Commissioning services for people with autism

History

What could be provided?

All health and social care services provided for people with autism should meet the NICE Quality Standards. These standards address access to health and social care, and mention just three areas beyond the care system – social contact, quality of life and employment, so it is a weak definition of an inclusive life. In addition, the NHS has published Improvement Standards.

Specific needs can be identified that could be addressed by a deliberate response from services. Some general remarks about each of the potential services are made in the bullet points below. Click on Commissioners might buy here for a catalogue of service responses that includes examples from around England of services that have actually been funded at one time or another in response to thesee issues.

  • Mental health support. 70-80% of autistic people experience mental health problems and autistic people are disproportionately likely to commit suicide. Advice is available from the LGA on supporting people with autism who have mental health needs and the Green Light Toolkit helps mental health services review their service, STOMP campaigns to stop the inappropriate use of psychiatric medication on people with autism. NAS has highlighted the increase in the number of autistic people in mental health hospitals here.
  • Behaviour that challenges. In 2015, NHS England published service models and additional information for commissioners to meet the needs of people with autism who presented behaviour that challenges. In 2017, NDTi published guidance for commissioners that is relevant to our topic. A four-page guide for commissioners has been trialled.
  • Diagnosis. NICE have published guidance on how to assess autism. Here’s two checklists that you can use to check out whether the assessor has upheld your rights – here and here. The words used in assessment are explained here. Research is underway on the use of social stories to prepare people for assessment. There are also issues connected with eligibility for support. Government has taken an interest in the waiting time for diagnosis.
  • Supported living and residential care.
  • Access to healthcare. The Westminster Commission present evidence on the barriers that block people with autism out of healthcare. The Royal College of GPs have published an online toolkit. Guidance for GP surgeries is available.
  • Access to social care. See the evidence review here and some information about the autism voluntary sector.
  • Networking.
  • Service Directory – such as the Calderdale Directory or this one from Surrey.
  • Reasonable Adjustments. Explained in a briefing note by a group of people in Calderdale.
  • Capacity Building to help mainstream organisations offer a respectful and appropriate service to people with autism.
  • Public attitudes can perhaps be changed – evidence is available.
  • Research. The Autism Research Network publishes evidence summaries.

Further analysis and examples of where these and other services have been commissioned can be found in this examples paper.

Other jurisdictions

  • Scotland published guidance in 2008 and a systematic review of prevalence data within a microsegmentation approach in 2018.
  • Wales did so in 2017, considering its guidance for commissioning services for people with a learning disability to also cover people with autism.

Local needs and strategies

Particular local authorities, CCGs or NHS Trusts may have conducted a careful Joint Strategic Needs Assessment, like this one from South Gloucestershire, this from Camden & Islington and this from Norfolk. The Public Health England Fingertip Profile does not include data on adults. They then go on to produce a commissioning plan for autistic people living in their own area. Examples include:

Adjacent policy areas

Competent staff

  • Commissioners. In January 2019, Norfolk County Council advertised for a Assistant Director for Learning Disability and Autism Commissioning, offering a salary of £83,000.
  • Champions. Surrey have identified Autism Champions and accredited them through the SPELL process.
  • Training. NAS has published guidance on general training, as well as an old version and newer versions of specific training for social care assessors. See a manual and curriculum guide for social workers. Skills for Care have also worked on a core skills framework that applies to those working with autistic people.
  • Safe staffing. Advice has been offered here, despite the lack of robust evidence.

Public consultation

Consulting with people, families and communities. Scarborough have done this regarding their diagnostic service. This area includes feedback and complaints (such as the Ask Listen, Do project run by NHS England), and independent advocacy.

Co-producing health and care