Asked by
To ask His Majesty’s Government what steps they are taking to
ensure NHS targets for autism diagnosis are met.
(Lab)
My Lords, I beg leave to ask the Question standing in my name on
the Order Paper, and I declare my interest as a vice-president of
the National Autistic Society.
The Parliamentary Under-Secretary of State, Department of Health
and Social Care () (Con)
We recognise that not all areas are meeting the NICE recommended
maximum of 13 weeks between a referral for an autism assessment
and a first appointment. In 2022-23, we invested £2.5 million to
test and improve autism diagnostic pathways. In 2023-24, there is
a £4.2 million grant to improve services for autistic children
and young people. In April, NHS England published a national
framework and operational guidance to help the NHS and local
authorities improve autism assessment services.
(Lab)
My Lords, by next year 190,000 patients are expected to be
waiting for an autism diagnosis—it is already 130,000, and 67,000
of them have been waiting for more than a year. Research shows
that there is a widening gap between the number of people who
need to be seen and the number of staff available. In the last
four years, we have managed to recruit just 19% more staff. The
letter that the Minister helpfully sent us in April indicates
that he is as concerned about this matter as any of us in this
House. We appreciate that, but my question is simple: what is
being done to recruit more staff?
(Con)
I thank the noble Lord, both for his question and for his
interest and work in this space. The House will know that this
topic is quite close to my heart as well. It is an area of
challenge. We have more demand than ever. We are committed to
recruiting more staff. We have a recruitment target for next year
of 27,000. Very promisingly—I hope I will have time to go into
this in more detail later, or I will speak to the noble Lord
afterwards—there is a pilot scheme in Bradford looking at
children’s early years scoring and how that can be used as a
precursor to screening and testing.
(Con)
My Lords, I too declare an interest as a vice-president of the
National Autistic Society—I am always pleased to work alongside
my colleague, the noble Lord, , on these matters. Very often,
parents, in desperation, particularly want an autism assessment
when their teenagers get to the stage where they are leaving
school and going on to further education or other types of study.
Without that assessment, no decisions can be made. We have many
excellent centres around this country, particularly places such
as the Lorna Wing Centre, where assessments can be made. Is it
not time that the Government outsourced some of this, as long as
the NICE guidelines are followed in giving that assessment, to
ensure that the list that the noble Lord announced to the House
is reduced much more rapidly than is happening at the moment?
(Con)
Yes, absolutely, we need to look at all areas where we can
increase and expand supply, including use of the private sector.
I am sure I will be asked about ADHD later on and the “Panorama”
programme, which shows that there are some pitfalls in all that,
but provided they are assessing according to the NICE guidelines,
it clearly has to be sensible to use as much supply as
possible.
(LD)
My Lords, would the Minister agree that when you delay an
assessment, you delay support from the entire structure of
government, which we have said should be helping? What help is
his department getting from the Department for Education and the
Department for Work and Pensions to ensure people are getting to
these assessments? If they cannot get the full assessment, can
some intermediate steps be taken to ensure that people actually
get the help they are entitled to?
(Con)
We are working closely with the Department for Education. The
Bradford pilot scheme I mentioned takes the early years
foundation stage profile scores of children. It knows that if you
have a low score, you are far more likely to have autism. That
triggers a multidisciplinary team to come in and inspect. That is
a way that we can use that as an early warning indicator and then
follow it up with volume. I hope that working very closely with
the DfE in this space will be a real way forward.
of Hudnall (Lab)
My Lords, the Minister has already anticipated receiving this
question—I would not want to disappoint him. He is clearly aware
that there is some question over the reliability of some
diagnoses that are being offered, particularly in the private
sector, for ADHD, which is another neurodevelopmental disorder.
Is he confident that, in trying to scale up the availability of
diagnosis, which is obviously an admirable aspiration, the
quality of those diagnoses will be maintained? Are the NICE
guidelines sufficiently robust to ensure that?
(Con)
As we all know, it is a complex area, and there is no black and
white diagnosis of autism. The noble Baroness’s point is
absolutely correct: we need to make sure that the quality is
there. The Bradford pilot has now been running in 100 locations.
Every child has to get an early years profile score. If we can
show the linkages and follow that up with the screening
programme, that will be very promising; but, absolutely, we have
to make sure that the right assessment is made.
(Con)
My noble friend the Minister has rightly said that it is
important to expand supply and work with the private sector. Can
he tell me about the work that the department is doing with civil
society organisations and charities in expanding supply?
(Con)
Yes, when I talk about supply, it is in all these fields. There
are organisations of which I have personal experience, including
the National Autistic Society, which does tireless work and has
helped me out personally. So I know just how good they are in
this situation. Absolutely, the whole strategy in this space is
to expand supply by both the private sector and the independent
and charity sectors.
(Lab)
My Lords, on autistic children, do the Government keep separate
facts and figures for minority communities? I have encountered
quite a few ethnic minority children who are suffering from
autism. Are there separate facts and figures anywhere for these
children?
(Con)
Clearly, we pull together all the numbers. Typically, about 2.9%
of children and young people are diagnosed with autism. I do not
know whether that is different among ethnic minorities. I will
happily research that and write to the noble Lord.
(Con)
My Lords, may I ask my noble friend about artificial
intelligence—AI? It is going to have a transformational impact on
our National Health Service, for good, or possibly for ill. It
will transform diagnosis, treatment, outcomes and—who knows?—it
may even help us to make appointments more effectively. Of
course, it will have an impact on those who work in the National
Health Service as well as those who are treated by it. Have the
Government started getting to grips with analysing what lies
ahead with artificial intelligence? If not, I encourage them to
do so very quickly because I believe that the impact of this will
come much more rapidly than we might perhaps think at the
moment.
(Con)
First, I totally agree with my noble friend’s sentiment about the
power that AI, when done in the right way, can have in this
space. Clearly, the stress is on the words “the right way”. I
think it is fair to say that we are all on the nursery slopes as
regards what it can do. I have seen how effective it can be in
taking doctors’ notes, recording a meeting and drafting action
points, which a doctor can then review. I am sure that we would
all agree that that is very promising. There are future
generations of AI being talked about that may be able to perform
diagnosis. In the 10 to 15 years of looking ahead in the
long-term workforce plan, these are some of the things that we
will have to try to take into account. However, we are in the
very early stages.
(Lab)
My Lords, when it comes to autism services, we know that there
are major disparities across the country which predate the
pandemic but which were made much worse by it. The number of
people waiting for an assessment has grown by 169% from
pre-pandemic levels. How will the Minister ensure that the
national framework and the standards for autism assessment within
it are deliverable at a local level and in every part of the
country?
(Con)
First, each ICB now has to have a lead for autism and learning
difficulties. The noble Baroness is correct that there are some
disparities— I am sure that she is aware of the two ICBs which
have restricted their services quite significantly, although,
thankfully, they are now rowing back on that. We need to make
sure that we are on top of all of them. As the noble Baroness is
aware, I and other Ministers are taking a personal interest in
this. Clearly, there is a lot of work to be done.
(CB)
My Lords, what are the Government doing? Are they supporting
research to find out the causes of this apparent huge increase in
autism which we have seen in recent years?
(Con)
There are a couple of factors. Obviously, the strains and
stresses of Covid have brought a lot of these things out into the
open. It is good that people are becoming much more aware. My
experience dates back 20 years when no one had even really heard
of Asperger’s, so it is good that we are aware of it today. It is
also good that many more people are now diagnosed with it.
