Children’s Service Manager – Health visiting and safeguarding

Mr Matthew Kershaw
Trust Special Administrator
South London Healthcare Trust

Thursday 13th December 2012
Dear Mr Kershaw

‘Securing sustainable NHS services-consultation on the trusts special administrations draft report for South London Healthcare Trust and the NHS in South East London’

I am writing as an individual and as the head of the Health Visiting Service for Lewisham Healthcare NHS Trust. I have worked in Lewisham for 17 years and need to put forward my comments to you in response to the consultation for South London Healthcare Trust.

Whilst I recognise the need for change I consider the approach to the consultation to be lacking in transparency. The health needs of the Lewisham population have not been fully considered prior to the consultation closing. As my esteemed colleagues within Children’s Services, Women’s Service’s and colleagues in Public Health have already pointed out to you, we are one of the most deprived boroughs, yet, you are proposing to eradicate key healthcare services to some of the most vulnerable members of our society, namely children.

This is the most alarming omission within your consultation paper, whereby you have not mentioned the services we provide for the children and families of Lewisham. We have approximately 25,000 children under the age of five who access our health services, but you have not given due regard to the specific healthcare needs of this group of the Lewisham population, you have generalised your approach under the reforms for Adult services which is completely inappropriate and places them at increased risk of poorer health outcomes because services will be dismantled.

You have not considered or mentioned the safeguarding risks to children if maternity services close. You have failed to mention the health needs of the Looked after Children who access Accident and Emergency services..You have failed to include how the specific health needs of the children with disabilities will be met with the closure of the Children’s Accident and Emergency Department. The families of children with disabilities need local services to meet their immediate needs they do not need the added burden of having to travel to other providers.

Maternity Services

Your proposal presented as ‘Option 1’ in the consultation is unsafe for the population of Lewisham on a number of counts:

1. The growth of the population within Lewisham continues to rise. Kings and Guy’s and St Thomas’s do not have the capacity to manage an extra 4-5,000 births per year. Furthermore between 10-20% of Lewisham pregnant mothers at any one time are receiving additional support from either maternity and health visiting services because of their complex health needs and/or vulnerability. With the closure of maternity services the lack of a robust pathway and timely communication from other non local providers of maternity services will place the unborn child and mother at increased risk of poorer health outcomes.
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2. We have a fully Integrated Safeguarding Team which has resulted in the development of a vulnerable antenatal pathway between midwifery and health visiting, identifying pregnant mothers at the earliest opportunity who present with additional health needs. This group of unborn children will again be at increased risk of significant harm because the joint pathway would not exist due to the closure of maternity services in Lewisham.

3. We achieved an ‘Outstanding’ Ofsted rating because of the strong partnership and joint working that exists between our community services and acute services in conjunction with our key partners across Lewisham, We have robust Safeguarding assurance processes and pathway’s in place that would be decimated with the closure of Children’s Accident and Emergency and Maternity unit. This would place our Lewisham Children at increased risk of exposure to significant harm because the Health Visiting service is reliant upon information being communicated in a timely way. Currently this happens well with our Lewisham Maternity unit and Accident and Emergency department, but the delay from other providers is problematic as it impacts upon our ability to track children at the earliest opportunity and meet our 14 day standard for a new birth visit.

4. The population of families within Lewisham is transient with some health visiting teams experiencing a 40% mobility rate, timely information from our acute colleagues is vital in keeping a track of the children but having to deal with 5 other providers of maternity services and Accident and Emergency attendance will create barriers that could lead to delay’s in finding those children who are already at risk of harm.

I am formally asking that you complete a health risk assessment on the needs of children prior to finalising the recommendations you put forward to the Secretary of State. I wholeheartedly support the Trust Board’s response to your consultation but feel that you are severely compromising the health needs of the children of Lewisham by your proposals.

Yours Sincerely

Beulah Lewis
Children’s Service Manager

Time: Friday December 14, 2012 at 8:32 am

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