Bristol City Council withdraws the Fair and Affordable Care Policy

I wrote in November last year that Bristol City Council was consulting on a Fair and Affordable Care Policy:

This means that in most cases Adult Social Care will provide services to meet eligible needs that are the most cost effective. In some cases this might mean that the service offered by the council will not be the one preferred by the individual with eligible needs.

Fair and Affordable Care Policy (draft) para 3.7

One of the main concerns about the policy was that it could result in people who were currently supported by the council to live in their homes being offered a place in residential care, where this was cheaper than a home-based package of care. In other words, many disabled people in Bristol could find themselves essentially having to choose between living at home with unmet care needs, or moving out of their homes into residential care against their wishes. Some people might not be considered to have capacity to make that choice, and it could potentially be imposed on them in their ‘best interests’, which in turn could require deprivation of liberty safeguards and potentially court proceedings.

It has been reported that the council has withdrawn the policy (BBC News, Disability News Service), although as yet no ‘official’ decision and explanation of why has been shared on the policy consultation website. It sounds as if the decision was taken by the Mayor, Marvin Reese, or at least ‘in discussion’ with him. This decision responds to a local campaign that was increasingly making waves in national media, with stories in the BBC, the Guardian, and ITV News, among other places.

I am glad the policy has been dropped. As I wrote before, I thought the policy was problematic because it had not given serious consideration to the impact on people’s wellbeing of requiring them to choose between unmet need or an unwanted move into residential care, or what the council would do if people simply refused to move. It had not considered the potential cost implications of imposing these changes on people (including potential litigation or breakdown in care for people with complex needs). There were discrepancies between the policy and the Care Act statutory guidance around ‘best value’.

Although the policy consultation described it as being based on ‘evidence’ of a similar policy working in Devon, it turned out there was no evidence concerning Devon’s policy because they had never audited it for its economic impacts or done any quality assurance for its impacts on service users. Although the policy consultation described Bristol’s policy as being ‘co-produced’ with disabled people, it was being challenged and opposed by numerous local disability groups. Consultation is not the same as co-production, and calling a policy co-produced by disabled people is misleading and gives the impression of greater support for the policy than it was attracting. And although the consultation claimed they were unable to identify which cohorts of care users it would impact upon, when others requested data on this it turned out they could actually extract details about the primary care needs and ages of population who would most likely be impacted. In other words, no matter what you thought about the content of the policy, the consultation process – whilst in some ways pretty thorough – had serious deficiencies, making it far from legally bullet-proof.

But whilst we celebrate in Bristol, we know the bigger problem has not gone away, and the underlying problem has just been kicked into the long-grass. Local and national elections are coming. Social care is, we know, so potentially toxic that elections are lost by trying to have an honest discussion. According to the BBC report, the council’s adult social care lead has decided that ‘officers will work on the basis that a future policy will come forward to a future administration for a decision.’ The Disability News Service reports that Bristol Disability Equality Commission (BDEC) (a group set up by the council) will be asked to set up a new group that would “consider how to build a system to fairly allocate Adult Social Care funding within the agreed budget to meet the diverse needs of the population”.

So, the budget will not increase. I am reminded of a speech given by Baroness Jane Campbell fifteen years ago, just as we began to tip into the austerity era, in which she asked whether we are ‘Fighting for a slice, or for a bigger cake?’

The ultimate objective of equality and human rights movements is not about dividing up finite resources among competing interest groups, but deciding priorities through debate and democratic argument

Baroness Jane Campbell

The new group will have to work out how to slice the cake thinner still, under the label of ‘co-production’. The problem is the cake itself is too small. There is no way to meet everyone’s needs without increasing the ‘agreed budget’.

Better to be involved in the discussions, for sure, better they are informed through democratic (and transparent) debate. Better that voices are heard (although not all voices will be in the room - what kind of representation will there be from the significant numbers of people with complex needs linked to dementia, learning disability and autism?). But there is a danger that ‘co-production’ becomes co-optation, becomes symbolic legitimation of a set of circumstances that is actively harmful for local disabled people, because they lack the power to fix the one problem we can all agree upon: the ‘agreed budget’ is not enough.