A clash of ambitions

Today (Tuesday 3rd March) has been an interesting day for the contrast between my morning spent in London discussing the 2nd draft of the Laughing Boy Bill (LBBill), a movement to see enacted in law changes that will improve the lives of people with learning difficulties and/or autism, and this afternoon/evening spent following the debate to set the 2015-16 budget for Birmingham City Council (BCC) where the Labour administration is having to enact £85m of cuts for the next financial year alone.

Now I have considerable sympathy for the position that Sir Albert Bore et al find themselves in. This is unprecedented in terms of scale. Yet some of this has been self-inflicted by successive administrations to favour the city centre development over citywide responsibilities. So in my area of interest, adult social care, Birmingham City Council is underspending comparatively with other metropolitan areas by 2.5% of budget or £39million in cash terms. That is an outlier that is significant by any stretch of the imagination.

It cannot be said with confidence that the budget that will be set today will meet the statutory requirements on the city as the 2014 Care Act comes into effect from April. Its an difficult juxaposition where Whitehall expectations are increased while the grants for BCC are decreased. If the consultation, budget or any service provision were tested legally, BCC would probably have more difficulties than the contingency fund would allow.

Against this, the 2nd draft of the LBBill sits as a statement of intent. In particular, clause 4.4 of the 2nd draft which asserts duties above financial resources. As a principle, this is absolutely right. In practise, if this culture of austerity for local authorities continues, it will inflict more pain on the functioning of any authority. It makes me uncomfortable because I know that 2015-16 isn't the worst point for Birmingham City Council. 2016-17 and 2017-18 will be harder still as the cuts drive deeper. Its against this background that I and others hope that Sir Albert, John Cotton etc will start working with us and others interested parties from May 8th to help the city mitigate the worse aspects of 2016-17 onwards and close that gap with comparable cities. Its a hard road ahead.

Against that, the 2014 Care Act does reduce the ability of local authorities to use financial considerations as a basis for setting who qualifies as having statutory needs. The imposition of national standards does challenge the 1997 Gloucestershire Judgement that local authorities have used to tighten qualification of substantial or critical needs. So clause 4.4 can be said to work with the 2014 Care Act. This will be tested in court soon I suspect.

So the optimism I felt this morning at Monckton Chambers with the diverse and knowledgeable individuals and organisations around the table, both in person and the disembodied voices on speakerphone, has been tempered by the ugly reality that is occurring in Birmingham's Council House.

Yet the ambitions of LBBill has to happen. We cannot compromise on the principle that underpins LBBill that is everyone has the right to live their lives however messy that may be. That it may make local government's life more messy is something we'll have to live with.

Birmingham's Autism Strategy for Adults consultation launch

It was the 6th World Autism Awareness Day on April 2nd as officially designated by the United Nations General Assembly to raise awareness of autism across all communities and societies. You may not have heard of WAAD but those involved in local government and the NHS across the UK are having to raise autism awareness among their staff. Not for a day but permanently.

The 2009 Autism Act and the subsequent national strategy published in March 2010 Fulfilling and rewarding lives: the strategy for adults with autism in England places statutory duties on local authorities and NHS bodies to develop strategies for increased awareness of autism and adaptation of service provision to enable autistic users to access services easier. The act also calls for reasonable adjustments to remove barriers to access and participation in public life.

And on World Autism Awareness Day at Think Tank, Millennium Point, the Birmingham Autism Partnership Board (BAPB) officially launched its Autism Strategy for Adults in Birmingham 2013-2016 as a consultation document.

Presenting the strategy were councillor Steve Bedser, Birmingham City Council Cabinet Member for Health & Wellbeing, Dr Ashok Roy, Chair of the BAPB who specialises in the psychiatry of learning disabilities, and Jonathan Shephard, Chief Executive of Autism West Midlands. Sitting amongst the audience were senior BCC officers who are grappling with the implications for service delivery from the budget cuts announced up to 2016-17. Dr Roy stated that this was an optimistic strategy. In this age of austerity for Birmingham, optimism is at least a free commodity.

The draft strategy sets out six areas where the BAPB wants to deliver progress: implement training and raise awareness; implement pathways for diagnosis; improve on opportunities for employment & education; improve access to services; improve transitions from childhood; and improve interactions with the criminal justice system.

These are all worthy challenges to pursue in aid of a more inclusive city. While there has been considerable attention to autism in childhood there remains large gaps in the understanding of how autistic adults in society function despite autism being a life-long condition. There were considerable difficulties in obtaining information about adult autistic service users because they often weren't being recorded. For example NHS trusts were particularly weak at information recording although this is changing with the NICE clinical guidelines issued in June last year.

Yet the barriers to inclusiveness for those on the autistic spectrum are not as obvious as say providing an access ramp for wheelchair users. Rather, it requires a cultural shift across service provisions within the NHS and local government to meet the needs of users with an autistic spectrum disorder. This represents some interesting challenges in terms of both recognition of someone on the spectrum and making reasonable adjustments for them by front-line public sector service staff.

It is worth reflecting on this truism: "if you met someone with autism, you met one person with autism". Autism is a developmental disorder where the brain has developed differently which can come from a myriad of physical causes. How someone's autism presents itself is diverse. Having an awareness of autism doesn't necessitate an understanding of autism or identifying what reasonable adjustments should be made when presented with an individual on the spectrum. Recognising a difference is merely the start of a communication process and requires freedom of agency from service staff which may not always be possible if the service provision is proscriptive in nature.

A major challenge to the ambitions of this strategy is the austerity that Birmingham is currently experiencing. Whilst the establishment of the Health and Wellbeing Board required by the 2012 Health & Social Care Act will support the strategy through a specific Joint Strategic Needs Assessment for autism, this remains the most challenging of times to attempt to reconfigure service provision and provide additional services given the cost pressures being experienced.

Yet the process currently being undertaken in preparation for BCC's consultation this summer on Adult Social Care provision from 2014 onwards should be identifying current costs being incurred to the city by those on the autistic spectrum across department budgets where possible. If genuine societal costs can be identified then some modelling can be undertaken to assess the cost-effectiveness of preventative work. This could then be widen out to involve the Police & Crime Commissioner/panel and NHS bodies which would also improve data gathering and assessment. From such work can negotiations for joint funding of preventative services or submissions for central funding take place as proposals could then be evidenced.

Therefore the biggest challenge facing an autism strategy for adults is the quality of information available and the lack of information from certain sectors. Whilst the BAPB has identified areas that will improve the lives of autistic adults if implemented, it does so from an incomplete picture of the city. If by 2016 we have considerably more quantitative and qualitative data from across the public sector then there could be a more informed debate in terms of service design rather than just spreading awareness. Such information would also inform a more detailed level of scrutiny regarding outcomes as they impact the city rather than just internal project milestones and outcomes. 

This strategy document is a welcome step forward for the city's autistic inhabitants and their families. The challenges will be how far the targets and/or aspirations laid out are able to be delivered and whether in 2016 the city has a more detailed picture of the needs of autistic adults within its boundaries. For this strategy to be truly excellent, a specific commitment to information gathering is required for me. 

The consultation runs until the 26th of June and information can be found here.