Meeting of the Parliament 11 December 2025
I thank Daniel Johnson for securing the debate. Daniel and I have had a couple of chats about this issue over the past couple of months, and we are all aware of the issue through our constituents. It is multilayered and multi-agency, and it impacts on children and families in health and education settings.
As many others will have done, I met the RCP in Scotland just last week to discuss its report. A few issues have come through. A key issue is the impact of neurodevelopmental conditions on many aspects of people’s lives; indeed, they have major emotional, social and health impacts.
Daniel Johnson’s point about access to diagnosis and medication is incredibly important. As we have discussed, there is also an issue in relation to GPs in health boards such as NHS Lothian. The issue of standardisation is really important, given that different GPs take different approaches.
Daniel Johnson mentioned the number of people who are impacted—NDCs impact roughly 10 to 15 per cent of the population. It is good that people are beginning to talk about the subject, because I think that such conditions are probably significantly underdiagnosed.
Between 2019 and 2021, the number of referrals increased between 500 and 800 per cent across health boards. That increase is being driven by several factors, one of which is that society is more aware of such conditions. In addition, there are unmet historical needs, as well as population growth. There is no denying the impact of Covid, either.
As the RCP has said, this debate is not necessarily about finance, although I will touch on that subject in a moment. More important is the need for standardisation of the referral, treatment and support pathways, and I hope that the minister will pick up on that issue—I have already had a quick chat with him about it. Without a nationally agreed pathway, it is difficult to see how we can move forward. The pressure will only grow in the coming months and years as people become more aware of neurodevelopmental conditions. Constituents regularly approach me on the subject, because, even within East Lothian, GPs take very different approaches.
As for what we should do in the future, which is the key issue addressed in the RCP report, there are some lessons that we should take on board. As part of the national autism implementation plan, a feasibility study on pathways was undertaken in 2021; the fact is that we are still talking about pathways, and there is still a need for such pathways to replace single-condition approaches. That is an important point. Those pathways must be accessible across the 14 health boards.
Daniel Johnson also talked about the need to deliver local stepped care pathway models. I interact with Stronger Together for Autism and Neurodivergence, which is very active in East Lothian, and that is one of its key aims. Such models include third sector and community services, such as access to self-help, peer support and a range of other services prior to—and, of course, after—diagnosis.
The RCP makes a number of other key recommendations that must be progressed. For example, it talks about the need for a governance framework and a competency-building framework at all levels of service provision.
Daniel Johnson touched on the delivery of the RCP’s four-tiered pathway proposal. The first tier involves a national public health approach, which is all about developing a public health campaign to promote awareness and understanding of neurodevelopmental conditions, with an emphasis on self-management.
The second tier is the availability of national self-help resources, which will involve creating a centralised platform to provide comprehensive self-help. The third is about establishing specialist third sector commissioning for NDCs. That provision must be localised; indeed, we have discussed the importance of that with NHS Lothian. There is almost a blame game going on, with the health board saying that GPs are responsible for local provision, and we need to clear that up. A key issue is how we prioritise investment in developing local provision, and there needs to be a multidisciplinary approach that includes clinicians and GPs.
There is much more that I could say, but I conclude by thanking Daniel Johnson for securing the debate. The issue will continue to be debated, and I look forward to hearing from the minister on the RCP’s report in particular.
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