An attempt to force Lancashire County Council to reconsider more than £4m of savings in its public health budget has failed.
Almost a dozen opposition councillors demanded that a recent cabinet decision to reduce support schemes, healthy weight programmes and rehabilitation courses should be “called in” for further assessment.
They wanted the changes delayed for twelve months until it could be demonstrated that an NHS-driven plan to redesign how some health management services are delivered would be enough to bridge the gap left by the public health programmes which are to be cut. But the request was rejected at a meeting of the cross-party health scrutiny committee.
The lengthiest discussion during the four-hour debate focused on the decision to scrap the Lancashire Wellbeing Service (LWS), a programme supporting 11,000 people with low-level health and social care issues, to prevent them from escalating into a crisis.
Teresa Jennings, chief executive of N-Compass North West - one of three charities which collectively deliver the service - said the suggested £2m net saving was a false economy. She warned that separate investment of £650,000 to address the acknowledged potential impact on the council’s own adult services department would prove inadequate.
“I believe there is a large [financial] risk to the county council and the savings could be more than swallowed up. For every pound the council invested in the LWS, £7 was returned...in reduced demand, increased resilience and improved physical health,” Ms. Jennings said.
She added that consultancy advice provided to the authority about the extra costs which could be incurred as a result of the cut had focused on only one out of the 14 council services which refers residents to the LWS for support.
An LWS user, Rhaya Barnes, said she had been helped with a range of issues, including post-traumatic stress disorder and agoraphobia - and asked who she should call if she has a relapse after the LWS ends.
“My main barrier to recovery has often been the ineffective mental health services available. These have often served only to hinder me or exacerbate my conditions.
“The wellbeing service was the first to understand the complexities and inconsistencies of my mental health,” Rhaya told the committee.
But County Cllr Shaun Turner, the Conservative cabinet member for wellbeing, said the council was “not walking away” from vulnerable people - and pledged that closer collaboration with the NHS was “the right thing to do”.
“This isn’t [a case of] flying by the seat of our pants - there is a lot of stuff going on in the background and it’s about continuing the good work going forward.”
“It’s a changing landscape being driven by the NHS and we have got to plug into that.
“The LWS is a great service and we want to continue its great work, but we think we can do it differently - and the budget says we have to look at doing it differently,” he added.
The government’s public health grant for Lancashire County Council has fallen by over £5m in the last four years.
The meeting heard that the NHS long-term plan has laid out a short-term vision to create primary care networks - groups of GP practices covering populations of between 30,000 and 50,000 people, working together to provide “wrap around” health and care services. These so-called neighbourhood areas - of which there are 41 in Lancashire - will receive a share of the £4.5bn being invested in community-based healthcare across England over the next four years.
Lancashire’s director of public health, Dr. Sakthi Karunanithi, said that the new neighbourhood-based arrangements would be in place before the LWS stopped accepting referrals in September, ahead of its closure in December.
“There are other services developing as we speak which will be expected to be in place before the [LWS] stops,” he said.
“The level of resources coming into [the county council] has been going down, but some money - although not the same amount - is reappearing in other parts of the system,” he added.
The local democracy reporting service understands that proposals will be put before the Lancashire Health and Wellbeing board next month after being discussed by the NHS and local authority organisations which comprise the county’s Integrated Care System.
But Labour opposition group leader Azhar Ali said there was a risk that those who have come to rely on the LWS could fall through a gap during the transition period and “end up at crisis point”. He called for the LWS to be retained until the end of 2020 by using some of the £3.9m underspend in County Hall’s public health budget in the last financial year.
“How many people who have got issues around mental health in particular are going to have the will and the energy to be able to [access the new services via their GP]?
“How many 999 calls are going to be made which didn’t need to be made and which could have been picked up by the LWS?”
“This service is not dealing with things we could do without, it’s dealing with people’s lives - and people will die as a result of this,” County Cllr Ali added.
Amidst some testy exchanges, the committee split along party lines - with members of the ruling Conservative group voting against the call-in and opposition members supporting it. County Cllr Ali suggested that the Tories had been whipped not to support the move, while Liberal Democrat leader David Whipp claimed they should have declared it if that were the case.
But committee chair, the Conservative, Peter Britcliffe, condemned their “amazing logic”.
"It’s questioned [if] it’s a whipped vote because all the Conservative members voted one way - but not questioned [if] it’s a whipped vote when all the Labour members voted the other way,” County Cllr Britcliffe said.
CALL FOR WEIGHT AND REHAB RETHINK REJECTED
Proposed call-ins on reductions in rehabilitation and healthy weight services were also defeated at the health scrutiny committee.
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As part of the cabinet decision earlier this month, it was agreed to cut £675,000 from the drug and alcohol rehabilitation budget by restricting eligibility for residential placements offered by the council and promoting community-based alternatives delivered by other organisations.
But Liberal Democrat group leader and committee member David Whipp told the meeting that the voluntary sector was “on its knees”.
“Given that people have addictions, it means they have lost control of their own lives and can’t look after themselves. So do you understand the necessity for having rehabilitation services?” County Cllr Whipp asked cabinet member Shaun Turner.
County Cllr Turner said “lower level” rehab programmes could be delivered effectively in the community.
“We feel we can do this without the cost of the building. I wouldn’t want to see this service go down, it’s one of the best in the country,” he said.
Meanwhile, a £1.5m saving on the council’s healthy lives programme will also now go ahead next March after the committee declined to call in the decision. That will bring to an end the 12-week exercise programmes currently offered to people who it is thought could benefit from them.
However, £500,000 will remain in the annual budget to develop new initiatives, which will focus on using digital technology to encourage people to make use of existing open spaces.
Director of public health, Dr. Sakthi Karunanithi, said face-to-face preventative work - on issues including diabetes - would continue via NHS-supported services. But he added that work by organisations like Lancashire Adult Learning to improve people’s confidence with technology was vital in enabling them to get the benefits offered by a new digital era for health.
“We don’t have the resource to provide [one-to-one] support for very single person who is overweight or obese, [because that equates to] about two thirds of the population of Lancashire,” Dr. Karunanithi said.
“People now use technology for peer-to-peer support...or to make things a more playful and less [overtly] health-focused.”
But West Lancashire Borough councillor Gail Hodson warned that technology would not help the elderly or those who do not live the “privileged” lives of committee members.
"What about those isolated people sat at home, day after day? They’re the people who need the safety net - and it’s human interaction that’s needed here, not digital,” she said.
However, committee member Stuart Morris said people often needed to take better care of themselves.
“It is not the state’s responsibility - totally - to look after [people’s] health. It is your own personal responsibility, whether that’s about exercise or [diet],” County Cllr Morris said.
County Cllr Turner accepted that he had encountered "some serious opposition" from some NHS organisations when the county council's plans had been revealed, but said others had been "more conciliatory" when discussing how the authority could work with them.