HC Deb 05 November 1970 vol 805 cc1407-18

Motion made, and Question proposed, That this House do now adjourn.—[Mr. Rossi.]

10.32 p.m.

Mr. Paul B. Rose (Manchester, Blackley)

Some hon. Members may have read an acutely disturbing and deeply moving account in a Sunday newspaper of a mother's struggle to raise her autistic child. The account concluded: Autism is a monstrous event, outrageous to life, which time, energy, intelligence and love can modify but not remove. Yet there is hope for autistic children, though one of our greatest problems is our lack of knowledge of the causes of, and sometimes what constitutes, autism.

I shall never forget my first personal experience of this, to me hitherto unknown, phenomenon. I returned home one evening in my car, stopped at the end of the garden path and saw my children playing with my neighbour's children. With them was a bright-eyed, fair-haired little boy and he was playing with the garage door, which in any event was hanging dangerously almost off its hinges. For fear that the door might fall on him, I shouted to the little boy, but there was no response. I shouted again and again, but there was no reaction from him. It was as though I was not there. At that point his mother came for him.

Later I spoke to my wife about the incident and to my horror I discovered that this bright, lovely-looking child was, in fact, autistic. It appears that his autism was discovered by accident when he was in hospital for something entirely unconnected with autism. To this day that child has no specialised treatment whatever. Then there are the autistic children who must travel more than 200 miles from Manchester to get any treatment at all.

I understand that autism is a quite recently discovered phenomenon, so that perhaps it is understandable that the facilities for treatment are inadequate. But on looking into this subject one finds that it is not merely that facilities are inadequate or that there is inattention but that there is virtually a complete lack of facilities over a very wide area. The bulk of the facilities, anyway, are situated in the affluent South-East. For example, only one in 11 autistic children in Cheshire is treated in autistic units. On the other hand, one autistic child in seven is in a hospital for the mentally subnormal. I believe that there could be no worse place to send an autistic child: to put a child in such a hospital is to make his improvement virtually impossible.

John Roper, writing in The Times of 18th November said: Autistic children are vulnerable to the bad effects of living in an understaffed institution. They are helpless and bewildered, unable to defend themselves against boisterous children and cannot tell the staff that they want anything, especially if it is affection, attention and cuddling. The result of this kind of treatment is that children whose main problem is in their inability to relate and communicate will either become more drawn into themselves or more disturbed. It is hard to think of a worse way of dealing with them.

Dr. Wing, a member of the scientific staff of the Medical Research Council pointed this out, and said: '…very little is known about the basic cause of autism, but lack of medical treatment does not mean that nothing can be done. Skilled and patient teaching, and understanding by relatives and neighbours, can do much to help the autistic child and his parents. I believe that psychiatrists who advise local authorities and still prescribe treatment in units which are reserved only for mental illness are committing a terrible crime against these children. Some of these children have a very high I.Q. One has been to university and obtained a mathematics degree. Others get their G.C.E. Some have a remarkable skill in such things as music and mathematics. It is precisely this peculiar aspect of autism that I find rather fascinating, because it gives hope in a situation that might otherwise be one of despair.

Last year it was reported that in a memory test 4-word messages were recalled better by autistic children than by a similar sample of ordinary children. The curious thing was that the normal children naturally performed better when the words were made up into sentences, but the autistic children were not affected either by whether the messages were in the form of sentences or were common words. This raises a distinction between memory and ability to understand. It is rather as though beings from another planet were set down in a world and in a culture-language pattern to which they cannot relate and in which they are only able to draw attention to themselves by shouting and screaming, for the fact is that, as the experiment showed, there seemed to be no automatic coding process with these children. They are not capable of benefiting spontaneously from the ordering of the material that comes to them.

The terrible fate that awaits an autistic child if sent to a hospital for the subnormal is that he will probably end his days, rocking in a chair, scratching himself because he has nothing else to do—rotting in his own private hell. And all this in a society which has just resolved to spend money on forces east of Suez, and which can spend hundreds of millions on the Concorde.

I quote once more from The Times, which has been particularly valuable in putting forward the problem of autism. In its first leader it said: It is an indictment of a country's social services that children who could benefit from specialised education are none the less doomed to spend the remainder of their days in a mental hospital. There is the economic cost to the community of paying for institutional care which need not have been necessary. There is the social cost of people never being able to contribute, as they might have done, to society at large. And there is above all the human cost of individuals being denied the type of fuller life which they might have been enabled to enjoy. I believe that specialist training should be a right for these children. This was recognised by my hon. Friend the Member for Manchester, Wythenshawe (Mr. Alfred Morris)—who was here a moment ago, Mr. Deputy Speaker, and who will probably seek to catch your eye on his return—in what is now his historic Chronically Sick and Disabled Persons Act, because in Section 26(1) of that Measure he makes it a duty for every local education authority …to provide the Secretary of State at such times as he may direct with information on the provision made… for, among others, children who suffer from autism. Has the Under-Secretary called for such information? Whether he has or has not, what action does he propose to take under Section 26?

What action does he propose to take to end the disgraceful situation which was revealed in his reply to my Question on 2nd November that in Manchester there is only one unit "specially for the autistic" among only four units for mentally ill or seriously maladjusted children with 57 beds and that there are only 40 beds in this great city of Manchester for mentally ill adolescents? The Under-Secretary said—or his civil servants presumably said, because it is the language of callous complacency: Autistic children are usually treated with other mentally disordered children."—[OFFICIAL REPORT, 2nd November, 1970; Vol. 805, c. 273.] That is the very worst way in which he could treat them.

What is so disturbing also is the regional imbalance. On the very day after I applied for this Adjournment debate the National Society for Autistic Children published its report on facilities available for autistic children. The report showed that in many areas provision is non-existent, that autism is not recognised as a group which is deserving of a specialist education, that 1 in 7 of these children were in sub-normality hospitals—a total of about 700.

I want to quote a few figures applying to the North-West and the North. In Derbyshire with a population of 152,200 under 15, there is no unit for adolescents. In Cheshire, a more affluent area, two small units cater for 10 children in a population of 272,400 under 15. It is estimated that there must be on average about 110 autistic children in that area, so 1 in 11 in that affluent area of Cheshire is getting treatment.

In Lancashire two units cater for 15 children with a population of 609,900 under 15. The estimated number of autistic children is 244. Again there is no unit for adolescents. Going further afield to Cumberland and Northumberland, there is not a single unit for either children or adolescents. Looking at a map of Britain, in a vast area of about nine-tenths of the country there is no facility for the special treatment of autistic children. Some parents have actually moved house and changed jobs to try to get some help. This is not a possibility that is available for many families.

This is not the first time that this problem has been aired in the Chamber. There was an Adjournment debate by Dr. Edwin Brooks on 10th December 1968—a very valuable colleague who unfortunately will not be back until the next election or perhaps before. He led the way in pointing out that a lifetime of dependency and institutional existence can be saved if we have the will to do so.

One of the points I stress is that, whereas for very good reasons the blind and the deaf attract interest and support on a voluntary basis, the ignorance surrounding autism is such that it tends to inhibit voluntary effort. There is always room for voluntary effort so that parents with similar problems can get together with specialists and willing helpers can also come to their aid.

Above all, there is a need, as my hon. Friend the Member for Wythenshawe recognised in his Bill, for public provision and proper diagnosis, because in some areas, as Dr. Brooks pointed out, children are often not even diagnosed as autistic when they manifestly must be. It was inconceivable, for example, that at that time only one child in the City of Liverpool was designated as autistic. Yet, if my hon. Friend the former Under-Secretary of State for Education and Science is right—he pointed this out in a debate—1 in 3,000 children is likely to be autistic and therefore it is unbelievable that there was only one autistic child in Liverpool at that time. We need to get our diagnoses right.

There is need for money to be spent on research. I for one, after today's debate, would be willing to give up my shabby 6d. relief in income tax if money were to be spent on autistic children, on these more unfortunate children in our society. I say that as somebody who is blessed by having three healthy and happy children of my own.

I should like to hear about the regional imbalance and how the Minister is going to correct it. What new facilities are to be provided, particularly in the North-West? How much money is currently being spent on this problem, on research, and on education? How many people are engaged in specialised courses on teaching for the autistic, because this is a very specialised job?

I am not satisfied with the reply which was given on 15th July this year to my hon. Friend the Member for Willesden, West (Mr. Pavitt) by the Under-Secretary of State for Education and Science, when he said that, Psychiatrists generally do not favour the provision of separate units in hospitals for autistic children. Which psychiatrists, and what specialised knowledge of autism do they possess to make them say that, in a field in which research is pointing more and more obviously to the conclusion that, apart from those autistic children with additional handicaps, such a diagnosis would be manifestly incorrect, and autistic children can only be damaged by being treated in that way.

I regard it as a terrible indictment of the reactionary thinking of the Department that it did not think it right to engage in any general development of expensive and highly specialised units".—[OFFICIAL REPORT, 15th July, 1970; Vol. 804, cc. 1690–3.] I wonder how much the "Ark Royal" costs, as a fly on the ocean, when the Minister can dismiss lightly 4,000 handicapped children in that offhand way.

There was at least one grain of humanity, hope and compassion at the end of the Minister's reply to that debate, when he expressed the Government's "real concern" and said something about the "integration of the education services". But action by local authorities and by the central Government is what we want, not merely expressions of concern. The National Society for Autistic Children is appealing for£100,000—and I urge a great public response—but£70,000 out of that£100,000 is already earmarked for four units, none of which is in the North of England. As the latest report of the Society concludes, there is not only a tragic lack of facilities, but 22 out of 32 educational units are in the South-East, while huge areas involving many hundreds of autistic children have no facilities at all. That£100,000, of which£70,000 is already earmarked, is nothing to what local authorities and the central Government ought to be providing to help these children, to help a section of our society which is forgotten.

Above all, as a North-West Member, I am particularly concerned about the problem as it affects my constituents and others living in the region who are struck by this terrible tragedy. I shall be grateful for an answer from the Minister dealing specifically with the facilities which he intends to see are provided in the North-West. I hope that, after this matter has been debated on three different occasions now on the Adjournment, we shall at last see a glimmer of hope, of compassion and of enlightenment on the part of those who advise the Minister on this heart-breaking problem, so that money is spent on these children, money spent where it is most needed, to make provision for those whose plight may well be hopeless if the Minister does not act, and act quickly.

10.48 p.m.

Mr. Alfred Morris (Manchester, Wythenshawe)

I am greatly encouraged by the interest and concern in this deeply human problem shown by my hon. Friend the Member for Manchester, Blackley (Mr. Rose). The House will recall that we had debates earlier this year, during the passage of what is now the Chronically Sick and Disabled Persons Act, 1970, on the problems of autistic children and other children suffering from different forms of early childhood psychosis. As the Under-Secretary of State knows, Section 26 of that Act, which is associated with my name and those of my hon. Friends the Members for Stoke-on-Trent, South (Mr. Ashley), for Eccles (Mr. Carter-Jones), and many others, places a new duty on every local education authority— to provide the Secretary of State at such times as he may direct with information on the provision made by that local education authority of special educational facilities for children who suffer from autism or other forms of early childhood psychosis". I hope that, in consequence of this debate, we shall hear that the Secretary of State is now making a direction under Section 26.

Section 26(2) provides further: The arrangements made by a local education authority for the special educational treatment of children suffering from autism and other forms of early childhood psychosis shall, so far as is practicable, provide for the giving of such education in any school maintained or assisted by the local education authority". I emphasise the importance of the word "shall" in that subsection of Section 28.

I know that the Under-Secretary and his colleague the Under-Secretary of State for Education and Science are both extremely concerned that we shall extend—and rapidly extend—public provision for children suffering from autism or the other disablements which I have mentioned. I am certain that we can rely on them for a constructive answer to the plea so eloquently made by my hon Friend.

10.51 p.m.

The Under-Secretary of State for Health and Social Security (Mr. Michael Alison)

May I begin by expressing my gratitude to the hon. Member for Manchester, Blackley (Mr. Rose) for once again raising this difficult subject? I ask him to believe me when I say that it is not for want of compassion, certainly on my part or on the part of any of the officers in my Department, or that of my hon. Friend, that the needs of these children are not fully and completely met. Indeed, any of those who, like myself and, I imagine, the hon. Member and certainly many officers of the Department, have seen, met and encountered the condition in the child, be it in or out of hospital, can be nothing but appalled and must long to be able to do something effectively.

The trouble is that the present state of our knowledge is such that there are so many areas of uncertainty about the condition which we describe as "autism". Hon. Members will probably be aware that the total number of autistic children, whether in the community or in different types of hospital, has itself not been fully established. We do not have very good statistics on this subject. Various estimates have been made of the total, but it seems likely to to be mercifully relatively small.

The trouble is that autism is a symptom and not a single condition. Austistic children do not form a homogeneous group. It may be due to a variety of causes, as the hon. Member will appreciate. Among them there are sensory defects, emotional disturbances of various sorts and damage to the brain. Similarly, there is a wide range of variation between one child and another in the severity of the symptoms and the relation of the symptoms to each other. Sometimes one is much more conspicuous and sometimes another.

As the hon. Member rightly pointed out—and this is one of the most problematic aspects of the question—there is a great range in the tested intelligence of autistic children. They may, on the one hand, be to all intents and purposes perfectly normal in their mental capacity and, on the other hand, the capacity may extend to the very lowest of the measurable limits.

The point I want to make is that the group is not at all uniform. Individual autistic children have very different needs and a very different capacity for development. Because of the variety of forms that autism may take and the variety of its underlying causes, we still have a great deal to learn about the nature of the condition and, above all, the best approach to diagnosis and treatment.

Mr. Jack Ashley (Stoke-on-Trent, South)

May I remind the hon. Gentleman that Sections 25 and 27 of my hon. Friend's Act deal with blind-deaf children and with children suffering from dyslexia? I hope that he will take that into account when discussing the problems of autistic children.

Mr. Alison

The hon. Gentleman is referring to the Morris Act. I take his point, but I am sure he will understand if I do not deal with it now.

On the subject of the best means of diagnosis and treatment, there is one quite clear point. It is that the earliest possible age of assessment is of paramount importance. The earlier that the condition is diagnosed, the more hope there is of doing something about it. Generally, it has to be done in a hospital setting, in order to have the best diagnostic and psychiatric facilities available.

Medical treatment, where appropriate, varies according to the nature of the condition. But, in the present state of our knowledge—and this is part of the tragedy—what is provided in many instances is in the nature of care rather than cure. That is the limitation of our knowledge at present. A minority of autistic children, especially those with emotional disturbance, are found to benefit from psychiatric treatment in hospitals, and we should not rule out hospital treatment, though I acknowledge the point that there are people in hospitals who would probably be better out of them and in the community. The majority can be managed at home. I am glad to have my hon. Friend the Under-Secretary of State for Education and Science with me, because education and training is thought to offer much the best hope to the majority who can be managed at home.

There is still much difference of opinion among those who are professionally responsible as to the most effective form that the education of autistic children should take. My right hon. Friend the Secretary of State for Education and Science told hon. Members on the last occasion that the subject was debated in the House of a research project set up in 1966 to make a comparative study of the progress made by children in three units in the London area catering in different ways for children with autistic symptoms. I understand that the results of this project are expected within two years. But it is unlikely that any single educational régime will be shown to be the best for more than a small proportion of these children.

Mr. Lewis Carter-Jones (Eccles)

Is the hon. Gentleman aware of the work being done in my constituency, which has one of the few autistic units in the country? Part of the tragedy raised by the hon. Member for Manchester, Black-ley (Mr. Rose) is revealed by the fact that people are prepared to move into the constituency in order that their children may be educated—not going to hospital, but to school. Does not he consider this to be a possible means of at least alleviating parental suffering, where a child shows no response at all to parental love?

Mr. Alison

I take that point. But again there is a division of opinion about the best way of providing schools or units which cater exclusively for these children. On the one hand, this may make possible more specialised treatment such as that to which the hon. Gentleman refers in his own unit, where an intensive study of the problems can be conducted. On the other hand, a group of children lacking meaningful speech or other means of communication may be almost unteachable in such a unit unless the staffing ratio is high enough to permit individual tuition for much of the time. This can be achieved only at the expense of other, equally deserving groups of children with severe mental and emotional handicaps, since the number of teachers with the willingness and the experience to undertake the work is not unlimited.

The hon. Member for Blackley touched on the position of adolescents, and I confirm that there are very few units for adolescent autistic children. But that may be partly due to a point of definition. The apparently withdrawn behaviour which gives the condition its name, particularly in the earlier age group of 8 to 10, may itself undergo a considerable change as the child develops.

The other problems associated with the child at an early age—difficulty in communication, educational backwardness and sometimes emotional disturbance—may carry on after autism, the condition itself, has been left behind and these later aspects of the condition of the adolescent are likely to remain the main determinant of their educational attainment.

I have little time and I am bound to telescope what I have to say, but I should like to touch on the position in other parts of the country. Children's units are unequally spread over the country and some regions are better served than others. The hon. Member for Blackley will be glad to know that the scale of hospital provision for children in the Manchester region is about the same as for England as a whole. Hospital boards have plans for about 350 more beds and while some plans are more advanced than others, the increased provision should help to restore the balance for the country as a whole.

I should like to say a little more about the north west since the hon. Member specifically asked me. I am told that there are educational units for autistic children at Eccles, Lancaster, Oldham and Salford in Lancashire, and at Birkenhead, Neston and Holmes Chapel in Cheshire. But these units do not indicate the full extent of the provision. A number of children are placed in special schools or junior training centres, while others are, of course, in psychiatric hospitals.

My right hon. Friend the Secretary of State for Education and Science is considering the issue of a circular of guidance to local education authorities which may include a request for information about the numbers of autistic children and arrangements for their care and education, but because of the lack of any clear-cut and generally accepted definition of autism, any information at present available or likely to be gathered in the near future can give only a rough indication of the needs or of the provision which exists to meet them.

It is for this reason, as well as on more general grounds of policy, that the planning of services must be seen primarily as a matter for local education and health authorities acting in concert with hospital services—

The Question having been proposed after Ten o'clock and the debate having continued for half an hour, Mr. DEPUTY SPEAKER adjourned the House without Question put, pursuant to the Standing Order.

Adjourned at two minutes past Eleven o'clock.