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Mental Health Services in Tayside (Independent Inquiry)

Part of the debate – in the Scottish Parliament on 11th March 2020.

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Photo of Clare Haughey Clare Haughey Scottish National Party

Last month, Dr David Strang published the final report of the independent inquiry into mental health services in Tayside. I thank Dr Strang, the inquiry team and Health and Social Care Alliance Scotland for their hard work.

In particular, I also thank everyone who contributed to the inquiry. More than 1,500 people shared their often incredibly painful experiences and personal testimonies. Far too many people have been let down. Although not enough on its own, I offer my apology on behalf of the Scottish Government for what they have endured. Many Tayside patients and their families and friends, including those who have lost loved ones, will have found the report challenging. Their bravery, courage and candour was vital to shaping the report.

I also thank staff who participated in the inquiry and who are committed to ensuring the delivery of excellent services in the future.

The report outlines a range of issues and calls for a new culture of working across NHS Tayside and the three health and social care partnerships. It makes 51 recommendations in five areas: governance and leadership, crisis and community services, in-patient services, child and adolescent mental health services and staffing.

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HS Tayside and its local authority partners have accepted the report, its findings and its recommendations in full. At NHS Tayside’s board meeting on 27 February, the chief executive, Grant Archibald, apologised to anyone whose experience of Tayside’s mental health services had fallen short of the expectations that we all rightly have for those services. The board agreed to collaborate with partners to deliver a Tayside-wide response to the inquiry’s findings.

Partnership working is the cornerstone of the approach that will be taken to respond to the inquiry report. A Tayside collaborative strategic leadership group has been established, comprising chief executives from NHS Tayside, Angus Council, Dundee City Council and Perth and Kinross Council, as well as the Police Scotland Tayside divisional commander.

Collective responsibility and accountability are emphasised in the group’s published statement of intent, which commits to implementing necessary improvements through the development and delivery of a Tayside-wide strategy and change programme for improving mental health and wellbeing.

One of the recommendations of the inquiry report relates to the delivery of mental health and wellbeing services in the context of health and social care integration. It recommends that the NHS board and the three integration joint boards review the delegated responsibilities for the operational delivery of those services across Tayside, to ensure clarity of understanding and commitment.

In line with the inquiry report and the views of national health service trade unions and professional bodies, the Cabinet Secretary for Health and Sport and I have made no secret of our concerns about the approach to the operational management of in-patient mental health services in Tayside. The arrangements have been unduly complex and are unique to Tayside.

That is why I am clear that the operational management of general adult psychiatry services must now be led by NHS Tayside, rather than an integration authority. NHS Tayside will implement that change and will work closely with its integration partners in doing so. I believe that that simplification will bring welcome clarity to the local arrangements and allow the partnership to focus on improved services for patients.

The issues that were identified by the inquiry cannot be resolved by a single agency, and it is crucial that there is a whole-system review of services. Last week, I received a progress report from NHS Tayside, which is published on the board’s website and outlines activity to drive change. I have been clear that a comprehensive action plan to detail how each recommendation will be met must be taken forward, and that work is under way.

For that to happen in a way that delivers the change that we need, NHS Tayside and its partners must listen to service users, families, carers and staff.

I am encouraged that NHS Tayside has set out a commitment to ensure that it listens to the voices of people who work in mental health services, service users, families and carers, so that future services can be co-designed and co-produced. The inquiry report recommends that a full plan be developed in partnership and published by June 2020, and I expect that timescale to be met.

Later today, I will meet members of the Tayside stakeholder participation group, which is chaired by Health and Social Care Alliance Scotland. I look to NHS Tayside and its partners to continue to build on that and to keep patient needs at the heart of the discussions.

Organisational development is vital. The report found that many staff did not feel valued, listened to or treated with respect. Staff reported “a lack of clarity” around line management and accountability, and a “culture of blame”, rather than an organisation that is open to “learning from adverse events”. That is unacceptable.

Engagement is the first step, and work with staff is already under way to support that. I am encouraged to hear that safe space meetings, which enable staff to discuss concerns confidentially, are happening.

The report explores the impact of workforce challenges on delivery of mental health services, which includes the ability of staff to participate in training and supervision requirements. That raises questions about how we ensure that people have the right skills and experience to do their jobs and how they are involved in helping to find solutions to workforce challenges across social work, social care, clinical settings and the third sector. I am encouraged that NHS Tayside is working with staff, unions and professional bodies to develop a response, which will form a key part of its whole-system strategy.

We are pursuing action in that area. Psychiatry recruitment challenges across the United Kingdom require collaborative, concerted action. To address those challenges, we are working with the Royal College of Psychiatrists, NHS Education for Scotland and medical schools to promote psychiatry as an attractive career. We are also on course to deliver our commitment to 800 extra mental health workers in Scotland by the end of 2022. As of 1 January this year, 375 posts had been recruited.

On 31 January, I announced a support package to help to deliver improvements in Tayside. That package includes multidisciplinary clinical and practice support and brings together specialists from across a range of specialties and backgrounds to provide support and challenge. I welcome the fact that colleagues who helped to produce a highly regarded Lanarkshire mental health strategy are now also working with NHS Tayside. That multidisciplinary support will develop a mental health strategy for all of Tayside, strengthen governance and reporting arrangements, improve consultation and engagement, enable delivery of Tayside’s improvement plans, create a Tayside-wide culture and change programme for all mental health and care staff, and undertake a review of current service provision. That will be complemented by programme management expertise that will be provided by the NHS Information Services Division. The multidisciplinary team will work with NHS Education for Scotland to engage with the NHS Tayside organisational development team, in order to ensure that it responds to the inquiry’s recommendations to support staff.

The Royal College of Psychiatry’s UK college centre for quality improvement—CCQI—will independently assess the quality of clinical services in Tayside. The CCQI will focus on four key areas: quality networks, accreditation, national clinical audits and research and evaluation.

Through the Royal College of Psychiatrists and the Scottish Government’s former principal medical officer, Dr John Mitchell, we have also facilitated expert clinical support and guidance, and Healthcare Improvement Scotland will offer specific support to Tayside to address the quality of adult community health services. That is not a one-off support package. Through the Tayside oversight group, we will continue to work closely with NHS Tayside and local partners, to seek assurance that improvements are being implemented. We will also continue to work with the Convention of Scottish Local Authorities to ensure that NHS boards, councils and integration joint boards are supported to work together across Scotland.

I am grateful that the chair of the independent inquiry, Dr David Strang, has agreed to undertake a progress update in Tayside in February 2021, which will provide an independent assessment of improvements.

I have already committed that learning from the inquiry will be fed into our national approach to quality and safety. We want to bring greater coherence to the arrangements for quality planning, improvement and assurance for mental health. That is why we have established a quality and safety board for mental health. On 19 February, I chaired the first meeting of that board. It will have an important role in taking forward two of the national recommendations that are contained in the inquiry’s final report. The first is for a national review of the assurance and scrutiny of mental health services across Scotland, including the powers of Health Improvement Scotland and the Mental Welfare Commission for Scotland. The second is for a national review of the guidelines for responding to substance misuse on in-patient wards. With regard to the latter, there are commitments in our mental health strategy and in this year’s programme for government that will drive service improvements for people with comorbid mental ill health and substance misuse. I look forward to updating parliamentary colleagues on the work of the quality and safety board in due course.

We must work to ensure that the issues about which concerns were raised in Tayside are not being experienced elsewhere. It is vital that we continue to put people at the centre of that work. The safety of our patients and the quality of the services that they receive are paramount.

I reaffirm this Government’s commitment to support Tayside to deliver the services that people need. I am committed to learning from the experiences in Tayside. It is vital that people in Tayside have access to high quality, safe and effective services, and that they have trust and confidence in their care. That is what they and all communities across Scotland deserve.