Transcript

So, welcome everybody to April's Health in Hackney's Commission. This is a joint session with the Children and Young People's Security Commission. So, welcome to all those members from that commission to the year. I've had apologies from councillor Patrick. Thanks to Amy, who maybe has helped pulling this together. I'm not sure if she's joining us, but I think she may be on a holiday. So, if she does join us, thank you very much for joining us from holiday, Amy, and also to Sarah for pulling the plan together and the slide and the presentation. We appreciate that. We've got a number of people here. So, I'm not going to do a cast of thousands introduction. What I propose to do is for those people who are presenting, I will introduce you. Obviously, as we all know, today's meeting is in relation to autism and ADHD, and we've seen a significant increase in the number of people coming forward and we have significant waiting lists of people waiting assessments as well, and those are some of the key issues we'll be looking at and exploring. Just matters of housekeeping. This is a hybrid meeting. So, I've got a number of people in the chamber. I've got a number of people online. If you are online, please don't start conversations in the chat. Please keep your microphone off unless you are speaking. If you'd like to ask a question, please raise your hand. If you are speaking and your broadband width allows, please keep your camera on. Members of the press may be watching. This is being recorded. It is being live streamed. It will be available on YouTube afterwards. A declarations of interest from members, please. Are there any? Councillor Lynch? I just want to declare an interest that I'm actually on shared care for my medication. Thank you. As Councillor Lynch just did there, can I ask members to please use your mic, and everyone in the chamber, please use your microphone when you're speaking, otherwise people online won't be able to hear. Here. So, I haven't been noted of any order of change to the business. So, with that, I'm going to go forward to the substantive item. I've already alerted the members. What I intend to do, I'm going to break this down broadly into four thematic areas. We're going to get an overview of the subject from Perpetua and Sarah Darcy, and I'll introduce them in a minute. Then going to move on to the children's aspect, or the young people's aspect, with Yvonne, Susan and Sarah Darcy speaking to that. The third area is Penny and John, with respect to the adult aspect, and then fourthly, the autism-friendly pilot. What I propose to do is, so the members and everyone isn't just being spoken at for an hour and 15 minutes, and then asking questions. After each presentation, which I'd ask the presenters to keep it somewhere in the realm of about seven minutes or thereabouts, I'll open it up to a few questions. I won't take everyone who puts up their hand, just to keep a bit of interaction, a bit of a flow. And then, after a couple of questions and a few answers, I'll then move on to the next one, and I'll repeat that four times through those four thematic areas. And then, hopefully, at the end, I'll leave at least half an hour, 40 minutes, for a bigger discussion. And then, if there's anything else I haven't been able to capture in those questions, that's an opportunity for everyone to come in at that stage. So then, having set that scene, for the first item, for the overview, we're joined by Perpetra Knight, who's the Deputy Director for Mental Health and Disabilities at the North East London level. Thank you for joining online, Perpetra. And Sarah Darcy, who's the CYP Strategic Lead in Citi and Hackney. So, between the two of you, I don't know, Perpetra, did you want to start off giving the overview? And for members, this is pages 14 to 20 of your agenda pack. So, Perpetra, over to you. Thank you. Thank you. I'll just check that everyone can hear me. We can. We're going to slightly turn you up inside the chamber, just to get a bit more clarity. Okay. Thank you. So, thank you for the introduction. So, as you've just mentioned, myself and Sarah will be presenting on the overview. So, I'll skip a few slides. So, if you could just go to the next slide, please, slide after that. Thank you. So, to start off with some definitions and background, when we use the term neurodiversity, we are referring to a group of conditions that affect the brain's development and function. These conditions are characterised by impairments in areas like cognition, which is how the brain thinks and understands things, how people communicate, behaviour and or motor skills. Some examples of neurodiversity conditions are learning disabilities, autism spectrum disorder or condition, attention hyperactivity disorder or ADHD, dyslexia, DCD, which is also called developmental coordination disorder or dyspraxia, dyscalculia and developmental language disorder. So, today, at the request of the scrutiny committee, we'll be focusing on autism and ADHD. So, I'm going to be calling those two conditions, autism and ADHD. So, just a bit of definitions for both conditions. Autism is a lifelong condition that affects how people perceive, how they talk, how they connect with others. And an important thing to note is that not all autistic people feel that it is a disability. So, that's quite important to just highlight there. And then ADHD is a condition where the brain works differently to most people. And the main signs include being inattentive and hyperactive or impulsive. Hence the term attention deficit hyperactive disorder. Some examples also include difficulty with focus, being able to focus, high energy fidgeting or tapping of hands and feet, being easily distracted, forgetting tasks or fidgeting or interrupting others rather. So, next slide, please. So, autism affects over 1% of people. So, 1 in 100 people in the UK with at least 700,000 autistic adults and children being diagnosed within the UK, according to research estimates. Just to also add that this number is likely to be higher than those with the official autism diagnosis because not all people with autism have been diagnosed. And just to also say that there is no definitive up-to-date figure for the exact number of people with ASD in CT and Hackney due to the data gaps and data challenges as well as the diagnosis challenges as we'll come through in a few minutes when we talk through that in detail. And then in terms of ADHD, on the other hand, it affects about 5% of children globally and about 3 to 4% of adults in the UK. This is according to NICE. But again, these figures are also likely to be an underestimate of the true number as many people are undiagnosed or waiting for assessment, similar to ASD as well. And a similar sort of picture in Hackney as well in terms of the exact figures for the borough. And then the next slide now, in terms of legislation and key documentation that's relevant for ASD and ADHD, there's the all age autism strategy. So that's clearly focused on autism for City and Hackney. And that's from 2020 to 2025. And this is a co-produced local plan that outlines support for autistic people across all ages and is quite vital for improving services in Hackney. There's also the 2021 to 2026 national strategy for autistic children, young people and adults. And as well as that, there's the 2009 Autism Act, which mandates better services for autistic people. And finally, relevant to both people with ADHD and people with ASD and wider people with neurodiversity and other disabilities. There's the Equality Act, the 2010 Equality Act, which safeguards people with neurodiversity from discrimination in employment, education and services and promotes equal rights. So next slide. Finally, we do recognize that people with ASD and ADHD face some significant health and wellbeing challenges that affects their quality of life. These include some of the ones that are listed on the slide that you can see, like high rates of having mental health conditions, higher mortality, and sadly, also facing discrimination, stigma and not having the right support. And alongside this, there are some key system challenges, and some of these we've outlined in the bullet points, and we'll talk through later on in the presentation. And these include long waiting list times for diagnosis, often exceeding several years, and that's the case in Hackney for both conditions. So ensuring people wait well is also a challenge, is quite important, but also a challenge. And making sure that there are those interim resources during those waits to make sure that people that are waiting for a diagnosis and are uncertain and maybe having heightened distress are receiving the right support is also quite important, but can also be a challenge. There's also challenges around health inequalities, which I've touched on earlier, particularly for people who are from diverse backgrounds or people who are from deprived areas. And these can also lead to underdiagnosis, sometimes amongst women, and as I've mentioned before, low income groups due to access barriers and low awareness. Other areas which are a challenge, but equally, you know, a priority and important is making sure that people get the right post-diagnosis support. And there's also making sure that there is autism awareness and acceptance, because this is key to ensuring that people are able to manage through life once they get their diagnosis, and making sure that some of the challenges such as stigma are addressed as well. We've also pointed out challenges around workforce and the shortages of specialists like psychiatrists, psychologists, and these restrict service capacity. And again, we'll touch on that through the presentation. And lastly, there are some really limited accessible services as well. And we understand that addressing these challenges is quite important. But whilst we also, another thing to point out is that we also acknowledge that whilst obtaining a diagnosis is crucial for people with ADHD and people with ASD, we are also looking at the importance of making sure that people are able to access, as I've mentioned, the right support that we are looking at more needs-based approach to providing support, making sure that people get timely support through accessible services. Thank you. Thank you. I will now hand over to Sarah. Thank you, Perpetua. So if we can move forward, please, Penny, to the next slide. Thank you. So just to focus in on some of the issues as Perpetua has described them, but as they relate particularly to children and young people. So this slide shows some of our, what we've called our guiding principles. So really reflecting what we understand to be really important to our autistic children and young people, those who may be neurodiverse, those who, you know, maybe do not have a diagnosis yet. So really, really taking our approach as an approach to inclusion, which Yvonne will talk to about shortly. Some of these, so I'll just pick out some of these principles. So it's very much about us being an inclusive system, an inclusive community and seeing neurodiversity as the norm. You'll see throughout the presentation that our focus is on moving away from pre post-diagnostic office of support that really hang around a diagnostic pathway to moving to a needs-based offer. And again, that's a real shared priority and commitment across education and health. Yes, we are really committed to reducing waiting times. We understand the impact of long waits for our children and families, but owing to increasing demand across our pathways, this has to be in parallel with supporting children and families to access support whilst they are waiting. And again, we will talk about that during the presentation. We haven't included content today around all of our work on crisis presentations. That's something that we can come back to you and present on another occasion. But obviously that's a really important part of the overall picture as well. And we have ongoing work to both reduce the numbers of crisis presentations. And that obviously really links with our early prevention work. But also to improve our response when children and young people do have crisis presentations and work to improve their experience during those presentations. And underpinning all of our work again across the whole system is our commitment to being systemic, anti-racist and trauma informed. On the next slide, I know this is quite difficult to see on the slide, but I think just the number of lines there reflects obviously the huge amount of jargon. And, you know, the entirety of the whole language around neurodiversity, neurodevelopmental pathways and services. I hope this list is exhaustive. I'm going to apologise if anyone sees anything that isn't fully spelt out and captured here. But we're really aware that this, as I say, this is the whole language in itself. Thank you. If we can move on to the next slide. So as part of being an inclusive community, a health and education system, a really important principle is around us using neuroaffirmative language. And I think, again, I won't go through these individually, but I think this is quite challenging and it's a learning kind of a challenge for all of us, whether we're professionals, whether we're in schools, whether we're within our families, our community environment, to really have quite a cultural shift around our thinking around using neuroaffirmative language. And hopefully you'll hear that and feel that during the presentation today. So I've talked about inclusion and I'm going to hand over to Yvonne Wade and Hackney's Head of Send. Can I just pause you there? Because I think that sort of comes to the end of where I was going to sort of like my first sort of introduction segment. I'm just going to take a couple of questions if there are from members. Just in terms of the definition, needs based offer, how do you define that in a couple of sentences? So this is around supporting children where they are, meeting their immediate needs as far as possible, and not making any access to services, to support, to information and advice dependent on a diagnosis. So in the order I saw, because I'm only going to take two at this stage, I saw Councillor Binney-Lavart and Councillor Gordon first. I'll take you two, we'll have the answers, then we'll move on and I'll come to others later. So Councillor Binney-Lavart. Thank you very much for those presentations, they're really useful. I was just wondering, how are we making sure that all of the situations young people find themselves in are inclusive? How can we make sure that that culture change and shift that you're talking about is happening, and that we're getting buy-in from, for example, academies and things where we might not have as much oversight? You know, I've heard of situations where that self-regulation piece isn't being done in an inclusive way. I'm wondering how we can get that buy-in, and also how much access to those services, you know, the money for those services follows an assessment. If I take Councillor Gordon now, then I'll ask Sarah to reply. Thanks very much. Just probably a couple of quick questions, really. The first one's about my understanding. It's autism, well neurodiversity is described both as a sort of lifelong condition, also as a developmental delay. So, I just really wonder whether you could sort of just expand on how those two sort of things interact, because presumably that means that people, although they've got a lifelong condition, that it presents in different ways at different times as they grow and develop. But I may have misunderstood that, I'd be interested to know the answer. And really quickly, there are some heartbreaking statistics in terms of life expectancy for some people with autism. Just wonder how up-to-date those are, and whether our increased understanding of these conditions and support has improved that really troubling picture. Thank you. Sarah, are you okay to take those? I'm going to give on, if I may, to respond to the first question. And then I may ask Hannah to just comment on developmental language, if I may, because I think that responds to the second question. So, yes, I'm going to ask you to hold on a few moments, Councillor Binny Lubbock, because that's what I'm going to talk about. With regards to Councillor Gordon's question about the difference between lifelong and the developmental delay, I think we've not really kind of caught up with our definition of autism in the way that we need to. We're moving all the time in terms of our learning and understanding. So, the lifelong disability came from the National Autistic Society. They came up with that definition. And I don't recall developmental delay being part of that. And so I'd need to go back and have a look at what you were reading. There is often around younger children, there are some, in some autistic children, some signs of developmental delay, and that can often kind of catch up. And for some of those children, but it doesn't for all of them. I mean, there's always going to be ranges in terms of development for children. I'm reading from page 17 the slides just to... And I think we're going to bring in Hannah there as well. Hannah's a speech and language therapy manager at the Homilton. Hannah, do you have anything to add to that? First of all, can you hear me? I just want to check. Yes, we can. Okay, great. I think Yvonne hovered it pretty well then. I don't think I would add much to that. I think, and forgive me, I can't remember everybody's name, but the counsellor who asked the question, the point that you said there about that profile, if you like, changing over time and through the course of an autistic person's life is, you know, correct. So there may very well be some developmental differences or delays and a person's presentation will change as they move through life and go through various different transitions. Sometimes their autistic presentation might be more obvious than at other times. So it's a very fluid picture, I think, is what I'm trying to say, if that makes sense. Thank you. No, that's very helpful. Thank you, Hannah. I'm going to move on then to the next stage of presentation. So we've got Yvonne, who's going to speak to the heading on the agenda, our approach to inclusion. And Yvonne Wade is the head of SEND at the London Borough of Hackney. And then following on from Yvonne, we're going to get Dr. Susan Croker, who's here and she's the clinical lead and psychologist at the Homerton Camps. So Yvonne, would you like to carry on? I think we're at page 26 now in the bundle. Thank you very much, Councillor. Beautiful. Thank you. That was the right slide. So here is a brief summary of some of the kind of key phases of the work we've been doing over the last three years. So in 2022, we launched our SEND strategy and there were four priorities. There are still four priorities in that strategy. And the two that are most pertinent here are prioritising outstanding provision across Hackney and developing an earlier response. And also in 2022, we became AET partners. AET is the Autism Education Trust. And they have co-produced a wide range of training materials and other resources. After the coalition government, they became the main providers for education around autism. And we've been using their training materials. And over the last three years, we've trained just short of two and a half thousand teachers, practitioners. We've covered most of the school, nearly all of the schools and settings in Hackney at the very beginning phase of introduction to autism. And there have been other levels of training since then as well using the AET resources. And most importantly, we've been co-delivering that training with parents and carers in Hackney as well. And had input from children and young people. Building on the AET frameworks and ethos, we already had been applying CERTs, that's social communication, SC, that's social communication. And we've been using the AET framework. And we've been using the combination of the AET training and the CERTs framework to support children and young people, support training of staff, developing our additional resource provisions, using it in our special schools as well, to support the development of autistic children at all sorts of levels. And I think it might just be helpful before when Petra was talking, she talked about autistic spectrum. There was a sort of viewpoint some years ago that there was a spectrum of need. So some children may have learning difficulties as well as being autistic. And some children, and adults as well I should say, won't have learning difficulties in that kind of more learning disability kind of way. So there's a kind of wide range of children and young people which is also contributing I think to the issues that Petra talked about in terms of us being able to identify all those people because there are a lot of people who won't need, in inverted commas, a diagnosis because they are able to function well or, you know, well enough in society and so on. So we've been working with those, we've had our speech and language colleagues developing an online platform called Virgo. So again, the aim of that is to support schools, early year settings in developing their skills and knowledge in identifying children with speech, language and communication needs and autistic children as well. And that's been rolled out since 2023. In 2024 last year, we relaunched and we reviewed and relaunched our description of our approach to graduated, a graduated response. Again, supporting schools and settings to be able to identify and assess children at the earliest point. And then to be able to use the appropriate resources and think about skill development, et cetera, to support children. And all sorts of children, including neurodivergent children as well. Later in 2024, we had some training delivered in Hackney called adaptive teaching. And that is very much about all teachers at the chalk face being able to adapt and present the learning, the teaching materials, the resources, et cetera, within their classroom. So we're looking at a more distributed leadership. So everybody who has contact with children and young people having the skills and knowledge to be able to support them in the best way for those children. So just want to talk a bit more now about a project that started last year. It was funded by NHS England called Partnerships for Inclusion in Neurodiversity in Schools or PINs for short. And across North East London, there was funding shared with the different boroughs. And in Hackney, seven primary schools have been involved in the project. And it's been co-produced, co-delivered with the Hackney Send Parent Carer Forum. Teachers in the specialist teacher team, speech and language therapists and occupational therapists. And the training that's been developed through that started with surveying children and parents of children in those schools to see what their needs were, what their views were on the current resources available. And the training package and support for the teachers and staff in those schools have been developed based on those outcomes. And the main aim of the project has been to foster a strength-based approach. Working with children's strengths, we find, is a much better way rather than focusing purely on deficits, the things they're not managing. And the program has been developing, rather, whole school practice for every child in the school, regardless of their needs that they're presenting with. And going back to Right Sport, Right Time, the aim of that document is, again, thinking about what are the needs of that child rather than a diagnosis. Because for every autistic child, every child with ADHD that you meet, you'll meet an individual within that. So we need to think about those children in that way. So here, next slide, lovely. On this slide, we've got a few of the messages that have come out from children and families and the schools that have taken part in the PINS program. We've also got quoted up in the top left there of this slide. We've got a group, a kind of expert panel of children and young people who are autistic and other neurodivergent conditions called INDEPTH. And we are using them very much as a kind of reference group through their expert experience. And here are some of their thoughts about what the work that's happened for them and the outcomes from PINS. And I'll let you read those at your own leisure. Next slide, please. So look at the PINS program. We've had really lovely feedback from, you need to keep pressing please, Penny. Really lovely feedback from the staff that have taken part in it and the children as well. So before, they might have talked in very kind of deficit language about children, saying that children were aloof or awkward, etc. But now we're finding that the language is much more neuroaffirmative in the ongoing interactions between staff and children. So if you can move on to the next one, please. Okay. So I think this is where you were particularly interested, Councillor Binny Lovock. So thinking about regulation, this is one of the things that I think has caused the most kind of impact for teachers trying to deliver lessons, children trying to receive it and how do we kind of meet both needs in there. So they've been working in the PINS project on really understanding the different needs of children in terms of their regulation. So understanding that some people, some children might need self-talk to help themselves regulate. And I think personally, I need a bit of self-talk myself for my own regulation. I think it's a fairly common kind of self-regulation tool. So there's much more acceptance now that these differences are not necessarily bad or difficult, but they are kind of necessary differences to help children with their self-regulation and understanding why children may be behaving in such a way. Now we'll say that the PINS project has only been in seven primary schools at the moment, but we are looking to roll that out further. So thinking about what next here is some, the next slide here talks about some of the areas that we're working on. So we, as part of the original SEND strategy, developed the concept of the team around the school, team about the setting, so schools knew exactly who those professionals were to work, who were available to work with them. So we're continuing to strengthen that relationship. We are looking at how we really support schools and staff, et cetera, in understanding what right support, right time guidance means for them. So we're developing some training modules to really get underneath the words in the documents and help people to understand and embed them in their practices. We're also looking at coaching approaches to embed the adaptive teaching strategies. And there have been some further training modules around neurodiversity that again, we're being being produced, not only with professionals, but with children and families and schools as well. We are also co-producing some exemplar policies for behavior, uniform lunch times, the areas that we're finding the most kind of difficult for schools and neurodiverse children to really come to some understanding around. And lastly, we, as I said before, we're looking to further sustain the learning from PINs and make sure that that is shared more widely across. Thank you. I think we're now going to move on to, thank you, Yvonne. We're now going to move on to Sitchin to talk us through the pathways, which will be able to serve the students. Thank you. I could have the next slide, please. Thank you. I'm going to just take us through some of the data briefly before Susan outlines our diagnostic pathways. So we have a CAM single point of access, which is intended to support referrals getting to the most appropriate service as seamlessly as possible. And if we look at the period April 24 to March 25, we had 780 requests for neurodevelopmental assessments coming through that single point of access. This is for our children who are between the ages of five and 18. So we're talking about the pathways relevant to them at this point. And only 42% of those actually needed a neurodevelopmental assessment. 34% did not meet that criteria for a full assessment. And that's when those children and families are signposted to other offers or interventions, including schools. So again, completely links and aligns with the work and the approach that Yvonne has just presented. And some of Susan's presentation later covers some of the offers that we're saying are needs based rather than diagnosis based. If we can move on to the next slide, please. Thank you. So in that period, 600 referrals were accepted onto the pathways and there were further 130 referrals accepted for ADHD assessment. So the average waiting times are detailed here. And just to note that children and young people will be brought forward on that waiting list for particular reasons. So those, for example, who are close to turning 18 rather than them then waiting on a children's list and then being transferred to an adults list. Those at risk of exclusion, for example. So you'll see there is a range in terms of those average waits across the pathways. It does detail the wait there for our 0 to 5 pathway, which we'll explain in a little more detail later on. For this period, that was 11.5 months. And then across the pathways for over fives, there was an average wait of 16 to 19 months across the different pathways. And for example, for our ADHD with learning disability pathways, 15 months. So again, we'll come on to some of the work that is being done to mitigate that waiting period for those children and families. Thank you. So we are focusing on autism and ADHD today, but just to include some information about other cohorts of children. So we referenced at the beginning developmental language disorder and selective mutism. For these cohorts in particular, early intervention is really key. And so there is no minimum threshold for intervention. And there is collaborative working and integrated offer between our speech and language therapists and CAMHS. So that across those services, we're supporting both the settings to support these children and directly supporting the families. I've got a, it's not on the slide, I've got just a snapshot of data that was back in 2023. We had 12 referrals for the developmental language disorder pathway between May and December 23. And they all came through our nought to fives complex communication clinic. So we are talking about smaller numbers there and Hannah may want to come in. Thank you, Hannah. Just to clarify, Sarah, that number is the number of children who came through a pathway. The DLD pathway, which is embedded within the autism pathway. So it was a piece of work around a differential diagnosis for those children because it was unclear where their needs lay. There will have been a much larger group of children who were given a developmental language disorder diagnosis, but didn't have any associated social communication difficulties. So weren't part of that autism assessment pathway, if that makes sense. Thank you. That's a really important clarification. Thank you. If we go on to the next slide, please. So this is data in relation to education, health and care plans. I know you won't be able to see all of the categories or the cohorts here. The top line is our children and young people who are autistic, who have that diagnosis. And then the following two lines, just so you can see that, are those with speech and language communication needs and then social emotional mental health needs. Thank you. Thank you. We've just got one snapshot here from one service in terms of our demographics data. But it really speaks clearly to why we need to have such a focus on disproportionality and why we have our commitment and work around being systemic, trauma-informed and anti-racist. Because if we can see that the number of black African Caribbean five to 18 year olds on the social communication assessment waiting list. So one of our five to 18 pathways, we can see that the numbers of children from those communities are in line with our HACNI demographics. But when we see those who have been prioritised to have a shorter wait of three to four months because they're at risk of exclusion, we see that 11 of 12 of those children and young people were from a black heritage background. So it's really stark and is a continued area of focus for us. So I'm going to hand over to Susan now. Thank you. Thank you. Thank you very much. Can I have the next slide, please? So you'll see here a slide that shows the diagnostic pathways for health in City and HACNI. If I go from the right to the left, I just want to also say that I'm presenting on behalf of my colleague, Dr. Wong, who leads on the under fives pathway as well. So she might pop in comments. She's online. So if there's anything that I don't quite say. But we have an under fives pathway and an over fives pathway. And that's pretty much because the NICE guidelines asks us to do that. And the way children present under fives and over fives is quite different. And also over fives, we have education as part of our kind of remit. And we do obviously have settings in under fives, but there's obviously much more of an understanding of a child within an education setting for over fives. So for an under five, there are two parts before the bit you see on there, which is categorized the CCC, which stands for complex communication clinic. But before that, we have a neurodiversity, neurodisability assessment clinic that happens before a child would get to the complex communication clinic. So all children are seen by a pediatrician, and if it warrants it for differential diagnosis, they would also be seen by a psychologist for joint assessment clinic before moving on to the complex communication clinic. The complex communication clinic is where autism and ADHD would be diagnosed in an under five, and that's a multidisciplinary clinic. And then as you move across the diagnostic pathways going from the under fives to the other side, we have a five to 18 pathway, which currently separates out between children according to needs. So we have it on a two level need system. So we have for children that don't have a significant mental health problem and children that do have a significant mental health problem. So at the moment, it's categorized by children that don't have also the requirement of what we would have called a tier three or getting more help kind of mental health CAMHS system alongside their assessment needs. We also have a dedicated disability pathway as well for children with co-occurring intellectual disability that's moderate to profound, because obviously they have a very different trajectory of need when you have an awful lot of complex care and medical and other needs alongside autism. And then we have ADHD pathway currently sitting within ELFT in specialist CAMHS. And that would also link in with other parts of the system if it's co-occurring ADHD and autism. So at the moment you have ADHD sitting on its own, but the two systems come together when it's both presenting. Thank you. Next slide. So we have a number of diagnostic pathways. As you know, the demand over the last few years has absolutely skyrocketed. And that's nationally, not just in City and Hackney. Our picture is the same as the national picture. About a few years ago, I would say 50% of our referrals had autism as part of the question. Now it's 80%. So that's a very significant increase. And that's seen nationally as well. COVID had a big impact on our waiting list because obviously this is a pervasive diagnosis. We want to be able to see the young person in multiple settings. We don't want to just make a snapshot decision on something that's potentially a profound decision to be made. So we stopped doing assessments during COVID because we couldn't go into school or into their homes to do that assessment and to do it well. And we didn't want to do a very bad job for something so important. So that made a six month backlog at that point, which we've never been able to catch up with because we just don't have the capacity. And then co-occurring with that was a huge increase. So kind of two things happened at once. And we've never recovered from that situation without really very tiny, a bit of extra funding in terms of personnel. So we've done some big piece of research, which I'll come on to in a minute. But through that, we've been able to really quantify what an assessment for an over five looks like, a child who's over five looks like. And that's about an 11 hour process. So that's about 11 hours would include the whole time from beginning to end. So they're kind of the beginning of the referral, the administrative time for contacting families, letting people know, kind of gathering information, making sure that the referral is in the right place. And that does require an assessment through to the actual assessment process, which would include normally going into school and gathering information from school, looking over past medical history notes, making sure that we have a whole longitude, kind of eye on what we have looking at speech and language therapy so far, early presentations within the under five pathways. So it's a whole host of information that we're looking at, not just the current assessment that that young person and their family are going through. And so that's about an 11 hour process and write up and feedback and diagnostic discussions and obviously discussion with the school or within the system that that young person is going back into. So just really, I want to say that considering all of the things that have happened with Covid and everything else, I think City and Hackney actually are doing a rather good job at managing our waiting list at the moment. Nationally, we are probably better than most other places, certainly in NEL where we have the best waiting times. And in Islington at the moment, it's three years and two months, and we are roughly around the 18 month period for us at the moment. So although that still is terrible and it's a huge burden on us, I still want you to hold that in the context of everything that's going on. I'm just going to go to the next slide, please. Somebody has a hand up. Do you want me to stop for questions as we go? No, no, we'll just wait, finish yours and then I'll take the capital off. Thank you. But I'm just conscious of the time. So can we just sort of highlight some of the key aspects in terms of to reduce the waiting times and then the sort of the what next slide, which I thought was sort of quite important about the future direction. Okay. And then I'll try and then I'll try and bring some. Thank you. So in terms of the underpriced pathway, we've had quite a significant redesign over the last few years. So we've been looking to get funding to really meet the demand coming in the front door. So this has been an ongoing project since before COVID and is still ongoing because of funding issues that have been still in process really in terms of getting the right personnel and securing the current funding to keep that personnel to do a whole system change model for the under fives. But we're almost there. We've made quite significant inroads in reducing that. That's now the best waiting time in City and Hackney is our under five pathway. And with the send money that we hope we will get soon, that will even be even better. And obviously for the underfires, we want that to be the best possible thing to get our children in and out as quickly as possible and get the right support early on and early intervention being the right way to go forward. So I'm going to move on from that if that's okay. So we have had some other ways of trying to reduce these weights. So we've had some extra Saturday clinics. We've had a Twilight Clinic running for last year. And funding we don't have for that at the moment either. But what we're trying to do is just to get more personnel on the ground to get through this and find ways around it and be as creative as we can, because we know this is a huge burden. The thing I wanted to speak most about is the hub and spoke model, which we've recently won an NHS England Send Award for, City and Hackney have for some research that I've been conducting over the past year. Basically, I've redesigned a completely different way of assessing for autism by utilizing the kind of community of practice that we have within the whole bar in education and in health. And it's a way of really looking at needs rather than diagnosis. And it's a way of looking at equity and inclusion. So it's about a young person not requiring a diagnosis to access any part of any of the CAM system that we go on need only and that every part of the CAM system should be able to pick up whatever that need is, regardless of whatever the person's technical diagnosis might or might not be. And basically the hub and spoke model is that we basically put the young person through dependent on their need. So when they turn up at SPAR at the beginning of a referral process, we put them into the pathway that meets the actual functional need that that young person has. And then alongside that, we do a joint assessment if through that pathway that young person requires a diagnosis. So someone from our specialist clinic would join the clinician who is working with that young person in an intervention to do a joint piece of work. They don't leave that intervention and sit on another waiting list to wait for an autism assessment. That waiting list comes to them where they're at in that piece of work. And the research which has happened now on nearly about 60 children shows remarkable results for two things. One, the wait list has gone down to eight months from 18 months, roughly, and also that everybody's profoundly happy. The clinicians feel ethically it's the right way to work. The families, because they get their needs met right at the point that they're asking what the question is, they're not stopping and starting again. They're not making new relationships. That young person gets the assessment at the right time. And basically, you know, that assessment and that diagnosis can then be part of that ongoing piece of work. It doesn't require a second referral at a later date to do some intervention. So we are hoping to now roll this out. So if we go to the next slide, please, in terms of what we do next. We're doing a whole piece of system redesign across the whole TAMS infrastructure so that we look at this right from the highest needs, highest mental health need, that this will be a hub and spoke model right through to the lowest mental health need, which is currently in our schools pathway, our MHST, which is our mental health and schools pathway. So we can do hub and spoke assessments where we do joint assessments. One of the specialist clinicians joining the treatment pathway, wherever it is in the entire CAMS system, so that the entire CAMS system becomes an equitable system for our young people. I'm not going to say any more. I shall stop. You can ask me questions. Thank you very much. Thank you, sir. I was indicating to the chair a little earlier. I didn't mean to interrupt your contribution. Thank you. I have a very quick question regarding the assessment. I'm curious to know, to hear from you whether, you know, the National Institute for Health and Care Excellence NICE approved this computer-based test last year and it was launched in July 2024 for use in the NHS. I'm curious to know whether this is used in our borough and what percentage and to support... Can you tell me what that is that you're using? So as a QB test? Oh, the QB test of ADHD, yes. So yes, we are. And how, if you could kindly tell us what the percentage of how much we use it to support with a speeding diagnosis or assessment. And I just had a very brief, sorry, very brief question for Susan earlier, which, you know, very impressive initiatives that you reported and that they're being implemented in seven primary schools. Is there any evidence that these initiatives and support to schools are leading to a reduction in school detentions and exclusions? Because as you may know, a lot of the same kids do have, I mean, the larger portion of the kids we sent do end up either excluded or... Yes, thank you so much. All right. Thanks. Thanks very much, Chair. So often with these things, I don't live in your world at all. You know, I'm not a medical person or anything like that. So you've... It's a whole sort of deluge of detail that has come. I'm going to be honest, I don't really understand that much of it. But what I do understand is my own experience of autism. And, you know, I'm just... I know you're probably going to reassure me, but it's kind of like scientists poking at an object and trying to deal with the problems to do with that particular thing, that particular person or what they've got. I just want to say that somebody who's autistic is a beautiful thing. It's an absolutely beautiful thing. And I've known many autistic children and I'm currently working with one who is learning Mandarin Chinese in one of our schools. And it's just tremendous, you know, he's learning. He's being accepted. But I'm just wondering, with all of that, that the person is not getting lost. And on page 29, I notice, I'm really thankful. Thank you for page 29, where a child is said, I'm smarter than teachers expect me to be. And I don't like teachers calling my name again and again when I'm already listening. That's the experience. That seems to me to be an authentic experience of particularly autism. And I just wondered that those things are not getting lost, you know, in all the process. And how are you using the community to help those so designated people who are in the community, who've maybe had autistic children or they're in their family or they're just, you know, they're encountering them in different ways. And just to say that I'm not sure that I'm glad to see that over 2,000 teachers and others have received training. I think that's absolutely brilliant because obviously I've been around in this borough for a few years. I can tell you a few years ago, people had no idea what autism was. And it was like something weird and wonderful that was, you know, awful. And I'm so glad to see what you are doing. I do just wonder about autistic children being singled out as needing special help, that there's something wrong with them. You know, not that you're saying that or whoever it is, but they are feeling like that because, you know, they just want to get on with their lives. So I don't know if that's a very helpful thing. I just really felt that quite strongly. Thank you, Councillor. I'm going to bring in one more at this stage and I'll go to some answers. Councillor Conway was the next. Thank you very much. It sort of touches a bit on the points that my colleagues raised. It's about pins quite specifically, actually, and just wanting to know whether we're seeing a reduction in the number of assessments that are being requested by parents and families from those schools. And the reason why I asked that question is because my sense is that often what prompts parents to request an assessment is challenges that the child is experiencing at school. And the sense that I need to have this assessment so that we can progress, access support that means that we can progress. If that's already being delivered also with a graduated response, are we seeing that go down? I'm not sure whether that's a good or a bad thing necessarily. Some people feel that it's really important to have a diagnosis, regardless of whether it, you know, invites additional support. But yeah, just curious to know what that is. Have we assessed that at all? I'll ask Sarah if you want to start off and lead the lead director would be best to answer different questions. Thank you. I think I would say that we've only just completed year one of pins, which in essence means actually that all of the schools have had about five days of support over sort of a three month period. We can, we can, we can already see we're hearing the impact of that from schools and professionals and from, and from parents through the communication with the parent carer forum, but it's very early in terms of seeing any wider impact. We're moving into year two. And I think some of your, your questions around, you know, are we seeing an impact on any kind of referral numbers or sort of questions about the need for referral is absolutely something we can build into that. And I'll, I'll, I'll have, I'll ask Yvonne shortly if she wants to add anything to that. But I did just want to, I did just want to pick up on your points, if I may, around, around celebrating neurodiversity. And I don't think that's come through in our presentation or slides necessarily, but it's, it's a real focus of our work. And it's a focus in that we know we're doing some of that, but actually we need to do a lot more of that. So, um, Jody, who's unable to join us today, but Jody has, um, over the last few years, led on our, um, our, our kind of pride celebrations, um, around neurodiversity. And that's something that we, we know we've had, has had good impact, but actually they're quite isolated events throughout the year. And we're really committed to bringing together, you know, a real kind of presence and consistency and a joined up way of, of celebrating diversity. And I would just draw your attention again to the kind of neuroaffirmative language earlier in the presentation. And it is, it is a real cultural shift that's required, isn't it to, for us to kind of feel that, um, and achieve that. Could I just say one, could I also, one thing as well, which is that part of the change in that I'm trying, I wish I had a lot longer to explain the, the change that we're trying to do in the whole CAM system is that, you know, CAMs must be the last resort. We're not trying to be the first resort. We don't want anyone in fact to be referred to us ever. We would love that to, to be the way. So we, we're trying to only assess children that really need an assessment to have a label. We don't want to be labeling or assessing children that don't need it. And I think you see from our spa results, you know, that we're trying to back kids away. We really do not want to do that. And so I think we're presenting this because this is our biggest issue. Our biggest issue is everybody is coming through the front door as if it's the biggest need. And we're trying really hard to do the opposite. So although we're not showing it, we are actually joining with you and saying, we do not need to diagnose children. We only need to work with young people where there is such a, you know, a kind of a difference between their lived experience and their wished lived experience. And that's what, where we need to intervene. And if that system requires a diagnosis in order to make a change, then we'll make that. And if it doesn't, then we don't need to make that. And that's why we want to work with needs, not with diagnoses. And we want the end result to be needs, not diagnosis, but for some, it will be a diagnosis because that is what's needed. And we want to get that absolutely clear, that with all the changes that are happening with inclusion and equity within the education system, as well as in CAMHS, we are hoping that we can move further and further away from that diagnostic position. And I'm hope I'm trying to redesign the CAMHS system so that we are not a diagnosis. We will not have a diagnosis pathway. We will have a joint assessment pathway into our needs led services. And I hope this is a profound change. I think we're one of the first, which is why we won this award. One of the first places to do this where, you know, and I think, I think it's exciting. And I think it's exactly without, I'm not, I wasn't as good in my language as you are, but that is exactly why we're doing it. So thank you for raising that. Can I just answer the QB question as well? Because I didn't answer it. I don't know if there's any of my colleagues from ELF Specialist CAMHS online. I don't know, Kirsten, I thought I saw you pop up. Is Kirsten online? Yeah, I'm here. Oh, is that a different Kirsten? Oh, I saw a different Kirsten. Different Kirsten. Is John Bradley's online from ELF? No, it's from Children's Services. So we use it in Specialist CAMHS. We don't use it in the Homerton CAMHS system at the moment. We just use a clinical diagnostic, you know, normal tool. We don't use an online tool like the QB, but it is being well used. I know in Specialist CAMHS in children with more complex mental health presentations. I can see many more questions, but I'm going to stick to my initial plan. I want to move on to the next presentation to try and leave about 30, 40 minutes at the end. For everyone then to come in for a wider discussion. So can I then now move on to the adult presentation from Penny Heron, who's joining us online. Penny is the Joint Strategic Commissioner for Learning Disabilities and Autism at the London Borough of Hackney. And also I think a possible contribution from John Bradley as well, who's the operational lead for Autism and ADHD at the East London Foundation Trust. And then I think I'll also just wrap into this section as well, the Autism Friendly Neighbourhoods Pilot. And I understand we're going to be joined by Matthew Quinn, who can speak to that as well. So if I could take all of that together and then that should hopefully leave us about 40 minutes or so for members' questions. So Penny, over to you. Thank you. Thanks very much. I'll take you through the first couple of slides and then pass you to John. And then I'll come back to myself with Matthew as well. So in terms of just covering very briefly some of the things that we're going to look at, John's going to go into a bit more detail around the diagnostic side of things. But there are a range of other kind of pathway options for autistic people in City and Hackney. There are, for example, things like the Learning Disabilities and Autism Acute Liaison Nurse at the Homerton. This helps advise on things like reasonable adjustments when people go into hospital into the Homerton. There's the Wellbeing Network, which looks at, I suppose, more that preventative mental health side of things. And as part of that, they have to sort of look at their demographics, look at the population for the autistic population and autistic residents. And then in social care as well, there is a link to, I suppose, the Autism Act. There is that mandate around they are entitled to a Care Act assessment. Now, whether or not somebody then becomes Care Act eligible is another matter to then have kind of support needs met. So that would be determined by a social worker. And we do have a sort of social work champion in adult social care called Kadeen, who leads on the Autism Drop-Ins, which are based down at the Opportunities Hub in Hoxton. And that's where autistic residents can come and ask different questions around things. Often there's quite a lot of things around form filling in and that. So there's a kind of support element there. There's also possibly the opportunity to access different apps on like phones and tablets and things like that. And they help a lot with things like organization and planning skills that can be very difficult for people who are autistic. And then there are obviously the mental health pathways and quite a bit of work being done. We touched on workforce and one of the things now is that is mandatory for the workforce to do in social health and care to do training on learning disabilities and autism. So that's a requirement. It sometimes gets called the Oliver McGowan training, which is a particular type of training. But that is there, too. And apologies, because that was a big focus a lot on the autism side. But there's obviously kind of the ADHD, the attention and hyperactivity deficit disorder, etc. And I think this is something that's come up a bit in the children's one as well. And just to reinforce, I suppose, that idea around the diagnosis and or that needs based approach. So I suppose what we're trying to look at is that those kind of wider approaches to improve different people's experience of services generally and make sure there is that equity there. We know that for some people that diagnosis is very important, including in adulthood for various things, including like the Equalities Act side of things in employment, for example. So what we want to to sort of make sure is that people are waiting well while they are waiting for those diagnoses. So we need to think a bit differently about how we do things. Susan said, it's a national problem around waiting times. Similarly, in adults, we've got wait times as well. And it is thinking about, well, what are the needs of these individuals? Is it more about their access to certain services and environments? In which case, rather than look at the individual and their kind of diagnosis, is it about those environments and looking at them? So having more of that social model approach of looking at what's going on for that individual as opposed to the individual themselves. And we've done quite a lot of work around the autistic friendly communities, which we'll come on to, as an example, in the autistic friendly neighbourhoods. And Matthew, he referred to, he's actually co-led Autistic Celebration with the Autistic Pride. I'm going to pass over to John now, who's going to talk a bit more about the pathways. John, let me know when you want the slides changed. Okay. Hi, Penny. Hi, everyone. So I'm funded as operational lead for the autism pathway, not funded as operational lead for ADHD here or in Tower Hamlets, but I do run those services. And that kind of illustrates the paucity of funding in adult diagnostic services generally in the local area. Also, I suppose, just touching on something that was said in the CAMPS presentations, we sit, although autism and ADHD are not severe mental illnesses, we sit within a trust that's caring for people with severe mental illness, which is slightly awkward fit. And we are somewhat somewhat to the side, although we're doing quite a lot of work to try and embed things a bit more. So this is the ADHD pathway you're seeing here. So these referrals come in to us primarily from GPs, sometimes from our colleagues within the trust, but mainly the people who go to their GP and think that they might have ADHD. We offer diagnostic assessments, we offer treatment and we offer some post-diagnostic work as well. The local offer, you'll see that this has changed quite a lot actually recently. GPs have started taking on doing ADHD medication reviews, which people on ADHD medication can expect 12 monthly. And we've added a kind of GP inbox, which to help out GPs with this. If you move to the next slide, Penny. So this is the autism pathway. This is a little bit different. A, there isn't treatment for autism. It's a condition where we're funded and commissioned to diagnose. We're not commissioned to do anything else, although we recognise that simply saying yes or no to people is a bit blunt and doesn't prepare them. So we do have a small post-diagnostic offer that we offer people for up to 12 months after we give them a diagnosis. And we would also signpost people who we don't diagnose to potentially to other services and other resources. But the bit we're funded for is very small. It's just the diagnostic bit. And if you go to the next slide. So this is the autism service. There's in all three and a half people that we're funded for. I'm point nine of that. Our administrator is one. So you can see the actual clinical core is tiny. We've got point one five of a consultant psychiatrist and point four of a speciality doctor. And then we have bits of other doctors. So I have fractions of clinicians providing this service. And I'd argue that we punch well above our weight. So we usually take two assessment appointments plus multidisciplinary discussions to make a diagnostic assessment. Sometimes it's many more. And at the point that we diagnose or don't diagnose, we discharge people. So they're discharged from the service technically. Although, as I've said, we do have a post-diagnostic offer that people can opt into if they want to. And that's something we're not funded for at all. And that's something we've built on our own time effectively, which we're quite proud of. If you want to go to the next slide. So this gives an idea like like with children's services, we were already seeing an increase in referrals for both neurodevelopmental services. Autism was ticking up before the pandemic. Through the pandemic, we had that double whammy as well, where people were stuck inside their houses. More of them became aware of difficulties they were having. And more of them began questioning whether they might have autism and ADHD and plus our service was suspended because we weren't deemed as being important enough at that point. And we were redeployed. So we had a period where we weren't doing any assessments at all. It does appear that the it's somewhat plattering now, but we've yet to see whether that's going to be sustained. And you'll see that we've got about 600 people waiting for assessment and we managed to do 14 assessments approximately a month. So these people are waiting three years roughly before they're even seen. So there's long a big group of people sitting on a waiting list. And so that's something we've been trying to address developing some waiting well resources, but we don't have any resource to actually. Make needs and these people are directed to contact GPS mental health services and sent resource packs for self help tips and coping strategies. If you go to the next slide. The ADHD service, which has even more demand has even smaller resource. So I've got point three of commissions, clinician for assessments. We do have half of a ADHD practitioner, which is a new provision. We had a psychologist post we couldn't fill. And because rather than have a vacancy, we've commissioned that it's essentially a pilot. We've got a nurse practitioner who's also has ADHD himself who's training to be an ADHD coach who delivers a post diagnostic offer. And we've had amazing feedback. People really, really love that. It is something they've not had before. And I should point out with both these services, administrator is absolutely crucial. The amount of admin generated by these services is off the scale. And I've I've had both administrators off for the last week and I'm drowning. So they don't run without admin. We do also augment what we have with some specialty doctors, doctors who want to learn who we're not paying for, but we're giving them free training. And my my time for this service isn't funded. And we do occasionally get special interest doctors coming in from outside the trust as well who want to learn. So we use them to do some of the assessments as well and try and broaden what we're able to offer. Next slide, please. We take this one as red. So it's conscious of the time. I think we've I think this is large and similar sort of point as you tell me otherwise. Well, the only the only thing I'd add is that we've got 2000 people on our waiting list. 1500 waiting for assessment and they're going to wait probably six years minimum. So that's probably something worth saying out loud, although I'm ashamed, but and you'll see that also the referrals have dropped off because GPs have decided with the ICB that they're sending all of assessment referrals from now on to right to choose. So money is going to private providers out of the NHS funded by the NHS. So which is obviously quite a shocking fact, but that's that's the reality and it means people can be seen within a year rather than wait over six years. So if you move on to the next slide, that's I probably don't need to go into that in any great detail. It's just to say that in ADHD, as well as diagnostic assessment, we're also offering treatment, medication reviews, treatment optimization. The GPs have taken on a certain amount of that with some support and we're offering a GP inbox that they can send queries and we can try and do a bit more arm's length work to skill up our primary care colleagues to take on some of the ADHD work. But we are we remain the specialist service, so all the assessments are coming through us that aren't going privately and we have the post diagnostic offer, which is funded and which is actually really, really popular and probably long needed. If you may move to the next slide. So at the moment, in terms of our backlog, we are attempting to clean our waiting list. We've been contacting all our patients, both advising them, finding out whether they've gone privately themselves, if they've moved out of area. If they still want an assessment, also advising them that they do have the right to choose. And that has removed quite a lot of people from our waiting list, but we still have a large, large group of people who want and need an assessment. We're giving advice and guidance to GPs. At the moment, we have a backlog of people who are mid titration. We had a couple of clinical staff pulled who were not funded, but we were rather reliant on. And we're left with people mid titration. So we're focusing on clearing those before we go back to looking at the medical reviews and assessments. And we're also offering pre and post diagnostic support and information for people on the waiting list and afterwards. And myself, I'm involved in a number of trust wide groups, quite high level groups looking at rethinking how we deliver ADHD as a piece, both in this trust and across North East London. Unfortunately, we haven't come up with any magic solutions yet, but there are some movements to change the way we do things. If you move to the next slide, please. And this is this is the good news that our primary care colleagues, unlike actually GPs in Tower Hamlets or Newham, are very keen to get involved in ADHD. They've taken on the annual medication reviews because the ICB for a very small sum are paying them for these, which they don't do in other boroughs. There's been a lot of partnering with Takeda, which is a pharmaceutical company, but they have a nonprofit making arm and they do a lot of very good ADHD training. I'm not I'm not I'm not paid. I'm not commissioned by Takeda. I haven't haven't done the training, but it's been very highly spoken of by the colleagues who do it. Obviously, some people have ethical issues with pharmaceutical company being involved. But given the demands, I think the ICB took the decision that this was too good to pass up. They're also funding to GPs to train and work with us in our clinic just to help us with our backlog. So that's where we are at the moment. And I was asked for some data. She's on the next slide, Penny. This just to say, actually, in terms of data around gender, we're seeing far more women now than men in all the services I run. And we don't know why this is, whether this is kind of lost generation or people are coming forward now who hadn't thought to because of awareness. But that's something that's very prevalent in these in terms of ethnicity, though similar things are happening. We've got an underrepresentation of black, black British, black Caribbean, black African in both services compared to the prevalence or the demographic prevalence in the borough. We've got an overrepresentation of white British people and some other groups are underrepresented. I mean, I suppose this is something that clearly needs work on. But the most striking piece of information in this is that we're not very good at capturing demographic data because 70% of people who come for ADHD assessment, we don't know what ethnicity they are. So there are some huge data gaps. There's clearly populations who aren't accessing our services. And if we could access them, they would have to wait even longer, unfortunately. So there is there's there's enormous piece of work to be done here around this, both in terms of access and then providing something for people once we allow them access. Sorry, that's that's more downbeat than I intended following the good work of my children's colleagues. Very helpful, John. Thank you. I'm conscious that I just want to do is if I can fairly briefly. But I understand Matthew Quinns here is a service user and I want to make sure he doesn't leave enough time. The Autism Friendly Neighbourhood Pilot. Penny, could you just give a very brief 30 seconds overview as to what that is? And maybe if Matthew can then speak to it for a few moments and I'll open out for questions if that's possible. Yeah, sure. Absolutely. And in fairness, this was something that Jodie has been a big pioneer on with Matthew, who has co-led much of the work in this. And I think I was going to ask Matthew to kind of come in about the importance of working with primary care in particular, who are things like GPs and GP practices to talk about the importance of doing that preventative work. It comes partly from the wider autism strategy, which is co-produced locally around accessibility issues. And I think one of the counsellors brought up about the health outcomes issues and how we deal with that. So one of the key things that we've been looking at is about promoting access to things like GP practices. But in order to do that, what you want is for people and services to make reasonable adjustments. But in order to do that, you need to support people to understand what that is and give them the tools to do that. So very much a lot of this work has been around things like creating autistic friendly checklists, which have become part of the GP contract. Is it OK if I switch to Matthew just to talk about this? Hi, Penny. Thank you. Hello, everybody. Yes, it's sad that Jodie's not here tonight because it's really been a huge piece of work that she's undertaken. And I've tried to support her as an autistic resident in the borough. Certainly when we we were designing or coming up with the autistic strategy, the autism strategy for the borough, it was it was pre pandemic. It was clear that access to health services was was was something that many, many of us, many autistic people find can find challenging due to not being understood the condition. We're going back even more years now, but the condition being misunderstood, stereotyped, generalised. What the work, the pilot work in London fields focused on was going going to GPs, talking to the reception staff and actually, you know, explaining that very broadly. Obviously, obviously, I don't speak for the autistic community. I'm just an autistic person. We're all as different as you neurotypical people that very broadly, you know, autism is about a different thinking style. It's it's it's about a different having a different social understanding and having a different way of perceiving the world from a sensory perspective. When you are, you know, being offered a bowel screening, in my case, I was past 50. I don't use the telephone anymore eight years on from my diagnosis. My diagnosis was a late diagnosis just to give you an example. So it was a question of establishing a series of reasonable adjustments where, for example, I'm now able to email my GP first. This has taken some she's fantastic, but it has taken some work. But now they're fully on board. And it's about asking each individual autistic person that they have recognizing their autism, asking them about the reasonable adjustments that they would like to be made. So that when you go for a bowel cancer screening, you're as as in in in a sorry, speech is not my my strength in terms of communication. So please bear with me that going to the GP when the lights are very the strip lighting is very bright. The doors are banging. If you have hyperacusis as this as I do, this is very, very alarming. People are can be very quick to move in front of your face and assume that you understand things because your your condition is hidden. So it's about it. We've we've I think we've I think we're pleased that the uptake has been very good. And we've had a lot of good feedback. Jody's presented and I've I've gone along and talked about my own lived experience and with the permission of some other autistic residents, some of theirs. And what the feedback we've had, which has been very strong, is that we people have said, well, we didn't really realize that or we thought that we thought it was much more. The autistic condition was much more of a linear spectrum. It was just you had a high level of need or a low level of need. Of course, that's that's really quite an old idea now. And it's very important, I think, in my experience that people start to understand autistic people as having spiky profiles. We are we can have a high level of need on one day in a certain area that impacts. So from a sensory perspective, for example, that impacts our cognition, that impacts executive function. It's as Hannah said earlier, we need to start looking at things as a much more fluid rather than a rigid kind of this is an autistic person or this is an autistic child. And I think, you know, we've heard some great things tonight about nothing about co-production, about what I loved that Patrick brought out about the fact that this is not, you know, the medical model is deficit based. Of course, it is, you know, it has to be, as Penny mentioned in some ways, and I understand that. But the celebration of autism, GP is actually understanding that hearing about what an autistic person loves about their autism. There's so much on the deficit, on the challenges we can make space. Someone else has referred, it might have been Yvonne about making space earlier. We can make space for members of our community as individuals when there's appropriate funding. Obviously, it was very important. I'm so happy to hear John speak about, you know, the service that he and Leda when she was there and Stephen offered when I received my diagnosis. You know, that was a whole 12 months of care that John and his team were able to offer me as a late diagnosed autistic person in Hackney, where my mental health, although John said it's not really a mental health, an SMI. Of course, you know, autism does carry with it, can carry with it rather, some severe mental health challenges as well. So John's team were able to really navigate that in my experience and the experience of other peers that I know to give us a space where we could actually come to terms with just getting that diagnosis. And I just want to say I've heard so many positive things tonight about people wanting to change things, the spoke and the I think it was the spoke in the wheel. Sorry, I've got that wrong approach with that with younger people. Patrick's mentioning about his his experiences and and and how beautiful it is to be autistic. And I would just like to second that there is so much about my autism that I'm so glad I know now that there are so many challenges. But I'll bring it to an end. Yes, it's just that can we find a way? I know resources are so tight for everybody, but can we really come together? And as the great autistic academic Damien Milton says, you know, embrace each other's empathy. We have to find a way around around these problems in a way that enables us to accept one another as as just different. We're just different human beings. And the autism celebration that we have every year. I think I'm really proud of the fact that we have its intersection. We have so many different cultures have come. Children from different cultures are getting involved. They celebrate their autism with us and that needs to continue and it will continue in the future. But I just want to. Yeah, thank you for giving me a space to. Thank you. You've got a few rounds of applause there as well. OK, that's OK. You're a primary goal. It's important to have a service user voice at these meetings. Thank you very much. I'm going to now open it up to questions. Just before I do, John, can I just clarify, just in terms of what you were saying a minute ago, you have to understand this, on the right to choose aspects for the ADHD. Essentially, patients are being offered the choice to get a private assessment. Does that money, when that happens, does Enel pay that money for that? So in other words, they're not funding your service to deal with the waiting list, but they are asking that actually North East London, not NHS England, but North East London, is the funding when individuals go privately. So it's completely perverse in that sense. Whereas if they funded you adequately in the first place, you could deal with a lot of this locally and in-house. Have I got that right? In essence, although when I've raised that point, my understanding is that the money comes from, I don't think it comes from the same pot. So the money that we're funded from, the budget we're funded from and the budget they pay right to choose, although obviously it's all our taxpayer money, it's NHS money. But I don't know, I don't understand the mechanism. Everyone in the NHS has the right to choose where they have their treatment technically. It's been supercharged in ADHD because private providers have recognised this and recognised that the NHS can't meet the demand. I mean, unfortunately, it's the reality now we have to accept that this huge industry has grown up alongside the NHS providing these assessments and treatments, and a lot of it is funded under right to choose. No, thanks. I see Curtin's just coming there. Curtin, do you want to add something? And then I'll throw it open to members. Yeah, I was just about the right to choose. So in the NHS, any organisation is being commissioned to provide a service anywhere in the country, anywhere in England, then a patient has got the right to choose to go to that service, to be referred to that service. So that's where the right to choose comes in. The patient can say, I want to go to that provider because somewhere in the country that local area has provided that, has commissioned a private provider to provide that service. I hope that makes sense. It is perverse, but I think we are in a situation in North East London where at PPs we have an option to either refer to our local services, which we've always wanted to do, and we've always promoted that. But then there's a six year waiting list to get seen, or patients are saying, well, I can choose to go to this service and get seen within the year. And it leaves them in a very difficult position, because you can't, you can't with any sort of, any sort of moral feeling, refer someone where they know they're going to take six years to get seen. I'm sure it's just whether anyone's sitting down at a North East London level, if they are the purse holder for both and saying, hang on a minute, this is, this doesn't make any, as well as the right thing to do in terms of treatment. This doesn't make any financial sense, because if we spend X amount on our own in-house service, it wouldn't be going out the back door on another way. I don't know how the budgets quite work on that, but it does look like whether that's being looked at. I don't, you may not know the answer to that, Kirsty. Amy's going to answer that for you. Hi. So it's not a complete answer, but there is something around, there's two things. One is that Right to Choose, it came in 2018, and it's national. So it's not necessarily regional money, and that will be changing over the next little while as well. So it is quite complicated. And there is something else around that, that providers who deliver through Right to Choose all have to have existing NHS contracts as well. So there is some sort of regulation there, although it's not completely ideal. Thank you, Amy. And thank you for joining us from your holiday as well. We very much appreciate it. Right, so members, members who haven't come to us, or Council Adams. Thank you, Chef. Thank you, Chef. Oh, I was just wondering whether somebody can talk a bit about how ADHD manifests differently across lifespan from childhood to adulthood. And secondly, how common is the co-occurrence condition of ADHD with the older neurodiverse development disorder? Thank you, Council Adams. And Council Lynch at this stage as well, and then I'll throw them into the two on top. So I have got quite a few questions, but I just want to say this has been quite depressing this evening for somebody who for 50 years of my life didn't know that I had ADHD. And what I have achieved and what Matthew has talked about, I don't know his background, but he survived, basically, I've just found this really depressing. We've completely used a medical model to describe something where we just, it's a bit like being left handed. We've just got something that's a little bit different in our brains. And actually, lots of successful people have, are now becoming diagnosed with conditions such as ADHD. And when I had my diagnosis, it's actually about a year ago, actually. And it was because another woman of a, you know, late 40s menopause said to me, you know, and I remember saying to my mum, I said to my mum, I said, Mum, I feel really awful. I feel like I did when I started my periods where I then sort of went to big school and I just found it really awful. And we know now that particularly for women, we haven't talked about the term masking. We haven't talked about the fact that it's not about us being, you know, I feel like I've been a burden. So some of the language that's been used by people today around, oh, we've got this, like all these backlog, we've got all these people waiting. It's quite offensive, to be quite honest. It really is. And I don't want to just be seen as somebody who's creating waiting lists or creating backlogs. And I think you haven't presented that the two diagnoses are completely different. If you have a diagnosis of autism, there's not much that you can do. If you have a diagnosis of ADHD, you then can start medication, which for many people is absolutely lifesaving. I first took medication and everything went quiet. I didn't realise that that's what it is. I don't like being described as hyperactive or disorganised. If you come to my house, it's the most cleanest house. I spent most of my life trying not to look like I haven't got myself together. I have had to work so much harder to achieve everything I've done. And I really hope for what Matthew's talked about is that as a borough, we start to celebrate people that have this because we're not a burden. We don't need a label. We just need treatment. So it's like people developing type two diabetes. Yeah, you give people the insulin and you go into it because I'm a nurse by background. There's lots of us in nursing. So thank God there is people with ADHD because that's some of the strengths we have, which Matthew talked about. But I just felt like I'm completely medicalised. I think it's very true that the fact that where we're commissioning stuff that it's been else that it's looked as a mental health disorder, like which we shouldn't even be discriminatory to people with mental health. I've not seen anything here about co-production. I've not seen anything here around what happens after you get a diagnosis. And I think the only sensible person I've heard today was yourself there that may acknowledge that actually, you know, from when Councillor Rathbone made the comments about the strengths that we have is around actually this isn't about us being a burden or being a problem. It's just how society is and how things are structured. And actually, if you just make a few adjustments for us or give people the confidence to say, actually, I've got ADHD. So actually, can I sit, you know, I'm not going to talk about what my needs are, but there's a trajectory of people with their needs. And we shouldn't be putting children into a rigid pathway that they end up in mental health services. Because when I see those demographics around the disproportionality of black young men, that gives me, that reminds me, I'm showing my age now, of when we had the disproportionate diagnosis of black young men with schizophrenia back in the 80s. And we were in real danger of over medicalising this. And I think for me, I, my actual question is, we haven't talked about pharmacies. There's a little bit on the slides, because this is the biggest challenge that people are facing. And the reason why people are going private is because we know it's been commented on now is that there is an industry there. So people are having to pay to get their medication. I probably have, you know, I'm very lucky, I've had a very supportive GP. They've, they've offered me shared care, which is brilliant. A lot of people don't know about that. But I just, I just wanted to make that comment, because I think it's really, really important that we start to move away to a more holistic, well, strength-based approach about what can actually people do. Because you know what, if you put the right things in place, we will fly. We will fly. I just wanted to say that statement. Can I just bring Sarah, in terms of that sort of challenge about over-medicalisation, what sort of, what's your observations with respect to that? Yeah, thank you for those comments. And what we've tried to do through this presentation, because it's such a broad and complex subject matter, isn't it? And I, yeah, I'm sorry if we've got the balance wrong in that, or if that's how you've seen our presentation. Because what we've tried to make really clear is that the diagnostic pathway is just one part of our whole system, of our whole approach. And it's, it's complex, and that's why we've spent some time to try to make it as understandable as possible within the time. But, you know, we really started with that neuroaffirmative language, that real focus on inclusion. And I hope that you've seen that throughout. I think in part because of timing, we haven't, we've missed some of our children's slides around waiting well. And in those, you will absolutely see that, again, our focus is on that, you know, early support without the need for a diagnosis. All of the work around trying to bring together support whilst waiting, moving away from saying this is post-diagnostic support, but making it available when it's needed. There is a huge amount of work going on there. I do want to say something briefly about co-production. We talked about PIN's work, and that is 100% co-produced. It's co-produced, it's co-designed, it's co-delivered with our Hackney Parent Carer representatives, who have absolutely influenced the way in which PIN's has been delivered, influenced the impact of it. And we're really grateful for their leadership and their involvement moving forward in that. We have, from a children's young people's perspective, we have parent carers on our neurodevelopmental subgroups. So at every point of our strategic thinking about these problems and how we're going to collectively address them, we've got our parent carers involved. And also, you'll see in one of the slides that we didn't talk to, but there's a link to the work that a colleague, Mariona, is leading on, again, pulling together with our CAMS colleagues, with our therapist colleagues, thinking about how we deliver the kind of waiting well offers differently. And again, Mariona presented to our Hackney Parent Carer Forum very recently on that. So, I can only speak from a children's perspective, but there is an absolute commitment to co-production in all of our work. So, before I bring Penny, because she's raised her hands, and other members, in terms of Captain Adam's questions. Dr. May Wong might answer it better than me, but off the top of my head, I think it's about 40% of young people have a co-occurring additional difficulty that might be epilepsy or an intellectual disability or ADHD alongside autism. So, there is quite a large number of crossover, although I totally understand that we can have autism on its own or ADHD on its own, but there is a large crossover to that. In terms of the lifespan question that you asked, I think that we do see young people mask their difficulties. And so, as I think this lady described, as more pressures come on, as different hormonal changes, societal changes, you know, bigger social kind of demands on young people, that's when we see other presentations coming out. And that masking may be struggle to keep problems. They become problems when they weren't problems, and that's when CAMS get involved. So, you know, CAMS never want to be involved, and we don't want to be seeing these young people. And that's why all the work that's going on in education is trying to make it that, you know, we only see those that absolutely need that intervention from our services, and that we're trying very hard to make sure that, and I didn't get to some of the, you've got it in your slide pack, but I shortened it because of time, but, you know, we have a whole range of offers that are commissioned in City and Hackney, both within NHS, within education, and in the voluntary sector, for other ways of living well with neurodisability. So, we're not trying to make this a mental health or a CAMS way of working at all, and that we're just showing that, because I think these are the questions that we always get asked about waiting lists, and we just came with that because we knew that that's what we'd be asked for. But that is a tiny bit of the whole picture, so thank you for asking that question. I can see online I've got Penny, Perpetua and John, but I'm conscious that I want to make sure members also have their chance for questions. Councilor Lucas hasn't had a chance yet for a question, and Lisa as well, so can I go for Councilor Lucas then, Lisa? Great, thank you. I just wanted to ask a question, you know, moving back to the CYP element of the conversation early on, and around PINs and some of the, you know, tools and training that's being rolled out across educational settings. I think you mentioned that Right Support, Right Time, there were guidance modules that were yet to be rolled out. I'm interested to know, sort of, what the timeline is for that. And you mentioned, obviously, around the sort of seven schools that had opted in or had been trialled in that first year. When does that expect to be expanded to a wider range of schools? What are the blockers around that? And then, just kind of linking to what we heard in the adult space, obviously, it seems like one part we didn't hear much about tonight, and I'm interested to hear if there's been any work done on this, is around the support in sort of workplaces, particularly public sector, but also private sector, maybe through HR and others, around how we're supporting colleagues to be more inclusive and to really be attuned to those dynamics within an inclusive workplace. So, is there any work that's being done through yourselves or anyone on the call in that space to make sure we're as inclusive as possible on, you know, right the way through the age groups discussed? Thank you. Thank you, Councillor Lisa. And Lisa? So, we know that girls present very differently with autism than boys, and this is something that you haven't talked about at all. And for John, maybe one of the reasons why you're getting more adult women being diagnosed than men is because boys traditionally were diagnosed as children, whereas girls were not. And I have Ehlers-Danlos Syndrome, and a lot of the people I know with Ehlers-Danlos women who are my age slightly younger than me have recently been diagnosed with either autism, ADHD, or both. And that's because they were not diagnosed either with Ehlers-Danlos or with autism as children. And I was just wondering if you've taken that into account, John, and whether you're doing anything with girls, because I know I have a friend who has an autistic daughter. She's now doing GCSEs, and... But she stopped going to school. She was a school refuser once she finished primary school because it was the beginning of COVID. She just couldn't leave the house. And she wasn't diagnosed, and eventually her parents took her privately and got her an aide to get for a private diagnosis because they didn't know what it was. Because it was such a different presentation. And then the guy going to care in school. Yvonne, would you be best placed to answer in terms of the PIMS timetable and wider school involvement? And then maybe, I don't know, Sarah, in terms of Lisa's question, from a young people's perspective, in terms of women and the level of diagnosis. And then I'll move on to Penny and John from the adult perspective. Yvonne? Thank you. Thank you for the questions. Earlier there were some questions out, so I wanted to say, Ben, in thinking about the kind of social model of disability, it's the world that disables people, not people being disabled. And I think that's the kind of work that we're working on in terms of education, thinking about life beyond education. I always say to children that this much of your life, if that's your life, that much of school is the rest of it that we've got to kind of think about and be prepared for. Now, and I've got my director sitting next to me, so I've got to be careful what I say about education. However, it's been a bit of a political football for a very long time education. And we are at a point now where schools, teachers are measured on performance. We have forgotten about, as I say, that bit of the child's life, which education is supposed to be supporting. I've got the political piece. I'll go back to the question now. So in that context, we have a wide range of different children. Yeah. And I kind of often think if I was at school now, may not be where I am today, but here we go. I was, I was last century being educated. And we, with that, with that pressure on being top of achievement tables, et cetera, otherwise Ofsted come, that has kind of narrowed a lot of the curriculum, a lot of the opportunities. Anyway, going back to the political football, arts, et cetera, have become foreboding haven't they in school. It's, you know, much other things are far more important. So we have to kind of think about all of that with those, with all of the different types of children experiencing lots of different things, et cetera, all trying to fit what schools need them to fit. And here we are kind of talking about inclusion, which is like, Hey, everyone's welcome. Everyone, you know, is valued, et cetera, et cetera. And it's taking time to re-program that, you know, people's kind of thinking about what education is. And that's the work we're doing. Was asked by Councillor Conway, is it working? It really is a bit too early to say whether it's working or not. This, when I, so I'm a educational psychologist by profession. When I trained back in 91, 92, I don't remember very much about autism being talked about in my course. And now it's on everybody's lips. And we've got a wider knowledge and understanding in that period of time, you know, 20, 30 years, however long, far too long. And the point that we're understanding and recognizing that you don't. So when I was a younger educational psychologist, it was the stereotypical boy spinning and flapping that was the autistic child. Now we're understanding, you know, actually probably more people in this room are neurodiverse than not. And that's, you know, kind of how we've kind of progressed. But we've still got a long, long way to go. And I'll leave it there. And you've got everyone just quickly, just on a counter-lutive point. The PINS pilot for Pathways, seven schools, timescale for rollout for the others, and going back to Council of Vinnie-Lubham in terms of the academies and the wider. So remember, PINS is in primary schools at the moment. And that's my precious, is my little speech just now, really. We've got kind of work to do. It's in primary schools. We can see from the feedback that we've sort of shared, teachers, parents, children are acknowledging that that has had some difference in those schools. Partly, some of the issue is the funding is still kind of limited because this is additional work to our usual work. But I think we've got at least another seven or so schools, haven't we, in the next crunch? Yeah, so in year one, the funding for North East London was, well, nationally, was to work with 40 primary schools within each integrated care board footprint, if you like. So we have seven of the 40 primary schools across North East London were Hackney schools. So the funding for year two, there's an embed element. So we will continue to work with the seven Hackney schools through a number of community of practice events, as they're called. So bringing those schools together to continue to embed the PINS approach. And then across North East London, we will bring another 30 primary schools into PINS. So we're at the very early stages of starting that engagement with schools. We would hope to have a similar number of Hackney schools again in year two. But I think part of the approach both within Hackney and across North East London is thinking about, actually, can we be spreading some of these approaches, you know, across a far greater number of schools as well, because it is about the way, the whole school approach and the way in which we want to work. I'd like to answer the next question about academies. Yes, very, very, very free. It's a very short answer. So I used that office of the speech as part of the answer to that question about the secondary schools. We've still got some work to do. We are working with them in just the same way as the primary schools. They weren't included in PINS, so we couldn't do the focus work that we wanted to do. But we are using the learning from this early start to move into secondary schools. Jason is director. Jason, do you want to come in? Thank you. Just to add a few points to that. We're in the process. I started my role in the summer. We've identified that we need a new strategy for education in the borough. That will come to the children and young people scrutiny later on. We're working on doing some early engagement around our Hackney education alternative… Sorry, our education strategy right now as part of that. I've met a fantastic group of neurodiverse young people, met a lot of parents. And at least three of those priorities will really capture this inclusion piece. So please look out for that. Countess will be invited to a session with Deputy Mayor Bramble on that in May. And just back to the Academy's piece as well. We're developing something else which will actually come to the scrutiny meeting next week. As part of our work on reducing exclusion, but also trying to really think about children that are underserved by the system. So it's an offer of support. It's a little bit complex. If you're around next week, you'll be able to see it in more detail. But that offer will be universal. Our academies will be able to access it. It will provide support to them to help address the needs of children, but also their own needs in terms of meeting children's needs better. So I just wanted to make those two points. Thank you. And Penny, just briefly. I don't think Councillor Lucas's second question with respect of work being done outside the public sphere and other employers. And Lisa's question in terms of a difference in the number of diagnoses or assessments of female and male and whether we're seeing that pattern continue. I'll maybe let John answer the bit about diagnoses. But in terms of, I suppose, the workplace side of things, absolutely there's work ongoing. And full credit goes to Hackney Works, who are actually based at the Opportunities Hub, which is where some of our autism drop-in sessions are. They're doing a lot of work in-house. There are in-house supported employment service, and they're doing quite a lot of work around autistic people and paid work and retention as well as part of that. And within that, there'll be a lot of work done with employers around the kind of adjustments to be made. So actually, that's going on. And we also have some good representation in our strategy implementation group from Adi, who's from the Job Centre, who often comes along and helps explain things as well, like changes to things like the benefits system, but is also kind of approaching it from that workplace angle and trying to support more people into employment. And I think it's probably worth saying that actually there's a lot of autistic people who are already in employment as part of things who maybe don't need additional kind of supports or whatever, or already accessing something quite separately and just going back to that point of the kind of strengths-based approach generally. So I just wanted to sort of flag that, I suppose. Thank you, Lisa. I'm going to bring Joy in to answer Lisa's question. I can see the requirement for lots more hands. We're at the time, and I'm very much aware of the number of people from across the Council and the NHS. I think we normally have great attendance at these meetings, but partly, I think, because we don't only take up more time than I initially say. So I think I'm going to go to John for his response to Lisa's question, and I think I'm afraid, because I know I think we'll probably go on for another hour in terms of the number of people's questions and observations. I was going to probably bring it to a close, I'm afraid, because of the timing and the hour. So can I go to John, just to answer Lisa's question, please, with respect of the different number of diagnoses of men and women coming through, presenting themselves. I think she came back on the fact that I'd said we were diagnosing more women in adult services than men. And I think her point was that was it not that men are easier to pick up or boys are easier to identify? Traditionally, boys got diagnosed, whereas girls, because they presented differently. So the criteria at the time was different. So they didn't get diagnosed. Yeah, and I'd accept that. I mean, but that's been our experience in all the services that we're seeing more women than men proportionally. And also, just to touch on something that you also said, that almost everyone we see has comorbidities, whether they're mental health or physical health. We're seeing a lot of Ehlers-Danlos, Potts, a lot of physical health conditions as well that we commonly see in both men and women. That's something we're picking up a lot. Well, thank you, John. Members, I'm conscious of more of you wanting to say things. Are there any final sort of very brief observations or comments that any of the members wish to make? To make a camera come while you're the chair of CYP, so I feel like I should. Very briefly, on the disparities, it's more of a statement. I think it's a really complex landscape. We see an over-representation of Black and South Asian children in our high needs, special educational needs settings. But yet the stats seem to suggest that we're reflecting the demographics of the borough. But that is not what you see when you go into those schools. So do we understand that? And then also then you've got the stats on the adults which show an under-diagnosis. You've got school exclusions where you see children who are suspected as having either autism or ADHD but haven't been diagnosed. So I'm not sure what, yeah, if there's more that we can do to understand that. And the final point that I had is it just does feel a bit desperately sad in relation to adults because it's a bit like, you know, people are getting a diagnosis and then what? We don't offer the same thing that we do to children and young people, which is that, and therefore you can access this support either before the diagnosis, during and after, but afterwards. It's like, okay, you're autistic. You found life really difficult. Now, now what? And what about mental health? If you've then gone on to have anxiety disorders, depression, which is obviously we know is the case for a lot of people, then you get offered eight sessions of IACT to fix the whole life of, you know. So it's how do we do PIN for adults? How do we do the graduated response for adults? Because what they want is probably not the diagnosis. Again, saying this as my colleague, as somebody who's neurodivergent, it's not the diagnosis. You want to feel better. So, and it's, if it's a societal issue, then, then that's where the solution is, right? Thank you. Councillor Gordy. Very similar points. Is there any scope to lobby government in terms of diverting funding into NHS services for adult diagnosis and ongoing support? I do really think that this evening's revealed that that does have to be a priority. I suppose, you know, as colleagues said, social isolation is a really significant issue for, you know, a lot of neurodiverse adults. I noticed in our local strategy that service users had wanted a, you know, a hub providing, as I understood it, more than employment. Also, you know, also sort of, you know, connection and community. And I'm not really sure that's something that the services, who do seem to be doing a sort of heroic task, you know, with very, very little resource, are able to provide at the moment. But that also sounds essential to me. I'll stop. I know we need to finish. My plan was, I see Perpetra is a director at nail level. She's had her hand up a few times. I'm going to let Perpetra have the final word, I think, and then I'm going to draw this to a close. But there's certainly, certainly your latter point on the, any political representations in terms of funding. Maybe something this commission or the Joint Commission can take forward. Perpetra, final word to you, please. Oh, thank you. And I've taken all points and noted around, you know, looking at how we can prioritize diverting funding into a nature service and really recognizing that we are facing some particular challenges. And I also just earlier on wanted to reiterate or echo Sarah's points around, you know, apologizing that we've not really been able to provide that sort of the co-production, the positive stories. But similar to children and young people, we have, you know, briefly touched on some of the work that we're doing around improving support during long waiting periods, prioritizing the needs-based support over the diagnostic-centric models, which is quite important and a key priority. And also enhancing workforce capacity by providing training for wider staff, so the Oliver McGowan training and other training, as well as supporting GPs to be able to support people with ADHD, as John referred to earlier. So I just wanted to just quickly summarize on that and also just point out that we have noted the very important points that have been pointed out. And in terms of the Autism Hub, the feasibility is currently underway. We've not got the recommendations out yet. And so once that's out, we will be able to, we'll be in a position to understand how we take things forward. Thank you very much. Thank you very much. I'm going to then draw this item to a close. I think, as alluded to there, I think there are certain things possibly we could make representations to or think more about on a political level or even just understand in terms of trying to lobby for diversion of funds. And Councillor Conway's latter point there in terms of great support for the adults and that model. And also it would be very interesting to see in terms of the PINS and Hub and Spoke model, what some of the results are of that at a later stage. And certainly I think the scope for this to maybe come back to a joint committee session in the future, to understand it in those contexts and certainly scope some aspects for us to take forward politically as well. Thank you all very much for an incredibly informative discussion. We've had all of you from across the borough in North East London and the user voice there as well, Matthew. So we're very appreciative. And so thank you all very much indeed. So I'll formally draw this to a close. I haven't been noted of any matters of any other business minutes. Can I take them as agreed, please, members? Thank you. And with that, I will formally close the meeting. Thank you, everyone. Thank you. I just wanted to say, I think we need to thank you.