The NHS Long Term Plan and autism

The NHS (National Health Service) here in Blighty has recently released its Long Term Plan [1]. 'Long term' covers a period of 10 years and how, faced with ever-mounting financial and resource pressures, the NHS is continually trying to serve the needs of the population it serves in an ever-changing world.

Needless to say that lots of media outlets have covered the Long Term Plan (see here for example) and the various priorities that it includes. 'Prevention' and 'Early Detection' are words used quite a bit both in the reporting and the document itself, as the focus moves slightly away from hospitals to other front-line services like general practitioners (GPs) and community care agencies.

Mental health also figures in the Long Term Plan, as this area continues on its 'parity of esteem' journey (see here). Being careful not to label autism as a mental health condition, I note that autism and learning (intellectual) disability also gets a mention in the Plan for quite a few reasons...

So, starting on page 52 of the report: "Action will be taken to tackle the causes of morbidity and preventable deaths in people with a learning disability and for autistic people." It's about time that this was 'tackled'. I say that because the statistics on early mortality with autism in mind are truly, truly shocking (see here and see here). It's also of interest that the LeDeR (Learning Disabilities Mortality Review) initiative is mentioned in this context too (see here). How exactly such inequalities will be tackled is however, not precisely detailed in the Long Term Plan.

Then: "The whole NHS will improve its understanding of the needs of people with learning disabilities and autism, and work together to improve their health and wellbeing." Allied to improving uptake of annual health checks that should be available, the document talks about working with partners to "bring hearing, sight and dental checks to children and young people with a learning disability, autism or both in special residential schools." It's a start given what said overlooked issues might be involved with (see here) but what about this who aren't in special residential schools? The Plan also mentions how: "By 2023/24, a ‘digital flag’ in the patient record will ensure staff know a patient has a learning disability or autism." I believe this would also solve a few 'issues' with regards to the (estimated) prevalence of autism and/or learning disability here in Blighty (see here and see here).

Also: "Children and young people with suspected autism wait too long before being provided with a diagnostic assessment." Yes, yes they do (see here). The Plan therefore sets out to "test and implement the most effective ways to reduce waiting times for specialist services." You've got to be kinda careful with the wording here because, as far as I can see, there is no commitment to a timescale of diagnosis unlike the commitment to reducing those with autism being accommodated at inpatient units for example: "By March 2023/24, inpatient provision will have reduced to less than half of 2015 levels (on a like for like basis and taking into account population growth) and, for every one million adults, there will be no more than 30 people with a learning disability and/or autism cared for in an inpatient unit".

I'll leave readers to decide whether this Long Term Plan represents something 'good for autism' or just skirts around some of the bigger issues. Personally I see some positives and some 'missed opportunities'. Positives? Well as I said, anything that can impact on those shameful early mortality figures in the context of autism is a good thing. I do have questions about how issues like suicidality, that contribute quite a bit to the early mortality stats, are for example, going to be addressed, but if lives are going to be saved and hopefully enhanced, I'm all for that. Reducing waiting times for assessments is also a good thing, as is the idea of the 'digital flag' to (hopefully) help enhance the doctor-patient interaction where autism is a feature.

Negatives? Well, there doesn't seem to be a great amount of details mentioned and even less discussed about adult autism and what the Long Term Plan is going to do for the thousands of autistic adults (many of whom are not also described as 'learning disabled'). There are many pressing issues for this group (see here and see here), some of which cross-over with the primary tenets of the Long Term Plan (see here) with autism in mind. It strikes me that there is much more to do in this area.

So I guess we'll just have to see what happens...

Music to close: And given some recent news about Weezer, a sublime blast from the past...

----------

[1] The NHS Long Term Plan. January 2019.

----------