Diagnosing autism in children can involve a range of observations over time and a number of different professionals. The time taken to formulate a diagnosis will not be the same in all cases.

There are concerns in some local areas that the length of time some children have had to wait for an assessment for autism to begin is longer than the three months recommended by the National Institute for Care and Health Excellence (NICE) guidelines from a referral to a first appointment. Whilst local clinical commissioning groups have been working to bring down the waits in line with the NICE guidelines, to date there has been no national collection of waiting times data.

The Government is taking steps to rectify this and NHS Digital have confirmed they will be collecting and recording waiting times from referral for suspected autism to a first appointment within the Mental Health Services Data Set from April 2018. This will mean that each area can be held to account in real time and action can be taken to support them when waiting times are increasing.

An indicative timeline for the development of care pathways was set out in the Five Year Forward View for Mental Health. The precise timetable for the establishment of a care pathway for autism will be confirmed by NHS England in due course.

This is a matter for NHS England. No decision has been made to close the Congenital Heart Disease (CHD) service at the Royal Brompton and Harefield NHS Foundation Trust.

NHS England has advised that they have performed impact assessments for all centres which would be impacted by its CHD service change proposals if implemented. We have been informed by NHS England that these initial assessments acknowledged that there would be an impact on paediatric respiratory and cystic fibrosis services at the Royal Brompton, if NHS England’s proposals were implemented.

NHS England has advised that a panel including respiratory clinicians and representatives from respiratory and cystic fibrosis patient and public groups has been created to assess the potential impact of its CHD service change proposals on the Royal Brompton’s paediatric respiratory services. This panel has arranged to visit the Royal Brompton in August and has requested to meet patients as a part of this.

This information is not held centrally. The Care Quality Commission looks at a wide range of services when inspecting hospitals.

NHS England has produced the following service specifications for audiology services that it commissions, which apply to all ages and sit in the Trauma Programme of Care (Specialised Ear and Ophthalmology Services):

- Specialised Ear Surgery: Cochlear Implants (All Ages); and

- Implantable Hearing Aids for Microtia, Bone Anchored Hearing Aids and Middle Ear Implants (All Ages).

Copies of these service specifications are attached.

NHS England has no plans to publish further service specifications for specialist audiology services used by children.

NHS England has also published commissioning policies for the following services that are available for children:

- Auditory brainstem implant with congential abnomalities of the auditory nerves of cochleae;

- Bone Anchored Hearing Aids; and

- Bone conducting hearing implants for hearing loss (all ages).

The Improving Quality in Physiological Services (IQIPS) accreditation scheme is run by the United Kingdom Accreditation Service (UKAS). The process of accreditation provides an independent assessment that a service meets the accreditation standards.

It is the responsibility of the service to ensure that they conform to the standard before application to UKAS for accreditation. There is a pre-registration process within the scheme that enables all services to be able to do an effective gap analysis so that they should be at a point of conforming to the standard on making an application to UKAS. If during an assessment mandatory findings are raised which show non-conformity to any part of the standard then the service agrees appropriate improvement actions with the UKAS team to rectify these and prevent re-occurrence.

The UKAS team base their recommendation for accreditation on the findings raised relating to the conformity to the standard, risk and whether the agreed improvement actions are appropriate and can be achieved within a three month close-out period. Therefore any findings raised must be cleared by the organisation if a positive recommendation for accreditation is to be granted.

In Commissioning Services for People with Hearing Loss: A framework for clinical commissioning groups, published in July 2016, NHS England strongly encourages clinical commissioning groups to expect providers to have completed the IQIPS self-assessment tool and applied for accreditation with UKAS, and achieve accreditation within the duration of their contract.

UKAS are supporting the NHS England business objective to increase the use of accreditation, and information about those services which have achieved accreditation is not held by the Department or NHS England, but is publicly available on the UKAS website.

Information on clinical contracts is not held centrally by NHS England.

The Improving Quality in Physiological Services (IQIPS) accreditation scheme is run by the United Kingdom Accreditation Service (UKAS). The process of accreditation provides an independent assessment that a service meets the accreditation standards.

It is the responsibility of the service to ensure that they conform to the standard before application to UKAS for accreditation. There is a pre-registration process within the scheme that enables all services to be able to do an effective gap analysis so that they should be at a point of conforming to the standard on making an application to UKAS. If during an assessment mandatory findings are raised which show non-conformity to any part of the standard then the service agrees appropriate improvement actions with the UKAS team to rectify these and prevent re-occurrence.

The UKAS team base their recommendation for accreditation on the findings raised relating to the conformity to the standard, risk and whether the agreed improvement actions are appropriate and can be achieved within a three month close-out period. Therefore any findings raised must be cleared by the organisation if a positive recommendation for accreditation is to be granted.

In Commissioning Services for People with Hearing Loss: A framework for clinical commissioning groups, published in July 2016, NHS England strongly encourages clinical commissioning groups to expect providers to have completed the IQIPS self-assessment tool and applied for accreditation with UKAS, and achieve accreditation within the duration of their contract.

UKAS are supporting the NHS England business objective to increase the use of accreditation, and information about those services which have achieved accreditation is not held by the Department or NHS England, but is publicly available on the UKAS website.

Information on clinical contracts is not held centrally by NHS England.

The Improving Quality in Physiological Services (IQIPS) accreditation scheme is run by the United Kingdom Accreditation Service (UKAS). The process of accreditation provides an independent assessment that a service meets the accreditation standards.

It is the responsibility of the service to ensure that they conform to the standard before application to UKAS for accreditation. There is a pre-registration process within the scheme that enables all services to be able to do an effective gap analysis so that they should be at a point of conforming to the standard on making an application to UKAS. If during an assessment mandatory findings are raised which show non-conformity to any part of the standard then the service agrees appropriate improvement actions with the UKAS team to rectify these and prevent re-occurrence.

The UKAS team base their recommendation for accreditation on the findings raised relating to the conformity to the standard, risk and whether the agreed improvement actions are appropriate and can be achieved within a three month close-out period. Therefore any findings raised must be cleared by the organisation if a positive recommendation for accreditation is to be granted.

In Commissioning Services for People with Hearing Loss: A framework for clinical commissioning groups, published in July 2016, NHS England strongly encourages clinical commissioning groups to expect providers to have completed the IQIPS self-assessment tool and applied for accreditation with UKAS, and achieve accreditation within the duration of their contract.

UKAS are supporting the NHS England business objective to increase the use of accreditation, and information about those services which have achieved accreditation is not held by the Department or NHS England, but is publicly available on the UKAS website.

Information on clinical contracts is not held centrally by NHS England.

The Improving Quality in Physiological Services (IQIPS) accreditation scheme is run by the United Kingdom Accreditation Service (UKAS). The process of accreditation provides an independent assessment that a service meets the accreditation standards.

It is the responsibility of the service to ensure that they conform to the standard before application to UKAS for accreditation. There is a pre-registration process within the scheme that enables all services to be able to do an effective gap analysis so that they should be at a point of conforming to the standard on making an application to UKAS. If during an assessment mandatory findings are raised which show non-conformity to any part of the standard then the service agrees appropriate improvement actions with the UKAS team to rectify these and prevent re-occurrence.

The UKAS team base their recommendation for accreditation on the findings raised relating to the conformity to the standard, risk and whether the agreed improvement actions are appropriate and can be achieved within a three month close-out period. Therefore any findings raised must be cleared by the organisation if a positive recommendation for accreditation is to be granted.

In Commissioning Services for People with Hearing Loss: A framework for clinical commissioning groups, published in July 2016, NHS England strongly encourages clinical commissioning groups to expect providers to have completed the IQIPS self-assessment tool and applied for accreditation with UKAS, and achieve accreditation within the duration of their contract.

UKAS are supporting the NHS England business objective to increase the use of accreditation, and information about those services which have achieved accreditation is not held by the Department or NHS England, but is publicly available on the UKAS website.

Information on clinical contracts is not held centrally by NHS England.

The Improving Quality in Physiological Services (IQIPS) accreditation scheme is run by the United Kingdom Accreditation Service (UKAS). The process of accreditation provides an independent assessment that a service meets the accreditation standards.

It is the responsibility of the service to ensure that they conform to the standard before application to UKAS for accreditation. There is a pre-registration process within the scheme that enables all services to be able to do an effective gap analysis so that they should be at a point of conforming to the standard on making an application to UKAS. If during an assessment mandatory findings are raised which show non-conformity to any part of the standard then the service agrees appropriate improvement actions with the UKAS team to rectify these and prevent re-occurrence.

The UKAS team base their recommendation for accreditation on the findings raised relating to the conformity to the standard, risk and whether the agreed improvement actions are appropriate and can be achieved within a three month close-out period. Therefore any findings raised must be cleared by the organisation if a positive recommendation for accreditation is to be granted.

In Commissioning Services for People with Hearing Loss: A framework for clinical commissioning groups, published in July 2016, NHS England strongly encourages clinical commissioning groups to expect providers to have completed the IQIPS self-assessment tool and applied for accreditation with UKAS, and achieve accreditation within the duration of their contract.

UKAS are supporting the NHS England business objective to increase the use of accreditation, and information about those services which have achieved accreditation is not held by the Department or NHS England, but is publicly available on the UKAS website.

Information on clinical contracts is not held centrally by NHS England.

No decision has been made to close the Congenital Heart Disease (CHD) service at the Royal Brompton and Harefield NHS Foundation Trust.

The particular circumstances at the Royal Brompton mean that NHS England’s CHD proposals would, if implemented, have an impact on the Trust’s paediatric respiratory service. NHS England has therefore formed a specialist panel to review the potential impact of the CHD proposals on paediatric respiratory services at the Royal Brompton.

If a decision is taken to stop commissioning children’s CHD surgical services, NHS England will work with the Trust to manage the impact on paediatric respiratory services.

No decision has been made regarding the congenital heart disease service at the Royal Brompton and Harefield NHS Foundation Trust.

NHS England will make a decision on its proposals for changes to adult and children’s congenital heart services in England following consultation, which closes on 17 July 2017.

The standards for congenital heart disease services were consulted upon and agreed by the board of NHS England in July 2015. The evidence base for the standards was published at the time and is available as part of the relevant board paper. The aim of these standards is to secure the best outcomes for all patients, including:

- improved opportunities for survivors to lead better lives;

- tackling variation in services, particularly to ensure resilient 24-hour, seven days a week care; and

- improved patient experience.

All of the standards, including those that refer to physical co-location of services, are based on expert clinical advice rather than published evidence, since research is not available to inform this aspect of service organisation.

The information requested is in the following table.

Median waiting times (days) of first outpatient appointments for treatment specialties ophthalmology, paediatric ophthalmology, medical ophthalmology optometry, and orthoptics in England for 2015-16

Source: Hospital Episode Statistics, NHS Digital

Notes:

The following codes were used to identify treatment specialties:

130 - Ophthalmology

216 - Paediatric Ophthalmology

460 - Medical ophthalmology

662 - Optometry

655 - Orthoptics

Which hospitals providing congenital heart disease services do not meet the standard for the co-location of paediatric services; and what plans his Department has to stop providing congenital heart disease surgery at those hospitals.

My hon. Friend has considerable expertise, but I am advised that having all relevant children’s specialties on the same site is the optimal model of care for the most critically ill children. It promotes closer,

more integrated ways of working between specialist teams, and ensures rapid access to key services, such as paediatric surgery, at the most critical times when they are needed.

Mr Speaker, you are absolutely correct in your comment.

Does the Minister agree that the standards review found that not all clinicians are in agreement about how essential the co-location of paediatric services is, bearing in mind that a child being treated right now at the Royal Brompton will have 24-hour access to all necessary medical specialties? Will he tell us what improvements co-location at the world-class Royal Brompton hospital would achieve?

The hon. Gentleman is right to point out that we have some world-leading out-patient outcomes for congenital heart disease, and I recognise the statistics that he read out. This is being driven entirely by seeking to improve patient outcomes across the country—improving them even on that very good performance—and to ensure greater resilience of service in some areas where there are relatively low volumes and an over-reliance on locums. I accept that that is not the case at the Royal Brompton, but it is in some of the others.

Mortality rates for the treatment of congenital heart disease fell from 14% in 1991 to 2% last year. The Royal Brompton, where the service is threatened with closure, does better even than this. What evidence is there that the closure programme will produce any further improvement, and if there is none, why is it being pursued?

I recognise that when the proposal was put forward back in 2012, it led to a process that we felt was wrong, and we therefore stopped it. This process, we hope, is being conducted in a more rigorous and fairer way, and will lead to outcomes driven, as I say, by improving patient experience.

The Leeds heart unit is performing very well, and is free from the threat that it was facing, unfairly, a few years ago. Will lessons be learned, however, from the disastrous Safe and Sustainable review process, which pitted hospital against hospital and clinician against clinician? Can we find a much better way—I hope the Minister will tell us that this is happening now—to reconfigure such services?

Standards for paediatric co-location for congenital heart disease services are not currently met by the Royal Brompton, Leicester and Newcastle hospitals. NHS England is consulting on proposals to cease commissioning level 1 surgical services from the Royal Brompton and Leicester. No final decisions have been made on the proposed changes. Public consultation continues until 5 June 2017, and I encourage my hon. Friend to participate in that consultation.