The national autism team oversees a set of NHS Long Term Plan commitments designed to improve NHS services so that autistic people can live healthier, happier and longer lives.

We work closely with a wide range of stakeholder partners, including people with lived experience, to ensure co-production is at the heart of everything we do. The team sits within the mental health, learning disability and autism programme in NHS England, and is strategically led by a deputy director and senior programme manager who oversee work priorities and support programme managers. Clinical leadership is provided by three national speciality advisers with backgrounds in psychiatry, psychology and general practice. The programme also has a dedicated research team responsible for ensuring clinical practice advice is underpinned by the best available evidence.

1. Improving quality and outcomes in all-age autism assessment pathways

In April 2023, the autism team published guidance for integrated care boards to support improvements in quality and outcomes across all-age autism assessment pathways. This included two key documents:

• A national framework to deliver improved outcomes in all-age autism assessment pathways – outlining 10 principles for autism assessment service providers and guidance on applying these principles throughout the commissioning cycle.
• Operational guidance to deliver improved outcomes in all-age autism assessment pathways – guiding strategic decision-making about the range and type of autism assessment services that should be provided in each area.

Both documents were co-produced with a wide range of stakeholders, including autistic people, their families and carers, clinicians, service managers, commissioners and researchers.

Since publication, we have been supporting systems and services to identify evidence-based opportunities for improvement and to consider how these might be implemented. As part of this work, we have collaborated with external stakeholders to develop best practice approaches for autism referral and assessment. This work was published by Autistica and can be found here: Best practice for autism referral and assessment | Autistica.

In collaboration with professional bodies and a range of health professionals, the programme continues to develop training and educational offers for the workforce, including future workforce modelling to support improved access to the autism assessment pathway.

To better understand variation in autism assessment waiting times across England, the autism team continues to work with analytical teams and system providers to drive improvements in the quality and completeness of data.

2. Reducing health inequalities

Autistic people experience inequalities across a range of health conditions, including cardiovascular disease, epilepsy and mental health. Supporting autistic people to access health services through reasonable adjustments to the way services are delivered is a legal requirement under the Equality Act 2010, and can include adaptations to the therapies offered to better meet individual needs.

NHS England is committed to reducing health inequalities amongst autistic people by working with primary care and partner organisations, such as local authorities, to improve access to all health services. Current initiatives include:

• Working with primary care to build greater knowledge of autism and the needs of autistic people.
• Improving the appropriateness of mental health interventions, such as psychological therapies, through co-produced information for people working in psychological therapy services.
• Commissioning Newcastle University and the charity Autistica to conduct a randomised controlled trial of a health check for autistic people. Results indicated that the health check was beneficial for those who received it.
• Building on this work by engaging with stakeholders to develop a combined health check for autistic people, people with a learning disability, people with a severe mental illness, or a combination of the above.
• Drawing on outcomes from LeDeR (Learning from Lives and Deaths) reviews to help shape work priorities. LeDeR aims to learn from the lives and deaths of people with a learning disability and autistic people, helping local systems understand why people die prematurely and driving improvements that reduce health inequalities nationally and locally.
• Using data to understand and address the health inequalities experienced by autistic people.

3. Improving the quality of and access to mental health treatment and support

Building upon the commitments within the NHS Long Term plan and Transforming Care, research evidence shows that autistic people experience significantly higher rates of suicidality (compared to the general population) and co-occurring mental illness, disproportionately longer admissions to inpatient psychiatric care and are more likely to experience restrictive interventions and trauma.

The NHS England mental health services dataset (MHSDS) shows that from April 24 to March 25, autistic people were 3.7 times more likely to access mental health care than non-autistic people, and 10% of patients in mental health services between the ages of 18 – 24 were autistic. In addition, assuring transformation (AT) data show that the proportion of autistic inpatients (without an intellectual disability) has been increasing gradually since 2017 and 10% of patients admitted to mental health hospitals are diagnosed autistic after admission. This represents the largest number of all reported post-admission diagnoses.

In 2023 NHS England published national guidance on meeting the needs of autistic adults in mental health services which aims to help integrated care boards across England to work with all partners, particularly those in provider services, to provide high-quality assessment, intervention and support to autistic adults who have any mental health symptoms or conditions.

It outlines ten principles which will help mental health services and integrated care boards provide appropriate mental health support in the community, with the aim of reducing the number of autistic adults admitted to mental health inpatient units.

The guidance states that all mental health services should:

1. ensure services are accessible and acceptable to autistic adults
2. support access to meaningful activity
3. facilitate timely access to autism assessment, when clinically indicated
4. use evidence to guide intervention choice
5. assess and proportionately manage risk
6. monitor and minimise the use of restrictive practices
7. support cohesive transitions
8. consider the physical health needs of people accessing mental health services

And to achieve this, all integrated care boards should:

9. develop a local commissioning strategy to ensure appropriately adjusted and tailored mental health provision is available for autistic adults, informed by local and national statistical data
10. develop and maintain a well-trained workforce.

We engaged with clinicians, policy makers, and people with lived experience to develop the guidance.

Autistic people are included as a priority group in the suicide prevention in England: 5-year cross-sector strategy (DHSC, 2023) due to their increased risk of suicide and suicidality in comparison to non-autistic people. Specifically, autistic people are around seven times more likely than non-autistic people to die by suicide and around six times more likely to attempt suicide. Autistic men and women are at a similar degree of risk, with autistic women around 13 times more likely than non-autistic women to die by suicide. This risk has been found for both diagnosed and undiagnosed autistic people and is recognised in NHS England guidance on Staying Safe from Suicide.

NHS England’s national specialty advisors for autism, and research leads recorded a podcast for primary care. Grassroots suicide prevention: Voices of expertise – a grassroots suicide prevention podcast.

While this podcast is primarily designed for GPs and primary care staff, its insights and strategies are of real value to any professional working with autistic people across health, education, social care, or community organisations.

The NHS England autism team have also worked with our partners and people with lived experience to develop a sensory-friendly resource pack which includes resources to support adjustments to the sensory environment in NHS settings.

The autism programme utilises data to understand the variation in autistic people’s access to mental health care in different geographies and in different age and gender brackets and have made this data available to integrated care boards and systems. Access to this data by systems supports discussions around barriers to access and the identification of opportunities for improvement.

Current areas of focus for the programme include:

• eating disorders
• anxiety and depression
• severe mental illness
• personality disorder

National autism research team

To address the health inequalities experienced by autistic people, the NHS in England must ensure that health policy and clinical decisions about the care provided to autistic people are consistently based on the best available scientific evidence. In March 2022, the five-year NHS autism research strategy for England was published in response to the inclusion of autism as a priority in the NHS Long Term Plan. This research strategy sets out the first steps that need to be taken to build better evidence-based physical and mental healthcare for autistic people in England. The national autism research team was formed in 2022 to oversee the implementation of the research strategy.

The aims of the five-year NHS autism research strategy for England are to:

1. Determine which areas of NHS autism service provision in England are based on reliable evidence and which areas require further research.
2. Ensure there is a better fit between the evidence produced and the evidence gaps in the NHS in England.
3. Facilitate the use of the best current evidence when making decisions about autism services provided by or paid for by the NHS in England.
4. Improve the mechanisms to robustly evaluate the effectiveness of policy and funding decisions about NHS-provided healthcare for autistic people in England.

The research strategy also outlines five pillars of action for improving healthcare provision and outcomes for autistic people, focused on engaging with evidence from scientific research to inform decision-making.

The five pillars of strategic action are to:

1. build an evidence culture in NHS autism services
2. appropriate funding for autism research in England
3. answer relevant research questions
4. raise the quality of research
5. use evidence in national autism health policy.

To achieve policy ambitions, including the NHS Long Term Plan commitment to reduce health inequalities for autistic people, policies should always be rooted in evidence and routinely evaluated to ensure real-world impact on improving health care for autistic people.

Our embedded national autism research team supports the use of the best current evidence in the national autism team across all three workstreams, as well as in the wider learning disability and autism programme. The research team also facilitates links between the programme and researchers and research funders to support the work of the programme. To work towards increasing the amount of evidence available to support the work of the national autism team and the wider learning disability and autism programme, the research team also identifies evidence needs to communicate to funding organisations and researchers, commissions projects, and provides support with commissioning projects across the national autism team.

National autism programme, cross cutting themes

• The rising demand for services requires a workforce that is fit for the future, and able to care for and support autistic people. We are working with the workforce, training and education directorate within NHS England to explore opportunities to identify the necessary workforce and their training needs.
• There is increasing recognition that autism and other neurodevelopmental assessment pathways need to be complemented by a comprehensive assessment of individual strengths and needs to ensure that person centred care can be provided pre- and post-diagnostic assessments. We are working with systems to support the adoption of the World Health Organisations’ International Classification of Functioning, Disability and Health (ICF) as the best evidenced framework to guide such needs led approaches.
• We have developed an autistic people’s healthcare information strategy to help  improve the information that is available about the health of autistic people and the healthcare received by autistic people in England. We continuously work with analytical teams to improve data quality and completeness.
• We have developed the five-year NHS autism research strategy for England, to ensure that good quality research and innovation  underpin everything we do.