Give you say lots of nice things about you, Bill. Welcome, Bill.

Hi. Hi, Henry. Hi, everyone.

Right, look, together we are campaigning for positive change for neurodivergent people, and that's across the ADHD community. And Bill Morgan is involved and is working with NHS rights, she's provider, Paloma Health, I'm looking forward to him being here, so thank you. We know that we have to get you know, we're making noise for change, but you need to make noise that actually gets noticed by those in power.

Something is a huge, huge campaign for us. The biggest thing, we've worked on it for months, maybe built it for years. Research was commissioned a long time ago. And with the coming to this enormous volcanic crescendo in our own world, and in Number 10 down the street, it's just a normal Tuesday, and it's just the thing that one of many that have just landed and is gonna get dealt with. And it's a completely different perspective. And if we don't understand it, we're not gonna be able to to get change. And that's this session is about looking at that.

He's gonna be talking about the current political situation around ADHD and ASD, what the government's thinking, what happens next, how can patients and providers shape what happens next. He has advised Prime Ministers, Health Ministers, Policymakers, world leading life science people, now you and me. Prior to that, he's worked at the highest level of Department of Health and Social Care. He's was a special adviser at number ten down the street there and to. He's also a lecturer in health policy. Like, it's a there's obviously a lot more on his achievement list. It's I think we can just all agree Bill's serious.

Over to you, Bill. Hopefully. Yes. Well, you know, I feel like I'm sandwiched between two very inspirational speakers, so I'll I'll do my best to be as as as useful. But, yeah, I guess, just by way of some opening reflections, number 10 is an interesting place to work because you tend to be firefighting most of the time. So you you tend to go into work, and the first sort of 75% of your day is spent dealing with whatever's in the newspapers that morning in your area. So in my in my case, it was, health. And you don't really have much time to do long term sort of strategic thinking in number 10. You leave a lot of that to the government departments. And what I'd say about ADHD autism services is.

It's it's an area which is very visible to number 10. So half your battle is already won because it appears in the education sector. It appears in welfare. It appears in health. So there's lots of people in number 10 who will cover different areas who are worried about ADHD and autism and and meeting demand. So that's that's half the that's half the battle one. But what people in number 10 don't have, and they can't push departments on, is how to solve the problems that they're facing, you know, these huge increases in demand, these constraints in supply. And in a way, the job of campaigners is not just to raise the visibility.

Of the issues because it's already very visible in number 10. And, Henry, your you you know, you you and your colleagues have been doing great work in parliament as well to raise raise the visibility of a challenge. It's about coming up with some solutions that policymakers can implement because, trust me, in number 10, you you you're hit with problems all the time, and what you really need is solutions. So that's that's what I'd implore everyone to be thinking about.

When I've met with political individuals before and I got a piece of advice which said solutions are only part of the key. He said like the basic thing that happens from charities and pressure groups is they just say here's the problem, which exactly as you say you go well, like, I'm very rushed for what am I going to do with this? Better charities come with the problem and the solution. And the really good charities and pressure groups come with the problem and a clear problem, clear solution, and they understand the blocks in the way. And then they go after the blocks as well as advocating for their solution. What do you think are the blocks in the way for ADHD.

And ASD and particularly around waiting times right now? Yeah. Yeah. Okay. I mean, just to just to just to add a few thoughts on that point about the best charities of those who propose the solutions and understand the blocks. So when you're in number 10, you're you're quite often in not conflict, but you're in a you're in a challenging relationship with other government departments. And the default setting that you have in number 10 is this is a problem which the media, the prime minister, other people here are worried about. And your job is to go to the department, the relevant department, in this case, Department of Health, and say, why aren't you solving this problem?

And then the department plays back to you, like, the ways in which they're solving the problem. And why it's so important for charities to offer solutions as well as just, you know, raise issues is because people in number 10, the prime minister, for example, can, can can challenge the secretary of state for health on well, you're doing x, y, and zed, but this charity is saying you can also do a, b, and c. So why aren't you doing that? And that's why it's so important to to to make sure you're presenting solutions that, you know, can be used inside government to to have these arguments and to test the approaches the government's the the the the the government's pursuing. So that's why it's so important.

In relation to the the the barriers and the challenges you mentioned, I think if I was going to characterize the the big challenge the government faces with ADHD and autism, it's it's that I think everyone in government feels that they've been caught on the hop over the last ten years as awareness has increased and as, you know, sort of pressures on the system have increased. And when you're in a when you're facing a situation where there's so much increase in demand, you're always running to not even stand still. You're running as fast as you can, but you're going backwards because the demand is loading more and more pressure onto the system. So the first thing.

The first thing you really need to do in government is some like, this is in respect of any issue where you're where you're facing this tidal wave of the I mean, this this rising tide of demand. You just need to make the demand go away. You know? You need to you need to take that step first because that's what allows you the space to think about longer term challenges. But, of course, in respect to this area, this is very hard because demand equals need, and you need to meet the need. So that's that's a sort of very big first order problem that you've got to deal with. So there's the there's the demand side of things. The thing which really frustrated me in government is.

You know, the the supply of services to meet demand. And then then, you know, there's there's obviously a need for autism assessments and a ADHD assessments and then ADHD and autism care. And there are loads of providers, you know, out there, not just the NHS, but other innovative providers. So they came to me in number 10 and said, like, we need to we need to be able to provide services. So there's enough people out there who are able to help the government, you know, to to help the government meet the demand that's there, but the government isn't using it properly.

And I think in respect of in respect of the barriers that, you know, the government really needs to be helped to overcome, it's understanding how, you know, they've got this big demand that they're facing, this really high level of need, which is growing. And they've got people willing to supply services. They've got people out there who are willing to, provide support, to to to the government to help meet that demand, but the two aren't in sync, which is a problem. And that's the that's the big policy problem that I think the government faces. And it's a it's a problem we faced in my day as well, which we, you know, we sort of tried to fix by facilitating the right to choose, but then that creates another problem, which is that your.

Budgets come under pressure. So, you know, you're you're you're you're sort of constantly facing these big barriers. And then the solution that you tried to put in place often creates another problem that you need to fix. It's a bit like painting the fourth bridge, really.

You talked directly onto Right to Choose. So how did you facilitate Right to Choose?

It's an interesting it was an interesting almost by accident. In fact, it was by accident. So me and Maria Caulfield, especially, who was the minister at the time who covered this area, we were very eager to help new providers of care to come into the to to provide NHS services to patients. And then in parallel, there was this, process we were following, not not in in respect of ADHD or autism. This was in for NHS services in general to set up an independent panel to decide when patients' ability to choose between different providers is being frustrated. So there's there were these two sort of totally separate things going on. There was Maria and Maria's focus on trying to bring new providers in, and then there was this independent panel.

Being set up. And we were working on this for both tracks for, like, for for many months. But then the first rule we set up the independent panel in early twenty twenty four, and then its first ruling, was on, ADHD assessment. And it said that patients do have the right to choose between different providers for this, service. And, yeah, at a stroke, that that solved the problem which Maria was trying to overcome, which is, you know, bringing new providers of services and sort of really helped open up the open up the sector. And there was a good write up in the Times, and I remember one of the providers was quoted in the Times piece at the time. This is about March, probably last year.

And, of course, it it it worked. It brought in you know, it helped it helped patients choose in more sort of supply into the market, into the NHS sector. But but then, of course, it creates a budget pressure, which is what the I think the current government's grappling with. And they you know, we have to find a sustainable way to meet demand. You know, it's the current the previous situation where there weren't enough suppliers couldn't continue. The current situation where there's suppliers, but not enough funding can't continue. So we've gotta find a way through. So, again, that's that's sort of where people in government really need solutions.

What what what do you think that looks like?

It's very it's, yeah, it's very it's tricky because there's not much money and solutions tend to cost money. I think there's the good thing is, from the campaigning perspective is the first thing, as well as awareness, which you've got, you need a process that the government's pursuing to dock into. You need a you need a you need a government plan. The government needs to be working on a plan to solve the problem, And you you have that going on now. You know, the the government is working on a autism and ADHD improvement plan. It was reported to the NHS England board last week. So they are there's a process that they're working through to understand.

How to solve the problems that they're facing. So, you know, for campaigners, trying to understand what what that process is doing, trying to understand what solutions policymakers are considering and how to inform the work that they're doing is, is important. I don't I mean, in respect of the solutions that I'd be thinking about if I was still in number 10, I think you can I think you can probably give more certainty to suppliers over a multiyear period and say, look, over the next five years, this is the budget we have available? How much how much how much how how how what level of service can you provide for this budget and use as almost a negotiating.

Pressure to to lever in more supply into the into the NHS sector to to provide support? So that's the kind of thing I'd be thinking of, I think, right now.

Which is significant because for what people are watching may not recognise is that for suppliers to the NHS there's this huge volatility and potential volatility and we're certainly seeing that potentially within ADHD and autism assessments and Right to Choose. And you're looking at that going: I've got contracts with people, rented buildings, giving people jobs. Me to unravel that, it's a huge issue. And so it's very hard to build up a service if suddenly rug might get whipped away from under me. So that kind of, like, long term contract thinking is is is a big deal.

Yeah. And just to add to that, I mean, it's not it's not just an issue facing ADHD and autism assessment sort of providers. There are there are other providers who deliver NHS services, who whose whose demand from the NHS isn't predictable because you have managers in the NHS who lose control of their budgets and then have to stop using services. So so the demand is very lumpy. It goes off and on. And to your point, Henry, this this really militates against investment in new services and investment in innovation, which can help. Yeah. And it's a real problem. This is why I think the the the core of the solution has to be providing more certainty to to suppliers because.

Suppliers need certainty. Because once they've got certainty, they have the confidence to invest in building their services up and things like that. So I think that's that's gotta be the foundation of what happens next. I should say as well for in in respect of the government, the government's got something which I never had when I was working for Rishi, which is that it's given the NHS a multiyear settlement. We were giving the NHS annual settlements, which meant that its budget was very unpredictable, but the government's given the NHS a multiyear settlement running through to 2028. So it does have the there are the conditions to offer that certainty now.

I hear you, but obviously there's big industrial disputes going on with various medic groups and so whilst the income part might have a fix, the cost part doesn't. You have a weird thing within ADHD and I'd be just interested in your take on it because I just don't understand it. ADHD and autism are specifically carved out of mental healthcare budget. So it's not included when we see mental healthcare needing to move relatively and not set with increases in physical health budget, we're not on that side of the ledger. We actually what we're seeing now is a big push into the priority areas for the government and particularly around certain wait lists, which we're not in and we're.

Sort of caught in the middle in a zone where they're looking to cut. Like, do you have any idea why we're not part of that budget? Like, and how that even happened?

No. No. And I have to say it's the first I've heard of that because I thought you would be covered by the it's called the mental health investment standard, but it sounds like you're not. So We're not. Yeah. I'd Specifically carved out. We got our own little segment saying you're not in this, which Alright. Well, here's an idea. So there's the health bill, which is about to go through parliament next year. And the mental health investment standard is anchored in legislation from 2022. So if you were so inclined, you could table a probing amendment to that health bill and say, why isn't autism and ADHD covered as part of the mental health investment standard? And then you get an answer from a minister.

This is the sort of stuff you get from an insider. It sounds like a cracking idea. And actually, one of the things we found very useful was working with parliamentarians to table questions to get them answered. And we've had a lot of support from that. We we do have support across parties. Could I was looking at Marie Caulfield to see where she's what's happening with her now. And I saw she's defected to reform. She has. Yeah. Yeah. And it was interesting, our dialogues at that time, which were, like, if I if I politely call them difficult. Well.

It's hard being a minister because you try and internally, you try and prove you like all ministers, I've worked with a lot of ministers. They are all inside trying to improve things inside the machine. But, of course, publicly, you have to you have to there are always trade offs of every decision you take. You know, there are people who win and people who lose in every decision you take. That's why we have ministers. And, of course, they have to front up those decisions then to the public, but they're always trying to do as well as they can. I think that's in you know? I mean, politicians get a bad rap nowadays, but I think of any party, they're all fundamentally trying to do the right thing even if they don't actually do it.

I've certainly met and knowledge on politicians who are very clearly trying to help make a difference. I mean, that's why they're there. I've also met some who I like, really do not like.

Yeah, yeah, yeah. There's some I don't like, but they're all Yeah. I'd.

Say, I think, think of a certain politician who then is now potentially with reform and they just said, they said people are getting ADHD assessments to beat the benefit cap and the kids, the children benefit cap, and that's why they do it. Know, they're looking at them going, like the wait times are years. Like, it doesn't there's just can't even it's not even a practical solution, let alone. And the idea that you devalue the medical community so much that you think they just have the wool over their eyes. I met with them and they said and I said, you've said this? And they said, oh, it's like it's always been. I've I was misquoted. And I I as people who've been watching this for now twenty hours will know, I'm rarely short for words.

At that moment, I genuinely was silenced until I could stutter out. I watched the video, you're not misquoted, and they said, oh, well, it's because it's all true. I back it to the hilt. I was like, oh my goodness. Liked my face. So that one, I don't like.

I mean there is is I'm sorry to say there is an interaction with a welfare debate on this area and it's just important. So talk to that I wanted us to talk to you. Yeah. Yeah. It's important. And this is where, you know, the work of campaigners can really, you know, be brought to bear to really inform decisions. That you know, the numbers are from from that side of the ledger, know, the welfare side, the numbers don't lie. There is a lot more sort of welfare claimants associated with, ADHD and autism. But, of course, what people need to understand is that's not evidence of people, trying to cheat the system. Because as you say, like, you know, you wait years, you have to you know, all of this, there there there's too much friction.

To in the welfare system to just to just, you know, sort of access it that easily. And, of course, what the welfare bill is showing up is the lack of support. So if you want to cut the welfare bill, and that's, you know, sort of perfectly fine, particularly, you know, for sort of mental health conditions, that's a perfectly noble aspiration to have. It needs to go hand in hand with additional support for the health services or, you know, to you need to be able to help people come off welfare by giving them support. So I think that's and that's, of course, something which gets a bit lost in the debate, you know, as you correctly highlighted. So.

Making sure, because I think the government's about to have another crack at welfare as we go through this debate, that the support you provide people is as important policy.

Goal that, as like, I mean, access to work, we're now seeing weights over a year, like Yeah. A critical support piece. Obviously, one of the main supports is medical support. We've seen huge, huge weights. We see economic damage in that you can't move. So if you're receiving ADHD medication or to move area and you've been locally assessed, you have to be reassessed when you move. So you can't benefit from economic opportunities outside of your own area. Kids don't get support in schools to the extent that they need. We see a huge amount of people drop with ADHD disproportionately in youth offending institutions. They're more likely to be a victim of crime as well as being involved in the justice system.

We see kids when they reach 18 getting dropped by cams, they're receiving medication, then they go back to the back of the adult queue. Snatch and one of the great you know, we snatch defeat from the jewels of victory. We take that support away. There is a big we're hearing from the top of people talking to the top of government that ADHD is being thought as just a path to benefits. You get an assessment, you go on benefits. One of obviously our frustrations is we see the exact opposite in the conversations we're having. And there's also a problem that we've been so underdiagnosed for so long. Yeah, we're appearing in all the statistics now. Because we couldn't before.

There was no way to add us there because we weren't getting identified or assessed. And so the idea that our sudden appearance therefore shows some calamity is just wrong. How would you this is not good data. So how would you argue the point against that fundamental thing that we're just a whole load of wasters trying to get on benefits and never work another day in our lives, which is what's sort of being presented. Not only is the cost of an ADHD assessment a direct cost, but then there's a cost of ongoing benefit support. I'm very clear, we meet and I meet so many people and it's just not the case. People are trying to turn their lives around. They're trying to understand themselves. They're trying to thrive and.

They're finding all these barriers in their place, notably huge weights and access to support. Right. Over to you. How do you how do you challenge that? Yeah. I mean I mean, fundamentally, the the welfare bill is a symptom of.

So, you know, health service failure, in this in this area. And that that there's there's a lot of examples, along those lines. So I'd I'd I'd approach it from that angle. You know? It's not like you as a as campaigners, as charities, you don't want people to just be claiming welfare either, you know, because that's not good for health either. You you as a charity want people to receive the support. So reducing reducing the numbers on welfare is a shared ambition, but it's gotta be done in the right way. So I think that's that's how I'd approach it in respect of adults. I would as well highlight this, you know, the the the, children and young people.

Waiting because they're not on waiting lists because they're trying to claim welfare benefits. They're on lists, waiting to be assessed because they have a need and their parents think they have a need. And even if you are you know, you've got somewhat somewhat views on adults and welfare and ADHD and autism, you you you should at least recognize there is a a massive level of need in respect of children and young people's services as well, which I think politicians would find hard to challenge. So, I mean, if if you encounter problems, if you encounter problem people coming at it from that angle.

But it's a kind of a sad position where you're like, okay, we have to focus on the kids. We can't focus on the adults. Mean, and that's literally just happened. Right? So in Warwickshire, the ICB there has said we will not see anyone over the age of 25. Full stop. Yeah. And the press release that went out said it's so we can focus on child services. And we're being asked to make a decision and sacrifice people who were themselves failed as children trying to get their lives back and being told, well, we've failed you. We're going to continue to fail you so that we can try and fail less people in the future. It's not a great answer. And in Wales, Therry, who was on before when she talked to me previously.

Of said that's a lot of the direction of travel. There's a focus on child services and not on adults. So, you know, there was a battle in 2008 because at that point ADHD hadn't been recognized in adults at all. And I believe part of it was a legal push where a kid was 17 and three quarters turning 18 and told, well, the moment you turn 18, the medication magically makes no difference to you at all. You're cured, and you don't need any support. Obviously, that's not Yeah.

Yeah. No. And, you know, I agree. It's it is it is tricky focusing on sort of children, young when, you know, when obviously there's adult need as well. I think in some cases, it makes for political eye. If you're trying to win a political argument, it makes it easier. And I've worked in health policy now for sort of twenty three years, and it's not it's not just ADHD and autism. It's not just that therapy. It's it's not just that sort of area which gets where this dynamic plays out. Twenty years ago, I was, you know, working on cancer services for, in in in health policy. And it's it's a rule of rescue. You know? You you you you tend to provide more priority and support to children than adults.

So, I mean, that that's just a sort of quite important dynamic always in politics and funding decisions as well, to be blunt.

And it was interesting. One of the things that get around to going at Roche, it it was interesting seeing their mental health services had green green buttons on their NHS dashboard for child services, green buttons for elderly services, and red and orange buttons for working age people. And I I saw that suck to be asked, if I'm honest. Yeah, yeah, And it's how to have those. It is it is the toughness of health care where you are making choices.

Yeah. And it's very I mean, the allocation resources in health care is a very, very hard, you know, very, very hard job. I would not want that job.

Yeah. Yeah. I mean, when you can you are actually looking at numbers going, if we do this, that many people will pass. If we do that, that many people will pass versus say, versus consideration on age. And I mean, I I know it's done with good hearts and people I've spoken to, but crikey, what a job. And obviously I know you've been party to that in terms of the decisions as you look at healthcare. It's an extraordinary difficult thing and really deemphasis. Okay. I have to go to final words. Like, what do you take, like, final words to the audience on making political change?

Okay. I think I'm I'm sort of very glass half full on this area because you've got a high level of awareness, which is, you know, sort of foundation one for doing something. You know? People in number 10 are concerned about this area. They're concerned about patients and people living with ADHD and autism, so that's that's good. I mean, it might be for good or bad reasons, but, fundamentally, you've got a high level of interest in in government in this area, which is great. That's the first thing. The second thing which makes me, encouraged is there's a, as I say, there's a live policy process going on which you can work with.

The NHS England is developing its, autism and ADHD improvement plan. So that's great. So you don't need to campaign as I remember the cancer campaigners were doing sort of twelve to eighteen months ago. They were campaigning for a national plan to be committed to, And now they've got that commitment and the plans underway, but you've you've already got a plan, so which is in development. So that's great. So you've got you've got that work. You've got a lot of people offering solutions and a lot of energy in the sector as well. And it's just about making sure that those solutions are conveyed to policymakers. So that's a really, really important task for the sector now, I think.

And then as I say, there's a health bill coming up next year. So if all goes wrong and, you know, you don't feel that you're being listened to by government, then you can kick up a big old fuss in parliament. So for all of those reasons, I think it's I'd I'd be encouraged if I was in a if I was in your place.

Well, thank you. And thank you for your time now. It's it's a big deal. You are an extraordinary person with extraordinary experiences, and it's very valuable being able to listen to you. And I know for everyone watching and looking to be part of making change, it's insights that we couldn't otherwise get and it gives so much food for thought and will help inform the future. I would honestly be like interview you all day. But it's a delight. Thank you for your time. I My very sadly have to say goodbye.

Thank you, It's good to join you. See you soon. Thank you.