Agenda item

RESOLVED that a referral be made to the Mayor and Cabinet, via Public Accounts Select Committee, as follows:

·         The Committee recommends that the proposal C-23 (that £350,000 of the Health Visitor budget transfers to other parts of the public health budget) is not made in 2021/22, considering the risk to families with children under 2 and Lewisham’s existing poor Healthy Child Programme (HCP) coverage. This would enable: efforts to be made to improve contract management and recruit and retain health visitors. Failing this, Councillors can be presented with a clear plan for support which will be given to families with 0-2 year olds to achieve the goals of the HCP in terms of support and surveillance. The Committee feels strongly that a detailed comparison of the public health budget for 2020/21 and 2021/22 and understanding of prioritisation is necessary to fully understand the impact of the proposal before any decision is made.

·         The Committee, taking into account compelling evidence of the escalating and damaging effect of the Pandemic on children and young people’s mental health, warnings expressed by specialist Health Professionals, Academics, Educators, Charities, Parents and Campaign groups, and the indefinite third national lockdown along with prolonged school closures (which were not anticipated when this proposal was initially drafted) recommends not to go ahead with Proposal C-22 (£250,000 cut in Council contribution to Children and Adolescent Mental Health Services) in the financial year 2021/22.

The Chair reminded the Committee that is could discuss any cut proposal, and was not limited to those relating to the Children and Young People (CYP) Directorate.

Pinaki Ghoshal - Executive Director for Children and Young People introduced the item.

The Chair invited Dr Tony O’Sullivan of the Save Lewisham Hospital Campaign (SLHC) to comment on proposal C-22 “Reduction in LBL contribution to CAMHS service” and any other proposals affecting health services.

Dr O’Sullivan addressed the Committee and made the following points:

1.    While the SLHC understood that the pressure of the financial cuts imposed by the government on the council, the concern was whether the proposed cuts were deliverable and would be safe for children.

2.    SLHC did not believe that the cuts were safe to make, and stressed the impact on children.

3.    Above all else SLHC urged the council to protect the mental health and safety of children especially during the Covid-19 pandemic.

4.    CAMHS had been historically underfunded in Lewisham. Although wait times had reduced, wait times for actual therapy remained long and unchanged since 2018.

5.    A high proportion of GP referrals to CAMHS were also turned down because of high thresholds

6.    Signposting to other services often referred families and young people to organisations that had closed due to funding cuts.

7.    Covid-19 would result in a flood of need.

8.    He implored the council to work with SLHC to campaign against the government cuts.

A discussion followed in which the following was noted:

1.    Members were concerned about long waits for treatment, highlighting that a year is a long time in a child’s life,

2.    Some members felt that campaigning was unlikely to make a difference to the funding available to the council.

3.    There was recognition of the impact of Covid-19 on child and adolescent mental health. The Chair quoted the Royal College of Psychiatrists who declared the mental health impact of the third lockdown a “national emergency” and that the “impact will last a generation

4.    The cuts proposals had been drawn up before this lockdown and school closures.

5.    Overall funding for CAMHS had increased from £5m to £7m over the last few years.

6.    The council’s financial contribution to CAMHS was small compared to overall CMAHS funding.

7.    The proposed reduction of the council’s contribution was offset by a greater increase in NHS funding.

8.    Waiting times for treatment were not increasing and the average wait for treatment was 17.4 weeks. Approximately two thirds of GP referrals to the service were being accepted.

9.    Although the current lockdown had now been considered when the proposals were drawn up, it was anticipated that although Covid would bring about an increase in emotional ill health, most children should not require CAMHS intervention as a result. Lewisham had developed a Mental Health Support Team, and was building an early help service. Family therapists and Family Thrive would form part of this offer, The Kooth contract would continue for mainstream mental health support.

10. There were currently no details on investment levels for 2021-22 but indications were that the investment would continue.

11. CAMHS had not seen an increase in referrals resulting from the first lockdown.

12. Members felt that the council should have an estimate of what demand might be to ensure that early intervention services were equipped to cope with the expected increased pressure, and that this should inform any decision to reduce CAMHS funding.

13. Various anecdotes were shared from Committee Members’ various personal and professional experiences of seeing the negative impact of the pandemic on children and young people.

14. Members argued that CAMHS referrals are lower when children are not at school. Officers replied that schools are still open to vulnerable children.

15. Members expressed concern about the proposal C-23 “Reduction in the Health Visiting contract” , arguing that, according to the Public Health England statistics, Lewisham compares negatively compared to its statistical neighbours on the 6-9 month, 12 month and the 2-2.5 year checks. Also Health Visiting (HV) is funded from the ring-fenced public health budget, and it was not clear where the savings would be redistributed to.

16. Members were also concerned that taking out this universal service would remove the only contact that some families have with statutory services.

17. Members wanted more information on intended reach of the HV service, following the cuts, as well as information on what it would mean in practice for families, considering that the population, and therefore the level of need for the service, was increasing.

18. Officers agreed to provide a comparison of the c. £24m public health spend and proposals for the coming year, and details on the healthy child programme Action – Exec Dir CYP

19. The expectation was that the public health budget of c. £24m would not be cut, but that the HV spend would reduce by c. £350k, releasing the funds for use in part funding the improved early help and prevention offer.

20. The HV service currently carries a significant number of vacancies, the value of which exceeds £350k. The Trust had struggled to recruit band 6 HVs do to a national shortage.

21. Officers explained that if the funding is allocated to the Trust for the HV service and it fails to fill the vacancies, the £350k does not return to the council.

22. Officers anticipated that the cuts would not reduce HV time for families and children, and the council would have the benefit of the reduction in spend rather than the Trust.

23. One Member asked if the council had applied for a s31 grant. Officers explained that s31 was part of the funding that the council received and could not be applied for.

24. Currently, around one third of the total spend on home to school transport for children with special educations needs and disabilities went on taxis.

25. Officers highlighted how complicated home to school transport was but felt the proposed cuts were achievable.

26. Regarding the proposal F-19 “Reduction in specialist legal advocacy and assessments for CYP proceedings” costs, better support and assessment and early social worker intervention was leading to reduced legl costs. In the past, the council had been overly dependent on specialist assessments but as the quality of social work was improving, the service was more confident about the assessments it was doing. This proposal would not reduce the service to children and families, but was a result of improved infrastructure. Fere children coming into care was also leading to fewer proceedings.

It was PROPOSED, SECONDED and RESOLVED following a unanimous vote that a referral be made to the Mayor & Cabinet via Public Accounts Select Committee be made in the following terms:

1.    “ The Committee recommends that the proposal C-23 (that £350,000 of the Health Visitor budget transfers to other parts of the public health budget) is not made in 2021/22, considering the risk to families with children under 2 and Lewisham’s existing poor Healthy Child Programme (HCP) coverage. This would enable: efforts to be made to improve contract management and recruit and retain health visitors. Failing this, Councillors can be presented with a clear plan for support which will be given to families with 0-2 year olds to achieve the goals of the HCP in terms of support and surveillance. The Committee feels strongly that a detailed comparison of the public health budget for 2020/21 and 2021/22 and understanding of prioritisation is necessary to fully understand the impact of the proposal before any decision is made.

2.    The Committee, taking into account compelling evidence of the escalating and damaging effect of the Pandemic on children and young people’s mental health, warnings expressed by specialist Health Professionals, Academics, Educators, Charities, Parents and Campaign groups, and the indefinite third national lockdown along with prolonged school closures (which were not anticipated when this proposal was initially drafted) recommends not to go ahead with Proposal C-22 (£250,000 cut in Council contribution to Children and Adolescent Mental Health Services) in the financial year 2021/22.”

Members praised officers for finding where savings could be made, and recognised that officers had tried hard to mitigate the damage. The Chair thanked Dr O’Sullivan for his contribution to the discussion.