Official Report 548KB pdf
::Welcome back. Our next agenda item is our final evidence session in our inquiry into neurodivergence in Scotland. I welcome to the meeting Tom Arthur, who is Minister for Social Care and Mental Wellbeing. The minister is accompanied by Georgia de Courcy Wheeler, who is CAMHS and neurodevelopmental improvement team leader, and Robby Steel, who is principal medical officer for mental health, in the Scottish Government’s mental health directorate. You are all very welcome; thank you for joining us. I refer members to papers 4 and 5 and invite the minister to make an opening statement.
::Good morning, convener, and thank you to you and to the committee for the opportunity to contribute to this important inquiry. I welcome the committee’s focus on the lived experience of neurodivergent people in education, criminal justice and the workplace, which are areas that have a profound influence on opportunity, wellbeing and future stability.
Neurodivergence is a natural and valuable part of human diversity. Neurodivergent people contribute talent, creativity and insight across our society. However, we must recognise that many of our systems were not designed with different ways of thinking, communicating and processing information in mind. In a world that is not always built for neurodivergent people, everyday interactions can become barriers, which is why building a more neuro-affirming society must sit alongside ensuring access to effective neurodevelopmental support. Valuing difference does not remove the need for timely, practical help when it is required.
Demand for support and diagnosis continues to rise and, although increased awareness is welcome, it has placed pressure on services. A model that is centred solely on diagnosis and waiting lists is not sufficient. What makes the greatest difference is co-ordinated, needs-based support—indeed, small, proportionate adjustments can often have a significant impact on someone’s confidence, stability and ability to participate fully.
Effective support must be whole system, holistic and multi-agency. It must span health, education, justice, employability and community services, including vital input from the third sector, and it must adapt as people’s needs change across their lives. Many of those themes were explored during the Health, Social Care and Sports Committee’s inquiry, which reported earlier this month. I have also considered many of those issues with a cross-party group of MSPs and experts at our neurodivergence summit at the end of last year. A follow-up to that summit is set to take place next week.
It is clear from all that work that the shared challenge is to ensure that systems recognise difference, respond proportionately and adapt as people’s needs change over time. Often, it is relatively small, practical adjustments, made at the right moment, that can have a significant and lasting impact on someone’s ability to participate and thrive.
I very much look forward to the discussion ahead.
::Thank you. We now move to members’ questions, and I will kick us off. What concrete actions does the Scottish Government intend to take to ensure that a functioning, consistent neurodevelopmental assessment pathway is available to people across Scotland?
::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.
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As the minister said, we have had the neurodevelopmental specification for children and young people for a number of years and we carried out an implementation review last year, setting out a range of actions to support health boards and education authorities in implementing that specification across sectors.
The cross-sector task force that the minister mentioned is playing an important role in supporting both the Scottish Government and the Convention of Scottish Local Authorities to take forward actions that aim to progress implementation of the specification. It applies across the whole of Scotland, so progressing its implementation will help us to have more consistent and appropriate pathways for children and young people by recognising the need for local delivery supported by national leadership and guidance.
We have been working with NAIT for a number of years to support health boards in developing neurodevelopmental services and pathways for adults. It would be fair to say that that work is less well developed than the work with children and young people, but we are committed to driving that forward in the next few years.
::How will the new £7.5 million of funding for neurodevelopmental assessments reduce waiting times and when will you see measurable improvements?
::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.
The committee will be aware that £7.6 million in the draft budget for the next financial year is earmarked for young people I can give a little bit of flavour about where we are at in our thinking.
As the minister said, our focus at the moment is on whole-system, needs-based support and we are guided by the neurodevelopmental specification. Along with our partners at COSLA, we are working through how that funding can best be utilised to deliver the biggest impact and change for neurodivergent children and young people and their families.
It will, of course, be for the next Government to consider how to take that forward, but I just want to state that, in our thinking and in our work with COSLA, we are ensuring that we listen to the voices of lived experience as well as colleagues in professions such as psychiatry and psychology, the third sector and education in guiding how we might use that additional investment, and with that long-term sustainable change that we know that we need to see for neurodivergent people very much in mind.
As the minister has mentioned, we have provided additional funding this financial year, and it very much builds on some of the smaller amounts of funding that we have been able to provide in the previous few years. We are now expanding on some of our work on testing digital assessment tools, and we are working with all health boards on their existing waiting lists to help them identify the support needs of the people on those lists at an earlier opportunity. That digital tool is still in the testing phase, but we are helping that work to progress.
We have also provided some additional funding this year to increase health boards’ capacity to assess and diagnose their over-16s. It is a one-off investment, but we are talking about an age group that is at risk of ageing out of services. Although that diagnostic focus does not represent the whole of our policy approach, we recognise that it was valid to use that funding to relieve some of the pressure in the system.
We have also invested some of the additional funding in testing digital support for young adults who are at that transition stage of leaving school and moving into further and higher education, in recognition of the fact that such transition stages can be particularly challenging points in people's lives. Furthermore, we have provided some additional investment for family support, because our review work with COSLA highlighted the huge value of third sector provision in such support and in empowering parents to support their children.
As we move into next year, we are looking at how we use that funding to build on all that we have learned from the investments that we have made up to this point and, as I have said, to make it more long term and sustainable.
::Thank you very much for that really helpful feedback.
::Good morning, minister, and thank you for joining us this morning. In my first question, I want to build on your previous answer and Georgia de Courcy Wheeler’s contributions, too.
When you talked about broader needs-based support—I am thinking of those situations in which a diagnosis is not required but we still need to ensure that those have access to support—you mentioned tools, digital support, family support and so on. What specific steps is the Scottish Government taking to ensure that people who need those support mechanisms know about them, first of all, and then can access them? After all, this is not always about funding, although funding, especially for the third sector organisations that provide such mechanisms, is crucial. What is the Scottish Government doing beyond providing funding to ensure that people have access to the support that is out there without diagnosis?
::I thank Ms Chapman for her important question, which highlights that providing services and investing in ensuring that they are available are one thing, but ensuring that people are aware of and know how to access them is another thing entirely.
There has been work on raising awareness in recent years—there was, for example, the Different Minds campaign a number of years ago—and there is certainly a recognition that we have to do more to increase awareness of the range of services that are available. A point that I would observe, and which the committee will be au fait with, is the proliferation of resources that are now available online. Some of them will come from reputable sources and can be of use, but I think that we would recognise that others are potentially more concerning in some of the information that they provide. Therefore, ensuring that we have clear and accessible publicly provided information and signposting to services will be a key focus of the Government, and our investment in expanding service provision will, of course, be complemented by that signposting and awareness raising.
Georgia, do you want to add anything specific about some of the work in that space?
As the minister said, a two-track approach is required. On the one hand, we need to ensure that resources, information and services for parents and families are reliable, good and available. On the other hand, we need to ensure that they are aware of them. We are working with the neurodevelopmental task force to look at how we can improve the shared knowledge base of the wide variety of available resources, particularly among professional groups, whether in education, health or the third sector. As the minister said, we acknowledge that more and continuous work is needed on that.
::I will go back to the questions on diagnostic assessments and the different pathways. We understand the point that diagnosis should not be necessary to get support, but people often find that, without the duty to support and to make reasonable adjustments that a diagnosis brings, they cannot access that support. What is the Scottish Government doing to ensure that people are able to get a diagnosis wherever they live in Scotland? Some health boards have just stopped that diagnostic pathway completely.
::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.
Diagnosis in the whole of medicine is a bit more complicated than is often portrayed. For example, your general practitioner might tell you that you have hypertension. The cut-off point for where your blood pressure has to be for that diagnosis and how often it needs to be checked to confirm that that is a true reading is inherently arbitrary. No risk curve in medicine has a sudden step at the cut-off point for hypertension. The risk curves for heart disease, stroke and so on follow a continuum. Similarly, with neurodevelopmental disorders, the side of a line that a person falls on as to whether they fit the diagnosis does not necessarily tell us what their needs will be or what will help.
As a psychiatrist, I would say that health boards need to be robust in their use of clinical mechanisms for confirming or refuting a diagnosis but that assessment is much broader than diagnosis. Assessment is assessment of educational needs. What might cause the biggest problem in a person’s life might not be the thing that they fulfil the diagnostic criteria for, if they fit it at all. We need good access to more holistic assessment, which will probably also act as a triage for access to clinical assessment if a person’s profile suggests that they might fulfil the diagnostic criteria.
People do not have a right to a diagnosis, but they probably should have a right to an assessment to see whether they fulfil the diagnosis. However, we need to stick with what the diagnoses are. The problem that Scotland is facing is the problem that all countries in the western world are facing: the sudden increase in awareness of these difficulties has led to new demand for assessment across the western world. I do not think that any country has cracked that issue yet. The result is that all countries have huge, pent-up demand from people requesting assessment that they have not quite figured out how to meet. That has ended up with national health service waiting lists in our system. Whether or not we need a new paradigm for looking at it, the way forward might be to allow people to access assessments and to reserve the NHS for those who have a profile that suggests that they need a full clinical assessment.
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We are looking at that, but this has all western countries on the hop, because systems that are designed for assessing 1 or 2 per cent of the population are the obvious pathways to provide assessments for 20 per cent of the population, and that does not fit, so they are struggling as a result. We have not yet come up with a good solution that is person based and puts diagnosis in its right place but offers assessments all round. I hope that that answers your question.
::That was helpful. Some people get a diagnosis privately but then find that that diagnosis is not recognised by the NHS, either for medication—if that is the appropriate route—or for other things. Is there a simple, quick fix that we can implement to ensure that a diagnosis, wherever it comes from, can be recognised and become the gateway to further support, whether that is medication or other things?
That was raised at the cross-party summit. As a psychiatrist, I would say that it is a political judgment, because it is about equity of access to NHS services, the argument being that those who can afford a private assessment will get the opportunity to jump the queue because of the strain on the shared care protocol. For example, once medicine has been prescribed for ADHD, a person’s blood pressure needs to be monitored and repeated assessment is needed to see whether they are still benefiting from it or whether it is causing more harm than good—that particularly applies to children, because it has an effect on growth potential. If people who can afford a private assessment jump into that limited resource for follow-up, they can inadvertently end up blocking those who cannot afford it.
You are a politician and I am not, so I am not sure where that will end up. I suspect that private assessments will have a role in dealing with the bulge in demand—as they do in relation to physical health—until it is dealt with. Ultimately, we need a system that has the capacity to meet the need.
::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.
::I agree with Robby’s last point about getting to a point where we have a capacity in the NHS to deal with the issue.
I go back to something that you said earlier, minister, when you were talking about the holistic cross-sectoral approach for children and young people and the national autism implementation team for adults. Are you confident that the Scottish Government has the right steps in place to ensure that post-diagnostic support is consistent across Scotland? We know that consistency is an issue. Are you confident that those two approaches will deliver that?
::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.
::Thanks, minister. I will leave it there, convener.
::We move on to questions from Marie McNair, who will be followed by Paul McLennan.
::Good morning. I will go back to Maggie Chapman’s point about not needing a diagnosis to access support. Unfortunately, we have heard during the evidence sessions—I have also heard this feedback from my constituents—that the reality on the ground is that, with regional variations, folk are experiencing barriers to support without diagnosis.
I do not agree with the point that it is jumping the queue to accept a diagnosis that might have been done by a private psychiatrist, because that psychiatrist might have been practising as an NHS psychiatrist earlier in the week. Surely private diagnoses would help with waiting times and the impact that the wait has on people’s mental health. Those are just a few comments, but I thought that I had to make them.
::Those are very important points. I will ask Robby to come in, but first I reiterate the point about situations in which assessment and diagnosis are undertaken by someone acting in a private capacity who also works in the NHS naturally leading to the kind of comments that you very reasonably put forward. I will also offer the balancing point about assessments that are not undertaken in a way that we would regard as robust and so cannot provide that assurance. I reiterate the importance of ensuring that, when assessments are undertaken, they are holistic, rounded and consider the full range of potential issues, challenges, conditions or circumstances that pertain to that individual—Robby can speak to that in a professional capacity—and that we are in a position where we have that assurance.
It may have been a witness from the Royal College of Psychiatrists in Scotland who used the perhaps blunt expression,
“if you have a hammer, everything looks like a nail.”—[Official Report, Equalities, Human Rights and Civil Justice Committee, 20 January 2026; c 15.]
That is an important point in relation to risk around single-condition assessment. However, I recognise and reiterate your point that there will be those who are undertaking assessments in a private capacity who also work in the NHS.
I am conscious of a range of views with regard to what the degree of utilisation of private capacity across healthcare should be. Clearly, there are very strong principles, and there is broad political consensus, which the Government is absolutely committed to, that the NHS should be free at the point of use. However, the issue of utilisation of private capacity has been raised. There are those who advocate it on the basis that it is a practical and pragmatic use of the capacity that is there, and there are others who raise what I think are fair and legitimate concerns around equity and fairness in the system. It is not always as straightforward as simply having an assessment and diagnosis outwith the NHS; it is about the on-going care and support that are required beyond that.
I add those nuances of complexity, but that is in no way to dismiss the points that have been brought forward. I recognise that that view is widely shared, and I reiterate my reassurance to the committee that we are engaging seriously on the issue, but we recognise that there are challenges.
Particularly in relation to what are described as shared care arrangements, but which are technically voluntary arrangements, it is not for ministers to seek to interfere in the decisions of the lead clinician or the general practitioner on whether to enter into any such agreement. However, I am conscious of the calls that have been made to the Government for greater clarity and consistency around policy. It is a complex area, and I assure the committee that we are giving it serious consideration. Would you like to add anything further, Robby?
On the issue of quality assuring private assessments—and you have given the example of an undeniably high-quality private assessment, Ms McNair—the problem with shared care is that GPs who are asked to prescribe a medication in which they are not experts understandably want the clinical reassurance that, if they request a specialist review, they will know whether the person still needs the medicine, whether the correct assessments were made of the person’s physical health before they started it and so on. Although that can be arranged through a shared care arrangement with the specialist provision in your health board, it is much more difficult to get that agreement with a private provider. That has traditionally been the stumbling block. I do not think that it is impossible—as I said, I could see a situation in which extra capacity in the private sector is used to get us through the pent-up demand—but there are problems with that in the long term, which are not unique to the mental health sector.
::I am reassured, for myself and my constituents, that the issue is being considered. I will wait and see where we go with that.
What actions is the Scottish Government taking to identify the most persistent barriers and forms of discrimination that neurodivergent people face? How will you ensure that the actions that are taken will lead to improvements?
::I have always sought to make it clear that Government ministers hugely value the contribution of lived experience, and I recognise that the committee does as well. I and colleagues and officials in Government have engaged several times with many of the individuals and organisations that were represented and therefore heard from at your round table, and we hugely value those insights.
I assure you that of utmost importance to us in relation to our policy development and implementation is that we take on board and respond to the expertise that is provided through lived experience so that the actions that we are taking are consistent with our values of inclusion and equality.
I might ask Georgia to come in with specifics in a moment, but I want to highlight a broader point. Although we will naturally focus on systems, this is also a societal issue. Although that is a much bigger challenge, given the concerted effort that is required over a sustained period to effect cultural change, it will be of the utmost importance to consider that this is not simply about a whole-systems approach but about a whole-society approach, too. As I said in my opening remarks, our world is perhaps still characterised by the norms and approaches that are relevant to neurotypical people but which often disregard the way in which neurodivergent individuals experience the world. That is something that we must address.
We recognise the significant progress that has been made over decades by taking a social model approach, to physical disability, for example. The barrier to someone being able to enter a public building or a theatre is not because they use a wheelchair, but because there is no ramp or because the equipment set-up is insufficient to allow them to fully participate. That social model approach has been very influential. Although we acknowledge that there is much work still to be done and much progress to be made, we can recognise the positive impact that the social model has had and that it is possible to effect societal change and to raise standards and expectations about inclusivity in society, so that everyone has an opportunity to fully participate and realise their rights.
Of course, that also has to apply to taking a whole-society approach in our response to the significant number of people who are seeking neurodevelopmental assessment support. We recognise that those individuals have always been there, but many of them now have greater awareness, due in part to the tireless campaigning of many of the lived experience organisations that the committee has taken evidence from and that I have had the privilege of meeting. Those organisations have helped to ensure that the community is finding its voice. In doing so, they are helping to effect change at a systems level as well as culturally and societally. I do not know whether Georgia would like to add anything on our engagement around issues of tackling discrimination and promoting a more equitable society.
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I would love to share a specific example with the committee. A lived experience organisation that the committee has taken evidence from and that we regularly engage with brought to the attention of policy officials that Scottish Government guidance relating to the blue badge risk in traffic scheme cut across our aim of ensuring that diagnosis is not a barrier to support. The Transport Scotland blue badge guidance recommended that local authorities looked for evidence of a diagnosis, or that a diagnosis was forthcoming when someone was being assessed as to whether they were eligible for a blue badge on the grounds that they are at risk in traffic. The policy team was not aware of that issue prior to the lived experience organisation raising it with us, so it is a great example of how important that engagement is for us. We were able to work with our Transport Scotland colleagues to revise the guidance that they produce for local authorities on blue badges, which no longer includes that requirement. That is a specific example of an issue that was a real barrier to people with lived experience and of where we were misaligned in our approaches, which we were able to address.
::I could flag other examples of barriers to neurodivergent people obtaining blue badges and will quite happily come back to you on that, and I totally agree with the minister’s comments about societal change.
::I have a few key questions, which come back to the shared protocol. During various sessions, we have heard about equity of access across private healthcare and the national health service, as well as across different parts of Scotland. My first question is, what can we do to ensure that we have equality of access across Scotland? That is fundamental. What can be done with the shared care protocol?
Secondly, I will move on from diagnosis to the question of who provides support. In my constituency, there is a situation in which a local authority is not letting speech and language therapists operate. Some children have had sessions for a number of years with speech and language therapists who are now not allowed access into schools. The local authority is saying that the support should already be there, but the support that is provided is not enough for those kids. My question is about equity of access across the country and how we ensure that private speech therapists who have been working with kids over a long number of years and who are now not allowed access into a local authority school can provide support. I will have a few other questions after that, but could you start with that, minister?
::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.
::The shared care work that you mentioned will be fundamental and I look forward to receiving an update on that.
I will move on to a slightly different question. You mentioned the Royal College of Psychiatrists. I have met with the college and the committee had an evidence session with representatives from the RCP, who talked about national guidelines for working conditions and reasonable adjustments for schools, higher education institutions and employers. What are your thoughts on that? They pushed the idea of a cross-sectoral approach.
Another key question comes from the evidence that we heard last week about neurodivergence training for teachers, which can vary within individual schools, never mind within local authorities. That issue was picked up by one group that we heard from last week. A lot depends on whether teachers have had training. How can we increase the level of training on and recognition of neurodivergence and how can schools look at the issue of reasonable adjustments?
::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.
I can add something about the particular issue of teacher training. We funded a project in this financial year to give parents access to digital support and advice, peer support, workshops and so on. There is also access for the teachers of those parents’ children and we are interested in seeing what the outcomes are and how that is received by teachers. We will use that to inform further thinking with our education colleagues about teacher training opportunities.
The royal college is a really important member of our task force and we are continuing to work with it both in that area and in the adult area to consider where there are gaps in our support system, particularly for adults, and where we can make improvements to deliver on the stepped care approach that it recommends. We know and recognise that there is more to do in that area for adults, than for children and young people.
More broadly on the training question, we have worked with the National Autism Implementation Team and also with NHS Education for Scotland to develop quite wide-ranging resources and information for people who work across health, education and the third sector. The resources are available for everybody to engage with. To touch back on some of Ms Chapman’s earlier questions on whether people know about those supports, we recognise that we could do more to promote the uptake of those resources and we are working with NAIT and NES to explore how to do that.
::The evidence that we took showed quite stark inconsistencies in the understanding of neurodiversity between not only education authorities or schools, but classes in the same school. It seems that any approach is dependent on a teacher’s understanding of various conditions and how to support them. What is your understanding of the underlying reasons for the gap between what legislation says about additional support needs and practice on the ground?
That gap was quite stark when we spoke to people from local authorities who were dealing with neurodivergence and to the people on the receiving end. It was almost as though we were speaking about two different things. Although those in charge of dealing with neurodivergence in statutory services seem to understand it well, that did not percolate to what people were experiencing on the ground.
::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.
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There have been some very good studies, particularly on ADHD, that have asked about the cause of the rise in demand and the reason why we are seeing more kids and adults with ADHD. The answer is that recognition of the underlying incidence has improved. The idea that there is a whole population who have been exposed to something in utero, such as paracetamol, does not come out in the literature at all. What has happened is that society has become much better at recognising that these traits exist in the population. Historically, people who have had these traits have just been disadvantaged: they were simply expected to fit in. I have heard it said that being neurodiverse is like being a Mac in a PC world and that the job is to make the world more Mac friendly. That is the nature of the problem.
The diagnostic nomenclatures—the “Diagnostic and Statistical Manual of Mental Disorders” and the international classification of diseases—follow societal norms, as psychiatry and, to an extent, medicine always have. From DSM-4 to DSM-5 and from ICD-10 to ICD-11, the diagnostic criteria have subtly shifted. Looking back further, autism was defined by Dr Kanner, who worked in a residential home for boys with learning disabilities. He saw that some of them showed traits that other kids did not share and called that “autism”. That is where the term originated. In the 70 or 80 years since then, we have come a huge way in changing what we recognise, which is that autism is not limited only to kids; it is a range of traits that are prevalent across society and these people can be helped to reduce the disadvantages that they are at.
That has happened very rapidly. With any change, institutions and individuals vary in their rate of adaptation to that change. You observed that in some schools, it comes down to one teacher who has really got it and is really good with the kids with these difficulties—maybe other teachers are old dogs like me who do not learn new tricks so easily and have not adapted. That is always going to happen with any change. This should be seen as a societal change, but one in recognition of something that was always there.
::The impact of that on individuals can be huge. If someone cannot cope without support, and for whatever reason they are not getting it, that could mean the difference between access to education or no education. We talked about education for teachers and how it is about getting it right for every child. How do we make sure that nobody is left behind?
::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?
Certainly. In the implementation review, something that came through loud and clear was the pressure on teachers and the fact that sometimes it is difficult to get the opportunity to do continuous learning and improvement. That speaks to Ms Grant’s concerns.
The task force is a co-chaired group; it is chaired by the chief executive of a health board and an Association of Directors of Education in Scotland representative. That has been a fundamental shift in the way that we are approaching the implementation of the specification: we are moving it out of the health space and bringing it together with education. That is playing an important role in getting us towards further development of the implementation of the specification, which is about all sectors providing holistic wraparound support for a child and their family. Without question, we are not there yet, but the work of the task force is helping us to get there.
We have work under way to develop a clearer picture of all the different roles of professional groups that might interact with a child and family. That will help us identify where there are gaps, including in support, training and knowledge around a child in the school arena. That will help us to build on what we do to plug those gaps, for example, where professional groups might need more support to access training in order to fulfil their responsibilities. That work is in development.
::Rhoda, do you want to ask your questions on criminal justice?
::Yes, I will ask them now. We see a lot of neurodivergent people in the criminal justice system, and that almost smacks of failure, because those people have been let down. What is the Scottish Government doing to ensure that services have the resources and the knowledge to deal with people who may be being treated as offenders, who are witnesses or who are involved in the criminal justice system?
::In answering that question, it is important that I recognise—this also applies to your previous question—that significant work still needs to be undertaken in responding to the challenges that are before us. As Robby Steel said, there has been a societal shift whereby we are seeing something that has always been there. That is a positive, but it is now incumbent on us collectively—particularly those of us who are in government and local government and who lead public services—to utilise that enhanced understanding to ensure that services meet the needs of everyone who interacts with them, whether that is in education or in the criminal justice system.
As in education, work is under way in justice to ensure that there is increased understanding and awareness of the needs of individuals who are neurodivergent, whatever their interaction with the system is and whatever capacity they interact with it in. I ask Georgia de Courcy Wheeler to give more specific information.
Although we are not from the justice portfolio, I would like to share that there has been Scottish Government-funded work to develop five principles for responding to communication support needs in the justice system. Work is also under way to develop more accessible approaches and materials in community justice settings. That includes a training course for justice social workers and work with ARC Scotland on supporting offenders with learning disabilities. That portfolio is actively involved in all that work, which is aimed at supporting neurodivergent people or people with learning disabilities who have received sentences for offending. As the minister said, there is more to be done, but work is under way.
::Even before that stage, people who are having difficulty coping at any point are being dealt with by the police. The police are the first port of call if somebody becomes distressed or upset, and those people are then remanded. Frankly, it is wrong that people are being locked up because circumstances have caused them to have difficulties and to express those difficulties. The people who are attending to them are not aware of the situation. Such people therefore find themselves in the justice system not for having committed a crime but for having been charged with breach of the peace, or something like that, and they end up on remand. Frankly, it is damaging.
::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.
::I have a final question, which is about employment—I recognise that it is not specifically connected to your portfolio. People with lived experience of being neurodivergent have told us about their experiences in the workplace and in trying to access work. Most of them really want full access to employment and want to be a part of society, but they find the barriers very difficult.
More work on the issue is needed with employers. Statistics show that the employment rate for autistic people is 29 per cent, compared with national employment rates of 82.5 per cent for non-disabled people and 50.7 per cent for disabled people. Those figures are quite stark, especially when we hear from lived-experience feedback that people really want to take their place in society, to have a sense of purpose and to earn money to support themselves and perhaps their families. What can the Scottish Government do to help support those workplace ambitions?
::That is a really important point, which I engaged with directly through my previous portfolio as the Minister for Employment and Investment. The committee will fully appreciate that employment law is a reserved matter, but we have certainly sought to engage constructively with the UK Government on its employment rights legislation and its wider programme.
There are various principles in our fair work policy to support the core theme of diverse and inclusive workplaces. We encourage all employers to have workplace practices that are not only consistent with having a fair and inclusive environment but which will give them access to a huge pool of talent, creativity and ingenuity that is too often excluded.
I can give another example. Members will be familiar with various initiatives that are designed to promote inclusive workplace environments. Although it is not directly connected with what we are considering today, I will talk about an analogous area that is connected with another part of my portfolio and which I had a long-standing interest in prior to being in government. The carer positive scheme is all about encouraging employers to have workplace practices that recognise and support those who are combining work with unpaid caring responsibilities. Those practices can include often quite small reasonable adjustments that enable people to balance their workplace and caring responsibilities.
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We know that employers that have such policies in place are able to access a significant pool of people in the workforce who want to work and to participate. It is very good for employers and, of course, it is good for any individuals who are unpaid carers and want to work. We also recognise that employment will not be right or suitable for every unpaid carer, just as not every disabled person will necessarily want to be in employment. However, we know that many do and are not able to access employment. That is why we have made a commitment to reduce the disability employment gap. Progress has been made on that and we continue to make progress towards the longer-term target.
Within the suite of devolved levers that are available to us, although we do not have a statutory power, through our convenership, our influence and our engagement, we seek to promote best practice in the workplace from the perspective of ensuring that we have an inclusive society and that everyone who wants the opportunity to participate in the workforce is able to do so. We also recognise that, in Scotland, we face significant economic challenges that are related to our demography. Unemployment is at very low levels, we have an ageing population, and we are operating within a restrictive migration environment because of the UK Government’s policies. It is of the utmost importance that we are able to create every opportunity to fully utilise the workforce in Scotland and ensure that those who want to participate in the workplace are able to do so, free of discrimination and barriers.
There are things that we would like to do but cannot do because of the devolution settlement. One example of that is more engagement and involvement with the access to work scheme. I state very clearly, and I hope that the committee will reiterate it, that employers should be taking every opportunity to ensure that they have diverse and inclusive recruitment practices—which many employers do—so that they can fully utilise all the talent that we are fortunate to have in our country. Many neurodivergent individuals are making a huge contribution to society at all levels, and I am sure that many of them are in this building.
::That is a great point on which to end. I thank the minister and his officials for attending the meeting.
We will go into private to discuss the remaining agenda items.
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Meeting continued in private until 12:41.
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