Daily Insight: When the criteria is ‘crisis’

Overwhelmed autism diagnosis services are introducing restrictions for assessments amid “unprecedented” demand, with some areas now only accepting referrals for patients in crisis situations.

Commissioners in North Yorkshire and York are the latest to introduce new criteria for autism and attention deficit hyperactivity disorder referrals. 

The changes, involving a new referral form for diagnostic assessments which states it is only able to accept requests where immediate harm and risk is likely due to a possible autism or ADHD diagnosis, have been prompted by “unacceptable wait times and the need to prioritise resources towards children and most at-risk adults”.

Health chiefs in Bristol, North Somerset and South Gloucestershire have done the same, announcing a set of six criteria children have to meet to qualify for a referral.

Getting a diagnosis can be key to unlocking care packages such as speech and language therapy and counselling. 

It comes as 140,000 people were waiting for autism assessments at the end of last year, an increase of 40 per cent from 2021. Of those, just 12 per cent received at least one care contact within the NICE-recommended treatment period of 13 weeks.

Turbulent times at CQC

The organisation responsible for holding trusts and other providers to account when their governance and processes are not up to scratch has been found lacking.

This week, the Care Quality Commission has published two major reports; one a barrister-led review into the regulator’s response to a high-profile whistleblower and another wider, internal review, led by Scott Durairaj, a CQC director who joined it last year.

The wider review was instigated by the CQC after concerns were raised by the employment tribunal of Shyam Kumar, a consultant orthopaedic surgeon in the North West, who was also a CQC specialist professional adviser.

Mr Durairaj and his team looked at a range of issues and found whistleblowing concerns were handled poorly, there is a “widespread” misunderstanding in writing about race and racism and a lack of confidence in its Freedom to Speak Up processes.

A series of detailed recommendations have been made and the review has called for training to be revised, high-risk cases to be regularly discussed, and greater awareness of the issues faced by health and care staff with a minority ethnic background, and other marginalised groups to be fostered.

However, this is all taking place alongside a reorganisation of staff and major transformation programme and recent internal staff surveys have revealed there is a lack of confidence in how the regulator implements change. The CQC has a mountain to climb.