Vaughan Gething, Cabinet Secretary for Health and Social Services

First published:
30 November 2018
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On 25 September I made an oral statement on the ASD Strategic Action Plan and outlined our plans for a Code of Practice on the Delivery of Autism Services, to be made under the Social Services and Well-being (Wales) Act 2014 and National Health Service (Wales) Act 2006.

Today we are fulfilling our commitment to strengthen the delivery of the Strategic Action Plan by publishing a consultation on our proposals for an autism Code of Practice.  We are seeking views on our plans to place requirements on statutory bodies to support autistic people based on their needs.

The proposals in the consultation document respond to feedback received from autistic people and their representative groups, and advice provided by specialist practitioners providing autism diagnosis and support services.  The consultation document sets out proposals on: 

  1. Arrangements for assessment and diagnosis.
  2. Arrangements for accessing care and support. 
  3. Arrangements for awareness raising and training.
  4. Arrangements for planning, monitoring and stakeholder involvement

Our proposals seek to ensure that the range of services and support for autistic people are communicated more effectively.  The proposals give direction to local authorities and local health boards about how to adapt their practice to better meet the needs of autistic people.   Through the Code we also intend to establish strong remedies enabling the Welsh Government to intervene where there is evidence that statutory organisations have not complied with the Code’s requirements.  

Specifically, our proposals will place requirements on statutory bodies to:

  • Provide autism assessment and diagnosis services which take account of NICE guidance.
  • Ensure local health boards prepare, publish and review diagnostic pathways.
  • Comply with the existing 26 week assessment waiting time standard which records referral to the first face-to-face appointment.  
  • Establish pathways to ensure prompt information sharing between services.
  • Comply with existing legislation that IQ must not be considered as part of the eligibility criteria for needs assessment under the Social Services and Well-being (Wales) Act.
  • To make sure that primary health services, such as general practitioners, are aware of the full range of autism services and that there are clear pathways for referral.
  • Ensure anyone carrying out a needs assessment under the Social Services and Well-being (Wales) Act has the skills, knowledge and competence required.
  • Ensure that local authority Information, Assistance and Advice services provide information on local autism services.
  • Assess the autism training needs of all their staff working in health and social care, and identify the level of training required according to their job roles and responsibilities.
  • Make arrangements to ensure all staff can access the training identified to meet their autism knowledge and awareness training needs.
  • Comply with relevant duties in the Social Services and Well-being (Wales) Act Parts 2 and 9 to ensure that the needs of autistic people are reflected in the development of Population Assessments and Area Plans.
  • Ensure stakeholders are involved in the planning and delivery of autism services.
  • Ensure that an autism champion of suitable seniority is appointed to represent the needs of autistic people.

The recent debate brought about by the Autism (Wales) Bill has enabled the National Assembly for Wales to discuss fully the needs of autistic people.  I listened and contributed directly myself as several National Assembly committees considered the merits of the Bill.  Alongside this, I spoke with many autistic people and their families and carers. 

I am in no doubt about the real struggles of individuals and families every day.  I remain convinced that we have all the legislative levers we need to improve autism services.  The answer must be to ensure the legislation we have in place is working for autistic people.  Legislation, which diverts resources away from support services and confuses practitioners as it cuts across the needs based legislation we already have in place will slow down rather than speed up progress.

We propose to continue with the 26 week waiting time target for children and young people and extend this to adults.  This approach records waiting times from referral to first face-to-face appointment.  NICE guidance advises that there the assessment should commence within 13 weeks, but this could be recorded in many ways just to meet targets.  Under our current system, during the waiting time period, evidence is collected to support the assessment appointment and to inform diagnostic decisions.  If a mandatory 13 weeks waiting time is introduced specialist resources will be diverted away from post-diagnostic support services or from other neurodevelopmental conditions to meet these conditions. 

I understand why there has been support for legislation, as autistic people rightly want their needs to be addressed fully.  However, by far the greatest weight of evidence from  professional organisations is critical of the Bill.  This includes evidence provided by the Children’s Commissioner, the Royal College of GPs, Royal College of Occupational Therapists, Royal College of Paediatrics and Child Health, Royal College of Psychiatry, Royal College of Speech and Language Therapy, the NHS Confederation and other practitioners working to deliver services in the NHS and local authorities.  

In recent years we have invested significantly in the development of autism services, most notably £13million to roll-out a new Integrated Autism Service, and £2m a year to improve children and young people’s neurodevelopmental assessment and diagnostic services. We continue to support the National Autism Development Team to support service development, hosted by the Welsh Local Government Association and Public Health Wales. The team has developed a wide range of acclaimed autism resources which are freely available on the ASDinfowales website (www.asdinfowales.co.uk).  

There is widespread agreement from organisations delivering improvements that we need time for the enhanced services we are putting in place to take hold.  I recognise that autistic people want reassurance that existing legislation will work for them in the long term, and this is why I am consulting on our plans for an autism Code of Practice. I want to hear their views on the proposals I am putting forward today including where we can make further improvements.