(1) The Secretary of State must prepare and publish a document setting out a strategy for meeting the needs of adults in England with autistic spectrum conditions by improving the provision of relevant services to such adults by local authorities, NHS bodies and NHS foundation trusts.
(2) That document is referred to in this Act as the autism strategy.
(3) The autism strategy must be published no later than 1 April 2010.
(4) The Secretary of State
(a) must keep the autism strategy under review, and
(b) may revise it.
(5) If the Secretary of State revises the autism strategy the Secretary of State must publish it as revised.
(6) The Secretary of State must consult and seek the participation of such persons as the Secretary of State considers appropriate
(a) in preparing the autism strategy, or
(b) in revising it in a way which would, in the opinion of the Secretary of State, result in a substantial change to the strategy.
(7) A document prepared and published by the Secretary of State before this section comes into force is as effective for the purposes of this section as a document prepared and published after that time.
(8) Consultation and steps to seek participation undertaken by the Secretary of State before this section comes into force are as effective for the purposes of this section as consultation and steps to seek participation undertaken after that time.. (Phil Hope.)
(1) For the purpose of securing the implementation of the autism strategy, the Secretary of State must issue guidance
(a) to local authorities about the exercise of their social services functions within the meaning of the Local Authority Social Services Act 1970 (c. 42) (see section 1A of that Act), and
(b) to NHS bodies and NHS foundation trusts about the exercise of their functions concerned with the provision of relevant services.
(2) Guidance must be issued under this section no later than 31 December 2010.
(3) The Secretary of State
(a) must keep the guidance under review, and
(b) may revise it.
(4) In keeping the guidance under review the Secretary of State must in particular consider the extent to which the guidance has been effective in securing the implementation of the autism strategy.
(5) Guidance issued under this section must in particular include guidance about
(a) the provision of relevant services for the purpose of diagnosing autistic spectrum conditions in adults;
(b) the identification of adults with such conditions;
(c) the assessment of the needs of adults with such conditions for relevant services;
(d) planning in relation to the provision of relevant services to persons with autistic spectrum conditions as they move from being children to adults;
(e) other planning in relation to the provision of relevant services to adults with autistic spectrum conditions;
(f) the training of staff who provide relevant services to adults with such conditions;
(g) local arrangements for leadership in relation to the provision of relevant services to adults with such conditions.
(6) The Secretary of State must consult and seek the participation of local authorities, NHS bodies and NHS foundation trusts before
(a) issuing guidance under this section, or
(b) revising it in a way which would, in the opinion of the Secretary of State, result in a substantial change to the guidance.
(7) Consultation and steps to seek participation undertaken by the Secretary of State before this section comes into force are as effective for the purposes of this section as consultation and steps to seek participation undertaken after that time..
This New Clause would require the Secretary of State to issue guidance to local authorities, NHS bodies and NHS foundation trusts in order to secure the implementation of the autism strategy. It would also require the Secretary of State to consult on the guidance and keep it under review.
Government new clause 3Local authorities and NHS bodies: duty to act under guidance
(1) This section applies to guidance or revised guidance issued under section [Guidance by the Secretary of State] to a local authority or an NHS body.
(2) Guidance or revised guidance is to be treated as if it were general guidance of the Secretary of State under section 7 of the Local Authority Social Services Act 1970 (c. 42) (local authorities to exercise social services functions under guidance of Secretary of State).
(3) For the purposes of guidance or revised guidance
(a) an NHS body is to be treated as if it were a local authority within the meaning of the 1970 Act (see section 1 of that Act), and
(b) the functions of an NHS body mentioned in section [Guidance by the Secretary of State](1)(b) are to be treated as if they were its social services functions within the meaning of that Act (see section 1A of that Act)..
This new clause would impose a duty on local authorities and NHS bodies to act under guidance given by the Secretary of State under New Clause 2. The duty is the same as that imposed on local authorities by section 7 of the Local Authority Social Services Act 1970.
Government new clause 4Interpretation
(1) In this Act
adult means a person who is aged 18 or over (and, accordingly, child means a person who is under the age of 18);
local authority means
(a) a county council in England;
(b) a metropolitan district council;
(c) a non-metropolitan district council for an area for which there is no county council;
(d) a London borough council;
(e) the Common Council of the City of London;
(f) the Council of the Isles of Scilly;
NHS body means
(g) a Strategic Health Authority;
(h) a Primary Care Trust;
(i) a National Health Service trust all or most of whose hospitals, establishments and facilities are in England;
(j) a Special Health Authority performing functions only or mainly in respect of England;
(k) in relation to an NHS body, means health services provided for the purposes of the health service continued under section 1(1) of the National Health Service Act 2006 (c. 41);
(l) in relation to a local authority, means services provided in the exercise of the authoritys social services functions within the meaning of the Local Authority Social Services Act 1970 (c. 42) (see section 1A of that Act).
(2) In this Act references to the provision of services include references to arranging for the provision of services (and references to services provided are to be construed accordingly)..
This New Clause is consequential on New Clauses 1, 2 and 3 and would provide definitions of terms used in those New Clauses.
Government new clause 5Extent, commencement and short title
(1) This Act extends to England and Wales only.
(2) This Act comes into force at the end of the period of 2 months beginning with the day on which it is passed.
(3) This Act may be cited as the Autism Act 2009..
This New Clause would make provision for the Bill to extend to England and Wales (although it would only have application in relation to England), to come into force 2 months after Royal Assent and for the resulting Act to be cited as the Autism Act 2009.
Clauses 4 to 9 stand part.
Government amendment 42, in title, line 1, leave out from make to and in line 3 and insert
provision about meeting the needs of adults with autistic spectrum conditions;.
I am delighted to be back here in Committee this afternoon and, indeed, proud to be speaking to Government new clauses 1 to 5.
Turning first to Government new clause 1, as the Committee knows, the Government are committed to taking action to improve services for people with autism. We are determined to see true transformational change. Our means for achieving that is through the development and publication of an adult autism strategy. The full public consultation on the content of that strategy began last month, which in itself is an indication of our commitment to it. I therefore have great pleasure in introducing a measure to place that commitment on a statutory footing.
Briefly, subsection (1) places a duty on the Secretary of State to prepare and publish a document setting out a strategy for meeting the needs of adults in England with autistic spectrum conditions by improving the provision of relevant services by local authorities and the national health service. With the strategys external reference group chaired by the chief executive of the National Autistic Society, we have identified the priority headings for an adult autism strategy. They are health; social inclusion, including employment; choice and control; and training.
Under the heading of health, we shall identify the barriers to accessing specialist health interventions and mainstream health care services and shall propose action and a strategy to address that. That will be informed by the report of the study currently being taken forward by the National Audit Office, which we expect to see shortly. Secondly, under the heading of social inclusion, the strategy will address issues of employment for people with autism.
The strategy will address issues of employment for people with autism. That includes building on work to address the commitments in public service agreement 16 to support more of the most socially excluded groups of people into employment and the forthcoming learning disability employment strategy.
On choice and control, we are commissioning work from the Social Care Institute for Excellence to publish evidence-based good practice guidance in spring 2010. That will be informed by an analysis of existing research by early summer, and an in-depth knowledge review which will include field work exploring best practice. On training, we will work with professional bodies to take action to address training issues. Skills for Care has recently launched a national consultation to create new knowledge sets to support people who have an autistic spectrum condition, with the aim of publishing in June the basic knowledge needed to support people with autism.
Subsection (2) confirms that the document is to be known as the autism strategy throughout the Bill. Subsection (3) is significant, because it ties the Secretary of State into publishing the strategy no later than 1 April 2010. Not only are we committed to producing the strategy, we are setting ourselves a statutory deadline for doing so. That is a significant departure from normal legislative practice, but I believe it is entirely right to lock in the Governments commitment in this way. In fact, we have already made clear our intention to publish the final strategy by the end of 2009, and that remains the case. The Committee will appreciate that, if we are going to take the unusual step of specifying a publication deadline in the Bill, we need to give ourselves a sensible margin of flexibility.
Subsection (4) imposes a duty on the Secretary of State, once the autism strategy has been published, to keep it under review, and gives him a permissive power to revise it if that is considered appropriate as a result of that review process. Subsection (5) is a logical follow-on from that permissive power, requiring that if the strategy is revised, it must be republished.
Subsection (6) is also significant in my view, because it guarantees proper consultation with stakeholders on the content of the strategy, both at the outset, and in the event that substantial revision is considered. However, the provision goes further, allowing some of those stakeholders to be actively involved in the development of the strategy, rather than just consulted. That reflects the close working relationship that we have with the National Autistic Society, which we want to ensure can continue. In addition, I recently met the Autism Trust, and attended an Autism Speaks reception only last week. I am looking forward to hearing their views and the views of many other organisations as the consultation process continues. Certainly, the strategy document has benefited from input from an external reference group comprising people with autism, families, carers, and health and social care professionals involved in the front-line delivery of services. I am extremely grateful to all members of that group, especially the chairs of the thematic groups, for all the work they have done to identify barriers to inclusion and options for interventions to transform lives. We will, of course, continue to work very closely with the group over the next few months to build on what it has already done, as we develop firm proposals for the final strategy.
My hon. Friend has just talked about the provision that requires the Secretary of State to keep the strategy under review. There is no sunset clause in the Bill, so does that mean that the Bill effectively lasts forever, until it is repealed, and that the Secretary of State is required continually to keep the strategy under review? How frequently would we expect the Secretary of State and the Department to look at the strategy to ensure that it was current?
My hon. Friend is right; there is no sunset clause in the Bill. Therefore, if we enact, it will be a permanent feature that the Secretary of State regularly reviews the strategy and republishes accordingly. That means that the review process should be continual, rather than a discrete exercise at arbitrarily specified intervals. It will be an ongoing process, so that we can respond as quickly as possible to any significant changesthe more important pointor developments in the autism field as a result of work that is done.
The Minister has done such a brilliant job that I rise to speak with some trepidation. On the very point that has just been raised, did he consider at any time whether the review might be regarded at the very least as an annual review?
Yes, we considered that, but the key issue is that we want to be able to respond to changes in the world of autism research, so that if something significantly changes in our understanding of the causes or the consequences of autism, or in the way to respond to the needs of people with autism, we are able to revise the strategy, rather than having an arbitrary annual process.
I think that we are reaching a wonderful consensus on this Bill, but in the context of regular reviews, the Minister will of course remember that the Valuing People White Paper set out a requirement that the Government strategy for learning disabilities should be subject to annual review. I will not press him on that now, but it is a model that he might wish to reflect on.
The hon. Gentleman makes a useful contribution. We looked at various models, but in this area of policy, in which we know there could well be significant changes in the development of our thinking, this is the right approach. Valuing People takes a different approach, which is more about delivery and implementation. With the strategy for people with learning disabilities, we need to ensure annually that we hold to account those responsible for delivering the strategy and making change happen on the ground.
I believe that the Minister is well intentioned on that point, but there needs to be some clarity about the tipping point for a review. If something comes up and there is an urgent review, that is a good thing, if the Minister is committed to it. However, the hon. Gentleman will not always be the Minister, so what assurance can he give to those in the future who might think that there is a need for a review and might disagree with the Minister in post?
By virtue of this procedure being in the Bill, it is imperative for whoever is Secretary of State to continually review developments in the world of autism, and if need be, to change the strategy to reflect them. I believe that the assurances to which the hon. Lady refers are provided by the procedure being a statutory requirement, and by my comments today on the new clause and the importance of responding to significant changes. It is important that future Governments are as committed as we are now to achieving the change that we want to see.
I commend both Ministers for the work they have done and also the promoter of the Bill, the hon. Member for Chesham and Amersham, for working with them.
On reviews, will the Ministers consider the timing of reviews and see whether there could be an amendment, even on Report, to firm that up? My other point concerns revising and continuing to look at the strategy. Can we be assured that the same groups of people involved in the consultation on the strategy nowparents, carers and those with autismwill continue to be consulted when any revision is taking place?
I thank my hon. Friend for her kind remarks. We want to ensure that in the development of the strategy, now and in future years, we continually engage, consult and work jointly withco-production is the term that I know we will learn to usea variety of stakeholders, particularly those who represent the families and the individuals who have autistic spectrum conditions. It is important that we find a way to do that. I would not like to tie future Ministers to a particular model. We have developed the external reference group, and as time goes on there might be other models that are more appropriate, but certainly there should be a mechanism for engaging and working with a variety of stakeholders, as well as the local authorities and the health service.
I am extremely grateful to the Minister for giving way and I promise not to trespass on his patience. He has made a good series of points.
In the spirit of the comments made by the hon. Member for Burton, will the Minister at least consider the possibility of a fall-backa maximum time of perhaps four or five years during which a review might take place? It would not preclude the possibility, if circumstances dictated, of an earlier review, but it would at least reassure the Committee that the strategy was not for ever. My hon. Friend the Member for Chesham and Amersham might have some reservations about that, but I would love to hear the Ministers answer first.
That strategy would mean that we risk always having a review every five years and therefore would not have a review to respond to any significant changes in the world of autism. I can see the arguments both ways. I recommend we adopt the approach that is in the Bill, although I understand hon. Members contributions about how we might go about doing it.
I am listening carefully to the Minister. I hope that it does not escape the attention of observers of the Committee that it is the Minister who is moving the new clauses, which shows what a great job of work has been done by the officials and the Minister. It is a most unusual development in a private Members Bill and people should recognise that.
In looking at the review and the general powers in which this area will be considered, I was hoping to seek the Ministers agreement to clearly identified and named officials in the Department whose names would be widely published throughout the world of autism so that people know who to focus on. I like the idea of a continual review and being able to respond rapidly, because, as I understand it, that is the nature of developments in autism today. I would be unhappy if any part of the legislation, were it to become an Act, inhibited that process.
I have a specific question on clause 2(5) and what should be included in statutory guidance. It is a comprehensive list but it does not mention local data collection databases, which is a central theme in the Autism Bill as it stands. Will the Minister consider looking at that before Report and Third Reading?
On the latter point, I shall come to clause 2 in a moment and I will address that issue.
I am grateful to the hon. Lady.
There has been a process of joint working. What we are doing is unusual, but there is a profound commitment across the House among different individuals and political parties to making a step change in what we do and how we respond to the needs of people with autism. That is why I said how proud I am to move these new clauses; the outcome has been achieved by work that we have done together. I want to put on the record my thanks to the officials who, with very short notice and at breakneck speed, have brought us to this position.
On the question about a named individual, the Department currently has a national adviser on autism, Elaine HillI am not sure whether I am allowed to name people but I have anyway. She does that work for us now, although I cannot guarantee that such a post will continue over the years ahead or that that individual will continue to hold it. However, recognition by the Department that somebody should have those responsibilities is a useful suggestion, and I thank the hon. Lady.
I will move on to subsection (7). As I indicated in relation to subsection (3), our intention is to publish the strategy before the end of 2009. As we know, parliamentary processes take time and it is conceivable that the Bill may not come into force until DecemberI hope that is not the case, but it is possibleso we might find that we want to publish the strategy before the Bill is in force. Subsection (7) covers that possibility and ensures that an adult autism strategy published before the Bill comes into force will still fulfil the duty of the Secretary of State.
Subsection (8) does much the same thing in relation to the consultation process for the strategy. It ensures that the current consultation fulfils the duty to consult, even though, clearly, it will have not only have begun but in all probability will have ended before the Bill is on the statute book. Taken together, the duties and requirements set out in the new clause tie the Government into the preparation and publication of an adult autism strategy in a way only rarely seen in statute. That is no more than we have already committed to, and I have no qualms about bringing forward legislation that gives hon. Members, key stakeholders and the general public a sure and certain means of holding us to account on the delivery of those commitments. I commend the new clause to the Committee.
On new clause 2, the development and publication of the adult autism strategy will be only the first stage in the journey of transformation of services for people with autistic spectrum conditions. We do not intend simply to put it into the public domain and leave local authorities and the NHS to get on with it. On the contrary, I have already made it clear that the strategy will be followed up by detailed guidance that sets out what the NHS and local authorities need to do to achieve the visionary changes that I expect to see described in the strategy. The new clause puts that commitment on a statutory footing in the same way that new clause 1 does for the strategy itself. As I shall explain, it goes further and guarantees that a number of topics will be included in the guidancetopics that I know are of great importance to our key stakeholders.
Taking the provisions in order, subsection (1) places a duty on the Secretary of State to issue guidance to local authorities and NHS bodiesincluding NHS foundation trustsabout the exercise of their respective functions in order to secure the implementation of the autism strategy.
I am grateful to the Minister and to the Under-Secretary of State for Children, Schools and Families, my hon. Friend the hon. Member for Portsmouth, North, because I know that a lot of work has been done on the Bill. May I return to the point raised by the hon. Member for Chesham and Amersham? My hon. Friend the Member for Blackpool, North and Fleetwood and I chaired a review on this matter two years ago. One of the points that came across strongly was that we did not have the information, particularly from local authorities, that was necessary to enable us to make our strategy as meaningful as we wished. We thought that local data collection was very important, and I wonder whether the Minister has given thought to that matter. He has got everything else right.
The particular point about information and data gathering that was raised by the hon. Member for Chesham and Amersham and my right hon. Friend is covered in the subsections. We have had to use appropriate statutory language, and paragraphs (5)(b) and (c), taken together, meet the point about information and data gathering.
I appreciate that the provisions bind public authoritiesquite properlyand that guidance will follow. However, at least in the guidance, if not in the Bill, will the Minister assure the Committee that he will expect public authorities to liaise sufficiently with the private and, more particularly, the voluntary and not-for-profit sectors, to take into account their views and to make use of the services and other opportunities they provide? They have great expertise and it is obviously sensible that they should be engaged fully in the process.
I think that I can give the hon. Gentleman those assurances, although not necessarily in the Bill. That is certainly how we expect the process to develop. Any statutory guidance issued has to have a 12-week consultation period and that gives us, as well as all the organisations that the hon. Gentleman mentioned and many more, the opportunity to be fully involved.
Will my hon. Friend clarify the point about data collection? He will recall that on Second Reading concern was expressed that some peoples autism is not such a problem at particular stages in their lives that they need services, but they may need services later on in life. That applies especially to some young people with Aspergers. Collecting the data is complex, so will my hon. Friend ensure that, as part of the guidance, he draws the attention of local authorities to the fact that there are people with autism to whom they might not be delivering a service now, but for whom they may need to plan to deliver a service in future?
My hon. Friend raises an excellent point about the need to ensure that the guidance does not leave anybody outthat there are no holes. Due to the legal approach to writing law, paragraphs (5) (b) and (c) together give us the outcome that we want. The details of how the guidance will look and its content, ensuring that the concerns that she has raised are not missed, will be a key part of the consultation process. The fact that my hon. Friend has made those points today will help to ensure that when the consultation process on the guidance starts, it covers the points that she raises. All stakeholders will have the opportunity to ensure that that is the case so that the issues that my hon. Friend is concerned about are covered when the guidance is agreed.
Subsection (2) requires the guidance to be issued no later than 31 December 2010. Again, that is an unusual step to take, but I am happy to do so to give greater reassurance that our commitments are, in effect, set in stone. It was one of the concerns raised on Second Reading. I am happy to be clear about our commitment by putting it in the Bill. I want to spend a moment explaining why we have chosen that particular date as the final deadline for the guidance. Some people may feel that nine months between the final publication deadline for the strategy and final publication of the supporting guidance is a long time.
First, it is a no-later-than deadline. There is nothing to stop us issuing the guidance sooner if we are in a position to do so. However, we need to go through a number of steps to develop the guidance. For a start, the guidance will be about implementing the strategy, so until we have completed the consultation on the strategy and are more certain about what the exact priorities for action are to be, we cannot start working up the guidance in detail.
Secondly, if we are to place an obligation on the NHS and local authorities to act in accordance with the guidance, it is only fair to consult with those organisations on its content to ensure that we do not, for example, set requirements that are impossible for them to meet in practice. As those who are familiar with the parliamentary process know, all these things take time. We have had to make a realistic estimate of how much time we will need and, as with the strategy, build in a little extra to cover the unexpected. Although it may well be possible to issue the guidance considerably earlier than the end of 2010, we have taken the prudent step of ensuring that we have sufficient time to do the job properly.
Subsection (3) places a duty on the Secretary of State to keep the guidance under review and gives a power to revise it. Subsection (4) ensures that in reviewing the guidance, we pay particular attention to how well it is doing its job of securing the implementation of the autism strategy. That is not the only thing to consider, of course, but it is of sufficient importance to justify its being specified in the Bill. I think that echoes the point raised by the hon. Member for Daventry about the Valuing People Now strategy.
Subsection (5) is particularly important because it is where the minimum coverage of the guidance is set out under broad headings representing the key issues that it is clear, even at this early stage, the guidance will need to cover if it is to be effective in improving services for people with autism.
Yes. These paragraphs include provision of diagnostic services and information gathering, including needs assessment.
On the question of diagnostic services, some of the most complex cases involve undiagnosed adults who are in the community. They may be middle aged or even older. In order to get the right person to make the diagnosis, an out of area referral is often appropriate because diagnosis of autism in some of the more complex cases needs to be done by someone who has lived and worked autism as a professional for many years. Would the Minister take a look at the processes for GPs and other health workers to make out of area referrals to specialists in the more difficult types of case?
The hon. Lady makes a very helpful contribution. We understand that improvements are needed in how a diagnosis is made and who makes it. The guidance will talk about the provision of diagnostic services, but I cannot say to what extent it will cover her specific points about out of area referrals. That must be a matter for the strategy and then the guidance and the consultation to follow. However, I assure her that the points she has made today can be part of that process.
In terms of the specialisms that the hon. Lady describes, one of the paragraphs includes a reference to guidance on work force training. That is an extraordinarily important point. Overall, the subsection covers diagnostic services and information gathering, including needs assessment, which I hope addresses the point made by the hon. Member for Chesham and Amersham. It also includes strategic planning of services, transition planningon Second Reading many hon. Members spoke about the transition between childhood and adulthoodwork force training and local leadership, because we all know that is what is required when we want to make things happen.
This is turning into a constructive dialogue, so I hope the Minister will take my intervention in that spirit. He referred to the training of staff who provide relevant services to adults with such conditions. That is clearly important where their services are directly appropriate to people within the autism spectrum, but there is a wider issue, which I hope he will relay across the NHS: all staff in the caring services need to be aware of the possibility of autism as a potential condition. They need to have at least a reasonably sensitive and, if possible, a perceptive reaction to people who present with certain difficulties so as to ensure that they then get the diagnosis and support they need.
I do not know whether the hon. Gentleman has seen my speaking notes, but I was just about to say that the themes we have identified reflect what happened in the consultation and in particular the importance of public services coming together to assess the needs of people with autism, and to consider what support they need to live independently and to be included in their communities. In that process, driving a change in attitudes and culture, particularly among all front-line staff who come into contact with people with autism, is particularly important. The hon. Gentleman is absolutely right and that is our intention with these measures.
I am encouraged by what the Minister has said. Would that approach get rid of the professional who occasionally says, We do not like to label.? One comes across that occasionally from social workers and health professionalsnot as much now as one used to. The failure to diagnose properly means that we remove from that individual access to services. It is the passport to the way forward and I hope that is what the Minister means in what he has just announced.
I cannot guarantee the outcome the hon. Lady describes, but the intention is to seek to ensure that the needs of people with autism are not overlooked, that they are properly assessed and services are developed to meet those needs. I hope that we might reach that position. We are talking about cultural change, which does not happen overnight, but the intention behind the strategy and the guidance is to deliver that change in attitude and approach for all staff who come into contact with people with autism.
The list is not exhaustive or exclusive. Provisions do not preclude other issues being included in the guidance; it is only required that those particular issues must be.
Subsection (6) places a duty on the Secretary of State to consult local authorities and the NHS before issuing the guidance, as I mentioned earlier, and before substantially revising it. Subsection (7) is included to allow for the possibility that the parliamentary process may mean that the consultation on the guidance begins before the legislation comes into force and provides that the consultation in those circumstances be valid for the purposes of discharging the duty to consult.
I believe that the new clause creates an airtight obligation on Government to issue guidance to local authorities and, significantly, the NHS to support the implementation of the autism strategy and to consult those organisations before doing so. It gives a concrete deadline for that to be done and it sets out some key topics that are of such importance that they must be included in the guidance. I commend the new clause to the Committee.
I tabled new clause 3 to fulfil the Governments commitment to putting the guidance on implementation of the autism strategy on a statutory footing as regards local authorities and NHS bodies. The mechanism we are using to achieve that is a little complex, so I hope members of the Committee will bear with me while I explain the approach we have taken.
Section 7 of the Local Authority Social Services Act 1970 gives the Secretary of State powers to issue general guidance. Local authorities are then required to exercise their social service functions in accordance with that guidance. Over the years, a body of case law has established that this requirement is more than simply taking account of any guidance under section 7. Local authorities are expected to act in accordance with such guidance unless they can show compelling reasons not to do so. A local authority that ignored guidance issued under section 7, or arbitrarily chose to disregard it, would be acting unlawfully and could find itself subject to judicial review or default action by the Secretary of State. Thus, although not law in the same way that regulations are law, the obligation to act in accordance with section 7 guidance is very strong and such guidance is commonly referred to as statutory.
This is an appropriate moment to raise with the Minister a matter I raised about section 7 on Second Reading. Health service circulars specifically relating to autismAspergers syndrome in particularhave been ignored. I have drawn his attention before to the one issued in August 2001. Although there will be repercussions if people do not adhere to the guidance, how will the Minister ensure that happens? To my certain knowledge, health authorities just file the circular I have mentioned. I have to hand out new copies to every social worker I come across to prove it exists.
Interestingly, a power similar to the one I have just described for local authorities does not exist for NHS bodies. Because of the points the hon. Lady has raised, I wanted to go further than the guidance for local authorities. Having listened to others and to the points people have made in debate, I wanted to issue guidance to NHS bodies because of their key role in caring for adults with autism. The Secretary of State can, of course, issue guidance to the NHS and does so regularly, as the hon. Lady has just been describing. However, as she said, nothing in health legislation places the same obligation on NHS bodies to act in accordance with it. They must take it into account, but can choose not to act in accordance with it after having given it due consideration.
To be fair, in practice most NHS bodies follow most guidance most of the time, but the fact remains that it does not have the same statutory status as the guidance issued under section 7 of the Local Authority Social Services Act. For that reason, subsection (2) specifies that guidance issued under new clause 2 is to be treated as if it were general guidance issued under section 7 of the Act. That covers local authorities and ensures that they would treat such guidance as statutory.
To create the same effect for NHS bodies, subsection (3) provides that, for the purposes of guidance issued under the Bill, NHS bodies are to be treated as if they were a local authority to which the provisions of the 1970 Act apply. Their functions are to be treated as if they were social services functions within the meaning of the 1970 Act. NHS bodies will be bound by the guidance to exactly the same extent as local authorities.
Such measures are certainly a breakthrough after years of campaigning, particularly by my hon. Friend the Member for Tiverton and Honiton and other members of the Committee. To put the matter beyond doubt in our proceedings, the new clause would bind local authorities and NHS bodies so that, in future, they cannot ignore, either accidentally or intentionally, the needs of people with autism and their families.
I thank the hon. Lady for her remarks. She is absolutely right. The body of case law that established the status of section 7 guidance as more than just advice to be taken into account will apply equally to national health service bodies.
I congratulate those who have been involved in the discussions on their ingenious solution of making an NHS body a local authority. We might learn from that point for other legislation. Nevertheless, everyone who has dealt with constituents or family members in their struggle with local authorities for any form of recognition and then treatment or care know that the process is difficult, and even more difficult with NHS trusts. That might not be a matter for the Bill today, but offering judicial review or the Secretary of State intervening on the basis of a default notice is still a tortuous process. Judicial review is expensive and complex, so within the strategy the Minister might look at what resources there are for individuals and their families to exercise the right to ensure that the guidance is in force.
I appreciate my hon. Friends point. The Bill does not cover that sort of support. Part of me wants to say that I hope we do not have to resort to judicial reviews to enable people with autism to get the services that they require. However, I understand that he is saying that that fallback position will now apply to NHS bodies as it now applies to local authorities. I hope that we see a cultural shift in the way in which NHS bodies act in accordance with the guidance issued to them after the Bill is enacted.
I have to nip down the Corridor for another meeting for a few moments, so I shall now make a point that I had intended to raise later as it is equally germane now. First, will the Minister assure us that when local authorities and NHS bodies act jointly, they will be jointly and severally bound to meet that duty and that they cannot get out of itfor example, by passing it on to their neighbour? Secondly, the Minister will know from the whole business of community care that such issues are very fraught, so in cases when a statutory bodyto use shorthandinvolves a private sector agent, or more likely a voluntary body, to deliver the service, can we be assured that its delivery will be equally bound by the duties as if it were carried out in-house?
I am hoping that inspiration will arrive on whether joint commissioning between local authorities and NHS will be covered jointly so that there is no game playing. I am pretty sure that is the case, but I may need to write to the hon. Gentleman[Interruption.] I can now tell him that when the guidance requires something of both a local authority and a national health service body, the answer to his question is yes.
That is a helpful answer, but the other point that I need to clear upwe shall take it as being covered, unless the Minister needs to write to the Committee to the contraryis a case in which, for example, two bodies in the NHS or, separately, in the local authority have merged their functions. They might have a joint board if they want to carry something out. Are they just as much bound as if they were individual local authorities?
We are delving into detail that I cannot answer at the moment. I may have to write to the hon. Gentleman to clarify the position.
As a result of all those approaches, NHS bodies will be able to be held to account for compliance with the guidance in the same way as local authorities. My hon. Friend the Member for Hayes and Harlington described the solution as ingenious; we of course considered alternatives for achieving the same outcome, but that was the clearest and most sensible way to ensure that the guidance would have the same status across the piece. The arrangements will need to be explained in the guidance document, and that may be the opportunity to cover the detailed points raised by the hon. Member for Daventry.
I do not expect a pat answer now, but to ensure that the letter is sufficiently comprehensive for the Committee, will the Minister also look again at the issue of what I shall call, in shorthand, private sector non-statutory bodies delivering? It is terribly important that there is no perceived loophole in that area.
I shall need to confirm that to the hon. Gentleman. I am not sure that the legislation will directly cover a third party commissioned by an NHS body or local authority, because the responsibility will be on the local authority or the NHS body to ensure that in commissioning its services in that way, the contract with the third party is robust enough to deliver the outcomes. The normal processes of contract compliance would apply, in order that the local authority or the NHS body fulfils its obligations under law. If I have got that wrong, however, I shall confirm otherwise.
I am satisfied that the new clause effectively discharges the Governments commitment to place the guidance on implementation of the strategy on a statutory footing and I commend it to the Committee.
I have tabled new clause 4 in consequence of new clauses 1 to 3, to define terms used in those clauses. Much of the content of subsection (1) of new clause 4 is self-explanatory, but I shall draw the Committees attention to a couple of points. First, the definition of local authorities has been put together specifically to ensure that only English councils are included; the same is true of the definition of NHS bodies. It is important to ensure that the Bill does not unintentionally extend to Wales.
The Committee will notice that NHS bodies does not include NHS foundation trusts. That is deliberate; NHS foundation trusts have greater autonomy than other NHS trusts and, therefore, we have had to distinguish in the Bill the status of guidance in relation to NHS bodies from its status in relation to NHS foundation trusts. Although new clause 2 provides for guidance to be issued to NHS bodies, NHS foundation trusts and local authorities, the guidance will be what is normally referred to as statutory guidance only in relation to NHS bodies and local authorities. That means that NHS foundation trusts must take into account the guidance, but they are not required to act in accordance with it at all times. However, NHS bodies, as defined in the Bill, and local authorities will be required to act in accordance with the guidance, unless they have very good reason not to, and a failure to act in accordance with the guidance in any other circumstance would be unlawful. That reflects the Governments wider policy in relation to the greater autonomy of NHS foundation trusts.
Yes. The Bill does not apply to foundation trusts for the reasons that I have just givenwider policy and so onbut if a PCT is contracting with a foundation trust, as I said earlier, the obligation of the PCT as an NHS body to ensure that it is carrying out its statutory duties is, therefore, handled through the contracting process. I emphasise that NHS foundation trusts have more autonomy in the system, which is why the Bill cannot directly apply to them in the way that it may apply to other NHS bodies.
Subsection (2) of new clause 4 will ensure that the commissioning role of local authorities and the NHS is properly covered by the Billthat is exactly the point that I was making to my hon. Friend the Member for Burton. Commissioning is not readily recognised in law because the duty to provide services in legal terms goes wider than just direct provision of those services. The duty also covers cases where the organisation on which that duty lays arranges for a third party to provide the servicesfundamentally that is what commissioning is about. I feel that I am repeating myself, but I want to get it on record. I am delighted that the third sector plays an important part here, along with other bodies, and we are committed to supporting such initiatives. It is important to find a way to make it explicit that we recognise the need for clarity around the extent of the Bill. Therefore, we have to express the concept of commissioning that is recognisable in law. The wording in the subsection,
arranging for the provision of services, is how I propose to do that. It puts the concept of commissioning into statutory language, and I commend the new clause to the Committee.
In my earlier remarks, I mentioned the work that we are commissioning the Social Care Institute for Excellence to do, to publish guidance on best practice and give people more choice and control. I think I said that it will be issued this spring. I should have said next spring, and I apologise to the Committee for that slight slip. Having described how we will put the concept of commissioning into the statutory guidance, I commend new clause 4 to the Committee.
New clause 5 is largely self explanatory, and there are only one or two points worth mentioning. After my efforts during the discussion on new clause 4 to specify that the Bill will not apply to Wales, the Committee may be slightly confused about subsection (1), which refers to England and WalesI know I was. I reassure the Committee that that is merely a technical legal requirement. An Act cannot extend to an area smaller than the whole of England and Wales, because they are a single legal jurisdiction. We can, however, ensure that the Bill will apply only to England, and we have done so in new clause 1, which specifies that the autism strategy will cover only adults in England. As I have already explained, the definitions of local authority and NHS bodies in new clause 4 refer to English bodies only. I hope that that is clear.
The joys of devolution. Will the Minister confirm that Wales has its own autism strategy? The strategy is a good documenta good way of moving forward. It is not often that I praise the devolved Welsh Assembly Government, which is a Labour-Plaid Administration, but in this case, I think that the Welsh Assembly Government and the Welsh Assembly have already done some good work and I commend them.
I agree with the hon. Lady, who I know speaks for the Opposition on matters relating to Wales. Wales has its own strategy, which it is pursuing, and it is important that we continue to learn from the experiences in both England and Wales to ensure that both jurisdictionsdevolved institutionslearn the best from each other.
I will not be drawn into any more debate about devolution, and whether the Scottish Parliament will take the matter forward. I hope that we are all learning from each other in our endeavours to do our best for people with autism.
Subsection (2) of new clause 5 takes the unusual step of determining the Bills commencement in advance. Normally, that depends on the laying of a commencement order no fewer than two months after Royal Assent is obtained. In this case, however, the Bill will automatically come into force two months after being granted Royal Assent, rather than being dependent on a separate commencement order. I am sure that I do not need to spell out the significance of, for example, activating the deadlines for the publication of the strategy and issuing the guidance.
The purpose of amendment 42 is to ensure that the Bills long title accurately reflects the Bills content, assuming that the Governments new clauses are accepted by the Committee and that the existing clauses are removed. I hope that I have sufficiently outlined the purpose and effect of the new clauses, which constitute an alternative to the Bill as currently drafted.
As I understand it, Mr. Gale, I must now speak to original clauses 4 to 9.
Thank you. Having commended the alternative Bill, it will come as no surprise that I do not support clauses 4, 5, 6, 7 and 9 of the Bill as currently drafted. I support clause 8, the money clause, which will remain as part of the Governments alternative Bill. I will outline my reasons for opposing the substance of the Bill as currently drafted.
I would like to inform the Minister that I intend to recommend to the Committee that clauses 4, 5, 6 and 7 be replaced by the new clauses. If members of the Committee agree with that intention at this stage, that will allow me to short circuit a rather long explanation from the Minister. I therefore hope that my intervention is of use.
I seek your guidance, Mr. Gale. The hon. Lady makes an excellent suggestion that saves me from having to explain why we do not want to include original clauses 4, 5, 6, 7 and 9 in the Bill.
On a point of order, Mr. Gale. If I recommend that we should accept the new clauses, what is the mechanism to substitute the Bills clauses as they currently stand with the new clauses? Will you confirm that I need only to recommend the withdrawal of clauses 4, 5, 6, 7 and 9?
The principle is fairly straightforward. We will shortly debate new clause 1, which will give members of the Committee the opportunity to comment on that, as well as on new clauses 2 to 5, which are grouped with it. In other words, there will be a general debate on all the Ministers proposals. Those new clauses will then be moved formally, voted upon and, I imagine, in the light of the sentiments that have been expressed, carried.
Thereafter, because the Bill has been read a Second time, the Chair must put the original clauses to the Committee. That system is again quite straightforward. Members may wish to comment on the original clauses, which will then be put to the Committee and, I imagine in the light of what the hon. Member for Chesham and Amersham has said, negatived. In other words, the whole Committee will vote against them. Since clause 8 is necessary as a money resolution I imagine it will be left in, although it is not for the Chair to determine that. Furthermore, one of the amendments relates to an existing clause, and it will also be called, but not yet.
In light of your guidance, Mr. Gale, I will not speak to clauses 4, 5, 6, 7 and 9 because there is consensus across the Committee. I will simply say that I will not support the original clauses for the reasons that we have just discussed.
I have listened to the Minister very carefully and I think that the whole Committee will see what a long way he has come in meeting the demands of this private Members Bill with the new clauses that he has tabled today. Therefore, I will take the unusual step of recommending to the Committee that we vote in favour of these new clauses.
I also want to say that, in all my years as a parliamentarian, I have never seen a Minister and his team of officials respond in such a courteous and rapid fashion to a subject that I believe needs to be remedied through legislation. He should be rightly proud of moving the new clauses today, because it shows Parliament at its best. We have seen a problem, identified the needs of a very large group of people and their families in our society and we are acting together to try to bring some alleviation and common sense.
The Minister is really responding to years and years of work by individual Members of Parliament to whom I have paid tribute beforewe all know who they are. I am absolutely delighted to recommend to this cross-party Committee that we accept these new clauses.
If we do accept them, we have to vote against many of the original clauses in the Bill, and I am very happy to do so. They are imperfect vehicles. They are imperfect vehicles because the Minister has gone further than I or the National Autistic Society and the 14 other charities that have been advising me have asked for. He has met their needs and demands at every step of the way. There is obviously some fine tuning to be done and I hope that there will be room for that on Report and Third Reading.
New clause 1 is key to this strategy, a strategy that has already started. I know that the fact that the consultation has begun is delighting an awful lot of people right across the country. They will be delighted that the Minister and the Department are making progress.
New clause 1 confirms the strategy for meeting needs. I think that all of us on the Committee know the sort of complex needs that are identified and required by people with autism. I have been particularly touched by some of the incidents that I have observed and by some of the discussions I have had with the professionals working in this area. The smallest intervention can make the largest difference in somebodys life. Alternatively, it requires a group of very dedicated and very well-qualified professionals to deal with the more complex needs.
Rather than delay the Committee, I will just pick out certain aspects of the new clauses. I am very pleased with the responses. It is extraordinary that the Minister has put a date in subsection (3) of new clause 1. I was particularly worried that this Bill, like many other pieces of legislation, might not reach the statute book, may not be enacted or may fall foul of all the bureaucracy of political timetables. Indeed, that was also the fear outside this House. However, new clause 1(3) states that
The autism strategy must be published no later than 1 April 2010.
That is a real step forward because there is no room for misinterpreting that date.
The Minister may like to hear that I am particularly pleased because when I was a junior Minister I did a great deal of work on a report about the position of women. We were running up to the 1997 election and my permanent secretary told me that I could publish the report but could not publish its conclusions. I felt that it was far from a political report; it was a report that was of interest to women generally. I did not want that to happen again, with any political timetabling, to a subject that is so important. That is why I was delighted to see that date of 1 April included in new clause 1.
We talked about the need to keep the reviews moving on and the general power. I think that a named individual, or a couple of named individuals within the Department, is still the way forward, because there is a need to know where to call. All the information I have received shows that many people do not know where to go. They do not know where the final arbiter is; they do not know where the contact point is. The Department could move towards having a very transparent interface with the outside world by ensuring that those people are clearly named. I think the Minister has given that undertaking, which I am delighted about.
Subsection (6) seeks to consult widely and not limit participation. That is, of course, something that we all welcome. It is also a response to the requests from the National Autistic Society and the people advising it. I am glad to see the ingenious way that parliamentary counsel has dealt with the fact that the strategy consultation has already been launched; that is a common theme throughout the Bill. Drafting counsel has moved so rapidlymuch more quickly than most of the lawyers I have come acrossand has come up with some quite good ways of putting into legislation what we required from the original Bill. Likewise, subsection (8) deals with that particular issue.
On guidance, I am delighted with new clause 2(5) and its paragraphs, because it reflects a particular request from the National Autistic Society. It is the basic shopping list, but it allows somebody to go to the shops and buy a few extra things. We know that there will be other items, and the list covers that. The real triumph is that subsection (5)(d) meets the requirements. The transition with which it deals has caused so many problems and such heartache. To read
planning in relation to the provision of relevant services to persons with autistic spectrum conditions as they move from being children to adults will gladden the hearts of so many people outside the Committee that it is hard to say what the effect will be on people with autism and their families.
New clause 3 is absolutely right. It gives section 7 guidance. I am grateful for subsection (3)(a), because that is a good device for tying in the NHS. I congratulate the lawyers on their ingenuity on that particular piece of drafting.
On new clause 4, I need reassurance that the list under NHS body covers mental health trusts. I think that is a given, but it is of particular importance because so many people with autism fall between the mental health trusts, the adult services and disabled services, and that is where I need reassurance from the Minister.
The Minister gave an excellent explanation of new clause 5. Again, I am particularly pleased to seeI was not aware of this until the clauses were tabledthat the Bill is not going to fester on the statute book and never be enacted. Much of our legislation is not discussed in detail, and much of it does not see the light of day and is overtaken by other legislation before it has been allowed to breath or has been tested; it is obsolete before we get there. This Bill will come into force as an Act two months after Royal Assent, if it gets through the rest of its parliamentary stagesit still has a long way to go. I am particularly keen for the new clause to go through.
On co-ordination between the devolved bodies, there is no doubt that devolution is here to stay in the United Kingdom, no matter what ones view of its success. I hope, however, that there will be co-ordination between the four nations of the United Kingdom on their strategies and how they learn about dealing with autism. That is particularly important. The Minister and I were at a reception last week, which I think many members of the Committee attended, at which the head of the Northern Ireland autism strategy spoke. Northern Ireland has been making progress in this area, and I would like the four nations to move together. That is not a matter for legislation, but I hope that there will be a sub-committee somewhere in the Department of Health that brings together the four relevant Ministers from the Governments in Wales, Scotland, Northern Ireland and Westminster so that there is a good exchange of information. That will be important, particularly at official level, because we are not operating in isolation, we are all part of the same United Kingdom, and as a Unionist I would like us all to benefit from that.
I do not wish to delay the Committee any longerI want to give other Members the chance to speak if they so wishbut it might help if I reaffirm what I intend to do. As the Bills promoter, I intend to recommend that at this stage the Committee accepts the Government amendments so that we can move the proceedings on. I have detected in this Minister a real determination that the Bill become an Act, and if that is the case I do not want to hold up the proceedings for too long because that will mean so much more to those with whom I have been dealing throughout the progress of the Billthe National Autistic Society and the other charities, and of the course the families and individuals affected. Once again, I commend the Minister and thank him and his officials for all the work that they have so rapidly done, and I ask the Committee to accept the Government amendments.
It is a pleasure and an honour to follow the hon. Lady. I congratulate her on her work on the Billon the effort and energy that she has put in to getting it to where it is today.
The hon. Lady commented on involving the four countries of the United Kingdom. I do not know whether she realises this but when I had the job that my hon. Friend the Minister now has, I went to Northern Ireland for the launch of a document about autism strategy, which closely followed the setting up of the new Assembly, after the Good Friday agreement. That was one of the first documents ever to get the signatures of both Ulster Unionists and Sinn Fein politicians. The need to deal with autism certainly crosses political boundaries. I should, of course, congratulate the Minister and his team on the amazing job that they also have done in getting the Bill to this stage.
I do not want to hold the Committee up, but I want quickly to make two points. The first is an issue that I think you, Mr. Gale, are probably familiar with and which you might wish to discuss, were you allowed to do so. Many children are placed in your constituency of North Thanet and my constituency of South Thanet from out of the local authority area, many of them by London authorities. The clauses that we are discussing do not directly relate to children but they do relate to children who are moving into adulthood. One of the many problems with children who are placed in our communities from other local authorities is that they should perhaps not be put there in the first place, and the guidance might need to consider that. Secondly, if they have been placed in North or South Thanet for a very long time, that becomes their home and, as they get older, that is where they want to stay.
We have had many debates over the years that I have been a Member of Parliament about whether the placing local authority should be able to wash its hands of responsibility for those young people and whether that should be at the age of 16, 18 or 21. Best practice has pretty much assumed now that the placing authority should have some responsibility for them until they are 21. In my experience that seldom happens. Many authorities are happy to forget about them entirely once they reach 16. I hope that the guidance will deal with the responsibility of authorities that place children out of their own area to support them beyond the age of 16, 18 and, indeed, 21. These are adults who will need support and the placing authority should still have some financial responsibility beyond the age of 21.
I hope my hon. Friend will acknowledge that that is a genuine problem for many of our seaside towns, including Blackpool, where young people are also placed. There is a danger that seaside towns get a preponderance of placements, and the adults remain and there are not enough services for them. There is also a problem with those young people losing touch with their families. Surely we should ensure that they remain in touch with their families and, if they wish, go back to their town of origin rather than remain in an area which they do not really know, but find themselves in by default?
My hon. Friend is right. I know that that is a problem in Blackpool. Indeed, it is a problem in many seaside towns around the country. It would not be appropriate for me to discuss the situation in Wales, but my hon. Friend the Member for Vale of Clwyd (Chris Ruane) and I went to meet the Minister on this very subject just a few days ago. I know that it is a problem around the country.
The hon. Gentleman makes the point well. That was why I was pleased to see in new clause 2(5)(d) the general expression
as they move from being children to adults.
It covers the whole spectrum. The questions raised by age switching, when a child becomes an adult and when the duty of care passes from one authority to another, cause a great deal of problems around the country.
The hon. Lady is right. That is a key area. I am sure that all of us who have campaigned on autism have spoken to people over the years who have fallen through that gap. I have never quite understood how local authorities get away with thinking that their responsibility can end at the age of 16, which many do, never mind at the age of 18 or 21. Despite her general point, which I am delighted to see reflected in the Bill, if a young person is placed miles away from a local authoritys area of responsibility it is much easier to forget about them and much easier not to transfer any resources to support them once they reach adulthood. I hope that there is a clear section in the guidance dealing with that issue.
The next point I want to make also needs to be in the guidance. I shall refer briefly to my amendment 41 and so will not need to move it later. Some work needs to be done to define what will fall within the scope of the Bill. It is all very well to say that it is autistic spectrum disorders, which is the definition that we have. However, all members of the Committee know, because we all have a certain amount of expertise in the matter, that autistic spectrum disorders range from very low levels of function, and what is called traditional Kanners autism, often with severe problems, through to the other end of the spectrumthe so-called high-functioning endwith Aspergers syndrome. We call all those conditions autism, and I assume that there would be consensus in the Committee that they should all fall within the scope of the Bill.
In support of that point, does the hon. Gentleman recall that there was a great deal of controversy about socialisation of people on the autistic spectrum, and that it was said that they could not, for example, have a statement, not being deficient or having a special educational need requirement? Is not such a comprehensive definition exactly what we are feeling our way towards?
The hon. Gentleman is right, and makes a good point.
Not having the definition will create two problems. The first is something that we saw clearly in one of the states of the United StatesI think it was California, but I may be wrong. The governor introduced an autism Bill and put new resources into supporting autistic people. In that state there was a huge increase in the number of people with autism. Some people attributed it to a growth in autism in the state, but it was actually due to the new support package and legislation, which provided an incentive to get a diagnosis of autism as a passport to that package of support. People put pressure on clinicians and others in authority in order to get that ticket to the relevant level of support for their children, or even for adults. We need the definition of an autistic spectrum disorder so that it will be clear that it refers to all people in the spectrum, and so that those who will have to decide who is or is not autistic will understand clearly who is to get the benefits of the package of support.
The hon. Gentleman has raised an important point. We would not want people to fall through the net because the Bill did not cover the matter that he raises. He is right; one hears about Kanners autism and Aspergers and even hears terminology such as autistic tendencies, which always worries me as it is so ill-defined. Would he be comforted by the idea that people within the range of the spectrumwhether they need care 365 days a year, or have Aspergers and a high IQ and, with a package of support, could do a job of workwould all qualify under the triad of impairment definition? Would he use the triad of impairment, albeit that the characteristics would all be different, as the definition of autism?
That is an excellent point and an excellent suggestion. I would not want to insist on that as a definition, but the Minister should, I think, consider it as a serious possibility. The hon. Ladys remarks lead me to my other concern about what would happen without a clear definition. We all read in the newspapers the other week that a scientist believes that he has identified the genetic connection to autism. Many of the newspaper reports were rather simplistic. I suspect that there is not one gene linked to autism, but a package of genes, and that the likelihood is that that package of genes will create a predisposition to autism, but that another trigger will probably be needed for symptoms to develop. That trigger is likely to be something that happens in utero, probably at a very early stage. My point is that if in the future that collection of genes is identified, it will become a diagnostic tool. Are we then to say that only people with that package of genes will be defined as having autism, and fall within the scope of the Bill? I suspect that what we in this Committee are seeking to achieve is support for people who are symptomatically autistic, whatever the cause or trigger. Regardless of whether there is a genetic link or of whether a clinician in the future redefines autismperhaps saying that Aspergers syndrome is not autism and has a different causewe would still, I believe, want those people to get the benefits of this package of support. It is important to have a definition of an autistic spectrum disorder. I hope that my hon. Friend will clarify on the record that the Government seek support for people who are symptomatically autistic, however that condition came about, because that might be important in the future for people to assert their rights. If that is the case, the guidance needs to include a definition that is consistently revised to keep pace with science and to ensure that symptomatically autistic people get the benefit of the Bill. That is what we are all trying to achieve. We would not want someone to be excluded from the benefits of the Bill simply because they fall outside some future definition.
I want to say a couple of quick things about issues that I raised in interventions. First, may I tell the Minister that I am pleased that the strategy was part of the consultation? I am going to respond to that formal consultation, and I do not wish to rehearse everything that I am going to say then, but I want to flag up the question of mental health services. The question of whether the status of some trusts and foundations within the NHS would exclude them from the remit of the Bill needs to be looked at. Some of the most complex autism cases involve the mental health services, which in some cases are very good. I have raised two debates on the Floor of the House about mental health services and Aspergers syndrome. The Minister will be aware that we have had some rather dramatic cases, not least the one that concluded with the Bournewood judgment in the European court. Unfortunately, we still have far too many practitioners in the mental health services who either do not know enough about autism when they come across it or are totally in denial about autism, even if another professional has previously diagnosed it. We all know the horrendous problems of people who are misdiagnosed as schizophrenic when in fact they are autistic. There can, of course, be circumstances in which people with autism are also schizophrenic.
The hon. Lady makes an excellent point, which is why the definition I referred to is so important. One reason why we need to diagnose properly someone as schizophrenic rather than autistic is because the treatments for the two conditions are entirely different.
Absolutely. I know the hon. Gentleman is fully aware of this. Somebody could be misdiagnosed as schizophrenic and try one drugand we all know how powerful they areand because there is a list of drugs, if the first one does not work, they go on to the second and down the list. In the end there is a scrambled mind and somebody who has been caused grievous damage by the health service. I have made this point before. If cardiology services treated patients like that, the patients would sue. These are the people who are least able to speak up for themselves, and some of the most tragic cases I have seen have been in this area. Because of the read across to mental health services, people with a psychiatric qualification who specialise in autism are few and far between, particularly in the provinces. If somebody comes to a hospital in London or in some of our other cities, the expertise is there. In the provinces, however, there is still a problem.
I speak regularly to people at the Royal College of Psychiatrists and I frequently nag them about that issueI make no apology for doing so, as they need to deal with the matter within the profession. They come and see me and I am assured that they are doing more than they did, but it is still a problem. This is an important area for autistic peoplechildren as well as adultsand I would not wish the Bill, through the definition of the trust, to allow mental health services not to provide the sort of services that we expect for people with autism.
I shall be brief, as we must conclude business fairly soon. First, let me pay tribute to the hon. Member for Tiverton and Honiton; I know that she has done a great deal to highlight the needs of people with autism. I also pay tribute to my hon. Friends the Members for South Thanet and for Erewashboth previous chairs of the all-party parliamentary groupfor the work that they have done. I also want to congratulate the hon. Member for Chesham and Amersham on coming first in the ballot, and I thank her for choosing to introduce the Autism Bill. I am delighted that we have found consensus and a way forward.
As soon as the Bill was introduced, even before Second Reading, the Government worked hard to meet the aspirations that it expressedindeed, perhaps they went beyond what was in the original Bill. I commend both Ministers and my hon. Friends on the work that they have done, and the officials on their work over the past week in drafting the new clauses. I also want to commend most highly the National Autistic Society, with which I have the pleasure of working as chair of the all-party group, on its work in producing the original Bill and taking it forward with the hon. Member for Chesham and Amersham.
This has been a good example of cross-party working. Getting to this stage has been an example of setting aside scepticism. We have progressed a great deal over the past few years as far as autism is concerned, and the legislation takes us a great step beyond where we thought we could be only a few weeks ago. I am delighted to support the new clauses.
I shall address the points made by hon. Members. First, I want to thank the hon. Member for Chesham and Amersham for her extraordinarily graceful and gracious remarks about the work that we have been doing. As my hon. Friend the Member for Burton said, we would not be here if she had not chosen to introduce a private Members Bill on autism.
The hon. Member for Chesham and Amersham made a specific point about mental health trusts and NHS foundation trusts. I want to make it clear that NHS foundation trusts are not excluded from the Bill; they are covered by itthat was the point made by my hon. Friend the Member for South Thanet. The guidance will apply to NHS mental health trusts and to all foundation trusts, which must have regard to it. They will not be subject to the statutory nature of that guidance because of their position as foundation trusts. That might raise anxieties for hon. Members, but that is the nature of the autonomy that foundation trusts have across the whole of the NHS. I am confident that the work that we do in producing the guidance, which will cover them, will mean that we will be able to ensure that those foundation trusts have regard to the guidance.
I understand the Ministers difficulty. Following the statement he has just made, anybody looking at the Committee proceedings, or interpreting the Bill when it is enacted, will see that it was the clear intention of Parliament that the foundation trusts should also be included in it. I hope that that satisfies the hon. Member for South Thanet.
My hon. Friend the Member for South Thanet brings great experience to the Committee, having served as a Health Minister himself in the past. He made an important point about young people in transition. I cannot pre-empt what the guidance will say about out of area placements. Clearly, that possibility exists, because the issues he raised are covered by the guidance in subsections (b), (c) and (d). As we go through the process of delivering guidance on those issues, he will be able to find a way of ensuring that his concerns about out of area placements are covered.
My hon. Friend the Member for South Thanet made an important point about definitions of autism. We all know that there is a debate about which conditions should be included under the umbrella of the autistic spectrum. We know, too, that there is professional disagreement on matters of diagnosis and the classification of conditions, which is why we think it would be inappropriate for Secretaries of Statein effect, lay peopleto include the definitions in primary legislation. We want to include those in the strategythe range of symptoms, the spectrum that the strategy embraces and the needs for which support and services must apply. We can keep the strategy under review, and as developments and new thinking occur, and as conditions become identified, we have the flexibility to revise the strategy, as we debated earlier, to embrace the matters that my hon. Friend raised.
My amendments were only ever intended to be probing. I never expected the Minister to put the definition in the Bill. Governments never do that, whether it is a good or a bad idea. However, I want the definition to be included in the guidance and be part of the process of review, so that there is clear guidance for the people who make decisions about whether a person is on the spectrum of disorders. I particularly want the Minister to use the words and state that it is his intention that the Bill will include people who are symptomatically autistic rather than what a future scientist might define as autistic.
In the good practice guidance, Autistic Spectrum Disorders, which the Department for Education and Skills and the Department of Health published in 2002my hon. Friend might even have been the Minister at the time, I am not surewe listed the conditions that might be considered to be on the autistic spectrum: Aspergers syndrome, atypical autism, Kanners autism, childhood disintegrative disorder or Hellers syndrome, high-functioning autism, pervasive developmental disorder not otherwise specified, and semantic pragmatic disorder. We made it clear in that guidance, and I hope that that gives the hon. Gentleman the assurance that he needs. In future guidance, we can address the approach that he described. We made it clear that it was a tentative list. We stated exactly which disorders should be included in the spectrum. How broadly the spectrum extends is controversial and still debated. The importance of revising guidance to take into account the approaches that he argues for gives us that opportunity. I know that he wants me to use particular words now in Committee. I fear that I will not be able to satisfy him in that regard, but I can say that he has made his point eloquently. When we publish the strategy and the following guidance, he will be able to press his points.
I want to reiterate my point. The Minister has given the list of disorders that we currently consider to be on the spectrum. I will have a little bet with himsome time in future, scientists will identify a genetic link to some of those disorders. Equally, one or more of those conditions may not have that genetic link. I do not want people with those disorders to fall outside the scope of the Bill, simply because we discover a genetic link to three quarters of the disorders.
I understand my hon. Friends point. I think that we both want to land in the same placethis is about how we get there. We do not want to risk excluding particular people by being too definitive in the Bill. However, through the strategy, which can be regularly revised, we may be able to embrace and include people who, as yet, are not identified. We want to arrive at the same place, but we want to get there in a slightly different way.
I want to support what the hon. Member for South Thanet said. Even if the first research shows specific genetic links, which I hope will happen within our lifetime, none the less, there may be many variables. I have to live with the fact that I have autism in my family. We spend a lot of time looking at our relatives and the people we know, thinking, Well, they all seem autistic to me. I sometimes feel that I am probably more autistic than the rest of them, but, seriously, we could say that, given the genetic basisif that is what is proved, and I personally think that it will bewhen two people come together there may be variations in their genetic make-up that produce an autistic child, but we do not know that yet. I suspect that the hon. Member for South Thanet is saying that the first research will not be the end, and it would be wrong for it to be taken as, This is autism.
The hon. Lady reinforces the point that I made to the hon. Member for Daventry about the value of reviewing the guidance and the strategy on a continual basis to respond swiftly to changes of that kind when we need to develop new approaches. The hon. Member for Tiverton and Honiton raised the issue of mental health services, which I think I covered earlier. Mental health trusts will be listed in the Bill, as new clause 4(1) states:
NHS body means...a National Health Service Trust.
That includes mental health trusts, and I made a point about foundation hospital trusts earlier. The hon. Lady made a point about misdiagnosis and individuals with complex needs or a variety of needs. I hope the guidance that will flow from the Bill, and which will specifically include issues arising from diagnosis, will cover that point when the time comes.
I want to put on record our thanks to my hon. Friend the Member for Burton, who is no longer in the Room. She is at a meeting about complex needsI think that I was supposed to be there too, but never mind. She has been a great champion for autism in her role as chair of the all-party group. We have other former chairs here, and we all know that all-party groups in this House play a highly significant role. They allow hon. Members from both sides of the House to have a shared purpose across party lines and to join organisations representing particular groups in which they have an interest to introduce proposals. I want to congratulate the all-party group on the work that it has done. I think that I have covered all the points made in our debate.