Dr.
Ladyman: It is a pleasure and an honour to follow the hon.
Lady. I congratulate her on her work on the Bill—on the effort
and energy that she has put in to getting it to where it is
today. The
hon. Lady commented on involving the four countries of the United
Kingdom. I do not know whether she realises this but when I had the job
that my hon. Friend the Minister now has, I went to Northern Ireland
for the launch of a document about autism strategy, which closely
followed the setting up of the new Assembly, after the Good Friday
agreement. That was one of the first documents ever to get the
signatures of both Ulster Unionists and Sinn Fein politicians. The need
to deal with autism certainly crosses political boundaries. I should,
of course, congratulate the Minister and his team on the amazing job
that they also have done in getting the Bill to this
stage. I
do not want to hold the Committee up, but I want quickly to make two
points. The first is an issue that I think you, Mr. Gale,
are probably familiar with and which you might wish to discuss, were
you allowed to do so. Many children are placed in your constituency of
North Thanet and my constituency of South Thanet from out of the local
authority area, many of them by London authorities. The clauses that we
are discussing do not directly relate to children but they do relate to
children who are moving into adulthood. One of the many problems with
children who are placed in our communities from other local authorities
is that they should perhaps not be put there in the first place, and
the guidance might need to consider that. Secondly, if they have been
placed in North or South Thanet for a very long time, that becomes
their home and, as they get older, that is where they want to
stay.
We
have had many debates over the years that I have been a Member of
Parliament about whether the placing local authority should be able to
wash its hands of responsibility for those young people and whether
that should be at the age of 16, 18 or 21. Best practice has pretty
much assumed now that the placing authority should have some
responsibility for them until they are 21. In my experience that seldom
happens. Many authorities are happy to forget about them entirely once
they reach 16. I hope that the guidance will deal with the
responsibility of authorities that place children out of their own area
to support them beyond the age of 16, 18 and, indeed, 21. These are
adults who will need support and the placing authority should still
have some financial responsibility beyond the age of
21.
Mrs.
Humble: I hope my hon. Friend will acknowledge that that
is a genuine problem for many of our seaside towns, including
Blackpool, where young people are also placed. There is a danger that
seaside towns get a preponderance of placements, and the adults remain
and there are not enough services for them. There is also a problem
with those young people losing touch with their families. Surely we
should ensure that they remain in touch with their families and, if
they wish, go back to their town of origin rather than remain in an
area which they do not really know, but find themselves in by
default?
Dr.
Ladyman: My hon. Friend is right. I know that that is a
problem in Blackpool. Indeed, it is a problem in many seaside towns
around the country. It would not be appropriate for me to discuss the
situation in Wales, but my hon. Friend the Member for Vale of Clwyd
(Chris Ruane) and I went to meet the Minister on this very subject just
a few days ago. I know that it is a problem around the
country.
Mrs.
Gillan: The hon. Gentleman makes the point well. That was
why I was pleased to see in new clause 2(5)(d) the general
expression
“as they move
from being children to
adults”. It
covers the whole spectrum. The questions raised by age switching, when
a child becomes an adult and when the duty of care passes from one
authority to another, cause a great deal of problems around the
country.
Dr.
Ladyman: The hon. Lady is right. That is a key area. I am
sure that all of us who have campaigned on autism have spoken to people
over the years who have fallen through that gap. I have never quite
understood how local authorities get away with thinking that their
responsibility can end at the age of 16, which many do, never mind at
the age of 18 or 21. Despite her general point, which I am delighted to
see reflected in the Bill, if a young person is placed miles away from
a local authority’s area of responsibility it is much easier to
forget about them and much easier not to transfer any resources to
support them once they reach adulthood. I hope that there is a clear
section in the guidance dealing with that
issue. 4
pm The
next point I want to make also needs to be in the guidance. I shall
refer briefly to my amendment 41 and so will not need to move it later.
Some work needs to be done to define what will fall within the scope of
the Bill.
It is all very well to say that it is autistic spectrum disorders, which
is the definition that we have. However, all members of the Committee
know, because we all have a certain amount of expertise in the matter,
that autistic spectrum disorders range from very low levels of
function, and what is called traditional Kanner’s autism, often
with severe problems, through to the other end of the
spectrum—the so-called high-functioning end—with
Asperger’s syndrome. We call all those conditions autism, and I
assume that there would be consensus in the Committee that they should
all fall within the scope of the
Bill. Mr.
Boswell: In support of that point, does the hon. Gentleman
recall that there was a great deal of controversy about socialisation
of people on the autistic spectrum, and that it was said that they
could not, for example, have a statement, not being deficient or having
a special educational need requirement? Is not such a comprehensive
definition exactly what we are feeling our way
towards?
Dr.
Ladyman: The hon. Gentleman is right, and makes a good
point.
Not having
the definition will create two problems. The first is something that we
saw clearly in one of the states of the United States—I think it
was California, but I may be wrong. The governor introduced an autism
Bill and put new resources into supporting autistic people. In that
state there was a huge increase in the number of people with autism.
Some people attributed it to a growth in autism in the state, but it
was actually due to the new support package and legislation, which
provided an incentive to get a diagnosis of autism as a passport to
that package of support. People put pressure on clinicians and others
in authority in order to get that ticket to the relevant level of
support for their children, or even for adults. We need the definition
of an autistic spectrum disorder so that it will be clear that it
refers to all people in the spectrum, and so that those who will have
to decide who is or is not autistic will understand clearly who is to
get the benefits of the package of support.
Angela
Browning: The hon. Gentleman has raised an important
point. We would not want people to fall through the net because the
Bill did not cover the matter that he raises. He is right; one hears
about Kanner’s autism and Asperger’s and even hears
terminology such as “autistic tendencies”, which always
worries me as it is so ill-defined. Would he be comforted by the idea
that people within the range of the spectrum—whether they need
care 365 days a year, or have Asperger’s and a high IQ and, with
a package of support, could do a job of work—would all qualify
under the triad of impairment definition? Would he use the triad of
impairment, albeit that the characteristics would all be different, as
the definition of
autism?
Dr.
Ladyman: That is an excellent point and an excellent
suggestion. I would not want to insist on that as a definition, but the
Minister should, I think, consider it as a serious possibility. The
hon. Lady’s remarks lead me to my other concern about what would
happen without a clear definition. We all read in the newspapers the
other week that a scientist believes that he has identified the genetic
connection to autism. Many of
the newspaper reports were rather simplistic. I suspect that there is
not one gene linked to autism, but a package of genes, and that the
likelihood is that that package of genes will create a predisposition
to autism, but that another trigger will probably be needed for
symptoms to develop. That trigger is likely to be something that
happens in utero, probably at a very early stage. My point is that if
in the future that collection of genes is identified, it will become a
diagnostic tool. Are we then to say that only people with that package
of genes will be defined as having autism, and fall within the scope of
the Bill? I suspect that what we in this Committee are seeking to
achieve is support for people who are symptomatically autistic,
whatever the cause or trigger. Regardless of whether there is a genetic
link or of whether a clinician in the future redefines
autism—perhaps saying that Asperger’s syndrome is not
autism and has a different cause—we would still, I believe, want
those people to get the benefits of this package of support. It is
important to have a definition of an autistic spectrum disorder. I hope
that my hon. Friend will clarify on the record that the Government seek
support for people who are symptomatically autistic, however that
condition came about, because that might be important in the future for
people to assert their rights. If that is the case, the guidance needs
to include a definition that is consistently revised to keep pace with
science and to ensure that symptomatically autistic people get the
benefit of the Bill. That is what we are all trying to achieve. We
would not want someone to be excluded from the benefits of the Bill
simply because they fall outside some future
definition.
Mrs.
Gillan: The hon. Gentleman makes a pertinent point and I
confirm that that is my intention in introducing the Bill and, I think,
the intention of the Committee, so we will be interested in the
Minister’s
response.
Dr.
Ladyman: I am grateful for that clarification from the
Bill’s promoter. If the Minister confirms that is his intention
and that this type of definition will be part of the document and be
constantly monitored then I am happy not to press the amendment I have
tabled.
Angela
Browning: I want to say a couple of quick things about
issues that I raised in interventions. First, may I tell the Minister
that I am pleased that the strategy was part of the consultation? I am
going to respond to that formal consultation, and I do not wish to
rehearse everything that I am going to say then, but I want to flag up
the question of mental health services. The question of whether the
status of some trusts and foundations within the NHS would exclude them
from the remit of the Bill needs to be looked at. Some of the most
complex autism cases involve the mental health services, which in some
cases are very good. I have raised two debates on the Floor of the
House about mental health services and Asperger’s syndrome. The
Minister will be aware that we have had some rather dramatic cases, not
least the one that concluded with the Bournewood judgment in the
European court. Unfortunately, we still have far too many practitioners
in the mental health services who either do not know enough about
autism when they come across it or are totally in denial about autism,
even if another professional has previously diagnosed it. We all know
the horrendous
problems of people who are misdiagnosed as
schizophrenic when in fact they are autistic. There can, of course, be
circumstances in which people with autism are also
schizophrenic.
Dr.
Ladyman: The hon. Lady makes an excellent point, which is
why the definition I referred to is so important. One reason why we
need to diagnose properly someone as schizophrenic rather than autistic
is because the treatments for the two conditions are entirely
different.
Angela
Browning: Absolutely. I know the hon. Gentleman is
fully aware of this. Somebody could be misdiagnosed as schizophrenic
and try one drug—and we all know how powerful they
are—and because there is a list of drugs, if the first one does
not work, they go on to the second and down the list. In the end there
is a scrambled mind and somebody who has been caused grievous damage by
the health service. I have made this point before. If cardiology
services treated patients like that, the patients would sue. These are
the people who are least able to speak up for themselves, and some of
the most tragic cases I have seen have been in this area. Because of
the read across to mental health services, people with a psychiatric
qualification who specialise in autism are few and far between,
particularly in the provinces. If somebody comes to a hospital in
London or in some of our other cities, the expertise is there. In the
provinces, however, there is still a problem.
I speak
regularly to people at the Royal College of Psychiatrists and I
frequently nag them about that issue—I make no apology for doing
so, as they need to deal with the matter within the profession. They
come and see me and I am assured that they are doing more than they
did, but it is still a problem. This is an important area for autistic
people—children as well as adults—and I would not wish
the Bill, through the definition of the trust, to allow mental health
services not to provide the sort of services that we expect for people
with autism.
Mrs.
Dean:I shall be brief, as we must conclude business fairly
soon. First, let me pay tribute to the hon. Member for Tiverton and
Honiton; I know that she has done a great deal to highlight the needs
of people with autism. I also pay tribute to my hon. Friends the
Members for South Thanet and for Erewash—both previous chairs of
the all-party parliamentary group—for the work that they have
done. I also want to congratulate the hon. Member for Chesham and
Amersham on coming first in the ballot, and I thank her for choosing to
introduce the Autism Bill. I am delighted that we have found consensus
and a way forward.
As soon as
the Bill was introduced, even before Second Reading, the Government
worked hard to meet the aspirations that it expressed—indeed,
perhaps they went beyond what was in the original Bill. I commend both
Ministers and my hon. Friends on the work that they have done, and the
officials on their work over the past week in drafting the new clauses.
I also want to commend most highly the National Autistic Society, with
which I have the pleasure of working as chair of the all-party group,
on its work in producing the original Bill and taking it forward with
the hon. Member for Chesham and Amersham.
This has been
a good example of cross-party working. Getting to this stage has been
an example of setting aside scepticism. We have progressed a great deal
over the past few years as far as autism is concerned, and the
legislation takes us a great step beyond where we thought we could be
only a few weeks ago. I am delighted to support the new
clauses.
Phil
Hope: I shall address the points made by hon. Members.
First, I want to thank the hon. Member for Chesham and Amersham for her
extraordinarily graceful and gracious remarks about the work that we
have been doing. As my hon. Friend the Member for Burton said, we would
not be here if she had not chosen to introduce a private
Member’s Bill on autism.
The hon.
Member for Chesham and Amersham made a specific point about mental
health trusts and NHS foundation trusts. I want to make it clear that
NHS foundation trusts are not excluded from the Bill; they are covered
by it—that was the point made by my hon. Friend the Member for
South Thanet. The guidance will apply to NHS mental health trusts and
to all foundation trusts, which must have regard to it. They will not
be subject to the statutory nature of that guidance because of their
position as foundation trusts. That might raise anxieties for hon.
Members, but that is the nature of the autonomy that foundation trusts
have across the whole of the NHS. I am confident that the work that we
do in producing the guidance, which will cover them, will mean that we
will be able to ensure that those foundation trusts have regard to the
guidance.
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