Written evidence submitted by The Commissioner for Children and Young People (NICCY), relating to the funding and delivery of public services in Northern Ireland inquiry (FPC0017)

CONTENTS

Executive Summary

1.0 Introduction

2.0 The impact of budget cuts on education services

2.1 Context

2.2 Education services

3.0 The impact of budget cuts on health and social care services

3.1 Child health waiting lists for hospital and community care

3.2 Children’s mental health services

3.3 Children’s social care services

4.0 Conclusions and recommendations

Executive Summary

The Commissioner for Children and Young People (NICCY) was established in accordance with ‘The Commissioner for Children and Young People (Northern Ireland) Order’ (2003) to safeguard and promote the rights and best interests of children and young people in Northern Ireland (NI). Under Articles 7(2) and (3) of this legislation, NICCY has a mandate to keep under review the adequacy and effectiveness of law, practice and services relating to the rights and best interests of children and young people by relevant authorities. Under Article 7(4), NICCY has a statutory duty to advise any relevant authority on matters concerning the rights or best interests of children and young persons. The Commissioner’s remit includes children and young people up to 18 years, or 21 years, if the young person has a disability or experience of being in the care of social services. In carrying out her functions, the Commissioner’s paramount consideration is the rights of the child or young person, having particular regard to their wishes and feelings. In exercising the functions of the Office, the Commissioner is to have regard to all relevant provisions of the United Nations Convention on the Rights of the Child (UNCRC).

NICCY is extremely concerned about the financial position of Northern Ireland’s public services in Northern Ireland and the consequences for children and young people. We very much welcome the Northern Ireland Affairs Committee’s Inquiry which includes review of the financial situation facing public services including education, health, children’s social care, and policing, and the consequences of budgetary pressures on the delivery of those public services.

This submission addresses point two of the inquiry, that is, the financial situation facing Northern Ireland’s public services and the consequences of budgetary pressures on the delivery of those with a particular focus on education and health & social care services, and impacts on children’s rights and best interests.

NICCY is extremely concerned about insufficient funding for education and schools in Northern Ireland, following years of under-investment and cuts, and the detrimental impacts of this on children’s access to high quality education, particularly the most vulnerable children. Our paper highlights a lack of investment and cuts in a number of areas, including schools’ budgets, a range of vital support programmes, SEN services and youth services. NICCY considers that these, and any further cuts to education services, will have serious and enduring implications for children’s educational outcomes, wellbeing and life chances, and will exacerbate existing inequalities.

Our paper further highlights the unprecedented pressures facing Northern Ireland’s Health and Social Care Services, and the immensely damaging consequences of funding shortfalls for service delivery, particularly children’s services. Health services in NI were facing significant pressures pre-pandemic and these have been further heightened by the Covid-19 pandemic, as well as a prolonged period without an NI Assembly and Executive. Key issues of concern include unacceptable child health waiting times, the capacity of the health system to respond effectively to children’s mental health and wellbeing needs, and unprecedented pressures within children’s social care services. Evidence clearly indicates the need for targeted investment and reform of the child health and social care system, and for government to take the lead role in driving this forward, to ensure children’s rights and best interests are upheld.

Conclusion and recommendations

Funding for critical services for children has been severely constrained over recent years, and despite attempts by the public sector to address educational inequalities, long health waiting lists, and inadequate SEN and CAMHS services, the situation in Northern Ireland is now in a grave situation. We have been disappointed that, despite the duties placed by the Children’s Services Co-operation Act (CSCA) 2015, on all key agencies to co-operate in the planning, commissioning and delivery of children’s services, and the enabling power it provides to allow departments to pool resources to address crosscutting children’s issues, that co-operation in the delivery of services for children remains the exception rather than the rule. Clearly the pooling of resources is critical in ensuring that budgets are used most effectively to deliver positive outcomes for children.

The challenge for government departments and agencies of maintaining (never mind improving) these services in the face of such devastating budgetary cuts is unprecedented. While understanding the importance of due diligence and financial management in public services, NICCY questions the Treasury requirement to ‘claw back’ the deficit in the Northern Ireland budget within the 2023-24 financial year. Given the devastating impact this will have on vital services for children, it is essential that alternative approaches are sought to address historical overspend. Vulnerable children, living in poverty, with ill-health, disabilities or complex needs, will be particularly hardest hit. The approach to the NI budget appears punitive, rather than working in a way to transform services over the longer term to reach a sustainable budgetary position and meet the needs of children in NI.

NICCY suggests that Committee members consider the following questions during evidence sessions:

- In relation to the Secretary of State for Northern Ireland:

What considerations were made of the impact of the UK government’s budgetary decisions on children’s services, and ultimately on children’s wellbeing?
What considerations have been given to finding alternative approaches, to allow the budget savings to be made over a number of years, rather than all in the 2023-24 financial year?
How is he promoting co-operation across government departments in the planning and delivery of children’s services?
Whether, recognising the importance of early intervention and prevention services in relation to ‘Invest to Save’, he is ensuring that these are not disproportionately impacted by budget cuts?

- In relation to the Department for Education:

What are the short, medium and longer term implications of the budget cuts will be on education services, and where the cuts will be made?
How early intervention and prevention services are being affected – are they being protected or facing disproportionate cuts?
How will budget cuts affect planned SEND transformation programme work?
How will the cuts affect the delivery of the Children and Young People’s Strategy?

- In relation to the Department of Health:

What are the immediate, medium and longer term implications of the budget cuts on health and social services for children, and where will the cuts be made?
How early intervention and prevention services are being affected – are they being protected or facing disproportionate cuts?
How will the budget cuts affect the ability of the Health Trusts to reduce the untenably long waiting lists for children?
How the budget cuts will affect the ability of the DoH and HSCTs to implement the recommendations of the Independent Review of Children’s Social Care Services, due to be published in June?
How will the cuts impact on children and young people in Northern Ireland?

We suggest the Committee considers the following recommendations:

A long-term, transformation approach should be taken to the Northern Ireland budget, with any repayment required on historic overspending to be phased over a number of years;

Child Rights Impact Assessments should be undertaken on all budget decisions;

Education and health and social care budgets for children must be, as a minimum, ring-fenced and over the forthcoming two to three years, raised to similar levels with other parts of the UK.

Funding should be specifically allocated to address the untenable waiting list backlog, and underfunded education and CAMHS services, and to ensure the full implementation of the Independent Review of Education and the Independent Review of Social Care; and

Co-operation in the planning and delivery of children’s services, and pooling of resources (as required under the CSCA) should be incentivised through the budgeting process, and funding ringfenced for vital early intervention and prevention services.

1.0 Introduction

It is deeply disappointing that there has been no functioning Northern Ireland Executive or Assembly since February 2022 to take action to address the many persistent problems facing children and families in Northern Ireland. NICCY has consistently called on all parties to return to Government to address the pervasive challenges affecting children in Northern Ireland, including unacceptable waiting times for key services, persistent inequalities within the education system, the impact of the Covid pandemic response on children’s wellbeing, the cost-of-living crisis and the poverty experienced by thousands of children and young people throughout their childhoods.

This submission will address point two of the inquiry, that is, the financial situation facing Northern Ireland’s public services and the consequences of budgetary pressures on the delivery of those with a particular focus on education and health & social care services, and impacts on children’s rights and best interests.

2.0 The Impact of Budget Cuts on Education Services

2.1 Context

NICCY’s vision for the education system is one where the education received by all children in Northern Ireland is of high quality and which develops every child’s personality, talents and abilities to the full. NICCY wishes to see inequalities in education and outcomes being comprehensively addressed and all children succeeding in education and developing to their maximum potential in line with Articles 28 and 29 of the UNCRC.

Northern Ireland’s school population

Northern Ireland’s school population has continued to rise and diversify in recent years. Latest school enrolment data reports almost 356,000 pupils in all funded schools in Northern Ireland, including around 171,000 pupils in primary schools (Year 1–7) and just over 154,000 pupils in post-primary schools. Recent years have seen a continued increase in newcomer pupils, who accounted for just 5.5% of the school population in 2022/23.[1] Currently, over 96,300 pupils in Northern Ireland are entitled to free school meals, representing almost three in ten of all pupils.[2]

Around 66,400 pupils of Northern Ireland’s school population are identified as having some form of special educational need (SEN) (18.7 % of the school population), including 24,291 pupils with a statutory statement of SEN.[3] The number of pupils with SEN has been growing at a rate that is proportionally higher than the general school population, leading to escalating demands for SEN services.

Educational inequalities

NICCY has consistently called for government action to end educational attainment gaps that have persisted over many years between specific groups of children in NI. Specific groups of children at risk of poorer educational outcomes include children in care; Roma and Traveller children; newcomer children; children with a disability; children with additional needs; children from economically disadvantaged backgrounds; and those entitled to free school meals. Additional groups of children at risk of underachieving in education include working class boys, children out of school, e.g. in Education Other Than at School (EOTAS) provision, informally excluded, children in hospital, children in Woodlands Juvenile Justice Centre and possibly children educated at home, although limited data exists on this group.[4]

While gaps in educational attainment are evident across a range of groups the most

pronounced differences are between the GCSE attainment of free school meal entitlement (FSME) and non-FSME pupils. In 2020-21, only 59.8% of school leavers with FSME achieved at least five GCSEs, including English and Maths, compared to an 83.8% attainment rate for non-FSME school leavers.[5] Notably, the attainment gap between non-FSME and FSME school leavers has not changed significantly in the last 15 years, demonstrating that much more work and targeted investment is needed to ensure that all young people experience their right to an excellent quality education in line with Articles 28 and 29 of the UNCRC.

In 2020, an expert panel was commissioned by the Department of Education (DE) to examine the links between persistent educational underachievement and socioeconomic background. The panel’s Final Report and Action Plan, ‘A Fair Start’, was published on 1 June 2021 and is currently in the early stages of implementation. The Action Plan contains 47 actions for change across eight key areas, including an emphasis on early years education and emotional health and wellbeing. Full implementation of the plan’s 47 actions, which have been costed for implementation over 5 years, will require a total estimated annual expenditure of £73.1m by year 5 (2025/26).[6]

2.2 Education services

As part of its response to ongoing and increasing budgetary pressures, the DE requested at the start of this year that the Educational Authority (EA) make cuts to address a £110m funding gap. NICCY considers the proposed cut to EA funding to be hugely unrealistic, with potential for catastrophic impacts on schools and pupils. Indeed, the Education Authority have advised NICCY that the financial cuts being requested would require thousands of staff redundancies, with serious implications for service provision and the quality of education provided to children.

It is worth noting that prior to these developments, a Landscape Review of the Education Authority, commissioned by DE, recently drew attention to the pressures faced by the organisation due to ongoing funding gaps and reliance on in-year monitoring bids, and the related challenges for budget and long-term planning. The review concluded that ‘the EA is probably under-funded for the scale of what it is expected to deliver’, with acknowledgement of the enormous pressure that escalating special educational needs services costs place on ‘already tight resources’.[7]

NICCY understands that the overall education budget in Northern Ireland has been cut for 2023-24 and that the Education Authority is facing a £500m pressure as it goes into the 2023-24 business year. The overall budget for schools, at just under £1.4bn, represents a 1.6% reduction compared to the 2022-23 closing position.[8] Schools have been advised of interim individual budgets for the new financial year to enable them to plan for 2023-24 though informed they should not assume that they would receive further allocations of money in 2023-24. The interim budget allocation reflects the likelihood of significant cuts to the 2023/24 education budget.[9]

NICCY is therefore extremely concerned about insufficient funding for education and schools in Northern Ireland, following years of under-investment and cuts, and the detrimental impacts of this on children’s access to high quality education. Our work in this area dates back to 2017, when we published our Cost of Education report examining costs associated with education and the impact of meeting these costs on the educational experience of children and young people.[10] All children in Northern Ireland should have access to a free education and adequate financial assistance being made available where required in line with the obligations on Government under Article 28 of the UNCRC. In this report, NICCY recommended that the Northern Ireland Executive, Department of Education and Education Authority should ensure that schools are adequately funded solely through public expenditure and should not rely on parents and guardians to pay for the shortfall in the costs of their children’s education.

Disappointingly, NICCY has seen little evidence of progress since the publication of our report almost six years ago. Schools’ budgets have remained ‘cash flat’ for a number of years and an increasing number of schools are operating in financial deficit. As the number of schools in deficit has grown, concerns have increased about the impact of cost cutting strategies, including increased class sizes, fewer extra-curricular activities and staff cuts, on children’s education. [11] [12]

More recently, statistics compiled by the Institute of Fiscal Studies (IFS) comparing the level of spending per pupil over the period 2009/10 to 2019/20 across the four UK nations, show school spending per pupil as lowest in Northern Ireland (see Fig 1). In fact, across the UK, NI has faced the greatest real term cuts (10%) in school spending per pupil since 2009-2010.[13] In 2019/20, spending per pupil in NI was £5,800, which was £300 lower than spending per pupil in England and Wales, and £1,500 lower than Scotland.

Fig 1. School spending per pupil across England, Wales, Scotland and Northern Ireland

Source: Institute for Fiscal Studies (2020)[14]

In November 2022, Secretary of State for NI told the Department of Education that it must make cuts to its ‘current spending trajectory’ despite clear evidence that meeting statutory obligations is increasingly difficult in the current financial situation. NICCY is gravely concerned that any further cuts to funding will negatively impact children’s educational outcomes and have enduring implications for their life chances. Many discretionary spend areas, if cut, will disproportionately affect the most vulnerable and disadvantaged groups of children and young people, including children in poverty and children with SEND. We have already seen evidence of this as the DE have recently withdrawn or discontinued a number of programmes that provide crucial support to some of Northern Ireland’s most vulnerable and socio-economically disadvantaged pupils. These include:

Holiday hunger payments made during school holidays to families with children entitled to Free School Meals since July 2020, were discontinued only days before the Easter break 2023. At a time when the cost-of-living crisis is forcing an increasing number of families to access food banks, and medical professionals are reporting severe impacts on children’s health and development due to poverty induced living conditions, the withdrawal of this vital support is unacceptable and devastating for many children and their families.[15] [16]

The Engage programme was introduced in September 2020, providing vital support for children’s learning and (re)engagement post-pandemic. The programme assisted many schools with an additional teacher to provide learning support to under-achieving pupils in both numeracy and literacy. In the first two years of the programme the NI Executive announced an extension of the programme in March of each year to ensure its continuation through to the end of June. However, in the current absence of a functioning Executive, this initiative was withdrawn with minimal notice leaving many pupils without crucial learning support.

The Healthy Happy Minds programme provided counselling and therapeutic support services for primary school pupils, including special schools and education other than at school (EOTAS) with a primary school cohort. While need for type of support for the primary school cohort has been identified for many years, this need has intensified post-pandemic and it is therefore hugely disappointing that this critical service has been curtailed.

Funding for the Extended Schools Programme which aims to improve levels of educational achievement for disadvantaged children through provision of additional learning and wellbeing support has also been cut. Since 2006, the funding has enabled almost 500 schools to provide extra support such as counselling, homework and after-school clubs to pupils and families. The interim allocation for the programme was recently set at just over £2m, representing a reduction of nearly £7m from the previous year, and the DE have announced that the scheme will end in June 2023.[17]

Funding for the Book Start Baby programme has also recently been ceased by the Department in response to budgetary pressures.

It is NICCY’s understanding that the removal of these services may be the ‘tip of the iceberg’ before the education budget is finalised later this month. Reliance on short-term and insecure sources of funding to provide these critical programmes has facilitated their rapid withdrawal, with minimal notice given in the case of at least two of the programmes. This is despite widespread acknowledgement of the need for focused investment to enable children to recover from the impacts of Covid related school closures on their learning and wellbeing, with gaps in service provision disproportionately impacting children from vulnerable groups.[18] [19] Research indicates that the impacts of lost learning on children and young people are very significant and potentially long-lasting if additional learning and wellbeing support is not made available.[20] [21] [22] Withdrawal of these vital support programmes will be hugely detrimental for children’s ability to fully participate in their education and will exacerbate existing educational inequalities.

NICCY is also immensely concerned about potential adverse impacts of financial constraints and further budget cuts on NI’s already underfunded SEN system. [23] [24] Spend per pupil in NI is the lowest in the UK, despite Northern Ireland’s comparatively higher proportion of children with SEN, and evidence clearly demonstrates that the existing SEN system is significantly lacking in capacity to effectively meet pupils’ needs. NICCY’s review of SEN provision in mainstream schools, ‘Too Little Too Late’ (TLTL), and other reviews,[25] have clearly evidenced a financially constrained and pressurised system which is consistently failing to meet children’s needs across all stages of the SEN process.[26] [27] It is extremely concerning that work planned under the SEND Transformation programme to address the implementation of TLTL’s recommendations, and those of other reviews, is now seriously at risk due to intensifying pressure on education and schools’ budgets.

Urgently needed reform of the SEN system has already been hindered by the lack of an NI Executive and Assembly, which has significantly delayed the implementation of the SEN Framework, including the Special Educational Needs and Disability Act (Northern Ireland) 2016 (the SEND Act) provisions i.e. the new Regulations and new Code of Practice (CoP). In the absence of this legislative framework, pressures within the SEN system have persisted, and in some areas intensified, as evidenced by the numbers of complaints received by NICCY’s legal and investigations department.

Going forward, reform of the SEN system must be matched by additional and targeted funding to ensure support services are sufficiently resourced to meet demand and are made available at the earliest stage possible. Crucially, this must include sustained investment in early intervention which is fundamental to achieving good outcomes for children with SEN and towards mitigating against increasing complexity of need because those needs have not been identified or addressed at the earliest opportunity.

NICCY is also very concerned about the impacts of cuts to youth services by EA which will reduce services for some of our most vulnerable young people across our communities and impact on interventions for those struggling with isolation, poor mental health, engaging in interface violence, being exploited or coerced by ex-paramilitaries (criminal gangs), involvement in group violence or other damaging behaviours.[28] This is at a time when many third sector organisations are already experiencing significant financial difficulties as the newly implemented UK Shared Prosperity scheme falls significantly short of the annual value of the European Social Fund (ESF), thus requiring the curtailment of a range of programmes supporting vulnerable groups, including young people from socio-economically disadvantaged backgrounds and care experienced young people. [29]

3.0 The impact of budget cuts on health and social care services

Health services in NI were facing significant pressures pre-pandemic and these have been further heightened by the Covid-19 pandemic, as well as a prolonged period without a n NI Assembly and Executive. Unprecedented pressures within Northern Ireland’s health system means that local health trusts are now facing sustained and growing demand for children’s services i.e. increasing referrals into Family Support Hubs and Gateway services; increasing child protection referrals; growing numbers of children on the child protection register; and increasing numbers of children in care. NICCY is also aware of the pressures (given complaints received more recently into our legal department) in children’s social care, residential care settings and respite provision for vulnerable children and families. The predicted £300m shortfall in funding going into the 2023/24 business year, requiring ‘high impact savings’ will therefore have immensely damaging consequences for service delivery within an already highly pressurised health and social care system.[30]

Simultaneously, children’s services provided by the Voluntary, Community and Social Enterprise (VCSE) sector are also facing intense pressure.[31] Survey research by NICVA shows children have been most affected by the funding crisis, with findings highlighting a reduction in family, children and young people’s services.[32] Specific services affected include parenting programmes, family support sessions and family advocacy services for parents/carers of children, young people and adults with disabilities/additional needs. There have also been cuts to voluntary and community services providing support to children and young people experiencing anxiety.

During the last four years, NICCY’s health policy work has focused on children and young people’s access to health services and on producing recommendations that focus on the development of a Child Rights-Based Health and Social Care System. Our ‘Still Waiting’ Review focused on access to mental health services and supports; our ‘More Than a Number’ Review focused on child health waiting lists for hospital and community care.[33] [34] Both Reviews demonstrated the need for targeted investment and reform of the child health and social care system, and for government to take the lead role in driving this forward. These issues are discussed in more detail below.

3.1 Child health waiting lists for hospital and community care

NICCY is very concerned that further cuts to NI’s health system will adversely impact health waiting times for treatment / operations which have been unacceptable for some time.[35] Overall waiting times are comparatively longer than in England, with people in Northern Ireland up to four times as likely to be waiting for planned care in 2021.[36] With regard to waiting times for children’s services, NICCY’s ‘More than a Number’ Rights Based Review (2021), details a concerning picture, with year on year increases in the number of children waiting for a first Consultant led outpatient or inpatient / day case appointment between 2017 and 2021. Statistics also show a considerable spike in numbers waiting for these services between 2020 and 2021, which was the period impacted by pandemic restrictions.[37]

More recently, as a further period without an Executive and related lack of decision making has pushed a previously struggling Health and Social Care system to breaking point, waiting times have continued to increase. Many more children are waiting over a year for a first consultant led outpatient or inpatient / day case appointment. In fact, updated waiting time statistics for April 2022, detailed in our Review, show a deteriorating picture in terms of numbers of children on health waiting lists, with many more waiting excessively long lengths of time - which extend beyond two years for some services.

Key statistics, taken from our More than a Number monitoring report published in October 2022 are summarised below.[38]

Key Statistics

At April 2022, 10,371 children were waiting for a first consultant led inpatient / day case appointment, representing a 9% increase, or 891 more children, in comparison to April 2021.
At April 2022, 41% (15,727) of children waiting for first consultant led outpatient appointment and 53% (5,462) of those waiting for first consultant led inpatient / day case appointment have been waiting more than 52 weeks.
Between 2021 and 2022, there have been large increases in numbers of children waiting two years or over for a consultant led appointment across all HSCTs.

The proportion of Inpatient / Day case referrals classified as urgent increased from 24% in 2021 to 32% in 2022.

NICCY considers it highly unacceptable that many children are experiencing prolonged periods of pain, discomfort and deteriorating health conditions as they await treatment, operations or care provision from a system that is insufficiently resourced to address their needs. Long waits for health treatment/care can be particularly harmful for children as they may impair their mental and physical development at a critical time of life. Children have a right to receive high quality healthcare without unnecessary delay and to experience childhood without struggling to manage health conditions.

Department of Health figures indicate that, as waiting lists have lengthened, the amount of money dedicated to tackling them has fallen since 2014 [39] and continues to fall in real terms going forward. Addressing the waiting list backlog requires multi-year funding over and above what is needed to deliver core services. It has previously been estimated that £750 million to £1 billion per year is required over a 10-year period to address the backlog and build capacity in the system to maintain waiting lists at an acceptable level.[40] However, there is currently no indication that this type of multi-year budgeting and investment required for long term planning will be achievable. As NICCY has previously highlighted, reform and redesign of services is urgently needed to ensure improvement of waiting times.

3.2 Children’s Mental Health Services

Children’s mental health and wellbeing, and the capacity of the health system to respond effectively is also of significant concern. Northern Ireland is reported to have the highest prevalence of mental health problems in the UK, and research conducted pre-pandemic shows around 25% higher rates of anxiety and depression in the child and youth population in comparison to other UK jurisdictions.[41] Yet overall spending in Northern Ireland is 27% less than in England and 20% less than in Ireland.[42] Worryingly, more recent research indicates rates of poor mental health may have further deteriorated post-pandemic, with the Young Life & Times and Kids Life & Times Surveys reporting that 41% of Primary 7 respondents and 52% of 16-year-olds felt their mental and emotional health had worsened during the pandemic.[43]

In the last five years, NICCY has undertaken significant policy work focusing on children and young people’s access to mental health services and produced a range of child rights orientated recommendations. Our Rights Based Review of Mental Health Services and Support, ‘Still Waiting’, published in 2018, examined children and young people’s experiences and pathways to accessing mental health services, identifying the need for a system wide response to the challenges outlined.[44]

In the five years since its publication, NICCY has systematically monitored the Review’s 50 recommendations which are being taken forward by an Inter-Departmental Group (IDG), established in 2019, and implemented via the framework of a Still Waiting Action Plan (SWAP). Disappointingly, our most recent monitoring report found that despite some ‘slow’ progress in implementing the SWAP, there is a lack of evidence that government actions are making a tangible difference in children’s access to mental health services.[45] In fact, the overall number of children waiting for Child and Adolescent Mental Health Services (CAMHS) as of March 2022 was the highest since NICCY started monitoring waiting times in 2017. Under resourced services also mean that, for the first time since NICCY starting monitoring CAMHS waiting times, 51 young people were waiting over a year for a first appointment. Overall, key service activity data collated as part of the monitoring process did not indicate a positive and sustained shift in trajectory.[46]

Following the Chancellor’s Spending Review Announcement in October 2021, government departments started to prepare a multi-annual budget covering the period of 2022-25. This was warmly welcomed, providing greater scope for departments to plan more effectively over a longer term. With respect to children’s mental health, this could have removed barriers to longer term planning and the delivery of reform of children’s mental health services. It could also have supported departments to work to shared PfG outcomes rather than departmental priorities, enabling greater pooling of resources as well as commissioning of services to the VCS.

The Executive agreed a draft budget in December 2021, and at the time of NICCY’s third monitoring report, in February 2022, the DoH planned to increase CAMHS funding on a cumulative basis from £2.5 million in 2022-23, £4 million in 2023-24 to £7 million in 2024-25. This was in line with the commitment made in Action 10 of the Mental Health Strategy 2021-2031 to increase CAMHS funding to 10% of adult funding, however this funding and any future funding was subject to Executive Approval. When the Executive collapsed in early February 2022, the multi-year budget was also stalled. The continuing absence of the Executive since then, on top extremely difficult economic pressures and a cost of living crisis, has resulted in a public sector funding crisis in Northern Ireland. Inevitably, this has impacted on public services, including those for children and young people. The IDG has reported that, while the DoH allocated some funding to support the implementation of the Mental Health Strategy, this has been significantly less than envisaged, including in relation to CAMHS services. In fact, rather than the additional £2.5 million allocation planned for CAMHS in 2022-3, this critical service received only 10% of the £2.5m of funding promised for the 2022/23 financial year.[47]

NICCY welcomes the commitment to increase children’s mental health funding in the Mental Health Strategy. However, this figure is not based on a detailed fund mapping exercise that takes account of the gap between current investment and what is needed to ensure children and young people have access to a ‘comprehensive range of mental health services’. It is our view that a fund mapping process would inform a long-term and sustainable ‘funding and practice partnership model’, which takes account of the investment required across all key services and sectors included in the Stepped Care Model for CAMHS.

3.3 Children’s Social Care Services

Children’s social care services have faced significant problems over a number of years, and the Covid pandemic has had a further severely detrimental impact. NICCY has had meetings with Health and Social Care Trusts in which we have been informed of increasing numbers of children referred to safeguarding gateway services (social services) who have not been / delayed allocated social workers, and some services having staff vacancy rates of as high as 40%. Trusts are reporting increasing caseloads, and that the cases they are receiving are increasingly complex and requiring more significant interventions.

The Independent Review of Children’s Social Care Services NI by Professor Ray Jones, started in November 2021. This is a fundamental examination of Children’s Services, with a focus on quality, equity, resilience and sustainability to ensure that Children’s Services are fit for purpose in terms of meeting the needs of children, young people and families with a range of vulnerabilities. While NICCY expects that some of the Review’s recommendations may not require budget, nevertheless funding will be required to fully implement all the recommendations and ensure the transformation needed by the system.

4.0 Conclusions and Recommendations

This evidence paper has outlined how the funding for critical services for children has been severely constrained over recent years, and despite attempts by the public sector to address educational inequalities, long health waiting lists, and inadequate SEN and CAMHS services, the situation in Northern Ireland is now in a grave situation. We have been disappointed that, despite the duties placed by the Children’s Services Co-operation Act (CSCA) 2015, on all key agencies to co-operate in the planning, commissioning and delivery of children’s services, and the enabling power it provides to allow departments to pool resources to address crosscutting children’s issues, that co-operation in the delivery of services for children remains the exception rather than the rule. Clearly the pooling of resources is critical in ensuring that budgets are used most effectively to deliver positive outcomes for children.

NICCY is aware that Departments, facing these extreme cuts, are trying to maintain the services they are statutorily required to deliver, but that all ‘non-statutory’ services are facing severe cuts or closure. Despite the vital necessity for early intervention and prevention services for children and young people, as noted above, these are among the first services to face cuts. As we have seen in the past, the removal of these vital, and proportionately inexpensive, services will have huge impacts on the wellbeing and ‘education readiness’ of vulnerable children and their families, with many then going on to require more intensive, expensive crisis intervention services in the future.

For NICCY this is a question of children’s rights and best interests: children should be provided with the services they need as quickly as possible to address the difficulties they are facing, rather than having to reach crisis before they receive intervention. From a longer-term economic perspective, it is not cost-effective to cut critical prevention and early intervention services then to have to provide considerably more expensive interventions at a later point.

‘Having inherited substantial budget overruns from the Caretaker Ministers, the Secretary of State’s Budget for 2022-23 achieves balance only by calling on the Treasury Reserve. This is in effect a loan that bridges the shortfall this year between available funding on the one hand and departmental spending allocations and forecast debt interest costs on the other. But under Treasury rules this advance on the Block Grant has all to be repaid next year rather than gradually over time.’[48] (our emphasis).

Given the devastating impact this will have on these vital services for children, it is essential that alternative approaches are sought to address this historical overspend. Vulnerable children, living in poverty, with ill-health, disabilities or complex needs, will be particularly hardest hit. The approach to the NI budget appears punitive, rather than working in a way to transform services over the longer term to reach a sustainable budgetary position and meet the needs of children in NI.

NICCY believes that this Inquiry is a timely opportunity to challenge the approach taken to setting the NI budget, and to scrutinise the impact this will have on these critical services for children and young people in Northern Ireland.

We suggest that Committee members consider the following questions during evidence sessions:

- In relation to the Secretary of State for Northern Ireland:

What considerations were made of the impact of the UK government’s budgetary decisions on children’s services, and ultimately on children’s wellbeing?
What considerations have been given to finding alternative approaches, to allow the budget savings to be made over a number of years, rather than all in the 2023-24 financial year?
How is he promoting co-operation across government departments in the planning and delivery of children’s services?
Whether, recognising the importance of early intervention and prevention services in relation to ‘Invest to Save’, he is ensuring that these are not disproportionately impacted by budget cuts?

- In relation to the Department for Education:

What are the short, medium and longer term implications of the budget cuts will be on education services, and where the cuts will be made?
How early intervention and prevention services are being affected – are they being protected or facing disproportionate cuts?
How will budget cuts affect planned SEND transformation programme work?
How will the cuts affect the delivery of the Children and Young People’s Strategy?

- In relation to the Department of Health:

What are the immediate, medium and longer term implications of the budget cuts on health and social services for children, and where will the cuts be made?
How early intervention and prevention services are being affected – are they being protected or facing disproportionate cuts?
How will the budget cuts affect the ability of the Health Trusts to reduce the untenably long waiting lists for children?
How the budget cuts will affect the ability of the DoH and HSCTs to implement the recommendations of the Independent Review of Children’s Social Care Services, due to be published in June?
How will the cuts impact on children and young people in Northern Ireland?

We suggest the Committee considers the following recommendations:

A long-term, transformation approach should be taken to the Northern Ireland budget, with any repayment required on historic overspending to be phased over a number of years;

Child Rights Impact Assessments should be undertaken on all budget decisions;

Education and health and social care budgets for children must be, as a minimum, ring-fenced and over the forthcoming two to three years, raised to similar levels with other parts of the UK.

Funding should be specifically allocated to address the untenable waiting list backlog, and underfunded education and CAMHS services, and to ensure the full implementation of the Independent Review of Education and the Independent Review of Social Care; and

Co-operation in the planning and delivery of children’s services, and pooling of resources (as required under the CSCA) should be incentivised through the budgeting process, and funding ringfenced for vital early intervention and prevention services.

April 2023

[1] A newcomer pupil is one who has enrolled in a school but who does not have the satisfactory language skills to participate fully in the school curriculum.

[25] Northern Ireland Audit Office (2020) Impact Review of Special Educational Needs; Public Accounts Committee (2021) Report on Impact Review of Special Educational Needs; Council for Catholic Maintained Schools (2021) Call for Change – Time for Action, and the Department of Education's SEN Learner Journey Project

[27] Northern Ireland Audit Office (2020) Impact Review of Special Educational Needs; Public Accounts Committee (2021) Report on Impact Review of Special Educational Needs; Council for Catholic Maintained Schools (2021) Call for Change – Time for Action, and the Department of Education's SEN Learner Journey Project