An unfunded autism diagnosis target may make things worse

Autism campaigners are today calling for guaranteed maximum diagnosis times. This is entirely understandable given that they are responding to reports that some people have waited seven years for a diagnosis. It is therefore sad that this seemingly reasonable request is at the heart of the problem of why diagnosis is taking so long in the first place.

It is entirely unacceptable that people who need support or even just advice to help them manage neurodivergence need a diagnosis first and are waiting the lengths of time they are to get it. This is a dereliction of duty towards the most vulnerable in society. But demanding a minimum diagnosis timescale won't help – or certainly won't help on its own.

Common Weal has repeated the mantra again and again that to achieve good care outcomes, rights are not enough. You need 'the four Rs' – rights, responsibilities, relationships and resources. Rights can be helpful in creating expectations, but they are probably the least important part of successful care out of the three.

The first important step is responsibility. It has to be someone's responsibility to meet need. At its crudest, a right isn't a right until there is someone you can sue if that right isn't respected. The duty of care for people who need it must lie on someone's shoulders. That is why Common Weal was so strongly in favour of a locally-delivered National Care Service.

But care isn't about diagnosis, it's about supporting people in their lives as lived. If there is a diagnosis which can help with that care, then that is helpful. But a diagnosis does not make people better, and care is not an amorphous thing. Care can only be delivered by a person and it is highly dependent on positive, secure relationships. It is knowing the person you can turn to after your diagnosis that counts, not the diagnosis.

And of course that person must exist, must have the time and ability to provide care and must be able to arrange material support where it is needed – such as mobility aids or secure housing. That takes resources. There is nothing more hollow than a new right which does not come with the resources attached to make sure the right is realised.

So what happens if you do create new rights without new resources? First of all, that right then takes preference over other aspects of care. If you set a compulsory deadline for a diagnosis but no baseline expectations of support or care afterwards, inevitably resources will drain away from care and towards diagnosis instead.

Without the professional judgement of trained experts identifying where resource is needed, this means that large amounts of money may be diverted from supporting people who need help immediately towards diagnosing people who may not even need additional care after diagnosis.

That, in a nutshell, is basically why the system as it is doesn't work in Scotland. Year after year a new failing is identified and so then a new right or a new binding target is set by politicians based on whatever has recently gone wrong. So then all the resources are diverted to that function and so inevitably away from other functions.

Those functions then fail, and so a new campaign is launched and a new set of rights or targets are imposed. Once this has been happening for a prolonged period the outcome is a system in which professional judgement is subjugated to the political imperative of responding to layer after layer of imposed blunt targets without flexibility or thought.

And of course then there has to be monitoring to ensure that these arbitrary targets are met, which creates an ever-increasing regime of paperwork and administration, the primary purpose of which is to create new management information so that more and more discretion can be taken from professionals who know what they are doing and transferred to managers who don't.

Rights and minimum service guarantees can be very powerful. Common Weal often cites the Danish example where, by law, all medical conditions must get a full diagnosis within four weeks and then any resulting medical procedure must begin within another four weeks – eight weeks maximum from first presentation to the start of treatment.

But the Danish implemented this with a full and coherent plan for ensuring that these targets could be met successfully and they invested heavily to achieve it. A deadline for diagnosis in our current system may increase the speed of diagnosis, but it will come at the expense of increased paperwork and something else in the system failing.

The alternative is proper professional-led wrap-around care based on need not political whim. That looks like this.