NHS: Standards of Care and Commissioning

My Lords, I join others in the House in thanking my noble friend Lord Turnberg for securing this debate. In the short time that I have at my disposal, I would like to focus my remarks on one area in particular: healthcare and autism. The noble Baroness, Lady Browning, and I, together with representatives of the National Autistic Society, recently met the Minister and we were given a very sympathetic hearing on matters that concerned us. We thank him for that. The National Audit Office’s investigation into public spending on autism found that one of the best ways of overcoming the alarming gaps in training, planning and provision across a range of services was to develop specialist autism teams that could diagnose and support people with autism. It went on to say that, if such teams are established, there is the potential to save money. It stated that, if local services identified and supported just 4 per cent of adults with high-functioning autism and Asperger’s syndrome, the outlay would become cost neutral over time. In addition, it found that, if these local services did the same for just 8 per cent, the Government could save £67 million per year. The Liverpool Asperger Team, which is the longest-standing specialist Asperger’s service, reports an identification rate of 14 per cent, so 4 per cent is certainly achievable. Will the Minister tell the House how teams such as the one in Liverpool will be funded if the Health and Social Care Bill is passed into law? In the Bill, health and social well-being boards have a duty to promote integrated working and, as such, would lead on commissioning specialist services. However, the White Paper published in July states that the NHS Commissioning Board will take responsibility for commissioning specialised services at both national and regional level, as informed by the specialised services national definitions set. These sets contain definitions of 34 services. Definition 22 covers specialist mental health services and includes specialised services for Asperger’s syndrome and autism spectrum disorder. There is clearly a difference between the White Paper and the legislation on how specialist autism teams will be commissioned to carry out their work. Will the Minister say whether the NHS Commissioning Board or, at local level, the health and well-being board will be responsible for this commissioning work? Each of the commissioning scenarios is not without problems. First, specialist teams are often commissioned through pooled budgets. There is concern that, if 80 per cent of the commissioning budget sits with the GP consortia but the health and well-being boards are responsible for commissioning the joint services, the major budget holders—the GPs—may not commission services whose primary benefit in the short or medium term will be the local authorities. The commissioning problems could potentially become more complicated when health and well-being boards have a number of consortia in their areas. It is possible that the GP consortia might take a free ride and not contribute. Secondly, if these services are commissioned through the specialised services national definitions set at regional level, that could make it more difficult for the teams to respond to local needs and integrate themselves into each local authority that they serve. The draft NICE guidelines on diagnosis, recognition and referral of autism in children and young people call for local teams to be created in each area. Teams such as the ones in Liverpool and Bristol are doing first-class work. A key way of getting over this problem of commissioning specialist teams is to strengthen the role of the health and well-being boards in creating pooled budgets and to ensure that the NHS Commissioning Board can intervene in any disputes over these budgets. I appreciate that this is a major problem still to be solved and I hope that the Minister will respond to that and to my other questions.