Independent Oversight and Assurance Group on Tayside's Mental Health Services: follow up recommendations discussed

• correspondence

• annex A

Correspondence

Tayside Executive Partnership

By email:

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

23 December 2021

Dear Partners

Thank you for your contribution at our virtual meeting on Monday 13 December where we discussed, in detail, the actions which have been taken to deliver the following from ‘Trust and Respect’:

• integration: recommendations 5 and 9
• public engagement: recommendations 3, 4, 8 and 24
• patient safety: recommendations 11, 17, 23, 30 and 31
• workforce: recommendations 10, 18, 27, and 42
• culture: recommendations 1 and 21

I made a commitment to follow up these discussions in writing, before the festive break, to outline what further information the Oversight Group requires at this stage, in order to take assurance on the progress with implementing these recommendations. I also want to reach a consensus on the most appropriate RAG rating for each recommendation which will help to establish a baseline for our ongoing work together.

The table attached to this letter at Annex A, sets all of this out for your consideration and I look forward to receiving updates in the New Year.

In the meantime, I hope you all have a happy and relaxed Christmas holiday.

Best wishes,

Fiona Lees

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

Annex A

Integration

Recommendation 5: Review the delegated responsibilities for the delivery of mental health and wellbeing services across Tayside, to ensure clarity of understanding and commitment between NHS Tayside and the three Integration Joint Boards. This should include the decision to host General Adult Psychiatry inpatient services in Perth & Kinross Integration Joint Board

Feedback:  what engagement has there been with the principal officer of the Angus HSCP who has been delegated responsibility to review the integration schemes and what is the latest update?  What is the TEP understanding of progress to meet the March deadline and how do the TEP keep abreast of developments and report back to their governing bodies? Will the TEP be able to clarify primary care planning, the inclusion of the Carers Scotland Act 2016 in the Dundee scheme, and the delegation of children’s health services to IJBs?

RAG assessment

TEP: Amber

Oversight Group: Amber

Recommendation 9: Clarify responsibility for the management of risks within NHS Tayside and the Integration Joint Boards, at both a strategic and operational level

Feedback:  more information is needed on the extent to which risks are effectively and sufficiently managed (in terms of roles and responsibilities) for mental health services in Tayside.  Are the TEP assured regarding management of risks and that the risk strategy working effectively?  What evaluation is undertaken to determine that this has had a positive impact. 

RAG assessment

TEP: Green

Oversight Group: Amber

Engagement

Recommendation 3: Engage with all relevant stakeholders in planning services, including strong clinical leadership, patients, staff, community and third sector organisations and the voice of those with lived experience of Mental Health

Feedback:  the progress updates from the TEP have a green RAG rating for many of the engagement recommendations which doesn’t align with the Trust and Respect progress report and what the Oversight Group have heard from stakeholders.  There appears to be a significant gap between leaders and lived experience so information is needed on how this will be addressed.

RAG Assessment

TEP: Green

Oversight Group: Amber

Recommendation 4: Establish local stakeholder groups as a mechanism for scrutiny and improvement design to engage third sector, patients’ representatives and staff representation.

Feedback: the stated outcome is actually an output so the TEP should revisit this. It would be helpful for the Group to see a schematic which maps out stakeholder engagement by communities of interest as well as place along with any analysis that has been done on gaps and work to address this. The Group would also like to see the strategy/plan which underpins engagement and community development. The Group will keep in view reports currently being made to IJBs, Councils and the NHS Board, however, it would be helpful for the TEP to draw to the attention of the Group past reports of significance, on this particular matter and more generally.    

RAG Assessment

TEP: Green

Oversight Group: Amber

Recommendation 8: Deliver timely, accurate and transparent public reporting of performance, to rebuild public trust in the delivery of mental health and wellbeing services.

Feedback:  the Group would like to see the agreed Performance Reporting Framework including dashboards and an indication of reporting frequencies.       

RAG Assessment

TEP: Amber

Oversight Group: Amber

Recommendation 24: Involve families and carers in end-to-end care planning when possible

Feedback:  need to better understand the baseline starting point and where we are now. The actions referred to can feel bureaucratic and it would be helpful to better understand the activity that sits behind these and the impact they are having. Accordingly, the Group would like to see details of the work being done to receive and act upon feedback. The Group consider that the actions, as described, may not deliver the intended outcome.

The Group feels it is for the TEP to individually reflect on what would give them assurance that this will be improved and to come back with thoughts.

RAG Assessment

TEP: Amber

Oversight Group: Amber

Patient Safety

Recommendation 11: Ensure that the policy for conducting review of adverse events is understood and adhered to. Provide training for those involved where necessary. Ensure that learning is incorporated back into the organisation and leads to improved practice.

Feedback:  this is a priority for the Oversight Group and is an issue which has dominated discussions with the Stakeholder Participation Group.  Information needed on the current position in terms of numbers and how the TEP assurance themselves on the rigour of reviewing adverse events and how learning is applied/embedded.

RAG Assessment

TEP: Amber

Oversight Group: Amber

Recommendation 17: Review all complex cases on the community mental health teams’ caseloads. Ensure that all care plans are updated regularly and there are anticipatory care plans in place for individuals with complex/ challenging presentations

Feedback:  the intended outcome is not an outcome so this needs to be revisited.  Completion date was November 2021 so impact may be better evaluated and discussed in the New Year.     

RAG Assessment

TEP: Amber

Oversight Group: Amber

Recommendation 23: Develop a cultural shift within inpatient services to focus on de-escalation, ensuring all staff are trained for their roles and responsibilities

Feedback:  need to reassess if the proposed outcome and specifically how a protocol entitled ‘Observation Protocol’ delivers on the actual recommendation. Run charts and dashboards can be provided as evidence here.  

RAG Assessment

TEP: Green

Oversight Group: Amber

Recommendation 30: Ensure all inpatient facilities meet best practice guidelines for patient safety

Feedback:  noted that 72% has been achieved thus far.  Information required on the remaining 28% and what is classed as in scope for this work.       

RAG Assessment

TEP: Amber

Oversight Group: Amber

Recommendation 31: Ensure swift (timeous) and comprehensive learning from reviews following adverse events on wards

Feedback:  clear connection with recommendation 11 in terms of learning from adverse events.  November progress update from the TEP states that all actions have been completed but that the provision of training is marked as amber.  However, if a learning system still needs to be developed, that is a significant piece of work and is unlikely to be achieved in next 3 months so the RAG status could potentially be red.  This needs to be reviewed and further information provided.

RAG Assessment

TEP: Amber

Oversight Group: Amber/Red

Workforce

Recommendation 10: Ensure that there is clarity of line management for all staff and that all appraisals are conducted effectively (medical, nursing, management leads)

Feedback:  November progress update from the TEP provides a green RAG rating but states that further work will be undertaken to understand the medical structure so this would suggest an amber rating.  More information required about the level of appraisals undertaken, whether they’re done effectively and what local data monitoring processes say about this.

RAG Assessment

TEP: Green

Oversight Group: Amber

Recommendation 18: Plan the workforce in community mental health teams in the context of consultant psychiatry vacancies with the aim to achieve consistent, continuous care provision across all community services

Feedback:  Need to better understand the staffing situation and arrangements for filling posts particularly leadership positions within Mental Health Services. The Group would welcome sight of job descriptions and information on the realistic prospects of filling the consultant vacancies. The Group would find it helpful to have further information on service redesign proposals and workforce planning programmes, in support of this work.

RAG Assessment

TEP: Amber

Oversight Group: Amber

Recommendation 27: Provide adequate staffing levels (inpatient gap) to allow time for one-to-one engagement with patients

Feedback:  more quantifiable evidence is needed in respect of the green RAG rating.

RAG Assessment

TEP: Green

Oversight Group: Amber

Recommendation 42: Ensure staff working across mental health services are given opportunity to contribute to service development and decision making about future service direction. Managers of service should facilitate this engagement

Feedback: Links with recommendation 3 on Living Life Well.  How do the TEP know that staff are engaged, and continue to remain engaged, in the way that is intended and which meets the outcome for this recommendation?

RAG Assessment

TEP:  Green

Oversight Group: Amber

Culture

Recommendation 1: Develop a plan for creating a new culture of working in Tayside built on collaboration, trust and respect

Feedback:  this sits at the heart of Trust and Respect and of the Living Life Well Strategy (LLW).  There is a need to do more but also to ensure the right actions are taken here.  Suggestion to reset what is being done to achieve the culture shift that is desired - to take a step back and review actions and the approach in a different way.  Also need to consider what are the key messages from LLW and how accessible are they across the piece.

RAG Assessment

TEP: Amber

Oversight Group: Amber/Red

Recommendation 21: Foster closer and more collegiate working relationships between the crisis resolution home treatment team and community mental health teams and other partner services, based on an ethos of trust and respect

Feedback:  need to consider how to evidence the trust and respect part.  There are lots of good action and commitment here but evidence is needed to show that this work is getting to the heart of the original Trust and Respect report.

RAG Assessment

TEP: Amber

Oversight Group: Amber