Independent Oversight and Assurance Group on Tayside's Mental Health Services: quarterly report - November 2021 to January 2022

 

To

• Grant Archibald, Chief Executive, NHS Tayside
• Greg Colgan, Chief Executive, Dundee City Council
• Phil Davison, Divisional Commander, Tayside, Police Scotland
• Thomas Glen, Chief Executive, Perth and Kinross Council
• Margo Williamson, Chief Executive, Angus Council

15 February 2022

Dear Colleagues

Quarterly report - November 2021 to January 2022 

Please find attached to this letter, a copy of the Oversight Group’s first quarterly report, covering the period November 2021 to January 2022.  The report has been signed off by the Minister for Mental Wellbeing and Social Care, and it is our intention to publish the report at 9am on Friday 18 February.  Can I ask that you please share this with your Chairs and Leaders, as appropriate, prior to publication and with a reminder about the need for confidentiality at this stage.

You will also be aware that the Terms of Reference commit us to publishing copies of all formal letters from the Oversight Group to the Tayside Executive Partnership.  We will therefore publish the first batch of these letters, also on Friday 18 February, and will routinely publish letters on a monthly basis thereafter.  The Secretariat will provide you with a link to the website once this week’s publications have gone live.

Best wishes.

Fiona Lees

Chair, Independent Oversight and Assurance Group on Tayside’s Mental Health Services

First quarterly report to the Minister for Mental Wellbeing and Social Care - November 2021 to January 2022 

The Independent Oversight and Assurance Group for Tayside’s Mental Health Services has been established to provide independent assurance on the progress made by the Tayside Executive Partnership (TEP) in implementing the recommendations of Trust and Respect, the Independent Inquiry into Mental Health Services conducted by Dr David Strang, and to improve outcomes for the people of Tayside in relation to mental health. Fraser McKinlay, David Williams and I were appointed on 11 October 2021 as members of the group.

The group’s terms of reference requires us to report on progress on a quarterly basis to the Minister for Mental Wellbeing and Social Care. This is the first such report, updating the Minister on our work to the end of January 2022.  The report provides an update of the work carried out to date; a description of the engagement we have had so far; our initial assessment of progress as at the end of January; and an outline of the work we intend to undertake with TEP colleagues in the coming weeks and months.

Background 

Since our appointment in October 2021, we have undertaken significant preparatory work to ensure we have a sound understanding of current issues and the operating context within Tayside. This has included extensive reading and desk research, alongside a series of both one to one and group meetings with the Tayside Executive Partners, Chief Officers of Integration Joint Boards, the Stakeholder Participation Group, a range of colleagues from the Scottish Government and Dr David Strang. 

Programme of work 

We have learned a lot from listening to people and from our reading, and this has informed our programme of work. We are undertaking our work across three phases, which we expect to progress during 2022:

• we believe there has to be a reassessment of progress against all 51 recommendations contained within Dr Strang’s Report, Trust and Respect. This will form the baseline against which assurance can be taken and support provided
• we will take the same approach in respect of additional recommendations made by Dr Strang in his progress report of July 2021
• we will then give attention to Living Life Well, the Tayside Mental Health and Wellbeing Strategy, published in January 2021. We will seek assurance that progress is being made on those issues contained in Trust and Respect, and that the strategy is appropriately resourced with an accompanying action plan

Engagement

We have engaged widely in our work so far, speaking to many people with an interest and stake in mental health services in Tayside. We will continue to do so as our work progresses.

We have met formally with the Tayside Executive Partnership (TEP) on three occasions, through monthly meetings in November, December and January. The minutes of those meetings are being made publicly available through the Scottish Government website. We are grateful to TEP colleagues for their time and contributions, especially given the severe pressures on health and social care and wider public services created by the ongoing COVID-19 pandemic. 

We have met twice with members of the Stakeholder Participation Group (SPG) who shared with us their experiences and the reasons which led to them becoming involved in the review of mental health services in Tayside. Group members were key contributors to Dr Strang’s first report and in September 2021 published their research report, ‘Listen - Key Findings from a Public Survey - January to April 2021’, which is a hard but essential read on the experiences of NHS Tayside Mental Health Services from the perspectives of those who use them. 

Their stories will stay with us, as will their need to see Dr Strang’s recommendations implemented in full. We see the Group as an important sounding board and plan to meet with them on a regular basis. We are grateful for their time, candour and insight. 

We are aware that many more people used to be involved in the Stakeholder Participation Group than at present. Through the Alliance, we plan to write to everyone to offer a meeting or simply a point of contact should they wish to know more about, or contribute to, our work.

There are, of course, many organisations representing communities of interest and place, who have a locus in mental health services and views they may wish to express. We have asked Tayside Executive Partners to suggest organisations to us, who they consider it would be helpful for us to meet. 

A number of recommendations contained within Trust and Respect focussed on workforce and organisational development. In reaching his conclusions, Dr Strang had the opportunity to hear from staff and this is something we will wish to build into our work in the coming months. We have also met with the Chair of NHS Tayside, and we are arranging to meet Council Leaders and with Chairs and Vice Chairs of IJBs. 

Finally, we have written to Tayside Members of the Scottish Parliament (Constituency and Regional List) and Members of the UK Parliament to ensure they are aware of our work, and we will arrange to meet with them to understand the matters which are important to them and their constituents.

Progress update

One of the key findings of the Trust and Respect progress report in July 2021, was a concern over the credibility of Tayside’s own assessment of progress against the recommendations in the original Trust and Respect report. Dr Strang concludes.

'There remains a long way to go to deliver the improvements that are required. Questions have been raised about the level of confidence in the accuracy of the reported progress against Tayside’s Listen Learn Change Action Plan.’

It is vital that we are able to provide assurance to you, and the people of Tayside, that there is a shared, realistic view of progress against the issues highlighted two years ago by Dr Strang.

The Oversight and Assurance Group has therefore undertaken a reassessment of Dr Strang’s original 51 recommendations, based on the Tayside Executive Partners’ June 2021 Position Statement. 49 of these recommendations are for the TEP, with two national recommendations being the responsibility of the Scottish Government.

In November 2021, we asked the TEP to provide realistic updates on all 49 recommendations pertaining to Tayside (in the case of recommendations 12 and 32, we made the same request of Scottish Government officials). In doing so, we encouraged Tayside colleagues and those in Scottish Government to consider the sufficiency of their proposed actions and the ambition of the outcomes they intend to achieve. 

Having received the TEP reassessment, we asked a series of follow up questions (over 80 in total) to better understand the evidence base and rationale behind their red / amber / green assessments. This work will give us a new baseline, providing a solid foundation for the work ahead. It is important that everyone, most importantly those with lived experience of mental health services in Tayside, can have confidence in the progress being reported. We carried out a similar process with Scottish Government for their two recommendations, both of which we have rated as ‘amber’.

At this stage, it is fair to say we are apart from the TEP in our respective assessments of progress, and we have some way to go to reach a shared view of progress. The TEP’s latest assessment has 28 recommendations rated as green and 21 as amber. Our independent assessment has 9 recommendations rated as green, 38 as amber and two as amber/red.

We will work through the detail of each recommendation with the TEP colleagues in the coming months. There are many reasons for the difference in views at this stage, but some of the common themes can be summarised as follows:

• there are a number of instances where we feel the TEP has taken a narrower interpretation of the recommendations than Dr Strang intended. In some cases, we have taken a more expansive and longer-term perspective on what success should look like
• there are a number of recommendations where we feel that the TEP has concluded that the production of new or revised strategies, policies and protocols is sufficient and will of itself result in changes in practice and improved outcomes for patients
• in some cases, we feel that TEP's stated actions and expected outcomes do not fully address the original recommendation
• in some cases, the TEP appear to have concluded the actions very quickly following publication of Trust and Respect, and the activity has moved to a 'business as usual process'. However, we have yet to see evidence of the positive impact on people of their actions
• finally, there are a number of instances where we can see certain recommendations have, in large part, been met and subject to getting the information we have requested from the TEP, we anticipate being able to provide assurance on those recommendations relatively quickly

While the gap in our respective assessments at this stage appears substantial, we are confident that over the next few months we will be able to work with colleagues in Tayside to narrow the difference. That process is already underway and will continue in the coming weeks and months.

We are encouraged by the openness shown by partners and by the time they have devoted to how they can better work together to deliver the changes required. As our work progresses, there may be differences of views on occasion, but we are assured that colleagues in Tayside are committed to working with us to better understand each other’s perspectives. We are all agreed that our shared interest is in improving mental health services and outcomes for communities in Tayside.

Next steps and work programme to April

Having established our new baseline, the next step is to gain an even deeper understanding of the work underway in Tayside, and for the TEP to fully understand our concerns in specific areas. Our approach will be both challenging and supportive, reflecting our dual purpose of providing assurance and securing improvement.

With that in mind, we have identified five priority areas for more detailed consideration, which will allow us to really get ‘under the bonnet’ of progress. These five areas are:

• health and social care integration 
• patient safety (including conducting and learning from Local Adverse Event Reviews) 
• workforce 
• engagement
• culture

By the time we produce our second report on progress, at the end of April 2022, we will therefore be able to present an updated assessment of progress against the 51 recommendations.

I hope you find this progress update useful. I, along with David and Fraser, would be very happy to discuss any aspects of the report with you if that would be helpful. 

Fiona Lees

Chair of the Independent Oversight and Assurance Group on Tayside’s Mental Health Services

February 2022