NHS and central Government to provide, especially in respect of commissioned clinical services. That is where the interplay comes between the independent voluntary sector and those vital statutory services—the clinical ones—that government has a duty to provide and the NHS has a duty to support.

I am particularly lucky as the local hospice that serves Swindon and the north and east of Wiltshire is situated almost next door to where I live in my constituency, in Wroughton. Prospect Hospice was founded in 1980, and has grown and thrived due to the generosity and good will of our local community. Some 30% of its income comes from fundraising appeals and activities. Another 31% comes from profit made by its charity shops, which exist throughout the length and breadth of our area. We have many in Swindon; in fact, a new one opened in one of our shopping centres only a few months ago that is already doing very well and serving its local community admirably. Some 11% of the income comes from legacy gifts. I am glad legacy gifts were mentioned by my hon. Friend the Member for Darlington (Peter Gibson), because they are vital. Together with other investment income, the amount raised in those ways comes to about 75%, with about 25% coming from the statutory services provided by ICBs.

We have all talked about the pressure of inflation, which is a reality for Prospect Hospice as well. Costs have increased significantly and the sad challenge we have faced in our hospice is that we have had to halve the number of beds, from 12 to six, and close the day therapy unit. That unit was invaluable. We very much miss the volunteers who worked in it and the support it gave people at end of life. In common with other hospices, covid wreaked havoc on the fundraising ability of Prospect Hospice; last year, it was left with a shortfall of just over £1 million. With the best will in the world, it is getting very difficult to make up that shortfall. This debate is important not just for Prospect Hospice, but for Julia’s House, the children’s hospice serving Wiltshire and Dorset, based in Devizes, which I visit very often. I know the benefits for children who were my constituents.

In this debate, we are talking not just about fundraising efforts, but about the involvement of volunteers in the service. Such involvement brings huge fulfilment and allows many thousands of people to make a difference by offering their time and talent. None of us wants to lose that, but a sense of reality is needed on the funding of commissioned services. There is no doubt that the Government have moved in the right direction—we have moved leagues in the last 10 or so years. The support that the Government gave to the hospice movement during covid was admirable. The introduction of the statutory duty, which we saw for the first time in the Health and Care Act 2022, was a signal moment when the hospice movement came of age, and end of life and palliative care was recognised, quite rightly, as an integral part of the way in which we provide and commission healthcare in this country.

My local ICB has set up an end of life alliance, which is good. However, more work needs to be done to ensure that the coming together of services around patients—clients—results in an avoidance of duplication, rather than the other way around. We need an acknowledgment that without hospices, such as Prospect Hospice, we will fail thousands of people who have come to rely upon this invaluable service.

There is much more that I could say. I pray in aid the excellent submissions and remarks made by right hon. and hon. Friends and Members. We are making a unified clarion call that we want to see our hospice movement thrive. That cannot happen without the input of Government and local health services.

Pharmacy First

Robert Buckland Excerpts

Wednesday 31st January 2024 Commons Chamber

[Dame Andrea Leadsom]

I seriously look forward to the re-establishment of the Stormont Assembly so that it will be possible for Northern Ireland to implement such a scheme itself.

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

I warmly welcome the statement. I have been a strong champion of pharmacies in my constituency. We are experiencing challenges, however, when the likes of Boots withdraw their services. It is difficult to transfer or apply for licences, despite the fact that we have a number of keen applicants who want to provide important pharmacy services. What more can the Government do to speed up and make the licensing application procedure smoother and better?

[Dame Andrea Leadsom]

I would love to hear more about that from my right hon. and learned Friend. I will be happy to look into it.

Countess of Chester Hospital Inquiry

Robert Buckland Excerpts

Monday 4th September 2023 Commons Chamber

[Steve Barclay]

Again, colleagues across the House know that protecting whistleblowers, including whistleblowers in the NHS, is something I have long championed. As I said earlier, the guidance has been strengthened, but one of the best mitigants is having much more transparency on the data, because the more transparent the data is, the more difficult it is for concerns to be ignored. There is a number of issues. We have strengthened the data. We have the freedom to speak up guardians. We need to look at whether, in Chester, if a freedom to speak up guardian were on the board, that would be the right approach. Do we need to look at whether these roles should be on the board? But significant work has already been done since these events and since Morecambe to strengthen the safeguards around speaking up and the Public Interest Disclosure Act. Alongside that, having organisations such as the Getting It Right First Time team looking at the neonatal data is a further important safety process to have in place.

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

It is difficult to imagine a more horrendous set of crimes than the ones committed by Letby, and her cowardly refusal to attend her sentence added grievous insult to the huge injury and misery she has caused to all the families. Can we put on record our thanks to the trial judge and the jury for the incredible work they did? I welcome my right hon. Friend’s commitment to a full statutory inquiry under the Inquiries Act 2005 and commend Lady Justice Thirlwall. Does he agree that it is important open justice is maintained fully so that we and the wider public can fully understand what on earth happened here, because this affects not just those families on the indictment—or the victims on the indictment—but hundreds of families across the entire region, and open justice has to be at the heart of judicial process?

[Steve Barclay]

First, I join my right hon. and learned Friend in paying tribute to the trial judge and the jury; it must have been a very harrowing case for them to sit on and deal with. He makes, as ever, an important point about open justice. I just have one caveat; I hope he will forgive me. It is that it is also important we get the balance right in respecting the privacy of families where that is their wish, particularly given that quite often these families will have other young children who may or may not know about aspects of this case. So it is important that we have open justice, but at the heart of our approach is ensuring that we are following the wishes of the family, and that includes respecting privacy where that is appropriate.

Urgent and Emergency Care Recovery Plan

Robert Buckland Excerpts

Monday 30th January 2023 Commons Chamber

[Steve Barclay]

I am very happy to meet with the hon. Lady and colleagues to discuss this further. I think most people recognise that, since the huge pressures from flu over the Christmas period, the flu numbers have come down, but of course there is continued pressure in the system.

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

I welcome my right hon. Friend’s statement. In particular, I welcome the announcement today of over £26 million of funding to expand the emergency department at Great Western Hospital in Swindon. He knows from his previous incarnation that we have worked together on this issue. It is particularly important, not just for the integration of emergency services, but for the freeing up of other space in the hospital to allow for further beds or other clinical interventions. Does he agree that it is this sort of long-term measure that will guarantee progress in our much pressed national health service?

[Steve Barclay]

My right hon. and learned Friend has been key to securing the funding. He has assiduously lobbied me and ministerial colleagues to make a powerful case on behalf of his constituents, and I think he should be proud of the outcome, which reflects his and his parliamentary colleagues’ work on this issue. He is right; indeed, the case he made was around how this frees up capacity in the system, which will result in much better care for patients in Swindon.

Special Educational Needs and Children’s Mental Health Services

Robert Buckland Excerpts

Wednesday 9th February 2022 Westminster Hall

[Aaron Bell (Newcastle-under-Lyme) (Con)]

It is a pleasure to serve under your chairmanship, Ms Fovargue, and a real pleasure to follow the hon. Member for Sheffield, Hallam (Olivia Blake), who made a powerful speech. Sharing her personal experience in this place is a brave thing to do. It has informed our debate, and I am sure that the Minister will refer to that when she sums up.

I congratulate my hon. Friend the Member for Newbury (Laura Farris) on securing the debate. Like her, I have been contacted by so many distressed parents of children with special educational needs. Their experiences of trying to get support for their children are summed up in exactly the word she used: a battle—it is really a battle. EHCPs are the entry ticket to specialist support, but the whole application and appeal processes seem designed to be difficult and time-consuming. As my hon. Friend said, too many times people have to repeat things that they have already said again and again. We must ensure that we have a tell-it-once approach to such things, however long the waiting list might be—she spoke movingly about that as well.

My constituent Samantha King’s four-year-old, for example, was receiving one-to-one nursery support in Wales before they moved to Newcastle-under-Lyme. She supplied extensive documentary evidence of the child’s need when they moved, yet she described having her child’s application refused on the basis that she had not included the reports that she had in fact submitted. That is all too common—things get lost and people have to fill in almost exactly the same form again or for another authority. It is extremely tedious and it breaks people down, and that is why this is such a battle.

Parents then find that they have to appeal to SENDIST, the special educational needs and disability tribunal, as the main route to access an EHCP. We need to analyse the proportion of successful appeals. If local authorities are turning down applications that are successful on appeal, those at the top of that league table need to think about why that is the case. They need to consider applications more carefully in the first place.

Even when someone gets an EHCP, the battle continues. Parents in my constituency report annual reviews not taking place, or the plans not being updated for months following review, severely impacting on a child’s progress through education. A lot of things go wrong in the transitions between stages of education or into work.

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

I am grateful to my hon. Friend for mentioning transition, because it is there that a condition such as autism or ADHD can turn into a mental health condition. Does he agree that one of the key issues for the Government to consider is the training and availability of clinicians? Funding is now much better than it was, but we still do not have the trained clinicians who could cut through the waiting lists, which are causing so much frustration to far too many families.

[Aaron Bell]

My right hon. and learned Friend is absolutely correct about the availability of clinicians. His intervention also speaks to the point made by the hon. Member for Sheffield, Hallam that if these conditions are not treated at school, they can lead to severely negative mental health outcomes later in life.

My constituent Mr Winkle has fought for many years to obtain suitable educational and therapeutic support for his son. Following a tribunal decision last month, he was sent a revised EHCP that still contained a number of inaccuracies, including out-of-date details about his son’s residential placement. I want to talk a little about residential placements, which have not been raised much so far, because the lack of suitable placements causes distress to many families.

One constituent described how the 14-year-old in her care only receives an hour’s at-home tuition a day, because a suitable therapeutic placement with a small and consistent staff team cannot be found. Alternatively, children are given residential educational provision that is unsuitable, which can cause them to regress and even, in one case, to self-harm.

Another common complaint is that social workers change too regularly, so the social worker does not truly know the child. Parents may not be told who the new social worker is and many have described the difficulty they experience when trying to get in touch with professionals, as telephone calls are not returned.

Despite parents being the ones with the most knowledge of the child or young person they are caring for, they struggle to be heard. Should they then complain, they describe encountering a complaints process that is frankly not fit for purpose: timescales are not followed; complaints sometimes seem to be ignored completely; and it is only possible to complain to the ombudsman with a final response, but that often never seems to arrive, and even when they do complain, it will take months for the ombudsman to reply. Furthermore, adults involved in the care of children can become fearful of complaining, in case there are reprisals in the form of their contact with the child being blocked.

Added to that is the struggle to obtain adequate mental health treatment. One constituent of mine was told that the priority waiting list for CAMHS—not the list to which my hon. Friend the Member for Newbury was referring earlier—is 11 months in Staffordshire. That is the priority list. Only this week, a constituent described how she is desperate for respite provision, having accepted a child back into her care on the basis that the local authority would support her.

The local authority has been good at keeping in touch, but its hands have been tied by what it says is a lack of resources. As well as struggling to find an educational placement for the young person, it has only just found an agency to take him on outings twice a week. After five and a half months of caring 24/7, my constituent is exhausted and in the terrible position of considering having to say that she can no longer look after the young man. She has been let down by a breach of implied trust—the local authority told her that it would support her, but it has not been able to.

As Members of Parliament, we inevitably hear the failures, rather than the success stories, but I welcome any support that can be given to improve the experience of so many. As my constituent Mr Winkle said:

“In this journey I have communicated with many regulatory bodies each claiming to have the child’s interests wishes and safety at the forefront of their agenda...but as I have experienced this is certainly not so...my assumption is that it’s a closed circle and these entities do not know how to facilitate or co-ordinate any kind of solution and just want it to ‘Go Away’.”

I am sure that is not the full truth of it, but that is the experience that people are having out there.

I welcome the imminent Green Paper and the additional funding, but too many people have been failed for far too long. I hope the Minister will be able to address that when she responds.

Mental Health Act 1983: Detention of People with Autism and other Lifelong Conditions

Robert Buckland Excerpts

Thursday 20th January 2022 Commons Chamber

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

It is a pleasure to address the House in a debate on an issue that has great resonance with and importance to many people and families across the country—the continued detention of autistic people and people with learning disabilities under the civil provisions of the Mental Health Act 1983. I am grateful to the National Autistic Society and Mencap for working with me in the run-up to the debate.

Remember, these are people who have committed no offence. They are not even alleged to have committed offences. They have been detained for what is still defined as a mental disorder. They have done nothing wrong. Here are some bald statistics relating to the use of powers under the 1983 Act. At the end of November 2021, there were 2,085 people with autism or a learning disability in in-patient units; 1,234 of them were autistic people, 200 of whom were under 18—they were children. The average length of detention is 5.4 years, some people having been detained for more than 20 years. In September 2021 there were 3,620 reported instances of restrictive interventions, and 595 of them involved children. Those interventions involved physical and, very often, chemical restraint. Those are not the complete figures, because there was data for only 31 out of 55 NHS providers and four of 16 private providers, so the real figure will be higher.

[Jim Shannon (Strangford) (DUP)]

I congratulate the right hon. and learned Gentleman on bringing forward this debate on an issue that is massive in his constituency and mine. The number of detentions under the 1983 Act seems to decline with age, but there seem to be significantly higher numbers of cases among children and young adults. Does he agree that there is a better chance of rehabilitation and wellness when mental health issues are dealt with properly from as young an age as possible than when there is long-term detention with no counselling or rehabilitation?

[Sir Robert Buckland]

I am grateful to the hon. Gentleman for his intervention. He has a long-standing interest in autism issues, in Northern Ireland in particular. He is right that if there is early intervention, more can be done to prevent a lifelong condition such as autism becoming a co-morbid mental health condition. I will explain that in a little while.

Behind the statistics are real-life stories of people whose lifelong conditions have led to the system, however well-intentioned it might be, ascribing a lower value to their quality of life. That implicit judgment, I believe, runs through everything from the continued lumping together of autism and learning disabilities with mental health conditions, which in many cases is wholly out of date and inappropriate, to the discriminatory and unjust application of “do not resuscitate” guidance to people with these conditions. Those are abuses in plain sight.

Furthermore, the profound sense that the system is, in effect, making assumptions about the life of people with learning disabilities in particular has been exacerbated by the use of DNRs during the covid pandemic. Not only do we need to stop new orders being issued inappropriately to people with learning difficulties, but existing inappropriate DNRs need to be retracted. I ask the Minister: when will the Government act on the Care Quality Commission review recommendations about better staff training and family involvement in decision making about care and treatment?

It is no longer good enough for people with learning disabilities to be discharged from hospital with a form in the bottom of their bag, effectively having signed away their rights about the end of their own life. That is what we are talking about; I cannot put it more bluntly than that.

[Darren Henry (Broxtowe) (Con)]

I thank my right hon. and learned Friend for securing this debate. We are heavily relying on hospitals to manage individuals with complex needs, which costs the NHS thousands of pounds per individual per week. If we invested more in care in the community, perhaps using the coming health and social care levy, we could prevent hurt or trauma to individuals and save money for the NHS.

[Sir Robert Buckland]

My hon. Friend is absolutely right about the waste of resources that I am afraid underlies much of this. I shall come to some of the figures, which are pretty shocking. He is right to highlight the levy that is being introduced in April. It is imperative that the £12 billion that we are told is being earmarked as part of the £36 billion to be raised from the levy is actually used on social care.

The worry we all have is that the money will be eaten up by spending on the health backlog, and that there will be no audit trail at all to make it possible to ensure that it is, in effect, ring-fenced and used in social care. I put that big challenge to Ministers. The Health Secretary knows my strong view; I was writing about it in the national media on Sunday. We have to really laser in on these issues.

The horror of Winterbourne View is still seared into my mind 11 years on, together with other instances of abuse. But in general, we are not in this position because of malice or hostility towards people with autism or a learning disability; we are here because of indifference, frankly. It is all too easy to make the assumption that because the person has been detained for their own safety, the letter of the law has been followed and the clinicians have given their opinion, that will just have to do. That really is not good enough in this day and age.

Recent news coverage of the cases of Tony Hickmott and Patient A has brought these issues into stark relief. I will briefly mention Mr Hickmott’s case, which was highlighted by the media just before Christmas. Ongoing legal proceedings mean that I must limit my remarks, but I read reports that this gentleman has been detained for more than 20 years under this system—nearly half his entire life. That is deeply distressing for his family and should be of grave concern to the rest of us.

Patient A’s case was reported in The Sunday Times just after new year, the result of some excellent investigative journalism. He has been confined for over four years so far in a secure apartment at the Priory Hospital Cheadle Royal. That apartment—I use the word advisedly—is the size of a large living room. He is monitored by CCTV. His food and medication are passed through a hatch. He is now 24 years of age. The story of his life leading up to this incarceration is heartbreaking in itself but also emblematic of failure. The interventions made exacerbated his existing anxiety, creating a descending spiral of deterioration in his health that has resulted in over-medication, more restrictions and even poorer mental and physical health. We are spending money on harming people rather than saving them.

[Tim Loughton (East Worthing and Shoreham) (Con)]

It is so good to have my right hon. and learned Friend on the Back Benches in some respects; he is such a champion of this cause and is making a very important contribution. Does he agree that it is a completely false economy not to be thinking smarter, and lazy not to be able to let people out of NHS facilities where there may be better community facilities and better working with the families? It would, of course, mean a much better life for the person involved as well. The chemical cosh that he just referred to and the use of restraint, which in some places is disproportionate, is a sign of failure, and that the person is not being looked after appropriately. That is what needs to change.

I should have declared my entry in the Register of Members’ Financial Interests at the beginning of this intervention.

[Sir Robert Buckland]

My hon. Friend, who has long experience of this matter, having served with distinction as Children’s Minister and as a long-standing campaigner on these issues, makes a hugely important point about the chemical cosh that is medication. I think he and I agree that we are not here to single out or criticise many dedicated care staff and NHS workers who do their very best to care for and support in-patients. They deserve our thanks; they are doing the day-to-day work. I am talking about the system that allows this to happen—that allows, in effect, a standing reproach to us all. This is 2022, not 1922.

There are two strands to the approach that we need. First, as the hon. Member for Strangford (Jim Shannon) said, earlier and better interventions are needed to prevent cases spiralling into crisis in the first place. Secondly, better community-based alternatives to the continued detention of in-patients are needed. It is my firm belief that with the better commissioning of community support, the need for recourse to detention would inevitably fall. That would create a virtuous—rather than vicious—circle, which would benefit all.

There is not only a social, health or moral price being paid for this failure, but a financial one. In 2015 the National Audit Office estimated that, in the year 2012-13, the NHS spent £557 million on in-patient services for people with learning disabilities whose behaviour could be challenging. More than half a billion pounds was spent on services that harm people, and that figure is from nearly 10 years ago. The cost now will be considerably more. That speaks volumes about the failure of the present system.

Although the Mental Health Act was reformed in 1983, it is, in essence, a replication of a regime that was created under the Mental Health Act 1959. That is a 60-year-old framework; to say that it is out of date understates the argument.

[Sir Robert Neill (Bromley and Chislehurst) (Con)]

I am grateful to my right hon. and learned Friend for giving way, and for the passion and knowledge that he brings to this topic. He refers to out-of-date legislation and how things have moved on. He will know from his experience as Justice Secretary that if we thought that we were applying the same regimes in terms of detention and use of restraint to people who had been convicted of offences after the passing of 60 years, we would rightly be outraged. Should we not be rightly outraged now that this is being done to people who have committed no offence and have not had the protection of due process that those going through the justice system have?

[Sir Robert Buckland]

I have good news, because it is Government policy to update the Mental Health Act. That is the plan that I and others, when I was in Cabinet, agreed on and I know that it is what the Minister will speak about. Reforming the Mental Health Act is Government policy because, goodness me, we have work to do. Between 2006 and 2016, the number of detentions rose by a staggering 40%. We owe thanks to the work of people such as the outstanding Sir Simon Wessely, whose independent review in 2018 gave the Government the clear course that I know they are adopting and following.

I particularly welcome the disaggregation of autism and learning disability from mental health in law and the end to their being classed as a mental disorder under section 3 of the existing Act. According to the Government’s policy, there has to be a clinically established concurrent mental health condition before detention can be allowed, and there will be a 28-day limit. All that makes immense sense, and I particularly look forward to the Government’s introducing a statutory duty to provide adequate community-based services, such as supported housing. In the White Paper that the Minister introduced before Christmas, we saw really healthy and useful reference to supported housing. It is my belief that, without that, we cannot create effective community-based services.

We still do not have a fully clear picture of the current commissioning landscape across England, but we know that people are being left in NHS-funded detention, because the lack of resources for local government means there just are not enough local government-commissioned community services for people to go home, back to their families and back to their local areas. Legislative change cannot come soon enough, so I would be extremely grateful if my hon. Friend the Minister could confirm the Government’s intention to bring forward that legislation, whether it will be first via the pre-legislative scrutiny process and, if so, when we can expect its introduction.

As time is short, I want to speak briefly about the Transforming Care agenda. We know that, when all agencies work together at the same pace, it is excellent, but the trouble is that we still have agencies dragging their heels or causing problems that mean people are spending longer in detention than they need to. The readmission of patients who are being discharged is another depressing example of our failure to break the vicious cycle in many cases.

We know what “good” looks like; we have the NHS England “Building the Right Support” service model and National Institute for Health and Care Excellence guidance. We know that there are pockets of good practice that the Government are actively promoting and supporting, but more needs to be done to join that up. If we are to see these figures starting to come down, consistent with the Government’s own priorities, the time for action is now.

There are, therefore, two things that the Government can do. They can not only bring forward the legislation, but fulfil their pledge to add more substance to the strategies they have outlined. The £74 million, pledged in the 2020 Budget to help with what are known as the double running costs when people with a learning disability or autism are discharged into the community, is extremely welcome. I know there are funding commitments in the NHS long-term plan to help the development of community support. However, as the recent Health and Social Care Committee inquiry noted, we still are not in the place we need to be. We still do not have that level of support that will make the discharge of patients a much more seamless and successful process. I know that ending those perverse incentives and this artificial division between the NHS and local government is part of the integration agenda, and I look forward to the White Paper that my hon. Friend will be publishing very soon, but I want everything to be joined up, in a way I was acutely conscious of when I was Justice Secretary.

I will end on this note: I was acutely conscious of the need for greater speed when it came, for example, to the approval of the recommendation of clinicians, which was the responsibility of my Department. Prior to the onset of covid, I collaborated directly with the then Health Secretary to jointly pursue the Mental Health Act reform agenda. My abiding regret is that I was not able to do more, and I want to say that I am sorry that I was not able to do more, but here I am in my place asking my friends to carry on the work, to pick up the ball and to take it further for all the people we represent and their families. By calling this debate and by making that direct request to Government to act, I hope that together we can make the necessary changes and save lives.

Adult Social Care

Robert Buckland Excerpts

Wednesday 1st December 2021 Commons Chamber

[Gillian Keegan]

My hon. Friend is absolutely right, and this is something that happens pretty much every year. For the short term, we have around £500 million as part of our winter plan to focus on the discharge process and to make it work as effectively and as efficiently as possible. Of course, a big part of that is making sure social care is in place. In the longer term, the integration White Paper is key to making sure we have much better processes so that people get the care they need, with the right care in the right place.

[Robert Buckland (South Swindon) (Con)]

I congratulate my hon. Friend on introducing the White Paper. I see the Secretary of State for Health and Social Care in his place, and I am grateful to him, too, for ensuring the Government published the major part of the White Paper process before the end of the year. We know the integration White Paper is to come, and that will be important.

Other hon. and right hon. Members have asked about accountability on funding and ensuring that we have a share of the pot for social care. In particular, I am interested in the excellent initiative of £300 million going to local authorities for supported housing and increased choice. How will we make sure that money is used to enrich the lives of, in particular, adults with disabilities, who currently do not have the choice they deserve?

[Gillian Keegan]

I thank my right hon. and learned Friend for his question and, indeed, for all his work in this area. I know this is dear to his heart. I look forward to working with him on a solution.

The £300 million is specifically to help to solve supported housing and to provide much better supported living and mental health support for young adults with disabilities or learning disabilities. Based on conversations with my right hon. and learned Friend, we have also put something in the White Paper on further help to get these young people into work, as many of them want help and support getting into work, and not enough of them are getting that support today.

Autism and Neurodiversity Research Funding

Robert Buckland Excerpts

Tuesday 16th November 2021 Commons Chamber

[Robert Buckland (South Swindon) (Con)]

It is with great pleasure that I rise in my first end-of-day Adjournment debate in the better part of eight years, but it is a topic that I am very happy to return to from this position. It is one that I championed in Government and one that I worked very hard on when I was a Back Bencher prior to my ministerial office. I am hugely grateful to Mr Speaker for granting me today’s debate.

Many hon. and right hon. Members will know that this issue has been close to my heart for many years: autism and the range of brain conditions that can be summarised by the word neurodiversity. From my own direct family experiences, which I spoken about in this Chamber when we held the first Chamber debate on autism back in 2013, and from the plethora of constituency casework that I have worked on over the years helping families of children and young people with autism and associated conditions, I have developed a certain knowledge and experience of these issues. As a Minister and a Secretary of State, I was glad to be able to push the agenda even further.

One of the privileges of being a Back Bencher is that I can put on record my thanks to local organisations in my constituency which do so much to support and work with people with autism, whether it is officers of the local authorities, volunteers in local carers’ groups such as the Swindon Carers Centre, or organisations such as the Uplands Enterprise Trust, which is pioneering and developing more post-19 support for young people with autism and other disabilities in my area, working with the excellent special schools network and the Brunel multi-academy trust in Swindon. It is really innovative work.

My debate today is the beginning of a process that was made clear in my exchange of letters with my right hon. Friend the Prime Minister on my departure from Cabinet two months ago: to bring about a sea change in how autism and other brain conditions are not only diagnosed, but supported and treated throughout the lives of those people. Our country is one of the most advanced in the world when it comes to these issues, but there is still a huge amount to do.

My successor as chair of the all-party parliamentary group on autism, the late, great Dame Cheryl Gillan, will always be remembered as the author of the groundbreaking Autism Act 2009, which was a new departure for health, in that a specific condition was delineated in legislation, much against the initial resistance of the then Government, but the strength of feeling in this place and outside was such that Dame Cheryl thankfully got her way. The autism strategy, which was revised in its latest iteration only in July this year, is the direct result of that important legislation. Twelve years on, I think we can safely say that awareness and diagnosis levels have risen dramatically, but the situation remains stark.

About 1 million people in the United Kingdom are autistic, but they still have some of the worst outcomes in our society. First, the death rates mean that they die on average decades before the rest of us. Secondly, with two in 10 in employment, they have the lowest employment rates of all disability groups. Importantly, and deeply worryingly, disproportionate numbers of autistic people and people with brain conditions end up in mental health detention or, even worse, in our criminal and youth justice systems. They are being locked up by a system that represents barbaric practices from a generation ago. I have certainly found, from my professional and ministerial experience, far too many in our prison system, our young offenders’ institutions and our criminal justice system generally with those conditions.

[Jim Shannon (Strangford) (DUP)]

I know the right hon. and learned Gentleman has had a particular interest in the issue for a number of years, for both personal and other reasons, so I congratulate him on securing this debate. I give an example from Northern Ireland, which to be fair is not the Minister’s responsibility, but shows what is happening: an increase of 148% in the number of children waiting for an assessment for autism and a 687% increase in the number waiting more than a year for an assessment. This is a system where the capacity is nowhere near meeting demand, as I think the right hon. and learned Gentleman has also said. Does he agree that a corresponding increase in funding to get to the root of autism and how best to treat and live with it must be a priority for the Government?

[Robert Buckland]

I am grateful to the hon. Gentleman, who rightly outlines some of the pressures on the system—the increase in diagnosis, which in many ways is a good thing, and the personnel and capacity issues that cause many of the delays in diagnosis, which are all too familiar a pattern for many families, including those in England, Wales and Scotland.

It is interesting to note that research by, I think, the Northern Ireland Assembly calculated the estimated cost to the country of the failure to deal with autism at a staggering £32 billion. Let us just think about that. What a cost to our country: resources wasted, lives wasted and lives lost as a result of these omissions. It does not have to be like this.

[Steve Brine (Winchester) (Con)]

It is such a shame to see my right hon. and learned Friend not in Government, but such a pleasure to have him on the Back Benches and to be here for his first speech from the Back Benches in what I suspect is a number of years. Seeing that we have a lot of time in tonight’s Adjournment debate, does he, as a former Lord Chancellor, agree that the way we look at people on the autistic spectrum within the secure estate, and the way he is proposing we might look afresh at that, might affect the way we look at the secure estate as a whole—to understand a lot more, and condemn a lot less? We have such a high prison population, many of whom, especially women, should not be in the secure estate. Could this be the issue that causes us to look afresh at our prison system?

[Robert Buckland]

I am grateful to my hon. Friend. In 2020, he and I visited his local prison in Winchester, a prison with many challenges and, there is no doubt about it, a share of the population with a brain condition, sometimes undiagnosed and often an acquired brain injury. Many people who are in for offences of violence have themselves been the subject of violence. Those issues are frankly endemic within the criminal justice system.

That is why, when I was Lord Chancellor, in last year’s sentencing White Paper, I announced a call for evidence on neurodiversity in the system. I was hugely grateful to Charlie Taylor, Her Majesty’s Chief Inspector of Prisons, and Justin Russell, Her Majesty’s Chief Inspector of Probation, for leading that independent call for evidence. Charlie Taylor was a public servant who came from the education sector, specifically the special needs sector, had real frontline knowledge and experience of autism and brain conditions and previously ran the Youth Justice Board for England and Wales.

The good news is that, thanks to the published results of the call for evidence, the Government committed—I am pleased to say I committed—to training for frontline staff and the upskilling of those staff right across the criminal and youth justice system, as part of a new custody and detention apprenticeship that is being offered and that will be completed by all prison officers. Her Majesty’s Prison and Probation Service is developing a revised policy framework and guidance all about those issues, but in particular about children in custody with those conditions. This work is carrying on. I will develop those points a little further. I know people are anxious to come in.

[Simon Hoare (North Dorset) (Con)]

rose—

[Sir Robert Neill (Bromley and Chislehurst) (Con)]

rose—

[Robert Buckland]

I will let my hon. Friend the Member for North Dorset (Simon Hoare) in first before my hon. Friend the Member for Bromley and Chislehurst (Sir Robert Neill).

[Simon Hoare]

I echo what our hon. Friend the Member for Winchester (Steve Brine) said in that it is a travesty that my right hon. and learned Friend is not speaking still from the Front Bench, but it is a delight to hear him speak this evening.

To go back to the point made by the hon. Member for Strangford (Jim Shannon), what is my right hon. and learned Friend’s assessment of the impact of covid on diagnosis, assessment, the provision of support and the crucial need to link up the Ministry of Justice, the Department of Health and Social Care, the Department for Education and the Department for Work and Pensions?

[Robert Buckland]

I am very grateful to my hon. Friend. There is no doubt that covid has had an impact on backlogs in all parts of the health system, including diagnosis. Having said that, there are significant advantages in the use of remote technology for people with autism and brain conditions. For them, very often the journey to a clinic, hospital or health centre is in itself traumatic and anxiety forming. I see remote technology as a real liberator for many people with autism, so the potential there is immense.

Sadly, the point my hon. Friend makes about the impact of covid is one that, without increased capacity and increased staffing, we will have to wrestle with for a number of years. On the point he makes about joined-up Government, I well remember saying on many occasions to anybody in Government who wished to listen that Justice could not do this on its own. As a downstream Department, it needed Education, Health, the DWP, the Ministry of Housing, Communities and Local Government and, frankly, all arms of Government to work together to identify some of these problems at the root to prevent them from becoming part of criminal justice, but I will speak more about that in a while.

[Sir Robert Neill]

My right hon. and learned Friend is making the case most powerfully and demonstrating, as other hon. Members have said, why it is a tragedy that he is not still on the Front Bench.

I welcome the very significant initiative that my right hon. and learned Friend made in relation to this when he was the Secretary of State—something that, as he will know, the Justice Committee warmly welcomed. Does he agree that it is very important now that we maintain the momentum for this, and in particular that the moneys available to the Ministry of Justice in the spending review are put into important areas of this system that for too long, until his work, were overlooked?

[Robert Buckland]

I am very grateful to my hon. Friend the Chair of the Select Committee. It was encouraging to see that the revenue settlement for the Ministry of Justice over the next three years was a pretty good one, with a just over 4% increase year on year. Obviously, it is now going to be for Ministers, in their allocation process, to work out precisely what they want to spend within that envelope. I very much hope that the announcements we made as a result of the call for evidence—published as part of the autism strategy document in late July, which I cleared together with my right hon. Friend the Secretary of State for Health—will be followed through on.

More than that, it became increasingly clear to me, as I read the response to the call for evidence and as I followed the debate, that screening people coming into the criminal justice system and the prison system is an essential prerequisite of understanding the best way to handle them. I think a screening process for brain condition would reveal acquired brain injuries. It might reveal an undiagnosed condition—maybe attention deficit hyperactivity disorder, attention deficit disorder, dyslexia even. Let us do that at this stage and work out what is going on in people’s minds, so that we can not just better manage them, but actually help them along the path of rehabilitation.

Do you know, Madam Deputy Speaker, that my worry is that, time and again—not just in the prison system, but in the probation service—regimes are set up and orders are made with the best of intentions, and the people with these conditions are set up to fail, because they are not able actually to access, understand or compute that in a way that perhaps neurotypical people can? That is not their fault; it is a fact of who they are and what they are. That is why we need to change the approach that we take. I do not want to see people set up to fail. I certainly do not want excuses for criminal behaviour, but I do want smart answers on ways in which we can meaningfully rehabilitate people. I have seen it happening. In Parc prison—a private prison, I have to say to those on the Labour Benches—in south Wales I was awestruck by the work being done on the neurodiversity wing. Prison officers trained in the right skills were working with some of the most difficult and complex prisoners in that estate and achieving results that might not to the naked eye look terribly remarkable but which, by the measure of the people they were dealing with, were extraordinary. We need to replicate that sort of work, which is being done in one corner of the estate, across the entire prison estate.

The wider debate is all about replicating the best practice we see across Government and local government, and across private enterprise and business as well, because I do not want this debate to be just about what the Government can do—me with my metaphorical hand out, saying, “More money please.” This is about society realising that if we are going to crack the issue and make a difference, we need carefully targeted research into what works.

[Nickie Aiken (Cities of London and Westminster) (Con)]

I welcome my right hon. and learned Friend back to the Back Benches. I am sure we will be hearing more from him over the coming weeks and months. Does he agree that as well as research, on which I agree entirely, societal support is needed? Organisations such as the Caxton Youth Organisation, a brilliant youth club in my constituency for children and young people with autism and learning difficulties, can play their part in supporting young people with autism. Society and Government also have a part to play because this is about us all working together to support these young people.

[Robert Buckland]

My hon. Friend is right. Drawing on her local government experience and having been directly responsible for many of these services she encapsulates the best practice we see in many local areas. The trouble is that we do not see it everywhere and there is, to use the dreaded phrase, a postcode lottery, which is just not good enough for so many families across our country.

I see where we are now as a moment to make a choice. There is a golden opportunity for Government and indeed for society, and I deliberately wanted to include neurodiversity in this debate because I believe it is hugely important. Diagnostic descriptions are vital for many families. Speaking from my own experience, they open a door to statutory services and obligations—statements, as we used to call them, or education, health and care plans as they became under the Children and Families Act 2014. However, the system is in danger of becoming a prisoner of that process. In the natural concern that public authorities have to conserve resources there is a danger that we start to become overly obsessed with labels and then find that if somebody is not labelled there is, to mix my metaphors, a cliff edge and nothing for the person who does not happen to get through the door marked “autism”.

Let us think about that for a moment—think about how wrong that is in terms of the lives we are dealing with. No one person just presents as autistic; they might have a range of conditions and challenges including, for example, epilepsy, which, sadly, is a very common comorbid condition with autism. There are also other conditions that might fall short of autism but if undiagnosed the consequences can be baleful, such as attention deficit hyperactivity disorder, attention deficit disorder, dyslexia and other types of impairment that mean that people cannot access education, for example, in the way that neurotypical people can. These conditions might not be seen as acute compared with some other conditions that are diagnosed but can lead to disaster for the individual if they are not diagnosed.

School exclusion—I see the hon. Member for Croydon Central (Sarah Jones) in her place—is the most obvious consequence. That is a particular issue, and the disengagement with the system that it can lead to all too often leads to a descent into criminality, which, frankly, then brings us back to the criminal justice outcomes that I have been wrestling with all my professional life and in my ministerial incarnation. In devising the right type of support, we need to try to put the process in its proper context. We must remember that this is about the person and centre something on the individual and their needs.

I am delighted after many years to renew my association with Autistica, our country’s leading autism research organisation. Today, by happy coincidence, it published an excellent support plan on autism. Having read it very carefully, I think it is groundbreaking. It is targeted, and it tries to move the debate in a direction in which I think all of us, including the families and those who have autism, would like to see it go. That contribution follows from the Government’s own commitment, in the revised autism strategy published at the end of July, to improve autism research, to improve innovation and to look for examples of best practice.

As we near a very important moment in the life of our country, with the Department’s publication later this year of the long-awaited White Paper on social care, Autistica has identified a gap in research—and guess where the gap is, Madam Deputy Speaker. It is in social care. We have learned so much about genetics and about the causes or the reasons for autism. That has been incredibly important in understanding that this is a condition, not an illness or a disease, and that there is no cure, and in moving away from all that redundant language and understanding the condition for what it is—and celebrating it too, by the way. We do not do enough of that. We tend to view it as some sort of wicked problem. For many people, it is actually their life; it is who they want to be and how they want to be recognised. We must never forget that.

[Greg Clark (Tunbridge Wells) (Con)]

My right hon. and learned Friend is making a powerful speech, and it is good to have him free to contribute in this way. Does he agree that, in so far as there are problems, they can be in people’s responses to those with autism, and that if people were to respond in a better informed and more generous way, then such problems as exist today may not be there in the future?

[Robert Buckland]

My right hon. Friend is absolutely right. There is no doubt that an inappropriate response, or a response, however well intentioned, that results from a lack of evidence or a lack of understanding, can make a bad position much worse for somebody with a condition such as this. Therefore, for me, research is not a luxury or an optional extra; it is essential. If we, as public services, as private enterprise, as business—as an economy that needs a supply of new talent, bearing in mind the announcement today that there are 1.2 million job vacancies in our country—are to really release the potential of people with brain conditions, then this is, to use the phrase, a no-brainer.

[Greg Clark]

I am grateful for my right hon. and learned Friend’s indulgence—

--- Later in debate ---

[Greg Clark]

I will address you directly, Madam Deputy Speaker. I accept your ruling on that.

One problem people with autism sometimes face is that, when they come to an age where they are looking for jobs, work experience is increasingly important and some employers are reluctant, based on lack of familiarity and nervousness, to give work experience opportunities to young people with autism and other conditions. Work experience is an essential gateway to employment. Will my right hon. and learned Friend join me in encouraging employers to open up and give work experience opportunities to a wider range of young people?

[Robert Buckland]

My right hon. Friend is absolutely right. We have seen that in other areas, for example mental health, where there has been concerted work, including by excellent organisations such as the Mindful Employer Network in my area, to demystify the issue and remove the stigma. Such work allows employers to understand autistic people, some of whom see the world in ways that you and I could not dream of. Going back to my celebratory point, it is all about the potential of people with neurodiverse conditions and what they have to offer.

[Sarah Jones (Croydon Central) (Lab)]

I congratulate the right hon. and learned Gentleman on the debate and on his cause. It is incredibly exciting that he has chosen this subject to focus on after his ministerial career—not that it is the end of his ministerial career; I am sure it will carry on—and I just want to stress how important it is that we talk about autism and educate people about it. In my constituency, we had a five-year-old boy who was excluded from school. He was on the path to being diagnosed, but had not quite been diagnosed. His classroom was moved around over half-term and when he came back, he did not understand where anything was. He kicked off and was excluded. The language used in the letter to his mother included strange adjectives—it said that he was being “manipulative”—and other language one would not use about a five-year-old, because his teachers did not understand his condition. Now he is in a good school that does understand and he is thriving. He will have a lot to contribute to society. I just wanted to congratulate the right hon. and learned Gentleman and say that I am very happy to support what he is doing.

[Robert Buckland]

I am very grateful to the hon. Lady. I think we formed a pact on Sunday night that we would work together cross-party on these issues. There are plenty of others on the Labour Benches—the hon. Member for Stalybridge and Hyde (Jonathan Reynolds) has a similar experience and knowledge of autism—who I know will put their shoulder to the wheel, and that will be incredibly powerful. She has done work on the issue of knife crime. All too often, there is a sad correlation between the isolation of people who might be suffering from anxiety driven by an undiagnosed condition and what I call a cycle of isolation that can often lead to the decision to arm themselves for their own protection. That is an aspect of knife crime—we always think and talk about gangs—that we misunderstand at our peril, so I am grateful to her for taking part in the debate.

I was talking about the golden opportunity we have. We are between the autism strategy as published and the White Paper, which I am waiting for with relish. The Prime Minister knows that that is another issue I will be pressing him and the Government on in the next few months. Many of us identify social care as an issue not just for older people, important though that this, but for adults with disabilities who need lifelong support. They must be part of the mix. More than half of local government expenditure is on adults with disabilities. If we do not pay regard to that in the plan, we are failing. Although I supported and am happy to support difficult decisions on national insurance and on funding issues, we have to make sure that the system that we are funding is well evidenced, produces the outcomes that we all want to see and has an element of accountability that, at the moment, is lacking. People talk about the black hole of health and social care funding. With respect to everybody concerned with that, that is what it feels like to us on the outside, and we have to change. That is why research on care will be so important.

[Steve Brine]

I am so pleased that my right hon. and learned Friend made the point that social care is not just about older people. That is so important. What he is actually talking about—who knew that the Back Benchers and Front Benchers were so joined up?—is levelling up. He is talking about realising the potential of everybody in our country. It is not that autism is therefore a condition to be managed and kept in its box, as we seek to minimise the damage, but that we want people to achieve their potential, and if everybody can achieve their potential, that is just levelling up really, is it not?

[Robert Buckland]

I could not have put it better myself. Levelling up is about people and communities, not things. Things are important and they deliver us levelling up, but levelling up is about people. That is why the Government have to show seriousness of purpose. I am with the Government on these things—I helped to author a lot of the documents on which they will be held to account. This matters, but if we do not focus on people, we are not going to level up. That is the point that my hon. Friend made so well.

I commend the Autistica report to hon. Members, but if I may crave the indulgence of the House for a little longer, I want to outline what Autistica suggests the key stages of support should be that will make a real difference. First, the report made the important point that support for autistic families around and shortly after the time that they receive a diagnosis has to be improved, because it is big news for families. It is a big moment when they get that diagnosis. I remember now the mixture between relief that the system is listening and deep sadness, grief and anger, and all the emotions that someone goes through as a result. These are big moments for families. It sounds axiomatic, but this does not happen, because we do not empower all families of people with autism to understand the diagnosis and to come to terms with what it means for them. This is a moment when services have an opportunity to get to know these families better and to ensure that their personal profile, which should be done, is really understood.

[Simon Hoare]

Does my right hon. and learned Friend share my concern that, very often, as with so many of these things, the children of the—let me use this phrase—“sharp-elbowed middle classes” seem to get a disproportionate amount of attention, care and support and those who are often least comfortable with officialdom and challenging professionals and asking questions usually get the smaller section of the pie? Quite a lot of work needs to be done on that to ensure that we have that uniformity of levelling up.

[Robert Buckland]

Again, that is a really important point. I do not make any criticism of the sharp-elbowed middle classes; these people are doing what they think is right for their children. I have been there and I make no apology for it, but among all those dedicated, wonderful, loving parents and carers, there are many families who do not have that wherewithal, and they often come to our surgeries and offices for help. We are the last port of call and, very often, we can make a difference. Looking back on the plethora of cases that I have dealt with, I am probably most proud—I know that hon. Members will share this feeling—of bumping into families years later and being told, “You helped our son. He has just finished his education and is going to go off and pursue a skill. If you hadn’t intervened six years ago, I don’t know where we’d be.” That is wonderful, but it should not be necessary: that is the big message that I want to convey today.

Rather than just stand here and make a general cri de coeur, my aim is to look at the bigger picture. Individual cases such as the one that the hon. Member for Croydon Central mentioned are symptoms of the problem, but it is all about dealing with the challenge itself. Documents such as the Autistica plan really help to tie the threads together and give us a blueprint that the Government, working with the private and charitable sectors, can run with.

I mentioned support around diagnosis. The document has some very interesting proposals for pilots and initiatives relating to how we can improve what is referred to as the diagnostic pathway. At the moment, there is a lot of ambiguity about precisely what is offered and what works, but the time of diagnosis is not a time for ambiguity. It is no good making educated guesses at that point; we want to know with certainty what pathways work. Families embarking on this new journey need that certainty, so I strongly commend to the Minister the document’s recommendations, particularly in relation to the work of the National Institute for Health Research.

As stage one, we need a framework that can be applied nationally, rather than relying on purely local initiative. Stage two, as the document describes it, is preparing for the future: after diagnosis, what systems do we have to match the needs of people with autism and brain conditions with the right therapies and services? We need to make those connections better; we need to connect people to safe practical advice, particularly from people who have been through the system. Peer-to-peer support works in so many contexts, and particularly in this one.

What we and Autistica are asking for is not a finger in the air, but evidence-led systems. It is no good just saying that the needs of autistic people are diverse. They are diverse, believe me: when you have met one person with autism, you have met one person with autism. They are all wonderfully unique, in my experience, but that should not be an excuse to say, “We’ll let a million flowers bloom and see complete diversity.” We need less of an unguided mêlée and much more of a framework—a mechanism by which, with evidence, we can ensure better support for people as they prepare for life and work out the pathway.

Finally, the third element of the report is meeting in a realistic and feasible way—we are not trying to create something totally out of this world—the evolving, ever-changing needs of people with autism. That is particularly important at the transitions, be they from primary to secondary, from secondary to tertiary, or from tertiary out of education. Age 25 is a big time for people who have an education and healthcare plan, because it is the moment when it stops—and what’s next? All such transitions can feed anxieties that if left unchecked can develop into a co-morbid mental health problem, with the concomitant waste that I spoke about at the beginning of my speech.

The truth is that the needs of people with autism and their families fluctuate and change. Instead of inviting crisis, let us plan for it and avert it. The support that the report envisages is all about services that will be there if things start to get a bit heavy, but that can be light-touch in other circumstances. The suggestions about nurturing expertise in the NHS and social care with hubs of expertise to deliver specialised services seem the most sensible way of developing those service models.

This is going to take investment, but, as I have said, I do not believe that it should begin and end with Government, which, hopefully, is good news for my hon. Friend the Minister. If she has had a chance to see the report that I mentioned—it was published only today, but I know that her officials will be familiar with it, because Autistica works very well with the Department, and I commend those officials for working with it so constructively—she will know that it sets out a costed programme, in which Autistica itself declares it will invest, or partner, to the tune of nearly £16 million. That is money from the third sector, but we ask the Government to step up, because the total cost of the projects that Autistica envisages in its list is just over £65 million. All those projects are designed to improve the evidence base and hence to improve the way in which we can deal with each of those three stages, and I warmly commend them to my hon. Friend.

What, finally, is the context in which we should work? I have talked—at the risk of stating the bleeding obvious—about the need for Government Departments to come together: the Department for Work and Pensions on employment, the Department for Education on exclusions, the Minister’s own Department on diagnostics and care, and my former Department on criminal justice. As I have said, however, this will require an effort from all sections of society, and the private sector must step up as well.

It is in businesses’ interest to get this right, if they are to unleash the talent of autistic people not just because it is good, but because it is damn sensible. It is to that sort of enlightened self-interest in the wider community that I want, through the House, to appeal tonight. I think that the offer of finance from Autistica is significant, although I want to see it scaled up. I think that the work we need to do outside this place to harness philanthropy and the support of the private sector could start to bring us much closer to the levels of research investment that we see in, for example, the United States, which, although it does not enjoy the wonderful national health service that we have in our country, is very far ahead of what we are doing here in terms of research investment.

If we are to succeed, that partnership between the third sector, the private sector and the public sector will be essential. The quid pro quo for Government is that our wonderful officials must remember that they do not have a monopoly on wisdom. I have sat in the Minister’s seat and worked with officials and worked well with them, but sometimes there is an institutional reluctance to go outside the tent because of fears about control, whatever form it may take, and, inevitably, about accountability. We must overcome that, because Government alone will not be able to crack this.

The last two years have, in many ways, opened our eyes to the potential that Government can offer. Government-led support and declarations of Government funding meant that we were able to create a vaccine manufacturing capacity virtually from scratch. I am about to see 250 jobs come to Swindon—jobs that would not have existed a few years ago, without the terrible crisis that we have all had to live through. The Government rose to the challenge, and I was proud to see them do so, underwriting, in effect, many of these initiatives.

We heard words such as “moonshot”, did we not? We heard about the Government’s big ambition to deal with the threat posed by the pandemic, and rightly so. Let us remember that. Let us bottle it and use it here. Let us have our autism moonshot; let us have our neurodiversity moonshot. Let use the power of Government—its convening power—to kick-start this research, and to lead our society in the improvement of research. Through the gathering of that evidence and Autistica’s work, we can reach some of Autistica’s 2030 goals. Its realisable ambitions for 2030 include: halving the employment gap for people with autism; services truly centred around the person with autism; proven support from day one; public spaces being more accessible for neurodivergent people; tailored health checks for people with neurodivergence; and, yes, screening at an early age, whether in the health system or the education system. That is a wider application of the principle that I wanted to see in our criminal justice system.

This could be a decade of achievement. It is up to all of us and the Government to make it happen.

Menopause (Support and Services) Bill

Robert Buckland Excerpts

2nd reading
Friday 29th October 2021 Commons Chamber

[Carolyn Harris]

I agree with the hon. Gentleman and thank him for sponsoring the Bill. I would say that this is about not just the symptoms women feel, but the consequences in relationships; we have seen far too many marriages and relationships fall by the wayside because of menopause and its symptoms, and now is the time to change all that.

Women presenting to their doctor are often diagnosed with anxiety and depression. That happened to me and I have told my story previously: I presented to my GP believing I was having a nervous breakdown and ended up on antidepressants for 11 years. It was only when I spoke to friends and colleagues in this place and we shared conversations that people do not normally have—or did not have until now—that I realised that many other women were also experiencing what I was experiencing. That means we are seeing women being prescribed antidepressants when hormone replacement therapy may well have been more suitable, or presenting with insomnia and being given sleeping tablets when HRT may well have been more suitable, or being sent to consultants for tests for early onset dementia when visiting their GP about their brain fog and forgetfulness when, again, HRT may well have been more suitable. As hormone levels drop, women are at greater risk of developing a series of other conditions—cardiovascular disease, osteoporosis, type 2 diabetes, obesity, osteoarthritis, depression and dementia—and the cost of investigating and treating these as well as the other additional appointments is putting extra unnecessary pressure on our NHS.

I have heard countless stories of misdiagnosis. As I have said, I went on to suffer for 11 years with what I considered to be depression. Little did I know that over a decade later when I started HRT, I would see my life become transformed and I would have more energy. God, isn’t that scary: more energy? My husband is heading for the backdoor now. But we cannot blame GPs; we must make sure our medical schools reassess their curriculums so in future doctors are educated in the menopause and are able to offer all women the same high-quality care and support. Women are routinely called for cervical smears and breast screening; we need to see them being called for a menopause check-up around the time they turn 40. This would be a quick and an easy solution to helping women become more aware of the symptoms so that they are prepared and, importantly, educated in the available treatments.

[Robert Buckland (South Swindon) (Con)]

I join the warm tributes to the hon. Lady’s genuine cross-party approach to this; it is a testament to her campaigning ability.

I was particularly struck by clause 2 of her Bill which talks about the wider strategy. Does she agree that while HRT is a wonderful prescription for many women there will be some for whom it is not suitable, and therefore wider issues about menopause awareness and training are going to be important if we are to reach as many women and their families as possible?

[Carolyn Harris]

I do agree and my mantra has become that we can all become menopause warriors because that means we acknowledge the issues and problems and are prepared to work towards ameliorating them.

We can look at the good practice out there to see what can be done. I recently spoke to practice nurse Sharon Hartmann from Tudor Lodge surgery in Weston-super-Mare. The surgery supported Sharon to develop a special interest in menopause care. She is now certified by the British Menopause Society and delivers evidence-based practice to her patients. She is able to monitor progress, control treatment plans and prescribe suitable medication for each individual. I would love to see this kind of service in surgeries or clusters all over the country, with doctors being able to identify the symptoms quickly and ensuring women are then passed down to someone with a wealth of knowledge and experience in menopause care. But it is not just the education of the medical profession that needs attention. We need to address education in our schools, so that the next generation of girls and boys is far more prepared than any of us were. I certainly did not talk about the menopause when I was at school. We did not even talk about periods when I was at school. We want the next generation to talk openly about it, understand what is to come and what they can do to help. We need young men to understand that their mothers, wives, sisters and partners may struggle at some point in their life, and that it is not that they do not love them any more, it is just that the menopause is denying them emotion.