As Birmingham City Council votes to set its budget for 2016-17 it will also confirm plans to cut £10m from services for the under fives over the next three years which are likely to see the closure of many of the 60 Children’s Centres in the city. (see BATC’s earlier report on Budget proposals for cuts to Early Years services)
The Council has been undertaking a longstanding service review of Early Years Services and has been considering the position of the Health Visiting Service alongside the Children’s Centres. A key strand of the Review’s proposals is the rationalisation of Children’s Centres and a move to new simplified commissioning arrangements based on providers tendering across ten districts of the city. The Review also raises the possibility of the Council ceasing to be a direct provider of Early Years services.
It is proposed that the Health Visiting Service will also be re-commissioned alongside the new Children’s Centre provision. At present the Health Visiting service has been commissioned from and provided by the Birmingham Community Healthcare Trust. Responsibility for the commissioning of the Health Visiting Service passed from the NHS to local Councils in October 2015.
NHS campaigners in the city are now concerned that the Council is embarked upon a future competitive tendering process for Health Visiting service which could open the door to private providers such as Virgin Healthcare to submit bids. The threat of privatisation is real here and we have seen Virgin Healthcare winning a number of similar Community Health contracts in different parts of the country over the last year.
Birmingham Keep our NHS Public has been challenging this Labour Council to find lawful ways to protect NHS provider services in the city. Here is their recent submission to the public consultation on the Early Years offer.
Submission from Keep our NHS Public Birmingham to the BCC Early Years Health and Wellbeing Services consultation
We fully support the principle of developing Early Years services to focus upon and to improve the health and wellbeing outcomes for all of Birmingham’s children. We do however object to the proposed £10m of cuts to the EYS over the next three years given the high levels of need amongst children and families in our city. It is wrong that EYS are being cut at a time when 37% of children in Birmingham are growing up in poverty and when it is predicted by the All-Party Parliamentary Group on Health in All Policies that child poverty will significantly increase as a result of the Government’s welfare reforms.
In preparing this response to the EYS public consultation we have also referred to the Committee papers for the Cabinet meeting on 29th June 2015 and to the background on the preferred Option 3 which is the basis of this consultation. These comments relate specifically to the Health Visiting service:
1. No evidence provided of inefficiencies in Health Visiting services
The rationale for the rationalisation of EYS is to realise efficiency savings at a time of an overall reduction in funding for Early Years over the next three years. It is unclear as to the evidence of the inefficiencies in the current provision of health visiting service and what is to be gained as added value from the proposed commissioning model regarding the Health visiting service.
2. Risks of fragmentation
Conversely, there is a failure to identify the impact and risks to the Health Visiting Service of fragmentation and other direct and indirect costs of the proposed commissioning model upon NHS provider services. The outline Business case provides no risk assessment of this point as it overwhelmingly focused on the Children’s Centres.
3. Future resourcing of HVS within Early Years budget
It appears public health money to fund the HVS will form part of an overall shrinking EYS budget. The consultation should have identified whether these ongoing budget cuts will lead to an overall reduction of level of HVS and public health outputs as part of the EYS. This critical information was also excluded from the BCC Budget consultation 2016+. If members of the public are being invited to comment on the EYS offer they should also be meaningfully informed as to the consequences of the cuts in resources that inform that offer.
4. Failure to identify the needs of young children and their families
This Early Years service review and this consultation are primarily a resource-led not needs-led process. There should have been a clear statement for the public of the health and wellbeing needs of Birmingham’s under fives against which the proposed level of future spending and resources can be judged. How else can the public assess and comment upon the likely level of support available under the universal and universal plus service offer?
5. Costs of Procurement and competitive tendering
The proposed procurement based upon a model of lead providers across 10 districts could create potential new inefficiencies and costs through a complex tendering process which will be imposed on NHS provider services. Further evidence should be provided to the public as to the likely additional costs of procurement and contract monitoring and management at a time of an overall reduction in service to the children and families in the city.
6. Opening the door to a Private Health provider
Further costs would be sucked out of the provision of the service through the possible award of a contract to a private health provider at a time of reducing level of service provision. There can be no justification of the award of a contract to a private health provider who will also be seeking a rate of return and profit from any public contract in the context of £10m of cuts.
7. Inadequate public consultation
The Early Years offer which is the basis of the consultation is an ‘apple pie’ offer to which the only conceivable answer is yes! Recent case law has set out the conditions of fair public consultation: one condition includes that the consultees have been provided with ‘sufficient reasons for any proposal to permit of intelligent consideration and response’ – i.e. do residents know what cuts are being proposed and why? For many of the above reasons we contend that the public have not been adequately informed as to the basis of the consultation that would allow for ‘intelligent consideration and response’.