Child and Adolescent Mental Health Services

Roger Williams Excerpts

Tuesday 3rd March 2015 Commons Chamber

[Roger Williams (Brecon and Radnorshire) (LD)]

The Minister will be aware from his visit to my constituency that young people from Wales are being treated in Kent and Northampton. Does he agree that that will do nothing to provide decent service, care and treatment for them?

[Norman Lamb]

I agree. It is intolerable. One can only imagine the impact on the family having to travel such long distances. My hon. Friend and I had that discussion in Brecon with the family concerned. It is shocking that that practice continues. It must be a priority.

My hon. Friend the Member for Totnes said that the importance of early intervention is a central theme of the report. There is great scope for much more to be done on public mental health. It was revealed recently that a tiny proportion of public health budgets in localities is spent on public mental health, and yet we know—there is loads of evidence—that, if we invest in public mental health, we can achieve a significant return on it. I welcome the report.

The hon. Member for Sheffield Central (Paul Blomfield) talked about what young people had told him. It was great that they were given a voice directly in this place. I welcome his comments.

In a very thoughtful speech, as always, my hon. Friend the Member for Southport (John Pugh) talked about a continuum. Many of us are susceptible to poor mental health in certain circumstances. That makes the point about the importance of schools, which other hon. Members mentioned, in building resilience and keeping youngsters stronger so that they can cope with all the challenges they inevitably face these days.

The hon. Member for Stoke-on-Trent South (Robert Flello) talked about Malachi, an organisation he was involved with, and about the triggers that can cause mental ill health among youngsters. Family breakdown is one, but bereavement can have a significant impact, as can bullying at school, which another hon. Member mentioned.

GP Services

Roger Williams Excerpts

Thursday 5th February 2015 Commons Chamber

[Sarah Newton]

That is a good point. We have to look at how general practices are set up these days. Not all general practitioners want to be part of the old partnership model, which is a sort of small business. Many now would like to be salaried and work particular hours in particular settings. I would not want to prescribe a particular model: we need to look flexibly at different models of provision that meet patients’ needs, taking into consideration what the work force need to enable them to play their full part.

GP practices in my area are expanding the range of services that they are able to provide to the community. As hon. Members will know, I represent a large, remote, sparsely populated part of the country, and such expansion is especially important for rural areas. One example is the Probus surgery of GPs, which serves many villages in its rural community. It is expanding into many areas, including minor surgery. I have yet to come across anyone who has anything other than praise for the Probus surgery, which provides the normal services one would expect from a surgery, but also works closely with its primary care partners and district nurses. It also links up with care managers for people with chronic conditions and elderly people living at home.

By comparison, a very different group of GPs work at Penryn surgery. They serve a large campus that is home to Exeter university, Falmouth university and parts of Plymouth university. There is a growing student population and the surgery has been able to expand its services to provide mental health services, prescribing services and on-campus surgeries. In attracting additional funding for services to meet the needs of the young people—we welcome them into the constituency to study there—they have additional resources from which the whole community can benefit.

Those are two very different examples of how GPs are working positively and constructively with local commissioners to expand services, bring in additional resources and improve patient outcomes for the local community.

[Roger Williams (Brecon and Radnorshire) (LD)]

My hon. Friend represents a very rural constituency, as I do. We do not have any single GP practices, but many of our practices have fewer than five GPs. Our experience is that when one leaves and the practice has difficulty recruiting, it really puts the practice under pressure. Can anything be done to make rural GP practice more attractive to young doctors?

[Sarah Newton]

That is a very good point, and I was just about to make the point that although I have given two good examples of larger GP practices that are doing very well, I also have similar issues to my hon. Friend in more sparsely populated areas of my constituency, such as the Roseland peninsula. It has an older population and it is difficult for GP practices to innovate and bring in additional services to make their future sustainable. I am in regular correspondence with NHS England, which has taken away some of the specific funding that used to be available to support remote rural GPs, in the expectation that they will be able to attract additional funding for providing additional services. That is really not possible or viable. In order to maintain access for people living in sparsely populated areas, where the population is unlikely to grow rapidly, NHS England needs to look again at funding for GP practices in such areas. I hope that my hon. Friend will make common cause with me in writing to NHS England to ask it to reconsider that point as part of its five-year plan.

The third point I wish to make is the positive work I see at the accident and emergency department at Treliske. The Royal Cornwall hospital is the only acute hospital in Cornwall and I am proud to have it in my constituency. The head of the A and E department at Treliske has worked innovatively with his primary care partners to introduce GPs into that setting. As people arrive at the hospital, a triage system is in place so that if people would be better served by seeing a GP, they can do so, which takes pressure off the A and E department.

Finally, I wish to share some of the learning from the integration pioneer work that is happening in Cornwall. The Government designated 14 areas of the country as pioneer areas to look at how we can better integrate care services with the NHS. GPs in Cornwall have provided an essential foundation for that work. Our pioneer bid is led by Volunteer Cornwall and Age UK Cornwall—I think it is the only voluntary sector pioneer bid in the country, and it is very much supported by the NHS right across Cornwall, and by Cornwall council.

By working carefully with GPs to identify frail, elderly and vulnerable groups of people with chronic conditions who tend to use the NHS a great deal—GP services, care services or the acute sector—the pioneer discovered that having a trained volunteer attached to a GP surgery to work alongside families, linking up all available support and enabling them to reintegrate into the community around them, leads to a huge reduction in the use of acute and GP services, and, most importantly, significant increases in self-reported well-being.

There are a lot of lessons that can be learnt from the reforms we have put in place. I am confident that if NHS England’s five-year programme learns the lessons from the pilots and the past five years and puts proper resources into primary care, we can see the improved health outcomes I know we all want.

Branded Medicines (NHS)

Roger Williams Excerpts

Thursday 4th December 2014 Commons Chamber

[Mr Jamie Reed (Copeland) (Lab)]

Time is short, so I shall keep my remarks brief, but it is a shame to truncate such an important debate on a matter that touches many lives.

The availability of medicines in our national health service affects millions of families throughout the country and with that in mind I must thank the right hon. Member for South Cambridgeshire (Mr Lansley) and congratulate him on securing the debate. I also thank the Backbench Business Committee for ensuring that the debate was heard. I know that the right hon. Gentleman tried to make progress on these issues when he was Health Secretary and I am sure that he is frustrated by the lack of progress in more recent years. In addition, I am sure that he will be amazed and potentially aghast when he hears that I agree with a great deal of what he said.

As I say, this is an important issue affecting millions of patients who rely on these drugs everyday. Members on both sides of the House want to see progress on improving access and ensuring that more people get the drugs they need. The issue was brought into sharp focus recently when, in September, NICE announced that it was not going ahead with its proposed value-based assessment reforms. That this was in part due to a lack of consensus in stakeholder consultation submissions to the proposals serves to highlight how complex an issue it is. We all accept that.

There are clear problems with access to medicines, as demonstrated clearly by recent publications from the Office of Health Economics and the Association of the British Pharmaceutical Industry. I want to make a number of points from those publications in my speech. There are issues, too, about the proposed changes to the cancer drugs fund, which have been highlighted by the concerns of charities such as Breast Cancer Care, that I shall come to later. None of them will be a surprise to the Minister.

A vital tool in improving access to treatments is the pharmaceutical price regulation scheme, the latest iteration of which came into effect this year. Some questions need answering about it. In 2010, the Conservative manifesto included a commitment to increasing access to drugs. The commitment was echoed and bolted down in the coalition agreement, which stated:

“We will reform NICE and move to a system of value-based pricing”.

As we have heard and discussed, value-based pricing was meant to be introduced in January this year when the drug pricing agreement between the Government and pharmaceutical industry expired, but despite the comments in the coalition agreement, when the new drug pricing agreement, the 2014 pharmaceutical price regulation scheme, was published in November 2013 it contained no plans either to introduce value-based pricing in 2014 or on the promised reform of NICE’s processes towards evaluating how treatments would be made available on the NHS.

When proposals were finally brought forward this year, they included not value-based pricing but value-based assessment, which is altogether different. The plans would have included two new modifiers entitled “burden of illness” and “wider societal impact”. The burden of illness modifier would have replaced the current end-of-life criterion. The burden of illness criterion that would have been introduced is already largely counted in the current quality-adjusted life-year measures. There are also wide-ranging issues with the other suggestions, so it was no surprise that, after lengthy consultation, NICE confirmed that the plans to introduce the changes had unfortunately been shelved. What this means in practice, though, is that the Government have failed to deliver on a key commitment, the fulfilment of which many people were looking forward to. I should be grateful if the Minister would reflect on progress to date.

Access to medicines is key because the UK is lagging behind other countries. From analysis of more than 60 medicines launched in the UK, the Office of Health Economics found that people living in the UK are less likely to have access to a new medicine for the first five years after its launch than people living in other countries. That shows clearly that reform is vital.

[Roger Williams (Brecon and Radnorshire) (LD)]

Does the hon. Gentleman agree that one of the real problems is that some of these treatments, such as abiraterone, are not available in Wales but are available in England? That is leading to people leaving Wales and taking up residence in England in order to get that treatment.

[Mr Reed]

I am grateful for the question. Without doubt, there are issues that need to be addressed on both sides of the border.

One major part of the issues that we are discussing today is the pharmaceutical price regulation scheme, which caps the expenditure of the NHS on branded medicines. It has existed since the 1950s. It is an excellent scheme in principle but must work properly in practice. Given that there has been essentially no parliamentary debate on the PPRS, I should be grateful if the Minister would explain a bit more how the new agreement is intended to work in practice.

As I understand it, if the NHS exceeds the agreed expenditure, as the right hon. Member for South Cambridgeshire said, the money is rebated back to the Treasury. But given that the outgoing moneys will presumably be taken from clinical commissioning group prescription budgets, can the Minster explain how the CCG in question will actually feel the benefit of the PPRS? If the rebate stays in the centre, rather than being reimbursed to CCGs, how will the PPRS work as a tool with which to increase access to treatments? Has the Minister considered how the rebate might be better used for incentivising improvements in access? What can be done to speed up drug accessibility and reduce the duplication by CCGs of work already undertaken by NICE? That is clogging up the system and slowing down access to new medicines.

The Minister will be aware that at Health questions last week I raised some of the genuine concerns of patients, such as Clive Stone in the Prime Minister’s constituency, and charities, such as Breast Cancer Care, about the cancer drugs fund. As the Minister knows, the overspend in the cancer drugs fund last year and the way in which it operates has led to its being under considerable pressure, and many in the industry believe it to be unsustainable. The former Health Secretary has been absolutely clear that it was always intended to be a bridge, and I welcome his candour on that.

The issue with any new medicines, which I know NHS England is now looking at, is how to balance clinical benefit and cost-effectiveness. None of us would pretend that that is an easy task, but it is clear that it needs to be done in a much clearer and more transparent way than is currently proposed, and I should be grateful if the Minister would set out how patients will be involved in the evaluation of drugs and represented in that process at the meeting of the cancer drugs fund clinical panel later this month.

One way to improve access to medicines would have been to back the Off-patent Drugs Bill that was before this House only a few weeks ago. That would have improved access to many drugs for many people but, as the Minister is aware—he was speaking opposite me at the time—the Government refused to support it. Will the Minister again take the time to explain why the Government opposed that piece of legislation, which originated from one of their own Members? It was certainly supported by Labour Members. The innovative medicines review has the potential to do real good in this area. I should be grateful if the Minister would speak to that, too, in some detail in the time available for his speech.

I realise that time is short, so I will draw my remarks to a close. We all want to see improvements to access and we are all desperate—I use the word in its accurate sense—for progress on this, so will the Minister set out what action he will take over the next few months and what progress he realistically expects to make before the election?

Hospital Car Parking Charges

Roger Williams Excerpts

Monday 1st September 2014 Commons Chamber

[Paul Burstow (Sutton and Cheam) (LD)]

To pick up the last point made by the hon. Member for Bolton South East (Yasmin Qureshi) about perhaps abolishing such charges outright, later this week the King’s Fund will publish the conclusions of the Barker commission. It is looking at several questions about the future of our health and social care system, and I am sure that it will say things about charging issues and how we pay for parking. It seems to me that such questions must be looked at in the round, and in the context of the overall resources available to the NHS, by asking how to make the best use of those resources to deliver the best possible outcome for patients.

I congratulate the hon. Member for Thurrock (Jackie Doyle-Price) on bringing this matter to the House, as she is absolutely right to do. Hard-working families face difficulties because of the inconsistent way in which different NHS trusts go about applying their policies, and it is right to highlight those that chose to see car parking as another cash cow at the expense of their patients. Hon. Members have spoken about the issue of the PFI and how it further complicates the picture—indeed, it ties the hands of NHS trusts—which is an incredibly important point. The Government need to do more to deal with the mess around PFI so that these things can be sorted out.

[Roger Williams (Brecon and Radnorshire) (LD)]

My right hon. Friend will know that hospital parking in Wales is free, but many of my constituents go to Hereford county hospital, which is a PFI hospital. A radiotherapy facility has just been opened there, but that fact is dampened by my constituents having to pay large parking fees.

[Paul Burstow]

Other Members have already quite rightly intervened to point out how exceptionally high and punitive car parking charges are in that area. If this debate does nothing else, I hope that it make that trust understand that it needs to look to its laurels, review its parking policies and perhaps introduce fairer charging for the future.

That matter relates to why I wanted to talk about what has been going on in my own patch. Back in 2010, the consumer organisation Which? published a study highlighting my local trust as a particularly bad one, including as one that was quite willing to use clamping regularly as a way to enforce its charging policies. I am pleased to tell the House—this is a model of what others could and should be doing—that the work by Which? spurred my Epsom and St Helier University Hospitals NHS Trust into action: it undertook a review, which involved its patients and carers, and its policy now reflects much of the good practice that we have already heard about in this debate. There is a discounted rate of £5 a week for out-patients who visit three or more times a week, those who are going in for dialysis, cancer patients who visit two or more times a week, cardiac rehabilitation patients and immediate family members of patients receiving intensive care or high dependency coronary or neonatal care. In other words, there is an effective policy that makes it affordable for people to visit their loved ones or to get the treatment that they need. More parking for disabled people also came out of the process. There is also a recognition that some people do not want to stay for long, but want to drop someone off or pick someone up. The trust has therefore introduced more short-stay dropping-off places. If the trust delivers an appointment an hour or more late, the parking fee is refunded. Those are the sorts of policies that other trusts could copy.

It is clear from the work published by Macmillan and others that too many trusts are not even following the guidance, let alone striving to be leaders in the field or to follow best practice. As the Care Quality Commission rolls out and refines its inspection regime for hospitals, it could do more in this area. Perhaps the Minister could ask the chief inspector of hospitals to ensure that car park charging policies are examined. For hospitals that are striving not just to pass muster in inspections, but to be leaders in their field, this is another area in which they could do so.

Finally, concessions and discounts are only part of the solution. They are only as good as the publicity about them and the public awareness of their existence. It is difficult for people to access something that they do not know exists. It is therefore important to ensure that there is information at the point of use so that people do not wind up paying more than they need to. Will the Minister look at the idea that I and others have put forward recently of a carer’s passport? Some hospital trusts already have it. It is about actively identifying more carers so that they and their families can benefit from concession and discount rates, as well as other facilities to support and ease the burden on family carers.

The hon. Member for Thurrock and her colleagues who secured this debate are absolutely right that punitive car parking charges and car parking being seen as a cash cow within the NHS cannot be acceptable, as Members on both sides of the House—judging by what has been said so far—are clearly indicating. I hope that in responding to the debate, the Minister will ensure that the NHS gets that message and changes in the ways that hon. Members are suggesting.

Tobacco Products (Plain Packaging)

Roger Williams Excerpts

Tuesday 3rd September 2013 Westminster Hall

[Chris Ruane]

I thank the hon. Gentleman for that intervention. He is right. Labour did many good things. We curtailed advertising. We introduced the ban on smoking in public places. But we did not do enough and we need to do more. When I spoke about this package at an anti-smoking do in Parliament, JTI—Japan Tobacco International—had a spy in the room and wrote to me afterwards, saying, “Mr Ruane, you’ve got it all wrong. These are called 14s because there are 14 cigarettes inside the packet.” It was a Miss Laura Oates who castigated me and she went on to criticise the Labour Government for not doing enough on proxy purchasing.

I agree: I think that we should take up Miss Laura Oates’s cry for more pressure on the tobacco industry and concentrate on that. This is just one step in the campaign to cut and then eliminate smoking in the UK. Thanks go to Laura Oates for suggesting other campaigns as well. I think that we should have a whole string of them over the next 10 years. It should be a long-term policy to—

[Roger Williams (Brecon and Radnorshire) (LD)]

Will the hon. Gentleman give way?

[Chris Ruane]

No, I will not; I have given way once.

It should be a long-term policy to eradicate smoking in our country. The tobacco industry is very successful at capturing young hearts, minds and lungs, to such an extent that 567 children a day start smoking. A majority of those smokers will continue smoking until the day they die—early.

The industry has been forced to get new recruits because people are dropping off on the other end. Mature people, adults, older people are stopping smoking. They are also dying—150,000 people a year are dying, so the industry needs to get new recruits as early as possible; the earlier it gets them, the more profitable it is. If it can get 50 or 60 years of smoking out of a 12-year-old, that is much more profitable than getting an adult at the age of 18. It is an extra six years of profitability, built on the back of that child’s life—or death.

I know that we should not be party political, but the Government have back-pedalled on this issue and that of the unit pricing of alcohol. There is time for a rethink. There is a lot of co-operation and support in the Chamber and outside. We ought to work together to force this issue and force it quickly.

--- Later in debate ---

[Jim Shannon]

I thank the hon. Gentleman for his intervention. It is clear that cigarette companies target young people and we need to address that. Cancer Research points to substantial evidence that shows advertising and promotion drawing young people into smoking and that packaging is an important part of tobacco promotion.

Standard packs would build on the success of the advertising ban. Eighty five per cent. of people back Government action to reduce the number of young people who start smoking and 63% of people support standard packs, with only 16% opposed. One hundred and ninety health organisations support standard packs, including the royal medical colleges and health charities, as well as the World Health Organisation.

I was not aware that we waited for countries, such as Australia, to implement initiatives before we would do so in the UK. It was my impression that we sought to lead the field in safety. Even if we are waiting on smoke signals, or hopefully a lack of smoke signals—forgive the pun—from Australia, research from Cancer Research that is making its way back from Australia shows early indications not only that the policy is making cigarettes appear less appealing, but that there is no evidence of problems for retailers.

I spoke to my colleague, Northern Ireland Health Minister, Edwin Poots, about the issue and he said that he fully supports the concept of plain packaging. He further told me that it was essential that there is a UK-wide scheme to tackle smoking.

[Roger Williams]

Will the hon. Gentleman give way on that point?

[Jim Shannon]

I cannot. I urge the Government not to put off the measure by waiting to get the all clear from Australia, when too many people are not getting the all clear from lung cancer and other diseases. Take the steps necessary. They might prevent some of the 567 children who may start smoking today, every day and every week, from doing so.

Cross-border Health Care (England and Wales)

Roger Williams Excerpts

Tuesday 25th June 2013 Commons Chamber

[Anna Soubry]

I do not doubt for one moment the veracity of what my hon. Friend has told me about what he, in turn, has been told. That is a substantial amount of money and it would go a long way to explaining part of the deficit. These are terribly important matters.

The funding formula has been raised yet again. The argument advanced by many Members on both sides of the House is that the formula does not take account of the relatively high cost of delivering services in rural areas or reflect the fact that many rural areas such as Herefordshire have relatively older populations. I have had a number of conversations with hon. Members who make exactly the same complaint as my hon. Friend.

I am reliably informed—this point is important—that allocations to individual clinical commissioning groups, which are made up of the GPs and other clinicians who now commission services locally, and the formula that is used to decide what those allocations should be, are the responsibility of NHS England. I am not seeking to pass the buck, but it does bear that responsibility. In making those allocations, NHS England relies on advice from the Advisory Committee on Resource Allocation. ACRA provides advice on the share of available resources provided to each CCG to support equal access for equal need, as specified in the mandate given by the Secretary of State to NHS England.

Therefore, NHS England does not set income for CCGs on an equal cost-per-head basis across the country. Instead, allocations follow an assessment of the expected need for health services in an area, and funds are distributed in line with that, meaning that areas with a high health need should receive more money per head. The calculation is based on the age of the populations, relative morbidity and unavoidable variation in cost. The objective is to ensure a consistent supply of health services across the country. The greater the health need, the more money is received because the more health services are needed.

I know that some hon. Members just do not accept that that is the reality with the allocations to their CCGs and, in effect, to their constituencies. NHS England plans to review the funding formula for 2014-15 and the following years better to reflect the needs of local communities and enable the best outcomes for local people. Perhaps there is hope in that. Obviously, I must say quickly that I cannot make any promises.

If anybody would like to intervene, we do have the time. Hon. Members often want to make a point, but do not feel that they can make a speech.

[Roger Williams (Brecon and Radnorshire) (LD)]

I thank the Minister for her kindness and I am sorry that I was not here at the start of the contribution from the hon. Member for Hereford and South Herefordshire (Jesse Norman). Hereford hospital is key in delivering medical services to people in my constituency in Wales. If it had not been for the co-operation of my predecessor, Richard Livsey, the rebuilding of Hereford hospital might not have taken place, because it needs patients from the east of Wales too.

[Anna Soubry]

I am grateful to my hon. Friend for that intervention. My officials will listen to the debate and read it in Hansard. All the points that have been made about Hereford hospital—equally important points could be raised by others about the effect on other hospitals—must be considered, because they are important. It would not be right or fair if hospitals felt that they were suffering as a result of a system that is basically not fair through no fault of their own.

People with Learning Disabilities (Abuse)

Roger Williams Excerpts

Monday 3rd September 2012 Commons Chamber

[Paul Burstow]

That goes to the heart of a number of the points made in the serious case review about the nature of the recruitment processes that were used by Castlebeck and the way in which it then carried on inadequately to train, supervise and monitor the conduct of those staff. I will come back to some of the actions that the Government are taking in that regard to make it much more difficult for that to occur again in future.

Of course, what happened at Winterbourne View came to light only as the result of the actions of the whistleblower, Terry Bryan, and the Panorama programme broadcast by the BBC. I personally thanked Terry for his actions when I spoke to him some months ago about the interim report that we published in June, and I do so again tonight. Thanks to Terry, the Care Quality Commission has changed its systems and set up a dedicated whistleblowing team. An even greater emphasis is being placed on the importance attached to the role of whistleblowers. That is why the Government have introduced a free whistleblowing helpline, not only for NHS staff but, for the first time, for social care staff, so that they can get advice on how to report concerns that they have. There has also been a strengthening of the NHS constitution to make these matters clear to their employers as well.

Terry Bryan blew the whistle on the worst excesses of a wider systemic failure. As I acknowledged in the Department of Health’s interim report in June, the problems revealed at Winterbourne View are more systemic. There has been a tendency when reporting on Winterbourne View to heap much, if not all, of the blame on the CQC. Indeed, the CQC seems to stand as the barrier to everyone else who should be in the dock being criticised, scrutinised and challenged for what went wrong. Although the CQC, rightly and properly, acknowledged its failings and apologised at the time, the issue of staffing and the freeze that this Government introduced on coming into office in May 2010 was specifically lifted for the CQC in October 2010, and there were no restrictions on staff recruitment. If there were failings of recruitment, the CQC would need to answer for them—indeed, it has—before the Health Committee.

Every part of the system—NHS and social care commissioners, providers, regulators and health and care professionals—has a part to play and, indeed, has questions to ask itself about what has passed.

[Roger Williams (Brecon and Radnorshire) (LD)]

The Minister rightly pays tribute to the whistleblower, but does he agree that when vulnerable people are moved away from their communities and, indeed, their families to care homes that may be many miles away, complaints are less likely to be made and, therefore, inspections less likely to be triggered?

[Paul Burstow]

My hon. Friend makes an important point and anticipates what I am about to say. The Department’s guidance is clear. People should be supported to live in the community, wherever possible, and only in strictly limited cases should assessment and treatment centres be used. Nowhere in policy or guidance is there justification for long-stay assessment and treatment hospitals. Indeed, the CQC found length of stay ranging from anything between six weeks and 17 years, with five to seven years not uncommon.

The hon. Member for Slough (Fiona Mactaggart) raised the issue of data during her intervention on the right hon. Member for Coatbridge, Chryston and Bellshill. I agree that we need to improve data collection so that we have a clearer picture of what is going on. The painstaking work of the serious case review, Department of Health officials and others to create a clear picture of the system begs questions about the adequacy of data collection for many years.

Child and Adolescent Mental Health Services

Roger Williams Excerpts

Wednesday 7th July 2010 Westminster Hall

[Roger Williams (Brecon and Radnorshire) (LD)]

It is a great pleasure and privilege to contribute briefly to the debate. I congratulate the hon. Members for Stalybridge and Hyde (Jonathan Reynolds) and for South Swindon (Mr Buckland) on making contributions based on their personal and family experience of this matter. Many of us have not had that experience and our comments come from a different level of understanding. However, the message that I get from the debate is that given the level of understanding and competence that there is for this condition, there should be much better training for the professionals involved and much better working together and co-ordination between those professionals—between people in the medical profession, between people in education and between people in social services.

Some of the things that I shall say may seem a little cold and uncaring, but although the diagnosis of autism and the triad of impairments—the three conditions that lead to a classical diagnosis of autism—have been established, we have since realised that this is a spectrum condition. Every child, every young person—and every adult, for that matter—is an individual and their needs are different.

I first became aware of this issue a long time ago, when I became a governor of a special school at about the time that Baroness Warnock produced her report that changed our attitude to the education of children with special needs. The idea was that every child should have the support appropriate to them. We have moved on a long way: at that time, autism was hardly ever talked about, and I did not really have an understanding of it. Our knowledge has moved on a lot and improved, and professionals have a much better opportunity to use it. My point this afternoon is that we still need to do more fundamental research on the condition. What causes it? Is there a genetic element to it? Is there an environmental element? Is there a social element? At the moment, we just do not have the necessary understanding of those issues, and unless we can understand them, the way we intervene will not be as effective as it should be.

The other day, I was at the Hay festival, which is in my constituency—if anyone wants to attend, they will be very welcome—at an event with Simon Baron-Cohen, who is a researcher at Cambridge university. He was looking at personality disorders and then autism. Obviously, autism is not a personality disorder, but the issue of empathy is relevant. People with personality disorders are unable to relate to other people, and there is an element within autism of finding it difficult to understand the nature of a person’s response. The good news was that that gentleman, doing his research, felt that there were ways in which the research could be used to ensure that interventions and the way autism is treated are more successfully dealt with and lead to great improvements in the quality of people’s lives.

My message to the Minister is therefore: please, in all this, do not forget the fundamental research that is essential if we are to make progress. Yes, make use of the knowledge that we have, but do not think that that knowledge is comprehensive, because it can be improved and then the lives of people with this condition will be improved as well.