Chamber and committees

:That gets to the heart of the work of the cross-sector task force, which Georgia is heavily involved in. Georgia, can you give more information about the review of the implementation of the specification, and the work that the task force has undertaken since then?

:I appreciate that that area is of significant interest to the committee, particularly given the evidence that I know you have taken over recent weeks. Similarly, it was obviously an area of significant interest to the Health, Social Care and Sport Committee.

I point to two pieces of work that have been undertaken. For children and young people, you will be aware of the neurodevelopmental service specification and, subsequent to that, the review and the establishment of the cross-sector task force, which has now been meeting. That work has been supported with resources, and further resource was announced for this financial year and in the budget going through Parliament for the coming financial year. The task force is co-chaired and has representation from health and education, which reflects the need for a holistic cross-sector approach. It will work to improve the development of the specification, recognising that many instances of a neurodevelopmental condition might first present and be identified in an educational setting.

With regard to adults, we fund the National Autism Implementation Team, which has been working with health boards to develop pathways and with the Government to engage with health boards to improve consistency, recognising that variance exists and that there is a need to ensure equity of access and support across Scotland.

I will ask Georgia de Courcy Wheeler to provide a bit more detail on the work that we have been doing in relation to pathways for both children and young people, and adults.

11:15

:I would appreciate it if you could write to me and furnish me with a bit more detail on that specific instance. I give an undertaking that I will respond to you personally and will investigate the matter. Of course, I recognise the autonomy of local authorities as education authorities, but I would want to understand the particular factors that are at play.

On seeking to drive greater consistency across Scotland for children and young people, we have spoken at some length about the work to review the implementation of the neurodevelopmental specification and about the task force to take forward implementation. Indeed, the task force is being co-chaired, with representation from the education and health sectors, recognising the need for rounded, cross-sectoral working.

On the principle of voluntary or shared care arrangements, I provide assurance that there will be an equity of approach across Scotland. Since coming into my post, I have sought to meet directly with senior leaders and chief executives from as many health boards as possible and at every one of those meetings I have raised the specific issue of what provisions are in place to assess and support those with neurodevelopmental conditions. I recognise that there is a variety of approaches in practice and that there will be instances of innovation and learning that can be shared and disseminated more widely. We want to ensure that that happens and will seek to ensure equity and consistency of approach across Scotland for children and young people and for adults. That is a key consideration and is one that is routinely relayed to me in correspondence from elected members, directly from members of the public and from organisations representing individuals. I give the member that assurance.

:In terms of principle and policy, the challenge is around implementation. Considering the new developmental specification for children and young people goes back a number of years. We had a specific joint review with COSLA on implementation, which led to the task force. That action, in itself, concedes the point that there have been challenges around implementation.

I recognise—indeed, this has been conveyed to the committee—the unprecedented and unforeseen increase in demand, but, from a policy perspective and in relation to the duties that are placed on education authorities around additional support needs and additional support for learning, the challenge is around implementation, which is exactly why we established the cross-sector task force, which brings together health and education.

:I am happy to come back on that, given that I am the politician sitting at the end of the table.

Committee members will be familiar with the issue of assurance in relation to any assessments that are undertaken outwith the NHS, because of the evidence that I imagine will come from your casework. I know that the committee has considered the concerns with single-condition assessments—there was some discussion about that in the session with the Royal College of Psychiatrists last month.

We have to ensure that any process is robust, but I want to provide the committee with reassurance that the issue has been regularly raised with ministers. As Robby said, it featured in the deliberations at the cross-party summit, and we are giving broader consideration to it.

Questions have been raised around equity of access, and there is also the point about the on-going need for monitoring in cases where medication is prescribed. It is a challenging and complex area. There are practical considerations about whether such a process could be administered. There are also political considerations around equity of access. Therefore, although I cannot offer the committee a definitive answer at this meeting, I am keen to consider the committee’s reflections when it publishes its report. The committee can play an important role in considering these questions and feeding into the work that has been undertaken by the Health, Social Care and Sport Committee and the work that is under way through the cross-party summit.

:That is a really good question. I think that there is something to be said, so I will offer some thoughts and ask Robby Steel to come in with his perspective.

We touched earlier on the unprecedented and unforeseen growth in demand. The significant increase in awareness and the rapidity of the pace of change have led to a situation where we are having to, in effect, recalibrate how our systems approach something for which they were not necessarily designed. The nature and definitions of neurodevelopmental conditions, and the approaches to diagnosis, have evolved significantly in the past couple of decades, too. The landscape that we are inhabiting has changed significantly, which may perhaps help us understand and account for some of the variation that has been taking place. What that speaks to, however, is a need to improve consistency. As I touched on earlier, we have the national specification, but there is a question around its implementation. That speaks to the work that we are doing with the task force. Then there is some of the work that Georgia touched on, around information and provision for parents and teachers.

A lot has changed in terms of how the nature of diagnosis and public understanding have developed over the past, say 20 years; I am thinking of the 22 years since the Education (Additional Support for Learning (Scotland) Act 2004 was put in place.

12:00

:I highlight at the outset that I very much recognise the importance of assessment and diagnosis to identity and validation and particularly with reference to ADHD, where diagnosis is required in some cases to ensure that the most appropriate treatment—and, specifically, medication—can be provided.

I am sure that we will touch on this in more detail: I know that the committee will have heard evidence that, although we have a system that is, in principle, based on need, many people feel that it is more difficult to access support without an assessment and diagnosis. I am conscious that that leads to greater pressure and focus being placed on assessment and diagnosis. In recognising that, I am in no way seeking to ignore the significance and importance of assessment and diagnosis. I touched on that in my opening remarks and I know that the committee has heard that diagnosis is not a requirement for accessing support. It can often be the case that small interventions at the right time can lead to profound improvements in an individual’s wellbeing.

When we think about utilising the resources at our disposal, we must apply them in a way that is consistent with a needs-based approach, so that we can ensure we are meeting everyone who has a need, while also recognising that some individuals will not meet the diagnostic thresholds but will still have support needs that must be addressed.

When we look at the overall principles behind resourcing and funding, we want to be consistent in taking a needs-based approach. Georgia de Courcy Wheeler may be able to give some more detail about how funding is being utilised at the moment.

:I go back to my earlier points about our work with NAIT and what we are doing to take forward its recommendations across health boards. It might be useful if I invite Robby Steel to offer a few thoughts and reflections on the broader question of diagnosis and the important role that it can play.

:Regarding the report from the Royal College of Psychiatrists, I attended the launch event in the Parliament and have met with RCP representatives on multiple occasions. I also responded to a members’ business debate in the name of Daniel Johnson and may even have responded to a question in the chamber from you, Mr McLennan. I take the opportunity to reiterate my sincere gratitude for the RCP’s report, which very much aligns with work that the Government has undertaken over a number of years.

As I touched on earlier, the report recognises the need for a whole-system and whole-society approach, while also recognising the unprecedented and unforeseen increase in demand, which could be characterised as a wicked problem. While recognising the complexity of the situation, there is also an implicit caution that we must not allow ourselves to gravitate too quickly towards simplistic solutions, whatever those might be. It is important to remember that when approaching anything that has a degree of complexity. That informs a lot of the work that we are doing and is reflected in some of my responses regarding voluntary or shared care arrangements. I will ask Georgia to come in in a moment and to talk about her engagement with the royal college.

I appreciate that the committee has taken evidence on education and training and I will be keen to consider what comes out of the committee’s report. I give an undertaking that that will be shared with my colleagues, including the Cabinet Secretary for Education and Skills, and with relevant officials. I do not want to speak in any detail on an area that is outwith my direct portfolio responsibilities, except for recognising that ASN is a component part of initial teacher training. I know that the issue of teacher training has been raised throughout the committee’s inquiry. As ever, the Government will give careful consideration to the report that the committee produces, which will be shared with the relevant minister and with officials.

I hand over to Georgia to talk about engagement with the RCP on the work that it has undertaken.

:That is an important point, which speaks to the need for the work that we mentioned to increase awareness and to ensure that everyone who works in our public services is equipped to respond appropriately, compassionately and sensitively to individuals, irrespective of what their needs might be. There has, understandably, been a great deal of focus on and interest in mental health and wellbeing and policing more widely. I recognise that that is a key area of interest for the Parliament. We as a Government have been working to make progress in that area—for example, through the distress brief intervention initiative.

We certainly recognise that there is more work to do. In responding to this inquiry, and to the wider interest that exists, I assure you all that it is recognised that the issue does not sit in only one portfolio. There is a breadth of interest across a range of areas, including education; I know that there has also been consideration of the economy and the workplace environment. There has been a whole-society approach.

I recognise the significant challenges, but there is a broad consensus across Parliament that was reflected in the work that was undertaken through the cross-party summit. Because of that, we have the means to work constructively so that, whoever is returned in the next session of Parliament, they can build on the work that has been undertaken to ensure a holistic, needs-based, whole-system and whole-society approach.

In my earlier remarks, I touched on the importance of assessment and diagnosis, but the work cannot be about just assessment and diagnosis. We have to take a whole-society approach, because the issue touches and impinges on individual lives in every facet of our public services.

We recognise the number of people in our population who are neurodivergent, and we must ensure that our public services respond to their needs compassionately, effectively and in a rights-informed manner. I certainly recognise that there is still a substantial amount of work to do, but I hope that my colleagues and I have conveyed the Government’s absolute commitment to doing that work.