§ 1.14 p.m.
§ Mr. Albert Murray (Gravesend)I offer no apologies for raising the subject of the problems associated with the autistic child. There was an Adjournment debate about a particular child last December, but autism is a continuing and increasing problem, and the House should devote more of its time not only to discussing it but finding ways whereby we can help those helping autistic children.
Being neither a psychologist nor a medical man, I shall not deal with the symptoms and pyschological and medical problems associated with autism, because there are many categories. But the best description I have heard of the condition is that it is a glass wall, that the children who suffer from it are imprisoned behind a glass wall unable to communicate with the outside world.
At least 3,000 children of school age in Britain suffer from autism. The number is increasing possibly by 400 or 500 each year. There are 1,400 blind children and 3,400 deaf children in the country, so the number of autistic children is almost the total of these two figures. There are also about 12,000 adults now in institutions of one sort or another who were autistic children.
I have a particular association with this problem. I want here to pay public tribute to certain people, because I have in my constituency the Helen Allison School for Autistic Children. It was set up by the National Society for Autistic Children and named after Mrs. Helen Allison as a tribute to a lady who has done so much work for autistic children. I am fortunate because also serving at the school is Mrs. Sheila Skeffington, who is known to so many of us as the wife of our hon. Friend the Joint Parliamentary Secretary to the Ministry of Housing and Local Government, and we are also very ably served by the principal of the school, Mrs. Landman. I now pay public tribute to them and to the many others who do work not only in my constituency but elsewhere.
Being a member of the board of governors of the school has made me ever more aware week by week of the problems which the parents of autistic 868 children face. Recently the board was discussing applications for children to become pupils at the school. Out of over 20 applications received, at least 17 had to be turned away. Yet the alternatives listed were predominantly none. There was no alternative educational establishment in most of the areas concerned which could cater for these children. The applications came from places as far apart as Bexley, Haringey and Hertfordshire.
In the light of all this, perhaps one begins to understand the size of the problem, not only in terms of the difficulties for parents and the cost to them, but the cost to society. It has been estimated in the United States, where a great deal more work has been done on this matter than here, that the direct cost of keeping people in mental institutions of one sort or another is about £60,000 over a person's lifetime. It has been estimated that the indirect cost can be reached by multiplying that figure by seven.
I do not suggest that those figures apply to Britain, because we have to take into account the difference in costs in both countries. But even if we halved the first of the figures we would still get a cost of about £30,000 in keeping a person in an institution for life, and then we must multiply that figure by the indirect costs inasmuch as the person concerned cannot earn a living or pay taxes or contribute to the gross national product. That is why the Government must spend more money on this sort of problem.
We have various estimates of how much it costs in this country to keep a person in a mental institution. Depending upon the institution, the direct costs are between £500 and £1,000 per year; the direct cost of keeping a person in an institution for a life span are £65,000 per person.
We have been dealing with what we know as autism only for 20 years. The Minister last year said that a great deal of research was being encouraged by the Department of Education and Science. Research is now being undertaken by Dr. Michael Rutter at the Maudsley Institute of Psychiatry which will take five years. Will the Under-Secretary say whether there will be an interim report on this research, and whether any action will be taken before the five years are up? 869 During that five years a newly-born autistic child will have grown to the age of five, and a 5 year old austitic child will have become ten years old. Five years in a child's life is a long time, but to the parents of autistic children it is a lifetime. I hope that we shall see early action as a result of that research.
In the South-East there are about 20 schools and units, whereas in the rest of the country there are only three. It is sometimes argued that a person's education depends on where he lives, but the chance of an autistic child who lives outside the South-East getting a place at a special unit or school is extremely limited.
This problem is associated not only with children but with teenagers. It is estimated that there are about 4,000 adolescents or young adults suffering from autism of whom about 2,000 are in institutions.
A recent survey of 42 adolescents and young adults of 17 and over showed that half were in mental hospitals or hospitals for the sub-normal. The results achieved by the other 21 showed what could be done by really tackling autism. Of the 21 who are not in hospital, one is at university, one is at the Royal College of Organists, one is an apprentice bricklayer, having studied at a technical college, and two are working in offices. So out of the 42 who were surveyed half have been enabled to return, although sometimes in a limited way, to normal life, and are able to play their part in and to contribute in every possible way to society. Will the Under-Secretary consider the creation of more facilities, particularly for youngsters around the age of 17?
Dr. Lorna Wing has suggested various ways of setting up such units. She suggests that the initial average capital cost would be about £30,000 and the cost of keeping a person in the unit would be about £1,000 per annum. This is a reasonable price compared with what it costs to keep such a person in a mental institution, even ignoring all the other costs to society.
Will the Under-Secretary consider also the listing in regulations of autistic children as a category needing special education? I know that the Government intend to introduce a new Education Bill and such a provision might be included in it. Because autistic children are 870 outside all the categories, people think that they are ineducable, which is an awful word and an awful thought. The inclusion of such children in a special category would encourage local authorities to pay more attention to them and to think about setting up schools or units. Even if an education authority could not set up a unit on its own it might co-operate for that purpose with other local education authorities.
Will the Under-Secretary also consider issuing a direction or an encouragement to local education authorities to support autistic children at school beyond the statutory school leaving age? At present this is a permissive power which is not used by all education authorities. The issue of such a direction or encouragement would be a positive move towards encouraging local authorities.
I do not want to ask the Minister too detailed questions, but will he tell the House the amount of money which is being spent on the education of autistic children? My hon. Friend the Member for Eccles (Mr. Carter-Jones) and I visited this week an organisation which deals with machines which help to educate, amongst other groups, austistic children. We saw the talking typewriter and the talking page. I will not go into detail, but the talking typewriter appears to be a very useful adjunct in the teaching of autistic children. It is an expensive piece of machinery, and it cannot be said to solve every problem. It costs between £15,000 and £16,000. If talking typewriters could be supplied to units which catered for 15 or 20 children, and if, as a result two or three children were brought back to play a useful part in society, on the basis of the arithmetic which I have already given to the House this would be a great saving.
We shall continue to press the Government to do more for autistic children. I hope that before long we shall have another debate on this matter, and that the Government will examine every possible method of giving help to autistic children, to their parents and to those who teach them, and show that the Government really care and are doing something about it.
§ 1.28 p.m.
§ Mr. Paul Dean (Somerset, North)I am sure the whole House is grateful to 871 the hon. Member for Gravesend (Mr. Murray) for putting the Parliamentary spotlight on this small group of our fellow countrymen who suffer from autism. One of the chief marks of a compassionate society is that it cares and wants to know about people who are handicapped, particularly, as in this case, comparatively small groups of people about whom not very much is known. Another mark of a compassionate society is the extent to which it is itself prepared to do something about this type of problem and not pass on the buck entirely to the Government.
I join with the hon. Member for Gravesend in paying tribute to the National Society for Autistic Children for the school which it set up and for the tremendous amount of work it has done in researching into this problem, in drawing it to the public attention and in itself doing something about it. That is of tremendous value in our community today.
Two things strike me about this problem. The first is the shattering effect which an autistic child can and often does have on the parents of the child. So often one finds an apparently normal child looking physically a very good specimen, who is unable to respond to its parents. This is a shattering experience to them and deeply disturbing for the child. It leads to the disturbed behaviour one so often finds in autism because of the inability of the child to understand and make itself understood.
The other feature is that research now shows that a great deal can be done for these children provided the problem is diagnosed in time and treated in time. So often for want of the right help at the right time these children are permanently resident in mental deficiency hospitals, whereas if they were trained from the earliest years many of them would be able to live a useful life, maybe with supporting services, and be able to earn their own living and have the dignity and independence of normal human beings. One can say this about a great many handicaps, and I do not want to exaggerate it at the expense of others, but I hope that the Under-Secretary will respond to the points which have been made by the hon. Member for Gravesend.
872 It is interesting and encouraging—and I mean no disrespect to the Ministry of Social Services—that we are to have a reply today from the Department of Education and Science, which is shortly to take on responsibility for education and training of the handicapped. I hope that the hon. Gentleman will be able to assure us that in taking on this responsibility—I welcome the transfer—his Department will keep in very close touch with the Department of Health and Social Security. I am sure the hon. Gentleman would be the first to concede that there are aspects of this disability, as of others, in which the experience the Ministry of Health has built up, will be of great value to his Department in the work it is to do, particularly in education.
Diagnosis is one of the difficult problems with children who look physically normal in their early years. So often the problem develops to the extent where it is very much more difficult to deal with because the diagnostic facilities are not available and the disability is not recognised sufficiently early. Although I realise that this is not quite the province of his Department, I hope the hon. Gentleman will tell us about what is being done to try to improve diagnostic facilities.
Another point mentioned by the hon. Member for Gravesend with which I entirely agree is that here we have a group of children who are not legally entitled to specialist education. As a result, understandably in the circumstances, education authorities do not necessarily pay the attention to this group of children which they pay to other groups that are entitled to specialist education. There is now very strong evidence that it is possible to train and teach these children, but a specialist approach is needed. I hope the hon. Gentleman will be able to assure the House that it is the intention of the Government to include autism as one of the categories which required and deserves specialist education.
There is need for more special schools or units in which this education can be given. The hon. Member mentioned the pioneering work which the National Society is doing in the school in his constituency, but there is a great shortage of specialist units. I understand there 873 are only 18 in the south-east of England and three in the rest of the country. Although the numbers of these children are small, there is a case for encouraging local education authorities to co-operate together and with the voluntary bodies interested in this development.
My final point concerns the follow-up from education. The hon. Member said that to cut off education of these autistic children at 16 or 18 is very unsatisfactory. In relation to normal children they are at a very much lower stage of development. It is necessary not only to carry on their education beyond that age, but to ensure that when their education and training is complete there is work available for them, in sheltered workshops where required and in hostels when it is not possible for them to live at home. There is a problem here which one finds in other types of disability. However good the work of education and training may be, unless employment is available after training so much of the money spent on training can be wasted. The psychological effect on the person concerned is then extremely serious. If these children come out from training full of hope that they can lead an independent existence and then they cannot find employment, the psychological effect is worse than if they had had no education or training. This is an important aspect if we are to improve the services available for these people.
It is not only the human aspect which is involved but the economic aspect. Here is a possibility for these children, when they grow up and are trained, of earning their own living. The economic effects of this can be considerable. From that point of view, as well as from the human point of view, it is highly desirable that they should be equipped to do this rather than to be incarcerated in mental deficiency hospitals of which the cost to the State is very considerable.
I appreciate that the hon. Gentleman who is to reply to the debate has tremendous demands on the resources of his Department at present. None of us can hope for a miracle overnight, but we can fairly ask that he and his Department will recognise the pioneering work which has been done by the National Society and that they will be able to give further help and encouragement to ensure that there is at least some 874 extension in co-operation with voluntary bodies of the facilities and services available for these children.
§ 1.39 p.m.
§ Mr. Lewis Carter-Jones (Eccles)I should like to associate myself with the remarks of my hon. Friend the Member for Gravesend (Mr. Murray) and the hon. Member for Somerset, North (Mr. Dean) on the problems facing autistic children and their parents. This matter is frequently overlooked. I suppose that all of us who are parents of normal healthy children have had the great joy and pleasure of having them looking and smiling at us and sometimes cuddling close to us and laughing with us. These are some of the joys of parenthood.
I have in my hand a pamphlet written by the headmistress of an autistic unit in my constituency. I join in the tributes which have been paid to the National Society and the schools which have been established. I represent Eccles which has one of the three schools in the North. It is disgraceful that outside London and the South-East there are only three of these schools. The title of the pamphlet is "She Now Cries with Tears". The moment that one gets this response one has broken through the barrier to which my hon. Friend the Member for Gravesend referred; one gets an emotional response.
The final paragraph of the pamphlet states:
How far we shall be successful in restoring these children to normalcy only time will tell. So far they have done better than I expected and the burden on their families and parents has been lessened. Enough has been accomplished to make it quite clear that all autistic children should have their educational chance"—that should be repeated—Enough has been accomplished to make it quite clear that all autistic children should have their educational chance and the setting up of suitable classes should not depend on the good-will of individual education officers or organisers.".It is the uneven spread of provision for this type of child which is so worrying. I pay tribute to the work which has been done at the Moat Hall School in Eccles since 1966 and the pioneering spirit of the education authority and its officers in establishing this unit. But all the work has to be done in a youth club. There is all the paraphernalia of setting up the 875 autistic school facilities, dismantling them, setting up the youth club facilities and then dismantling them, and so on. The way in which this lady works is incredible, and the results which she has achieved are incredible.I should like to quote from the publication entitled "World Medicine" in which there is an article about an autistic child at a Surrey County Council school. It reads:
Before she was accepted by The Lindens, her worried parents",who were trying to get a response from her, a smile, a tear, a flicker of recognition, no more than that—had taken her from doctor to doctor to psychiatrist with little improvement. Life-long incarceration in a mental institution seemed the only solution. This is the grim fate of many of these aloof and often strikingly beautiful children for whom human warmth appears to mean nothing at the height of the disorder. Yet statistics from Britain and America show that many can attend school and college. One is now a mathematician, another a noted nuclear physicist.The "noted nuclear physicist" is making his contribution to society.I very much agreed with my hon. Friend the Member for Gravesend when he referred to the direct cost and the indirect cost to society of not taking care of these children. I suppose that it is difficult for a Welshman, brought up in a religious environment, not to be emotional. But we know that it is morally right to help these people, and we know that we should do it. But some extremely sound economic arguments can be advanced as to why we should do it. If we put them into institutions, we shall have to face a ghastly bill over the years. In a paradoxical way, we have to face a ghastly bill for being compassionate and prepared to look after them.
It seems that whenever I speak in the House I ask some Minister to try to deal with both sides of the balance sheet. It is rather unfair that I should ask my hon. Friend the Under-Secretary of State to do that today, but he is concerned with the expenditure side. Somebody from the Treasury should be on the Front Bench to account for the cost to society, both directly and indirectly, if my hon. Friend is not given the money to carry out the necessary task. The Treasury should be 876 answerable. As we are now talking about cutting public expenditure, there should be a spokesman on Treasury matters on both Front Benches. I should have liked to see my right hon. Friend the Chancellor of the Exchequer and the Opposition Shadow Chancellor of the Exchequer nodding approval of the value analysis argument that it is economically sound to provide as much money as possible to achieve a breakthrough for these children. They could then also have the glow in their cheeks of knowing that it was morally right.
§ 1.46 p.m.
§ The Under-Secretary of State for Education and Science (Mr. Denis Howell)I entirely agree with the hon. Member for Somerset, North (Mr. Dean) that the House owes a debt of gratitude to my hon. Friend the Member for Gravesend (Mr. Murray) for initiating this debate. It is the second debate on the problems of autistic children which we have had in recent months. I do not complain about that. Indeed, I welcome the fact that attention is given to the subject. Those of us who are blessed with normal, healthy, wholesome children should never cease to give thanks for that fact and have an added responsibility when we consider the plight of these children and the families who shower such dedication and devotion on them. The more time I spend as Minister responsible for the education of handicapped children, the more this point is borne in on me.
One advantage of having had these responsibilities for a number of years is that I see initiatives taken four years ago beginning to pay off. When I joined the Department four years ago, the terrible word "ineducable" was prevalent. These children were solely the responsibility of health authorities, not education authorities. I like to think that perhaps one of the most compassionate things which this Government have done is to say that no child should be written off as being beyond the help of education. The Prime Minister's announcement, with the fact that it was welcomed on both sides of the House, that responsibility for these children should be transferred from the Health Department to the Education Department gave great personal satisfaction to me. I can say the same for the officials in the Department, the medical officers and civil 877 servants in the special services branch, who have responsibility for these matters.
I agree with my hon. Friend the Member for Eccles (Mr. Carter-Jones) that when we get involved in passionate arguments about where the money is to come from and we talk about cutting public expenditure it is worth while stopping to think that this is the end product of the exercise. It sounds very nice to cut back in large global terms, but the end product is the quality of life of ordinary people; and to make it possible for these children to have an education which they did not have before means that we must take compassionate decisions, not only about personal social services, but about global questions of Treasury finance.
I am happy to associate myself with the tribute which my hon. Friend the Member for Gravesend paid to the teachers and head teachers. He mentioned those in his constituency. He will not mind if I widen the point. It is most touching and moving to go round the special schools and to see the work which has to be done by teachers and the hours of dedicated work which they spend with two or three children or sometimes only one child, in order to get a response or, as my hon. Friend the Member for Eccles said, a flicker. Society certainly owes a debt of gratitude to these teachers.
The great problem is that of early diagnosis. This is recognised today on all sides of the House. Autism is a relatively new category of handicap in our knowledge. It has existed for many years but was not defined until recently. This largely explains why the special provision for these children is, possibly, so inadequate compared with other handicaps.
On the previous occasion I listed the nine symptoms by which one could generally recognise autistic children. Suffice it to say that, on the whole, they are children who have considerable difficulty in establishing personal relationships with most other people. This expresses itself in different ways—severe head-knocking/rocking and banging, apparent deafness and/or tremendous reaction to noise in other children. The great difficulty, which we are now beginning to understand, is that very often these children do not have only one handicap. They suffer from multiple 878 handicaps. They can be not only autistic, but deaf or partially deaf, too. Therefore, the problem of diagnosis in children with multiple handicaps is of tremendous difficulty. I will mention presently some of the things that we are doing in this respect.
I think that we are all agreed in welcoming the formation of the National Society. The fact that it has managed to get two Adjournment debates in one Session in this House is a great tribute to it. It is marvellous that we have people who are prepared to focus attention on these matters. There is no difference of opinion, based upon the surveys which have been done, between the National Society and ourselves, that the size of the problem is thought to be about 3,000 children in the country as a whole. We are continuing to do work on that question.
Indeed, the House will be glad to know that during the last 18 months Her Majesty's inspectors in the Department of Education, in association with the old Ministry of Health, now the Department of Health and Social Security, have done a survey, in conjunction with local education authorities and regional hospital boards, to try to assess what diagnostic facilities are available in homes for mentally handicapped children and in other places so that we can assess the need for the Government officially to give further guidance to the appropriate bodies on diagnostic facilities and procedures in order that the autistic children who can be found shall be found and have their special handicap looked at. My hon. Friend will be glad to know that this field work and activity, led by Her Majesty's inspectors of education, is going on.
Since the emergence and diagnosis of this handicap is relatively new, we need much more research. Doctor Rutter's research project, the cost of which the Department is paying 75 per cent., is proceeding apace. I am told that it is proceeding a little more slowly than when I last spoke to the House. We hoped to have the results this year but I am sorry to say that it is a year behind time. The reason is that the children in the units with which Dr. Rutter is working are showing very different degrees of retardation and emotional disturbance. It has, therefore, been necessary initially to 879 assess the stage of the development, intellectual and emotional, in the use of language and social behaviour which these children have reached, in many cases having to devise special test procedures, since all this is new.
I am glad to say that special techniques have been developed to describe and record in quantitative terms the differences between the units in the methods of dealing with children's behaviour and to get a degree of consistency about all this. It is hoped to re-test the children after one complete year, which is why there is a year's delay, in order then to draw reasonable interim conclusions, which, I believe, is what my hon. Friend wanted, rather than wait until the whole project is completed before we can hope to benefit by at least part of it.
On the subject of provision, it is entirely for the local authorities, plus the voluntary bodies, to provide these facilities. I am advised that it is possible in certain circumstances for the Government to give financial assistance to the voluntary bodies for capital equipment. I am not certain of the extent of that. My hon. Friend took me by surprise in mentioning it. I will, however, have inquiries made into that aspect and will write to the three hon. Members who have taken part in this debate. Obviously, the provision of capital equipment and other things is an expensive business.
I have been asked questions about categorisation. It is true that in the existing categories autism, for the reasons I have mentioned, does not appear. I am not quite sure that it should appear, although I have been asked three times to have it written in as a category. I think that everybody knows that we are drafting legislation to bring before the House for the transfer of responsibility, and there is also the possibility of another Education Act.
Our thinking at the moment—it is open to influence; we shall be glad to hear what people say—is that autism has emerged as a new handicap since all the known handicaps were last defined in Regulations, and it might be better not to include any categories of handicap at all because other new categories of handicap 880 might emerge as medical knowledge becomes more available to society.
Our present inclination is to say that whatever handicap emerges, it should be the responsibility of local authorities to provide suitable education to meet it—in other words to eliminate altogether the types of category, leaving the responsibility where it now lies. Even though autism is not at present a special category, I can give the assurance that it is still the duty of local education authorities to provide special education for these children suitable to their needs even though autism does not appear in the Education Act, 1944, as a special category.
In respect of the Regulations which will come before the House, I am glad to say that the old Ministry of Health and my own Department issued a Circular, No. 18/68, in October last year—in connection with defining handicaps and their analysis. I like to think that that was the start of the new philosophy of the Government away from the old idea that any children might be regarded as ineducable and beyond the educational process. That was followed by the announcement by my right hon. Friend the Prime Minister a month later concerning the responsibility for these services.
One other question which remains for me to deal with of all those which have been mentioned is that of teenage autistic children. I share the view that this is a matter of some importance. Perhaps rather less has been done on this front than on all the other fronts in the relatively short time. There is certainly not much point in society trying to diagnose, educate and get the medical research right if at the end of the day, when children come out of the school system, there is nothing for them.
Therefore, the provision of sheltered employment for teenage autistic children is certainly not the least important part of the whole operation, although it can be said in honesty that it has hitherto been the most neglected. I can, however, assure hon. Members who have spoken, and the House generally, that we intend to give a great deal more thought to this aspect as soon as my Department has responsibility for the whole of this problem. It will mean co-operative arrangements being established between 881 local education authorities, the voluntary bodies, and schools, in providing care and employment. My inspectors are keen on this; my Department is keen on this: I am keen on this.
I just conclude by saying that I think my hon. Friend has done a service to these children by raising this matter. I certainly hope this is not the last time he or other hon. Members will raise it, because what we would like to do most of all, having fixed public attention on the requirements in this field, is to see that the House gives regular attention to these matters.