Autism Bill


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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.
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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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