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"I first realised there was something wrong with Jon's development at the age of 2 but was told by my Health Visitor that I was comparing him to his older exceptionally bright brother and that he was fine. I continued over the next 2 years to say that 'something wasn't right' until she eventually agreed to get his hearing checked-he wasn't interacting with me, seemed in his own little world and wouldn't even respond to his name. His hearing was fine so she referred him to a speech therapist as he didn't talk much but after a few weeks of attending, he was discharged saying he was ok. It was only once he'd started school that he was referred"-
"But the consultant...decided that Jon must have a form of epilepsy as he would 'switch off' in the playground and was oblivious to his surroundings. He did months of tests but they revealed nothing".
"I have no idea what or how to access services which may or may not be available to Jon especially CAMHS. He is 17, 14 stone and 6ft 3, and can have tantrums like a 2 year old-just as sudden and just as violent. I asked my GP if there was some kind of Anger Management course available to him or if he could see a psychologist that could help him. He said I would have to see Jon's consultant".
"I feel that many health professionals are unaware of the battles faced by those living with autism. I have often found those from outside agencies quite hostile towards our clients...not realising that they need to be treated differently from neurotypical people. Most of these students have diagnosis in other things such as Obsessive Compulsive Disorder, ADHD and Pathological Demand Avoidance and attachment disorders."
"hard to find people with the right expertise to deal with these disorders as they usually have not dealt with people with autism before, leaving these other diagnoses untreated. Add this to the fact that the provision for all of these services usually drop away once a person with autism reaches 19 and are transferred into adult services and it seems we are failing those with a diagnosis"
"My experience with CAMHS for Sam has been quite negative. We saw an ASD Nurse Specialist from CAMHS for about 6 months. He knew very little about autism, in fact he used to borrow books on autism from parents".
"We are consistently told by professionals that they are severely overstretched which from personal experience and talking to
other parents leads to very few families receiving adequate support...Maybe if money was invested on these children as they deserve...then they would be more likely to develop into functioning adults who are able to contribute to society in a positive way rather than developing into adults with mental health issues who are totally reliant on the state."
Autism is not a mental health problem, which makes it difficult for people to access appropriate services. As we have heard from the hon. Gentleman, a large proportion of children with autism have mental health problems, which may develop because of the symptoms that they express and subsequent interaction with other people. They may become more socially isolated at school because of their characteristics. The problem snowballs if the symptoms of autism are not identified early, and the child's journey does not include trained people who understand its complexities and varieties.
Mr Mark Williams (Ceredigion) (LD): The debate is rightly concentrating on the inadequacies of CAMHS, but my hon. Friend knows of my interest in teacher training and teachers' awareness of identifying the characteristics of autism. There is understandable frustration among teachers at the lack of training facilities and opportunities available to them.
Annette Brooke: My hon. Friend and I, along with many others, have worked hard on education, and we are slowly making progress. Today's debate takes us further afield because we have to get the whole package right for children with autism.
Being mindful of the time, Mr Benton, I would like to touch on two issues. First, I would like to emphasise the need for training for CAMHS professionals, which is vital for all the communication issues mentioned by the hon. Member for Stalybridge and Hyde. The issue is not straightforward, which means that there must be training; there must be flexibility, patience, skill and understanding. The local CAMHS commissioning process is designed to identify and address skills gaps in the local work force. What steps will the Government take to ensure that such gaps are identified and addressed with regard to autism?
I have been involved with the Every Disabled Child Matters campaign, and one area of concern that we have identified is the falling apart of services for disabled children during the transition period. There is a lack of forward planning for the transition, starting about age 14. That is particularly true for children and young people with autism, because they are likely to require ongoing mental health support and to need a smooth changeover between children's services and those for adults. One issue that I have with children's trusts is that in some local authorities, there is a great dichotomy between children's and adult's services. The best local authorities manage the transition well, but there is the potential for people to fall through the gap. How do the Government intend to ensure that CAMHS and relevant adult services work together to plan appropriate ongoing support for children with a mental health problem and an additional disability, such as autism, and for all young people who require ongoing mental health support?
Cathy Jamieson (Kilmarnock and Loudoun) (Lab/Co-op): I, too, congratulate my hon. Friend the Member for Stalybridge and Hyde (Jonathan Reynolds) on securing this important debate. Hon. Members who know that I come from north of the border may wonder why I choose to speak on a matter that essentially relates to devolved issues in Scotland. However, in a number of areas, we have to look across the UK, and the National Autistic Society has a facility-Daldorch House-in my constituency, which has become a centre of excellence in the local area and is looked to by a number of local authorities, not just in Scotland but across the UK, for advice on how to approach work with young people with disorders on the autistic spectrum.
I have taken an interest in this subject over many years, and I first came across young people with disorders on the autistic spectrum 30 years ago as a young art therapist. It is fair to say that there have been a number of positive moves both in recognising the range of issues that people face, and in looking at different ways of working with people and the different services required. Despite all those improvements, all of us as elected Members of Parliament will come across people in our constituencies who still have to battle, fight and almost scream from the rooftops to get the services that they need for their children.
One difficulty that people often face-I certainly experienced this as the Minister responsible for education in Scotland when I tried to introduce legislation that should have provided additional support for learning-arises because parents are suspicious of any change, as they feel that it might lessen the rights of young people, rather than give them increased rights to education and other support.
This morning, I received in my e-mail inbox a piece of correspondence from a constituent, which I think sums up how much further we still have to go. The parents were writing about the needs of their teenage son, and the difficulties that they have encountered in finding appropriate educational placements. Their son is already in a school but, according to the parents, that school does not have the necessary skills and experience to cope with him and does not want him there for reasons of health and safety. Another school has been identified in the local authority area, and although it has the skills and expertise, it does not have enough support staff to take the teenager on. The parents are extremely worried about the impact of budget cuts that are already being made in the local authority, with learning support assistants-and others-being made redundant.
As a result, those parents told me that they do not know whether any schooling will be available for their son after the summer break. They have been advised by both schools that they are unlikely to hear anything from the education authority until two days before the start of the new school term. All hon. Members who are aware of the issues surrounding education for young people with disorders on the autistic spectrum will know that that is an unacceptable way to deal with young people who require support and preparation, and for their parents, who need to know what is going to happen.
I am conscious of the time, but I want to say that we must work to identify who these young people are. Every local authority and health board has a responsibility
to identify young people with disorders on the autistic spectrum and put in place appropriate support packages. I am concerned that we are not doing enough to recognise that those young people will grow into adults, and at some stage will require not only support to enter further education or employment and all that goes with that, but support with the ageing process. At some stage, there will be a significant number of people approaching their elderly years who are diagnosed as having a disorder on the autistic spectrum. We have not done anything to look at that issue.
It is important that parents receive support. Everyone who has been the parent of a teenager knows that it is a difficult time. I used to joke that my son disappeared into his bedroom aged 14, and came out a better person aged 17. [Hon. Members: "Too early!"] Perhaps I was lucky. For people who have teenagers with disorders on the autistic spectrum, it is a difficult enough period. The added pressures and the support that parents require have not been adequately recognised.
We must pay attention to the number of people who end up in young offenders institutions and prison systems but who probably, had their condition been picked up at an earlier stage, would have been diagnosed as being somewhere on the autistic spectrum. I have also raised that issue in a Scottish context. When people are in a place such as a young offenders institution or prison, we should be able to identify the problem, get them the appropriate help and support, and look specifically at how we can help them in the future.
I am grateful for the opportunity to make a brief contribution to the debate. When the Minister responds, perhaps she will say something about what the Government are planning to do about the transition from education into employment, and about the specific issue of how we can provide support for people as they go through the ageing process and inevitably require a degree of support from the state.
Mr Robert Buckland (South Swindon) (Con): Thank you, Mr Benton, for giving me my father's name. Robert Buckland is my true name. I am grateful for the opportunity to speak in this debate, and I congratulate the hon. Member for Stalybridge and Hyde (Jonathan Reynolds) on an excellent and comprehensive analysis of the report from the National Autistic Society, which many of us have read and found extremely useful.
I declare an interest because, like the hon. Gentleman, I am the parent of a child on the autistic spectrum. My experience, although initially negative, is something that I have decided to try to be positive about, again like the hon. Gentleman. Having had the honour of being elected to this place, I regard it as my duty to raise those experiences, talk about them and do whatever I can to advance the cause of children, young people and adults with autism, the autistic spectrum disorder and Asperger's syndrome.
The "You Need to Know" campaign touches on an issue that all of us, whether Members of Parliament, parents, professionals or members of the public, may have experienced in recent years, as the extent of the diagnosis of autism has dramatically increased. A group of individuals and their families feel utterly isolated because their experiences have, in the words of the hon.
Member for Mid Dorset and North Poole (Annette Brooke), resulted in their having to scream and shout from the rooftops, bang on doors and adopt behaviour that they might never have contemplated at the beginning of their journey. I simply ask the eternal question: why does it have to be like this? Why on earth are we still in this position in the second decade of the 21st century? The National Autistic Society was founded nearly 50 years ago. Medical research on, and analysis of, the condition that we now know as autism began as long as 70 years ago. I appreciate that the calls on the public purse are immense, but progress on this issue is too slow, and that is betraying an entire generation of children and young people.
Provision for the transition from youth to adulthood is-I hesitate to say this, but I will press on none the less-nothing short of scandalous. The excellent provision in the education and children's services sector suddenly vanishes when the young person reaches the magic, or should I say tragic, age of adulthood. Time and again, I have met constituents who are crying out for the help and support that they thoroughly deserve, but who are not getting it. They understand and are conscious of the fact that they are increasingly a burden on our society, but it should not be like that. They should not be a burden on the rest of us; they should be making a valuable and meaningful contribution to our society. We should not forget the talents, idiosyncrasies and amazing abilities of children and young people with such lifelong conditions. I talked about the initially negative experience of learning and understanding that one's child has autism. As I said at the beginning, however, the positive aspect of such conditions must not be forgotten. These children and young people are not a burden; they add to the mosaic of human experience, and we need to understand and embrace that as we address the questions.
I know that we have touched on this point in the debate, but we should not forget the position of parents and carers of young people with autism. All of us with experience and knowledge of the position of parents and carers will understand that the pressure on them is often intolerable. They often need support and access to mental health services themselves if we are to avoid some appalling scenarios. In one appalling case in south Wales recently-I will not go into it, because it is sub judice-a parent was detained under the Mental Health Act 1983, and a young child lost his life. In the second decade of the 21st century, that is unacceptable in any book.
Hon. Members have eloquently outlined the need for training, and I need not repeat what they have said. Professionals who are outside this place, or who may be present, will say that they are doing all they can with limited resources to deal with the huge variety of problems they are presented with as paediatricians in the national health service or as mental health practitioners. I understand that resources are tight, but as has been said-I make no apology for repeating it-there is huge potential for saving money by intervening early and recognising problems. In these times, when finance is understandably the Government's paramount consideration, is that not a strong and persuasive argument for supporting provision?
Mr Russell Brown (Dumfries and Galloway) (Lab):
My hon. Friend the Member for Stalybridge and Hyde (Jonathan Reynolds) mentioned west Berkshire. As a
result of the pressure that I and others in my locality have put on our local health board, we now have an integrated ASD network, with speech and language therapists and a whole host of professionals. The hon. Gentleman has hit on the central point: early intervention, with good, sound, solid professionals working together as a team, will make the difference. That can save money in the long term, but, more important, it can alter the quality of life for young people and their families.
Mr Buckland: I thank the hon. Gentleman for that important intervention, which leads to the point that I was about to make. We could spend hours in a chicken-and-egg argument about whether mental health conditions precede autism. Let us not forget that autism is often accompanied by physical disabilities and a range of other conditions, so it is a complex area. Similarly, mental health problems will accompany autism in some families for hereditary or genetic reasons, so it is probably not worth getting into the chicken-and-egg argument.
There is, however, no doubt that a number of young people who present themselves to CAMHS will have had an imperfect or late diagnosis of their condition, and I am afraid that my personal experience in that respect has been rather negative. Experienced paediatricians, whom I will not name, because they are distinguished in their field-one in particular is very distinguished in the medical-legal field-told me that diagnosis at two or three was not possible for autism and ASD. I was a mere layman in those days, and I had not made the journey that I have now, so I accepted what I was told at the time, but I learned later that it was not the case. If that attitude is still prevalent, we have a problem. I do not want to criticise health care professionals, who do a wonderful job, but the point being made by the National Autistic Society is that we need more training, awareness and understanding. That is all we ask for in this debate.
The hon. Member for Mid Dorset and North Poole asked the proper question about transition provisions. We now have the Autism Act 2009, and we await the statutory guidance, which is all-important in fleshing out the bones of the Act. The guidance is key, and we need the Government to give a clear steer in it as to how we manage the transition from childhood to adulthood. That is a key time, but there is, as I have said, a scandalous dislocation in provision, which needs to be dealt with properly.
As the hon. Member for Dumfries and Galloway (Mr Brown) so eloquently said, we need to look at key intervention at the earliest stage. A lot of the mental health conditions that accompany autism can be avoided through early intervention, which would mean that there was less pressure on CAMHS and less of a crisis in the key early and mid-teen years.
I know that other hon. Members want to contribute, so I will finish on this point. We have seen some excellent examples of provision, and west Berkshire has been cited. In authorities such as mine in Swindon, the PCT and children's services are integrated and work very well. They are starting to do the outreach work in CAMHS in the primary sector that will help to identify problems and improve early intervention. However, although that integration is all very well, the question,
which the hon. Member for Mid Dorset and North Poole posed, is whether there is proper integration with adult services. Therein lies the problem, and more work needs to be done.
I am grateful for being allowed to contribute to the debate. I hope that this will be the first of many contributions that I make on the subject in the years ahead. I thank you for allowing me to speak, Mr Benton.
Mr Andrew Smith (Oxford East) (Lab): I, too, congratulate my hon. Friend the Member for Stalybridge and Hyde (Jonathan Reynolds) on securing this important debate and on his well informed and persuasive speech. It is encouraging that the debate is so well attended and that it is informed by the personal experience of parents of children with autism.
Like other hon. Members I have received a number of representations from constituents in support of the National Autistic Society "You Need to Know" campaign. I applaud the work of the society and its supporters in raising the profile of the needs of children and young people with autism and of the importance of ensuring that there is proper diagnosis and support from CAMHS, GPs and other health professionals for the 70% of children with autism who also have mental health issues.
My hon. Friend set out both the range of difficulties that young people face as they go through life and the opportunities that are opened up by the right skilled help. I want to raise a couple of points that I think are important. The first is the interaction between autism and mental health and the number of young people who are not in education, employment or training. An interesting Audit Commission report on re-engaging young people-published today, coincidentally-includes an analysis of the characteristics of young people in the NEET category, and shows for example that whereas young people with either learning difficulties and disabilities or one or more special educational needs statements comprise 10% of all young people, they comprise 23% of young people who are not in education, employment or training for six months or more. It does not give figures specifically on those with autism, but the proportion will be significant-not counting, of course, those who have not been properly diagnosed. That is an important issue.
One of the key recommendations of the Audit Commission report is that local councils, especially with the transfer of 16-19 funding, and all the existing and coming pressures on local budgets, need to understand the nature of their local NEET population and to target their support appropriately. I urge that understanding the extent of autism and mental health difficulties among those young people should be a key part of the analysis and of the supportive action that needs to be provided by health, education and training professionals.
Another point that I would like to stress follows from the comments of the hon. Members for Mid Dorset and North Poole (Annette Brooke) and for South Swindon (Mr Buckland): it is the importance of improving and joining up support for young people with autism as they move into adulthood, which is understandably a particularly stressful time for the individuals concerned and their parents. Certainly in my area in Oxford, although there is still some way to go, there have been welcome
improvements in support for children and young people in education. Parents have praised to me the work done by Oxford and Cherwell Valley further education college. However, as youngsters become adults it can be an especially uncertain time, when the prospects for work, other meaningful activity, further training, social relationships and housing become problematic, and their parents are getting older. There needs to be a better joined-up approach between health, social services and housing providers so that there is a coherent system of support. As the Audit Commission report recommends, there is a need for better co-ordination between Connexions and Jobcentre Plus, and better handover arrangements as people move forward and look to the possibilities of work.
At a time when local council budgets face huge cuts, it is all the more important that we should speak up for the needs of those young people, which have so often been misunderstood and neglected in the past. They must not be marginalised in the battles for funding ahead. One crucial point from the Audit Commission report is that early intervention and the right early support not only make a huge difference to people's quality of life, but, as the hon. Member for South Swindon said, can save big sums of public money in the long run. The report illustrates that fact by contrasting the example of a young man with Asperger's who gets the right support and ends up with a life in work, and one who does not, and ends up with a life on benefits.
I would be grateful if the Minister let us know what guidance and support will be given to local councils, health authorities and others on relevant matters so that young people with autism and their families can face the future with more confidence, and in particular what action the Government will take to ensure that CAMHS and adult mental health teams work together so that there is the right continuing support.
Dr John Pugh (Southport) (LD): I want to add a few footnotes to the excellent introduction to the debate by the hon. Member for Stalybridge and Hyde (Jonathan Reynolds), who set out the major issues carefully and meticulously. Mental health and autism cropped up emphatically in debates on the Mental Health Act 2007. We were then largely concerned with the treatment of young people, including making treatment specific to them, rather than putting young people into adult accommodation or the like, or giving them adult services when juvenile services would be appropriate. While recognising that that was not always possible, I pay tribute to the campaign by YoungMinds for adolescents to receive adequate, full treatment no matter what their condition or mental health.
I pay tribute to the work done on the 2007 Act by the hon. Member for East Worthing and Shoreham (Tim Loughton), who has gone on to greater things, and to Baroness Browning, the former Member for Tiverton and Honiton, who was a champion of autistic people in this place and who pioneered the work that was taken on by other hands as the basis for the private Member's Bill that subsequently became the Autism Act 2009. Off the back of the 2007 Act, I carried out my own research on provision for children and adolescents and wrote to every PCT for which I could obtain a name. I wanted to focus particularly on adolescent mental health provision,
rather than childhood provision, and on waiting times. I accept the point that all the hon. Members who have spoken have made about the critical nature for families and, obviously, patients, of waiting times-the time between a suspicion that something is wrong and getting a diagnosis and treatment. Those are of course different things-one can get an early diagnosis but be slow in getting treatment.
It is not surprising that that issue is crucial during adolescence, when huge hormonal, physiological, social and personality changes are happening. That is a stage in life when, often, psychotic and other disturbances first become evident. One of the more depressing passages included in the Library debate pack deals with that fact. It states:
"Mental illnesses are the chronic diseases of young people."
"It is a curious paradox that better physical health in young people has been accompanied by steadily worsening mental health."
That is indeed what the national statistics show, and it is why early intervention matters, because if it is successful and efficacious it means someone does not have a life of ongoing suffering and disturbances.
My inquiries of the various PCTs unsurprisingly produced patchy results, in accordance with the well-documented contributions made by other hon. Members. There was a general variation in standards, which I think people might expect, and which has been vouched for today, but what disturbed me more was the lack of clarity about who was responsible for the standards. My inquiries were passed from PCT to CAMHS and back. People did not seem clear about who would carry the can if provision were less than adequate. The implication is that for people using the services no one is ultimately responsible; that is the nagging feeling.
Another feature that cropped up in my research was an apparent lack of dedicated facilities and expertise in many places, and a recognition that although in some places there were adequate facilities for children, facilities for adolescents were wholly inadequate. There is no excuse for that state of affairs in relation to Asperger's syndrome and the autistic spectrum, because what is required for progress is very clear. Certainly, early diagnosis is required, but the National Audit Office report that I have seen-which I think Baroness Browning did something to trigger-clearly stated that specialist autism teams were the way forward, coupled with good integration, and so on. That is all known, but hon. Members have reported that across the country none of it has been perfectly accomplished.
May I make a personal constituency point? I increasingly receive complaints from parents of children who are mildly autistic but are now being excluded from services because needs must-there are pressures on local authority resources, as the right hon. Member for Oxford East (Mr Smith) illustrated. That is profoundly depressing, because the result is that people who could progress to independence and, in later life, manage far better for themselves and not become problems as adults are not making progress at the key point at which they could be making the progress necessary to become independent of parents and institutions.
My conclusion and, I think, the conclusion of the whole debate is that we are confronted with a situation in which there is a known complaint, a known solution,
enormous support from the voluntary sector and clarity about what is required, but on the statutory side there is a somewhat ham-fisted response. Getting that ham-fisted response removed and replaced with something better is the thrust of the debate.
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.
Pat Glass (North West Durham) (Lab): I thank my hon. Friend the Member for Stalybridge and Hyde (Jonathan Reynolds) for securing the debate, which has been excellent. I do not disagree with anything that I have heard, nor do I intend to repeat any of it. I shall concentrate on the areas that I have the most concerns about.
We have come a long way in recent years and there have been improvements, particularly in education, but we must not be complacent and there is still a long way to go. The two areas that I have the greatest concern about are transition, which I shall come on to, and diagnosis. This refers back to the issues of child and adolescent mental health services. In my experience, far too many children still receive a diagnosis that is less related to their symptoms and difficulties than to who they are and where they live. I still see too many cases in which clinicians go down the route of attention deficit hyperactivity disorder or EBD-emotional and behavioural difficulties-first, because of the family and where they live. That means that those children and their families do not gain access to the diagnosis, services and provision that they need. That is one concern, and it relates to what I said in an intervention about the quality and consistency of CAMHS across the country. If people look at the issue geographically-on a map, as I have done-they will see hot spots of certain diagnoses, and sometimes around certain clinicians. Those issues need to be addressed.
Everything that I have heard today about transition, particularly transition in the early years, is absolutely correct. If we get that right and provide access to the right services-good, well co-ordinated provision-the mental health of those children and their families will be much improved, outcomes will be much improved and we will save money in the long run. Transition in the early years is crucial and will save us money in a time of austerity.
The transition at the other end is also an issue. A lot of emphasis has been placed on that in recent years, but in my experience that has been about the process-the right forms filled in by the right people, and the right people being at the right meetings at the right time. For the families, the process can be fabulous, but if there is nothing to transition on to, it is a disaster for them.
When I was in my former role in education, we recognised that there was almost a time bomb here. Children are going through the education services and coming up to the adult services, but those services are not there for them. Will the Minister consider the issues of diagnosis and quality of provision across the country to ensure that a child's diagnosis is right and not based on the family's circumstances or socio-economic grouping? Will she also consider transition in relation to the quality of provision, not just the processes, forms and meetings?
Mr Mark Williams (Ceredigion) (LD):
I thank the hon. Member for North West Durham (Pat Glass) and my hon. Friend the Member for Brecon and Radnorshire
(Roger Williams) for the speed with which they spoke. I intended to make a bigger contribution about some of the good precedents and good practice that we have experienced in Wales, in the hope that the Minister might have a look at that, but I shall just highlight the launch on 28 June by the Welsh Assembly Government of their new child and adolescent mental health strategy and the work commissioned by the Assembly Government from Professor Sue Leekam of the Wales Autism Research Centre. It is undertaking evaluation of the assessment and diagnosis of children with disorders on the autistic spectrum, which will analyse and strategically examine CAMHS provision and many of the inadequacies of that, particularly in professional training, which we have heard about from hon. Members.
I wish to highlight also the work being undertaken by the Betsi Cadwaladr university health board, which operates in north Wales, to develop a register for children and young people with autism. I applaud what the hon. Member for North West Durham said about the lottery of service provision, but the strong message is that we must identify the extent of the challenges that face the nation. The problem was not addressed by previous Governments; I hope that it will be addressed by this one.
I end with a brief anecdote. We have heard some powerful stories this afternoon. My earlier intervention about teacher training was deliberate. I spent 12 years in the classroom and I always realised that, even as a professional, I was sometimes failing the children in my care. The problem of the little girl who used to wander around the playground with no friends should have been addressed, but teachers are not often equipped to do so. The fact was that when we told her, "Don't touch the hot boiler in the corner of the room," we knew that she would probably end up touching it and burn herself. I should have been equipped to deal with the many problems that that girl presented.
However, there are huge opportunities, which is a point that was made strongly by the hon. Member for Stalybridge and Hyde (Jonathan Reynolds) and others. If we create the right environment-a nurturing, caring and enriching environment-in our classrooms and in our health service provision, people on the autistic spectrum will be able to make a huge and valuable contribution to society.
Barbara Keeley (Worsley and Eccles South) (Lab): It is a pleasure to serve under your chairmanship again, Mr Benton, and I congratulate my hon. Friend the Member for Stalybridge and Hyde (Jonathan Reynolds) on securing an important debate to which many hon. Members have contributed.
I pay tribute to my hon. Friend and to those parents-we heard about them again today, and our debate has been enriched-who have campaigned for vital improvements to services. As of yesterday, 136 Members from all parties, including my hon. Friend and, I expect, others here today, had signed early-day motion 160, which highlights the fact that 10,000 children with autism use child and adolescent mental health services every year. It also highlights a survey showing that using such services will not improve the mental health of two thirds of those children. As my hon. Friend said, the children are not getting the support that they need.
Children with autism are particularly susceptible to developing mental health problems, and many Members mentioned the fact that there is a range of reasons for that. Such children may experience social isolation, and 70% of children with autism struggle to make and keep friends, compared to 10% of other children. Children and young people with autism also find it challenging or impossible to express how they are feeling. The struggle to communicate causes frustration and anger, which can lead to mental health problems.
With the right support given at the right time, many of those problems can be prevented. Given that one child in 10 who accesses child and adolescent mental health services has autism, that should be a priority for the professionals in that service. However, only just over half the parents surveyed by the National Autistic Society thought that staff working in CAMHS had a good understanding of autism. Many of the professionals to whom the society spoke felt strongly that there were not enough training opportunities-many hon. Members touched on that point. Professionals need to develop their clinical expertise in order to work with children with autism and mental health problems. There is good experience of that happening up and down the country.
The high number of children with autism, coupled with the lack of skilled professionals, leads to many children being seen by professionals who are unable to meet their needs or simply being turned away. I have some questions for the Minister; I may be repeating some of them, but it will not hurt to do so. Will the Government ensure that all child and adolescent mental health professionals are provided at least with basic autism training, so that they can meet their duties to make "reasonable adjustments" under the Disability Discrimination Act 1995 and provide services that meet children's needs? How will the Government ensure that specialist autism support is available within CAMHS?
As we have heard, autism is a complex disability. When mental health problems arise in children with autism, they are harder to recognise, evaluate and treat. Professionals need a good working knowledge of autism to do those things. Providing mental health support to children with autism is a specialist skill, and research conducted by the National Autistic Society found that if an autism specialist is involved in the support of such children, outcomes and service satisfaction improve dramatically. Indeed, those parents whose children had received support from a specialist in autism were twice as likely as those whose children had not to agree that the child and adolescent mental health service had improved their child's mental health. Sadly, coverage is not good, and only two in five parents say that their child has had such support.
Specialist autism support is vital. We need to adapt therapies and interventions so that they are effective. Skilful adaptations will obviously make them relevant and useful to children with autism. Many Members spoke of the importance of early intervention. Autism specialists can also help other professionals to develop their skills, and they should share their experience with schools and social services.
The subject of commissioning was mentioned by a number of Members. It is particularly important, given the radical changes that the Government have indicated that they wish to make to local commissioning. The way services are commissioned locally for children with autism and mental health problems is clearly important.
Commissioners obviously need to know how many children with autism live in their area, how many of those children also have mental health problems and how local services are working. They need expert advice on what is needed to deliver the right mental health services. They then need to use those data to plan the right services for the children. If the commissioning changes that have been signalled are to be made, it is important to take those factors on board.
Commissioning must also take account of CAMHS waiting times, rates of return and family outcomes for children with autism. Specific local pathways should be developed for the mental health support of children with autism. Parents and children affected should be involved in the commissioning process, together with front-line professionals.
The Labour Government introduced a vital new duty, which came into force in April 2010. Children's trusts now have to plan to meet the needs of children with special needs and disabilities. That represents a significant step forward. What action will the Government take to build on Labour's work, to ensure that services are planned and commissioned at the local level so that every child with autism and mental health problems starts to get the support they need? How will the Government ensure that parents and young people are involved in the development of services to ensure that they meet local needs?
We know that the number of children with learning disabilities and of children with autism who use such services are similar. It is clear from improvements to services for children with learning disabilities achieved under Labour that having the right measures in place does make a difference, which was mentioned during the debate. As my hon. Friend the Member for Stalybridge and Hyde said, the Labour Government achieved improvements to services for children with learning disabilities through the 2004 national service framework. That highlighted the importance of providing adequate child and adolescent mental health services for children and young people with learning disabilities.
Specialist training, the adequate resourcing of learning disability specialist support and access to specialist in-patient support were also recommended. As we heard, a specific indicator was recommended for local authorities to rate themselves on their provision. As a result, specialist support for children with learning disabilities more than doubled between 2005 and 2007. In 2010, two thirds of primary care trusts rated themselves four out of four for their provision of CAMHS for children with learning disabilities. Based on the improvements for children with learning disabilities made under Labour, I urge the Government to commit themselves to achieving the same benefits in the coming months and years for children and young people with autism.
I shall speak briefly about early intervention. As was said by my hon. Friend the Member for Dumfries and Galloway (Mr Brown) and my right hon. Friend the Member for Oxford East (Mr Smith), putting support in place early makes a big difference in the long run. It can help to prevent difficulties from escalating into mental health problems. Over recent years, there has been a strong focus on improving support for children with autism and improving the emotional well-being of children with autism in schools. I hope that that continues.
The autism inclusion development programme has helped to improve teacher training. The social and emotional aspects of learning programme has helped pupils at school to gain emotional and social skills, and has helped them with self-awareness and managing their emotions. The early support programme has helped families of disabled children under the age of five to get co-ordinated support and information early, so that problems do not escalate.
Hon. Members touched on the fact that Labour initiatives, such as the Every Child Matters agenda, also helped to ensure that agencies work together, which is important in providing support to our most vulnerable children. Parents at the Every Disabled Child Matters reception in the House yesterday wanted assurances from the Minister that schools would continue with the initiative. They felt that they had created the initiative, and that it was not just a Government thing.
Government leadership over recent years has made a significant difference to aspects of the mental health system for children. In today's debate, we are asking for similar action for this other group of children. We must continue to prioritise children and young people with autism because they are among some of the most vulnerable people in our society.
"There is no doubt that these changes can happen, where there is a will on the ground to make them happen."
The Parliamentary Under-Secretary of State for Health (Anne Milton):
I congratulate the hon. Member for Stalybridge and Hyde (Jonathan Reynolds) on securing both this debate and his seat. The subject is of huge importance to him, and he brought with him his invaluable personal experience, as indeed did the hon. Member for Manchester, Withington (Mr Leech) and my hon. Friend the Member for South Swindon (Mr Buckland). Those personal experiences are crucial to the debate, as are the contributions from those who are experienced in the provision of services. This debate is vital, and I will ensure that all the representations that have been made today are fed back into the policy process. Time is short, but I will just say to the hon. Member for Worsley and Eccles South (Barbara Keeley), who speaks for the Opposition, that some of us were fortunate enough to have listened to and participated in debates on the Autism Act 2009, promoted by my right hon. Friend the Member for Chesham and Amersham (Mrs Gillan), as it made its passage through the previous Parliament. At the time, there was an increasing dislike of and disillusionment with politicians, so I mention that measure because it showed this place in its very best light. It was about cross-party working and building a consensus. It was a genuine attempt by Members from all parts of the House to work together to improve the lives of others-in this instance it was the lives of those with autism. I pay tribute to Angela Browning, the former Member for Tiverton and Honiton, who was sometimes a lone voice
calling for services for people with autism. She, too, brought her own personal experiences to the debate thereby helping to raise us to the next level.
I echo the comments made by the Minister of State, Department of Health, my hon. Friend the. Member for Sutton and Cheam (Mr Burstow), at the recent National Autistic Society reception. He said that the standards of care highlighted by the society in its "You Need to Know" report are unacceptable. He was grateful to the society-as indeed we all are-for its tireless campaigning, and was struck by the particular contribution of the young campaigners group. I am sure that he would pay tribute to them were he able to be here today.
The coalition's programme for government makes it clear that we are committed to supporting the most vulnerable and to tackling health inequalities. There is strong consensus on what needs to be done to improve the emotional well-being and mental health of children and young people. More work is needed on prevention, early diagnosis and early intervention. Those are the key things that are needed by people with autism and mental health problems. We need better integrated working and more evidence-based approaches. The work force must be developed, and, crucially, we must do more to tackle stigma for people not only with autism but with mental ill health.
The National Advisory Council for Children's Mental Health and Emotional Wellbeing report earlier this year reinforced the scale of that challenge. It called for action to strengthen leadership, build a confident and skilled work force, improve commissioning and ensure real participation by children and young people in service development. For me, commissioning is a vital part of that. It has never been done that well, but there is a general acceptance of the fact that if we improve commissioning, the services will then follow. As has been mentioned during this debate, there are examples of best practice, which we need to be able to transport to other areas. We need to consider all those issues to get the services that we want.
The Government have also promised to deliver measures in "Fulfilling and rewarding lives: the strategy for adults with autism in England". There are many areas in which improvement in adult autism services will yield benefits for children's services, such as developing local autism teams, improving access to diagnosis, better planning and better commissioning of services. As several hon. Members have said, raising awareness of the issue and improving skills in the work force should go much wider than just those working in the autism field, and should include teachers and sports clubs and all those who are involved with young people.
Our focus must be on improving the quality of services that we provide to all children. We must ensure that no one suffers the indignities and difficulties that are sadly all too common. I am referring to the frightened young person who is restrained by police because crisis services were not available; the child who feels isolated and frustrated, only to find that health care staff are not trained to help or able to understand them; the parents who desperately want to see an improvement but feel let down by services that do not treat their children as people with individual needs; and parents who are desperate, isolated and at the end of their tether. That is why it is so important to improve the standard of care across the board.
We must plan and build on the work that has been done on integrating services so that local partnerships can work together to deliver what we want. It will require incredible commitment from local NHS providers to engage with the work force to resolve difficult issues such as training and service design. Improving the reach and quality of child and adolescent mental health care means looking carefully at the different services that make up the whole picture. I am referring to universal services that play a pivotal role in promotion for all children and young people; targeted services that provide early interventions for vulnerable children and young people; and specialist services, which the hon. Member for Stalybridge and Hyde mentioned, for young people with complex, severe or persistent needs.
Anne Milton: I am sorry, there is no time. I already have far too many questions to answer. If hon. Members feel that their questions have not be answered or addressed, I urge them to write to me and I will make sure that we respond.
I have only two minutes left. The hon. Member for Stalybridge and Hyde said that staff working in child and adolescent mental health services should have the necessary values, competences and skills. That is vital. The coalition document made it clear that we are committed to supporting the most vulnerable and to tackling health inequalities, and we will make more announcements about public health. Appropriate tier 4 child and adolescent mental health services should be available to all children who require them, including children with autism. There are a number of other vital issues, including diagnosis and transition. I am proud of my own field, which was highlighted by the previous Government, for some of the things that they achieved on transition. I should also like to pay tribute to Sara Truman, who has done a huge amount of work with the National Autistic Society.
We have not touched on the health outcomes for people with autism and mental health problems, but if we look at them we will find that they are truly shocking. Parents and carers carry a huge burden. There are many issues that we have not covered, including respite and research. We still do not understand why people get autism. We also need to look at those children who are not yet diagnosed. There are significant challenges that will require real commitment and buy-in from the staff who work hard in CAMHS across the country, but I am greatly encouraged by the number of contributions here today and by the amount of expertise that is sitting here. There is a role for Government to play. I hope that hon. Members appreciate that we cannot provide all the answers-
Before I go any further, I just want to say that I understand many of the pressures on Her Majesty's Courts Service, particularly given the fact that in the last three years of the previous Government, magistrates services received a 7.5% funding cut in the-[Interruption.]
Andrew Percy: As I was saying, Mr Benton, there was a 7.5% cut in magistrates budgets, which occurred for each of the three years before the general election. There is also a massive backlog in refurbishment and capital projects, which built up in HMCS in the previous few years. In Goole, that backlog stands at £80,000. I could make some comments about the fact that it was a shame that in the run-up to the general election, when Labour Ministers were heading to my constituency with all sorts of blank cheques, they did not offer a blank cheque on court services.
I want to confine most of my comments this afternoon to the proposal to deal with the court at Goole. As I have made clear to the Speaker's Office, my hon. Friend the Member for Selby and Ainsty (Nigel Adams) will, with your permission, Mr Benton, take some of my allotted time to speak about the closures in Selby. There is a proposal to close the county court in Goole and to merge the local justice areas, but that proposal is less controversial, and indeed it is something that the magistrates in the Goole area do not oppose.
There are a number of reasons why the magistrates service in Goole should continue. Those reasons relate to the efficiency of the court, which was shown by a review just 10 years ago, and to the cost implications for my constituents in the Goole area if the court should close. Goole magistrates court is administered within the Humber and South Yorkshire region, which consists of the courts in the East Riding of Yorkshire, northern Lincolnshire and south Yorkshire. There is evidence that the throughput of work at Goole is the second most efficient in the Humber and South Yorkshire grouping of magistrates courts. There is a very low ineffective trial rate at Goole, and trials at Goole are listed much more quickly than in larger courts. The proposal is to move the work from Goole to a much larger court at Beverley. Breaches of court orders can be dealt with very quickly at Goole. My own personal view-and what I hoped was the view of the new Government-is that bigger is not always better when it comes to the delivery of services.
The courts building at Goole is fully compliant with the Disability Discrimination Act 1995, which is made clear in the consultation document about the proposed closure. There is a peppercorn rent for the facilities in Goole, and there is a 125-year lease for the building that will not expire until 2130, so there will be no problems in relation to those running costs in the next few years. There is also a modern prison and vulnerable witness
link in place, and the court building itself is situated right next to the police station, with adjoining access to modern and recently refurbished cells.
The utilisation rate in the two courts at Goole would be at 80% but for the fact that a number of meetings and other hearings are held in court two. That utilisation rate compares with what we are told in the consultation document is a relatively low utilisation rate of the courts at Beverley. I would like an assurance from the Minister that the court at Goole is not being closed simply to solve that under-utilisation problem.
Of course, there is also a huge issue relating to localism. As a coalition, we are committed to a localism agenda and I am increasingly concerned that, if we should lose the court in Goole along with the magistrates court in Selby, we will effectively be left with a justice "black hole" in our part of the country. Our court in Goole deals with a number of family matters, which are best dealt with locally. As I said a few moments ago, the courthouse in Goole is situated next to the local police station, which itself was recently renovated at a cost of £2 million. The cells at the police station were also recently refurbished, at a substantial cost to the local police authority.
A review was undertaken of the court services in the East Riding of Yorkshire about 10 years ago. At that time, our county lost the magistrates courts at Howden, Pocklington, Brough, Driffield and Withernsea. We were left with the court in Beverley-anyone who knows the geography of the East Riding of Yorkshire, as I hope hon. Members do, will know that Beverley is roughly in the centre of the East Riding-and courts at the two extremes of the East Riding. One is in the east at Bridlington and the other is in Goole, in the western part of the East Riding. Of course, we also have the magistrates court in the large city of Hull.
Little has changed in Goole or indeed in much of the East Riding since that review was undertaken, except that we have had an influx of immigration from eastern Europe, which-I must be careful with my wording-has presented the courts with certain issues. I would suggest that that actually strengthens the case in favour of retaining our court in Goole. After the review 10 years ago, the rural parts of the East Riding were left with courts at Beverley, Bridlington and Goole. The arguments that are being used to close the court at Goole now are exactly the same arguments that could be used in relation to the court at Bridlington, although there are no proposals to change what is happening there-and I am not suggesting that we should save the court at Goole and sacrifice the court at Bridlington. There is a strong case to keep both courts.
The consultation document makes it very clear that the court in Goole is administered from Beverley and that legal advisers travel from Beverley to attend the court in Goole. The same administrative unit also covers the magistrates courts in Beverley and Bridlington. We in the Goole area are therefore a little confused as to why the area is being treated differently from Bridlington, which is 22.5 miles away from Beverley, compared to Goole, which is 28 miles away from Beverley.
If the closure of the court at Goole goes ahead, there will be massive cost issues. Goole is one of the most deprived areas in the East Riding, and on certain measures it is among the 10 most deprived areas in England. A high proportion of our residents are on low incomes or
in receipt of benefits, so I have a huge concern about the transport costs involved in getting to Goole from Beverley if the closure goes ahead. There are not just the costs of witnesses to consider, but the costs of family members who may wish to go and support people in court.
There are no direct buses to Beverley from Goole. To get to Beverley from Goole, someone would have to take a public bus to Hull, in the process almost going past the magistrates court in Hull, before changing bus to continue the journey up to Beverley. That journey would be close to 40 miles in total, so the distance of 28 miles that was quoted in the consultation document only applies to those who have access to a vehicle. There is a train service from Goole to Beverley but, equally bizarrely, the train service, too, passes through Hull before going on to Beverley. The cost of a return train journey is £11.90 and travelling by bus from Goole to Beverley would take a minimum of 1 hour and 25 minutes, involving the change in Hull that I have just mentioned, so there would be huge costs for anybody who wants to travel to Beverley from Goole via public transport. Furthermore, Beverley has some of the highest parking charges in the East Riding for anybody who wished to drive there.
We must also consider the historical value of the court building at Goole. We are trying to build up awareness of the history and heritage of the town. The court building is a late Victorian building, and one of the oldest buildings in Goole. Although its historical value may not be much of an argument in the rationalisation of HMCS, its closure would have a huge impact on the regeneration of Goole. The building is particularly beautiful, and we are concerned about what would happen to it should we lose the court.
I would like the Minister to tell us whether we can have a full breakdown of the running costs in 2009-10 of the court at Goole. Some broad figures are given in the consultation document, none of which tell us a great deal. I want to know how those running costs were quantified and how they compare with the running costs of the court at Bridlington. Can the Minister also give us an assessment of the likely costs for justices of the peace and witnesses to travel to Beverley, and say what consideration has been given to diversifying work at Goole? I am not in favour of someone being against something unless they have other solutions. Has any work been undertaken on bringing other services into the court at Goole, such as the tribunal service?
The new coalition Government have made a commitment to localism. I hope that in the 10 minutes in which I have spoken, I have made a strong case for why we in the Goole area, on the edge of the East Riding, deserve to be treated a little differently in the closure programme. The East Riding is the biggest unitary authority in the country and the decisions made 10 years ago were made for very sensible reasons: to maintain one service in the centre and two on the extremes either side of the East Riding. With your permission, Mr Benton, I shall hand over to my hon. Friend and colleague the Member for Selby and Ainsty, who will no doubt wish to speak about the issues affecting Selby.
Nigel Adams (Selby and Ainsty) (Con):
I am grateful to my hon. Friend the Member for Brigg and Goole (Andrew Percy) for securing this Westminster Hall debate.
Although I understand that the consultation is ongoing, I would like to use this opportunity to put forward a case for retaining Selby magistrates court.
Both Selby and Goole magistrates courts are in vital positions, and the closure of either or both presents a real risk of what my hon. Friend referred to as a justice black hole in our local area. If Selby magistrates court is closed, the nearest courthouse for my constituents is York, which will involve defendants and witnesses leaving the constituency to travel there. For my constituents in the southern district of Selby and Ainsty, that is a particularly long journey. It is incredibly inconvenient to get to York using public transport, and it would be almost impossible to arrive on time for an early morning hearing. From the south of my constituency-below the M62-there is no direct access to buses or trains to York and constituents would instead have to go via Selby or Leeds to travel to York magistrates court.
The Magistrates Association has specified that everyone should be able to reach their local magistrates court within an hour. For people in the south of my constituency, that will not be possible if the court in Selby is closed. I have been informed by the area director of Her Majesty's Courts Service in north and west Yorkshire that no HMCS staff are currently based at Selby magistrates court, and that it is now seen as a satellite court. However, it would be preferable for court staff to travel from York to work, rather than to expect, hope and assume that witnesses and defendants, particularly those from the south of my constituency, will make the extra journey to York magistrates court.
The rolling monthly average percentage of courtroom utilisation in Selby magistrates court was 60.6% in the financial year 2009-10, which is just below the national average of 64%. Courtroom utilisation is defined as the time a courtroom is used, against the hours that it is available for use. Given that the usage of Selby magistrates court is aligned with the national average, it does not make much sense that it is closed instead of other magistrates courts, such as those in Blandford, Bournemouth, Poole, Weymouth and Wimborne in Dorset. The overall reduction in work load in those courts led to a utilisation rate in Dorset in 2009-10 of just 38.8%, which is almost half that of Selby. The situation is similar in Lincolnshire; there are courts in Boston, Grantham, Lincoln, Skegness, and Spalding, and courtroom utilisation is just 37.2%.
Over the past 18 months, Selby magistrates court has actually transferred certain motoring and trading standards cases to, among other places, Northallerton magistrates court. Those courts were under threat of closure because of lack of work. Selby came under the threat of closure in 2003, but-as is the case now-the proposal came up against strong opposition from the Selby bench, and a casting vote at the North Yorkshire magistrates court committee decided the matter.
Is the Minister aware that after securing the future of Selby magistrates court in 2003, substantial improvement and remedial work was carried out on the courthouse, which cost the taxpayer around £821,000? It was reopened in 2008 following that refurbishment. The overhaul included facilities for the disabled, which are not provided in York. Selby is therefore the designated court for York's disabled population. We also have vulnerable witness capabilities at Selby, such as a specialist court for hearing domestic violence cases, and the technology
to view CCTV evidence and to use video links for vulnerable witnesses. None of those facilities is provided at York magistrates court.
By bringing York's services up to the same standard as those in Selby the Minister would be creating more expense for the taxpayer. It is estimated that an investment of £170,000 would be needed to provide the facilities required under the Disability Discrimination Act 1995, and which are currently available at Selby. The dock in court two at York would also need refurbishment if the decision to close Selby went ahead.
There is a case for retaining Selby magistrates court in light of the £821,000 recently spent and the special facilities it offers. I fully appreciate the dire financial legacy that the previous Government have left behind and the need to make cost savings, but I would find it difficult to justify closure of a service that has recently cost the taxpayer almost £1 million. Selling off the whole building would not realise anywhere near that sum. I urge the Minister to take those points into account during his consultation.
The Parliamentary Under-Secretary of State for Justice (Mr Jonathan Djanogly): I thank my hon. Friends the Members for Brigg and Goole (Andrew Percy) and for Selby and Ainsty (Nigel Adams) for contributing to the debate. I compliment them on the quality and sincerity of their defence of their local courts.
I shall set out the Government's position on the court reform proposals, and provide some details about the courts that currently sit in Goole and Selby. I shall also explain the reasoning behind the inclusion of those courts on the list of possible closures.
In my new role, I have taken the opportunity to visit courts and meet the staff, professional judiciary and magistrates who work hard to deliver justice in communities throughout England and Wales. I have been very impressed by all that I have seen so far. It is evident that courts are run by a dedicated partnership of Her Majesty's Courts Service staff and judiciary, and I am personally committed to continuing to support their contribution to justice.
What has also been clear in my first few weeks in office is the country's economic position, and the immediate need to take action to address the structural deficit. Following the emergency Budget, my right hon. and learned Friend the Lord Chancellor outlined our plans to consult on the closure of a number of courts, as well as to seek wider views on how court services could be modernised. That is one strand of the Ministry of Justice's plans to look critically and holistically at how we deliver justice, and to think about how we continue to deliver those critical services in the future. We have also announced plans to consider sentencing and legal aid.
The decision to consult on the closure of courts was not taken lightly or in isolation. We know we cannot deliver the quality of facilities the public rightly expect and deserve, because we are working out of too many courts. Our low utilisation rate-only 65% across England and Wales-shows that we do not need the number of courts we currently have. Recent improvements in transport and communication links mean that people can travel
further in less time if they need to. More can be done to access justice online and via the telephone, which reduces the circumstances in which a visit to court would be necessary.
We need some fresh thinking about the wider issue of access to local justice. We need to consider whether past ideas about needing a court in every town are relevant today or whether-as with almost every other aspect of modern life-things can be done differently, and innovation and technology can be embraced to meet the needs of modern society and ensure better access to justice.
We are already doing a lot to improve the service experienced by witnesses, defendants and other court users. We have increased access to online and telephone services. Currently 70% of money claims, and the vast majority of possession actions are issued centrally via electronic channels. People can pay fines online for driving infringements, or for not paying their TV licence on time. They can also pay off debts or court fees online using a wide variety of methods. We are improving the availability of information provided on the web and over the telephone from dedicated information centres. That will allow front-line staff to focus on people who need to see a judge. We are increasing the use of video link technology between prisons and courts, and piloting video links between police stations and courts.
Whenever possible, we need to support people to explore a variety of dispute resolution routes for family and civil cases. Such routes are better for those involved in cases that can be mediated, as they can avoid unpleasant prolonged and expensive litigation. Such a situation is also better for the courts because it should reduce court time and overall costs.
We are exploring how local communities can support those charged with a minor offence before their criminality escalates. We are working closely with local support agencies and networks to ensure that appropriate help is available for people with multiple underlying problems that drive their offending behaviour.
The court reform consultation seeks views on the proposed closure of 103 magistrates courts and 54 county courts that are underused and have inadequate facilities. It began on 23 June and will run until 15 September. All responses will be fully considered before decisions are made. The consultation will set out a sustainable arrangement of court services across England and Wales to meet the needs of local communities and will allow us to deliver services in the most efficient way. The proposals would achieve savings of £15.3 million a year in running costs and enable us to avoid a maintenance backlog costing £21.5 million. A further assessment will be necessary of the savings that could be achieved and the value that could be released from disposal of the properties. However, I appreciate that those are generalities.
My hon. Friends asked about the two magistrates courts in their constituencies. I have listened to what they have said and will continue to listen to what they and others say during the consultation. The Lord Chancellor's decision on whether to close Goole and Selby magistrates courts will not be easy; nor will his decisions on the other courts listed in the consultation. Each decision is balanced against several factors, including utilisation, maintenance costs and proximity to other courts. My hon. Friends' points are valid, but we have to look at each court's work load in the context of local justice across each area.
Goole magistrates court has a low utilisation rate, as it sits for less than a third of the available time. It sits in a local criminal justice board area whose overall utilisation rate is low, which we consider does not deliver value for money to taxpayers. Given that we know that there is so little demand for a magistrates court in Goole, I find the argument for investing considerable public spending there on backlog maintenance work of around £80,000 difficult to make, especially as Beverley, where the work would move, is only 28 miles away and has ample capacity to take on the additional work.
With regard to the point my hon. Friend the Member for Brigg and Goole made about distance, we consider a one-hour journey by public transport acceptable for travel to court. Not many people are frequent users of magistrates courts. I assure him that we do not propose closing the court in Goole only because of the performance of the court in Beverley, but we must look at utilisation over the whole area.
My hon. Friend asked why we do not close Bridlington magistrates court. The decision was taken by local management and took into account a range of aspects to ensure sufficient capacity in the area, based on the total number of courtrooms in each court.
Andrew Percy: On the point about people being within an hour's journey of the court, the figures I mentioned indicate that it would take at least an hour and 25 minutes to travel by bus from Goole to Beverley, including a change in Hull because there is no direct bus. Incidentally, there is a direct bus service between Bridlington and Beverley, although I do not suggest the closure of Bridlington. The figure of one hour and 25 minutes is a minimum, and the journey time is more likely to be one hour and 39 minutes.
Mr Djanogly: My hon. Friend makes a fair and relevant point, which he should submit for consideration in the consultation. The original reason for the location of many courts is that they were intended to be half an hour's horse ride away from population centres. We thought that a one-hour journey by public transport was probably more in tune with modern thinking. I assure him that we will do our best to provide him with information on running costs and the other statistics he requested. Again, he should advise us in his response to the consultation of any statistics he has.
As Goole is the only magistrates court in the local justice area of Goole and Howdenshire, we propose that the three LJAs should merge to create a single entity for east Yorkshire, covering the whole of the East Riding. Relatively few magistrates sit at the three benches we propose to combine-only 95 in total. Combining the three will provide a pool large enough to facilitate a more efficient listing of work and reduce the amount of administrative work involved. There will also be advantages for magistrates, allowing them more flexibility in sittings and a wider variety of work.
Although Selby magistrates court has good facilities, as my hon. Friend the Member for Selby and Ainsty said, it too is underused, sitting only around 60% of the time available. Like Goole, it sits in a local criminal justice board area that has a low overall utilisation rate. Selby benefits from being located only 15 miles from York, which is capable of absorbing the work from Selby and has good transport links to all parts of west and north Yorkshire, although I believe my hon. Friend questioned that in his earlier remarks. His point was
that people in the south of his constituency did not have such good access. I encourage him to make that point in the consultation. I was aware of the refurbishment of the Selby magistrates court, but I believe that there is currently a backlog of maintenance work to the value of about £100,000.
Selby and York local justice areas already have joint panels, so merging the two would simply formalise that arrangement and reap the administrative benefits. I understand that the closure of courts in several communities will concern hon. Members and some of their constituents. I welcome views on the proposal, and they will be taken into account before decisions are made. However, I want to make it clear that I believe that operating out of around 530 court houses is unsustainable and does not offer the taxpayer value for money. I reiterate the point that we need to think more widely than bricks and mortar when considering access to justice; we need to embrace in the justice sector many of the technological advances that we take for granted in our work and social lives.
Another point I will address in the time remaining is the impact the proposals will have on local justice. That important point was picked up in different ways by both my hon. Friends. My answer is that there absolutely will not be an impact on local justice. The Government remain committed to a system in which justice is done and seen to be done in the communities affected by crime. The quality of justice matters equally. It is not assured simply by having a court building in each small town, as populations are more mobile and use more sophisticated communications than ever before. The speed with which cases are decided, the facilities we provide to meet the needs of all court users and the respect for the quality of our justice system must be as important, if not more important, than locality. The involvement of communities in the justice system is absolutely key to that, both as magistrates and assistants. With more than 95% of criminal cases heard by magistrates, there is no doubt about the scale of community involvement in justice. I will continue to support magistrates as the bedrock of our justice system. I have held meetings with magistrates' associations and individual magistrates, and will continue to do so to prove the Government's support for the magistracy.
HMCS provided £21,000 of funding in 2009-10 for magistrates in the community scheme run by the Magistrates Association. On community engagement, HMCS works with magistrates and other justice agencies to host regular open days that provide local communities with insight on how justice agencies work together to serve the community, staging mock trials to encourage understanding of the justice system.
We want people to resolve civil disputes more quickly and effectively. County courts, of course, are involved in the proposals as well. Justice does not take place only in court; uncontested money and property disputes can be resolved through our online services, Money Claims Online and Property Claims Online. We are exploring ways of increasing the use of alternative dispute resolution when it can provide more effective and satisfactory solutions than a day in court.
The time is right to take a fresh look at the provision of court services to meet the challenging and changing needs of the justice agencies and society. Work loads are falling in the magistrates courts and court time has been
saved by magistrates and court staff working together with increased efficiency. An example is the success of "Criminal justice: simple, speedy, summary", which speeds up the time from charge to disposal and drastically reduces the need for adjournment. We are developing better ways of delivering justice and will continue to improve them.
I am sure that Members in all parts of the House agree that children who need heart surgery should have the best-quality care. Outstanding treatment is provided in many parts of the country, including at the congenital heart centre at Glenfield hospital in my constituency. My first visit as the new Member of Parliament for Leicester West was to the centre. I met staff in the paediatric intensive care unit, which is the seventh busiest such unit in the country, and staff on the children's ward and from the cardiac nurse liaison team, seeing for myself the excellent professional and high-quality care that they provide.
I also talked to parents about their experiences, and they spoke about their shock at discovering that their child had a congenital heart problem, their fears about the operation and other procedures, and whether their child would survive. They talked about how they were coping with having a very sick child at the same time as holding down a job and looking after other children, particularly if they lived a long way from the hospital, as many of the parents do. Above all, however, they talked about the excellent care that they receive at Glenfield and about how the help and support from the doctors, nurses and other staff is second to none. I am proud to have Glenfield's congenital heart centre in my constituency, and I express my gratitude to all the staff for their excellent work.
Although excellent care is already available in many parts of the country, experts in children's heart surgery have for some while argued that change is necessary, to ensure that all children get the highest-quality care. Those experts include the Royal College of Surgeons, the Society for Cardiothoracic Surgery, the national clinical director for children, young people and maternity services, and the NHS medical director.
Children's heart surgery is complex, and is becoming ever more sophisticated. Technological advances mean that care is becoming increasingly specialised, capable of saving more lives and improving outcomes for very sick children. Many clinicians, however, argue that services have grown up in an ad hoc manner and now need to be better planned to ensure that all care is safe and sustainable, and that surgeons need to treat sufficient children and have sufficient variety in their case load to be skilled and experienced enough to deliver care of the highest quality. They further argue that that is likely to require fewer and larger specialist centres. I have always believed that when changes in hospital services are necessary to improve patient care, we should have the courage to make them happen. I therefore welcome the review, which was initiated by the previous Government.
However, we need to ensure that the right principles and criteria drive the review, the right balance is struck, the right weight is given to the different criteria and principles, and the views of parents and families are properly heard. The Government document "Children's Heart Surgery: The Need for Change" sets out four key principles to guide the review:
"High standards. All children in England who need heart surgery must receive the very highest standards of NHS care,
regardless of where they live... Personal service. The care that every centre provides must be based around the needs of each child and family... Local where possible. Other than surgery and interventional procedures all relevant treatment should be provided as close as possible to where each family lives... Quality. Standards are being developed and must be met to ensure that services deliver the best care."
I want to say more about those principles. My first point is about the number of surgeons and of patients required in each centre to ensure that all children receive the best possible care. "The Need for Change" stresses that each unit needs enough surgeons to provide care 24/7 and to avoid surgeon burn-out in this complex and demanding field. It questions whether units with two or fewer surgeons can achieve that goal, and states that four surgeons is "the magic number."
The document also emphasises that surgeons need to treat enough patients and have a sufficient variety of cases to get the skills and experience they need, and to ensure that junior doctors have the best training. I fully accept the review's concerns about units with two or fewer surgeons, but from talking to clinicians I understand that the clinical evidence on the optimum number of surgeons and the precise number of patients a centre should treat a year is the subject of some discussion, both in this country and internationally.
The centre at Glenfield hospital provides care 24 hours a day, seven days a week. It has three surgeons, treating about 300 cases a year. The staff in the centre are determined to continue to improve the quality of care that they provide, and are planning to appoint a fourth surgeon in the next few months and increase the number of operations to more than 400 a year. Nevertheless, Glenfield hospital and my local primary care trust are very clear about the fact that the centre already delivers high-quality, safe and sustainable care.
Wider clinical issues also need to be considered by the review. Many children who need heart surgery often have other complex conditions, so the review needs to consider the range of surgical and other specialties available in hospitals with children's heart surgery units, and look at how they all link together. Glenfield deals with congenital heart defects in babies, and follows them through childhood and into adult life. Staff and patients say that that continuity of care is a crucial factor in delivering high-quality, personalised services, and it will become increasingly important as survival rates improve.
Glenfield is also the busiest of four ECMO centres in the UK. ECMO-extra corporeal membrane oxygenation-allows blood that has been drained out of a patient's body to have the carbon dioxide removed and oxygen added before being returned to the body, thereby allowing the heart and lungs to rest and recover. Because of its ECMO facility, Glenfield can provide complex thoracic, or chest, surgery in children, especially for those who also have cardiac problems, as well as cardiac surgery for children who have reduced heart or lung function and who otherwise might not be able to have heart surgery, or recover.
Glenfield is the only centre in the country that provides ECMO for patients of all ages, from newborns to adults. It treated 180 patients last year, including 50 swine flu patients. ECMO is provided by the same staff who work in the congenital heart centre, so if the centre closed, Glenfield would lose its ECMO service too-a service used by patients across the country.
Another issue that the review must fully consider is access to care. "The Need for Change" says that most parents would travel long distances to ensure that their children got the best possible care. That is true. Parents would travel to the ends of the earth if they had to. Many parents whose children need heart surgery are, however, already travelling very long distances. Glenfield's centre serves the entire east midlands, with outreach clinics in Nottingham, Derby, Mansfield, Peterborough, Boston, Grantham, Lincoln and Kettering.
Mr Andrew Smith (Oxford East) (Lab): I congratulate my hon. Friend on securing the debate. I know that the time available is limited, but I wish to underline the importance of the point that she has just made in relation to our own heart centre in Oxford. It is critically important that there is close liaison and consultation with the parents whose babies are affected and who are campaigning to save the centres.
I am a former director of the Ambulance Service Network, and I know that paramedics are highly trained professionals-increasingly to degree level-who can provide lifesaving treatment for patients while taking them to specialist centres further away, but that is not always possible, and the review must thoroughly consider the implications of further travel for the lives that could and will be saved.
High-quality care is not just about standards of surgery, the links with other specialisms or the ability to access planned and emergency care. A recent event organised to discuss children's heart surgery in Leicester was attended by more than 800 parents and former patients, and those present felt that many more people would have attended if the event had not been held mid-week and during working hours.
The families said that the help and support that they get from the nurses, doctors and other staff at Glenfield are outstanding, and the key point that came up time and again was the excellent communication and support provided by the centre. Parents spoke about how staff go the extra mile to explain diagnoses and procedures simply and clearly, often at a frightening and worrying time. Every child gets a diary that explains in a way the whole family can understand what care they have received. It provides something for the children to look back at when they are older.
Parents said that the staff were like members of their own family; they could ring them day or night if they had any concerns. That familiarity with individual patients and families is crucial. All the studies by groups such as the Picker Institute of patients' experience of care prove that individual, personalised care and communication are vital. One young man said that the staff knew him as a person, not as just another case, and that he was worried that that would be lost in a larger unit or if his care were split between outreach clinics and other centres.
Families also spoke about the fantastic help they get from the Heartlink charity at Glenfield, which has raised money to provide accommodation so that parents can stay overnight with their children, a play area so that brothers and sisters can play while families are
visiting the child, and day trips for the patients as they get older. Those wider aspects of care are vital to parents and patients, but are barely mentioned in "The Need for Change". I urge the Minister to ensure that the review has fully considered those issues when it makes its recommendations.
The final factor that the review of children's heart surgery needs to take into account is affordability. It must be driven by the need to improve quality, not to cut costs, and, in these financially constrained times, it must acknowledge that there will be costs associated with changing children's heart surgery in England.
Nicky Morgan (Loughborough) (Con): Like the hon. Lady, I have visited the Glenfield centre, which is close to my constituency. As the parent of a healthy child, I felt humbled by the care that I saw there. The point that she is making about cost is important, because we appear to be achieving neither safer care-there has always been safe care-nor more efficient care. I understand that the reconfiguration would be very expensive, and she speaks rightly about straitened economic circumstances at this time.
Liz Kendall: I agree absolutely with the hon. Lady. The costs associated with changing children's heart surgery centres include not just physically expanding a centre's buildings, beds and equipment, but retraining staff. When I went to Glenfield, I was told that many of the staff would not move if the centre were changed. It takes time and money to train new staff, particularly in such a specialised area, and the review must take that into account when it makes its recommendations.
Sir Peter Soulsby (Leicester South) (Lab): I, too, congratulate my hon. Friend on obtaining this timely debate and on how she is expressing her concerns. She obviously has considerable understanding and experience of and expertise in these matters. Will she join me in asking the Minister to give an assurance that cost will not be the overwhelming issue that drives the decisions, and that the concerns, fears and wishes of parents and practitioners will be foremost in his consideration?
I welcome the Government's review of children's heart surgery and their objective of ensuring that all children get the best quality care, but I urge the Minister to ensure that the full range of clinical factors-not just the ratio of surgeons to patients-is taken into account as part of the review, in particular implications for accessing care, including in emergencies, and the knock-on effects for other specialisms. I urge him to ensure that other aspects of care that are critical to parents and families, such as the quality of communication, and the wider facilities and support, are properly considered.
I urge the Minister not to conduct the review on the basis of cutting costs-there will be costs associated with any changes-and to ensure that the views of parents, other family members and former patients are fully taken into account before recommendations are made in the autumn. I look forward to his response.
The Minister of State, Department of Health (Mr Simon Burns): I congratulate the hon. Member for Leicester West (Liz Kendall) on securing this important debate on the national review of paediatric cardiac surgery. I pay tribute to the dedicated national health service staff who work in paediatric cardiac care. It goes without saying-hon. Friends will agree-that during the course of their working day they do tremendous and fantastic work looking after critically ill and vulnerable children.
As the hon. Lady said, this is a complex and understandably emotional area. In 2008, the NHS management board asked the national specialised commissioning group to explore whether a reconfiguration of paediatric cardiac surgery services in England could improve levels of safety and sustainability. There had not been a problem at a particular centre, but surgeons, other clinicians, parent groups and the media had raised concerns over the risks posed by the unsustainable nature of smaller surgical centres.
The national review aims to ensure that paediatric cardiac services deliver the highest standard of care, regardless of where patients live or which hospital provides their care. All 11 centres in England that currently provide paediatric cardiac surgery, including Glenfield hospital in Leicester, are being assessed as part of the review. The objective of the review is not to close paediatric cardiac centres-I assure the hon. Lady that this is not a cost-cutting exercise.
Surgery may cease at some centres, but they would continue to provide specialist, non-surgical paediatric cardiology services for their local population. The review seeks to ensure that as much non-surgical care as possible is delivered as close as possible to the child's home through the development of local paediatric cardiology networks. I emphasise that no recommendations have yet been made about which centres should continue to undertake surgery.
Recommendations on future services will be published for the three-month consultation in the autumn this year. The trend in paediatric cardiac care is towards increasingly complex surgery, which requires large surgical teams that provide sufficient capacity to train and mentor the next generation of surgeons. The focus of the review is to develop services that are clinically appropriate, sustainable and safe.
As I said earlier, paediatric cardiac services are complex, and it has taken time to set up a transparent review structure that takes into account the views of patient and parent groups, and relevant professional societies. As part of the review, the commissioning group has held 10 stakeholder events. The invaluable contributions from parents and NHS staff will inform future stages of the review process.
The commissioning group has set a series of service standards, developed by experts, that take into account the contributions of parents and professionals. The standards cover the whole of paediatric cardiac services and emphasise the need for networks of providers to ensure a coherent service for children and their families. The current centres have been asked to assess themselves against those standards, and an expert panel chaired by Professor Sir Ian Kennedy has visited and independently assessed each centre. The standards will be subject to public consultation this autumn together with the recommendations for change.
I shall now deal with the standard for the numbers of procedures and of surgeons to which the hon. Lady referred. Questions have been raised about the evidence that underpins the standards for the minimum number of paediatric cardiac surgical procedures per year, and for minimum staffing levels. The recommended level of activity-between 400 and 500 procedures a year-is based on the level needed to provide good quality care around the clock while enabling ongoing training and mentoring of new surgeons. The professional consensus is that having four surgeons in each centre should enable services to avoid the risk of surgeons performing only a small number of some of the more complex procedures, which may not be enough to maintain their skills. Transforming a service from adequate to optimal requires sufficient volume, expertise and experience to develop what Sir Bruce Keogh calls "accomplished teams".
Mr Burns: As I said a minute ago, that recommendation is the consensus within the professional bodies. However, I am more than happy to give the hon. Lady a commitment that I will write to her after this debate to elaborate, providing as much extra detail as I can, if she believes that will be helpful.
Turning to the other criteria, the review will also take account of surgical centres' physical location relative to others and the impact of reconfiguration on other important services, including the highly regarded ECMO or total life support service at Glenfield hospital in the hon. Lady's constituency, which she described with such eloquence in her remarks. The final part of the review will involve centres' ability to attract key clinical staff and their families. I hope I can reassure the hon. Lady that transportation options and travel distances will be evaluated, including travel times specifically. The Paediatric Intensive Care Society has advised on the issue, and we continue to investigate and seek advice. I appreciate fully the importance of the issue and the concern that it causes many families.
Nicky Morgan: Will the review also consider the impact on other services? For example, at Glenfield, there are two intensive care units for children in the city, and I understand that one team covers both. If the centre were to be closed-this might also apply to other centres-it might destabilise other services within the hospital.
Mr Burns: The short answer is that I cannot make that commitment myself. As my hon. Friend will appreciate, the review is independent and will be carried out at arm's length from the Department of Health and Ministers. I do not have a role, and it would not be correct for me to seek to interfere in the process. However, having said that, I am confident that my hon. Friend's point will be considered as part of the review, because it will be comprehensive and across the board, considering all aspects of this highly specialised and important health care provision. I hope that reassures her.
The available research evidence suggests that larger surgical centres deliver better clinical outcomes. As cardiac expertise is available round the clock, they can perform a wider range of complex procedures, meaning fewer transfers between centres. Larger centres can still provide a personalised service. The service standards make it clear that tailoring services to the needs of each child is critical. That is an extremely important factor that I know the hon. Member for Leicester West understands and accepts fully.
I also assure the hon. Lady that any changes to local health services will not be driven from the top down. The review has strong support from external organisations. It has been instigated at the request of parent and patient groups, clinicians working in the service and professional associations, including the Children's Heart Federation, the Royal College of Surgeons, the Royal College of Paediatrics and Child Health, the Royal College of Nursing, the British Congenital Cardiac Association and the Society for Cardiothoracic Surgery in Great Britain and Ireland. It is important to understand that any recommendations on the future number and location of surgical centres will be made not by any central body but by the 10 specialised commissioning groups working with local NHS commissioners. The review will consider access to services for the whole country.
The national specialised commissioning group was asked to lead the review because of its co-ordinating role across the 10 specialised commissioning groups. I am sure that the hon. Lady will agree that that was the most sensible approach to take when the review was devised and set up just over two years ago in 2008. The group was ideally positioned to engage with commissioners and clinicians from across the country.
I reiterate that the review is being undertaken in response to the concerns of parents and professionals about the future capacity and capability of paediatric cardiac services. It will be an open process; I assure the hon. Lady that the outcomes are not predetermined. It is a genuine review seeking genuine answers in order to maintain the highest standards of quality in a specialised and difficult area of patient care. The national specialised commissioning group will set up a consultation process on its recommendations and standards this autumn. We must wait and see what the review says and then go through the consultation process, during which anyone will be able to input their thoughts, recommendations, comments, criticisms or praises of the review's findings, before any final decisions are taken.
I thank our external partners and their patients for their input to the review so far. I find it encouraging that the review has broad support across the board. As the hon. Lady will accept, children deserve the best possible care. The Government are determined to provide the best paediatric cardiac care possible after the review and consultation processes have been concluded and the final decisions reached.