Independent Oversight and Assurance Group on Tayside's Mental Health Services: follow up recommendations not discussed at meeting

• letter

• annex A

Letter

Tayside Executive Partnership

By email:

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

23 December 2021

Dear Partners

Following our virtual meeting on Monday 13 December, I committed to write to you with feedback from the Oversight and Assurance Group on the recommendations from Trust and Respect that we did not manage to discuss. This is set out in the table attached to this letter at Annex A and I welcome further information from you in answer to our questions.

For the sake of completeness, we will discuss the remaining recommendations (numbers 33, 34, 35, 36, 38 and 39) which all relate to children and young people, at our January meeting. The Secretariat has also provided you with a written update on national recommendations 12 and 32. The Oversight and Assurance Group is assessing both these recommendations as amber in the meantime, pending further information and discussion with Scottish Government colleagues, and will continue to work with them to monitor progress in these areas.

Best wishes.

Fiona Lees,

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

Annex A

Recommendation 2: Conduct an urgent whole-system review of mental health and well-being provision across Tayside to enable a fundamental redesign of mental health and wellbeing services for Tayside

Feedback: The Group felt that the creation of Living Life Well, while welcome, was not the same as delivering ‘a fundamental redesign of mental health services and wellbeing services in Tayside’ we would therefore welcome further explanation as to how the whole system review has delivered that fundamental redesign of services. The group also noted that the financial framework still needs to be agreed, which is why we currently assess this recommendation as Amber.

RAG Assessment

TEP: Green

Oversight Group: Amber

Recommendation 6: Ensure that NHS Tayside Board members clear about their responsibilities, confident and empowered to challenge and make sound decisions. Review their selection, induction and training processes in preparation for their important role

Feedback: The Group would like to know how the TEP were assured that the NHS Tayside Board members feel ‘confident and empowered’ - for example, has feedback been sought from Board members themselves?

RAG Assessment

TEP: Green

Oversight Group: Amber

Recommendation 7: Provide sufficient information to enable NHS board members to monitor the implementation of board decisions

Feedback: Similar to recommendation 6, the Group would like to see evidence of embedded progress reporting or monitoring that provides the TEP with assurance on this.

RAG Assessment

TEP: Green

Oversight Group: Amber

Recommendation 13: Ensure that there is urgent priority given to strategic and operational planning of community mental health services in Tayside. All service development must be in conjunction with partner organisations and set in the context of the community they are serving

Feedback: Linking to recommendation two, the Group believes an agreed financial framework is an important aspect of strategic and operational planning, The Group would therefore like some additional assurance that the strategic and operational pans in place in the three areas are supported by robust financial plans.         

RAG Assessment

TEP: Green

Oversight Group: Amber

Recommendation 14: Consider developing a model of integrated substance use and mental health services

Feedback: The Group recognises the significant amount of activity in this important area. The progress update describes a very busy landscape. We would therefore welcome some additional assurance on the strategic framework that underpins this activity. Further, the Group would like to be advised on the overall reporting arrangements in force for ADPs. For example, how are TEP monitoring progress of the CORA Dundee project? The Group would like to view the minutes of all TEP meetings as evidence of TEP oversight.

RAG Assessment

TEP: Amber

Oversight Group: Amber

Recommendation 15: Develop comprehensive and pertinent data-capture and analysis programmes, to enable better understanding of community need and service requirement in the community mental health teams

Feedback: The Group would like to hear how the data capture is delivering on the recommendation. In particular, the progress update states, ‘Further work will be undertaken to understand and improve provision of community mental health service across each HSCP’. Given this seems central to the recommendation, it is not clear why it has been progress has been assessed as Green.

RAG Assessment

TEP: Green

Oversight Group: Amber

Recommendation 16: Prioritise the re-instatement of a seven day home treatment team service across Angus

Feedback: The minute of the Scrutiny Group, dated 14.12.2020 states ‘GA notes that R16 will never be completed’, The Group would welcome an understanding on how this stated position was able to be transformed into the outcome achieved including confirmation that the seven-day home treatment team services in Angus has been reinstated and is now up and running. The wording in the progress update isn’t 100% clear.

RAG Assessment

TEP: Green

Oversight Group: Green

Recommendation 19: Prioritise the development of safe and effective workflow management systems to reduce referral-to-assessment and treatment waiting times. This should also include maximum waiting times for referrals

Feedback: The Group noted that the progress reporting template only referred to the 4 hour limit for crisis care and that the recommendation goes further than this – they would like to see more data on referral to assessment to discharge and the timescales involved for need that is not in the urgent and crisis care category. 

RAG Assessment

TEP: Green

Oversight Group: Amber

Recommendation 20: Consider the development of a comprehensive Distress Brief Intervention training programme for all mental health staff and other key partners to improve pathways of care for individuals in acute distress

Feedback: The Group would like clarity on how DBI training as set out in the recommendation is being delivered through the DBI service set up in the progress reporting template.

RAG Assessment

TEP: Amber

Oversight Group: Amber

Recommendation 22: Develop clear pathways of referral to and from university mental health services and the crisis resolution home treatment team

Feedback: With students not on campus, as noted by the TEP, how will they measure this on an ongoing basis? Would the TEP also be looking at colleges in the Tayside area?

RAG Assessment

TEP:  Green

Oversight Group: Amber

Recommendation 25: Provide clear information to patients, families and carers on admission to the ward, in ways which can be understood and remembered

Feedback: The Group would like to know how the TEP gets assurance that the information produced under this recommendation is understood and remembered by patients, families and carers.

RAG Assessment

TEP:  Green

Oversight Group: Amber

Recommendation 26: Make appropriate independent carer and advocacy services available to all patients and carers

Feedback: The Group would welcome some additional information as to how TEP gained assurance that all patients and carers are aware of, and make use of, carer and advocacy services. What are the feedback mechanisms?

RAG Assessment

TEP:  Green

Oversight Group: Amber

Recommendation 28: Ensure appropriate psychological and other therapies are available for inpatients

Feedback: Recognise that much of the early work in respect of this recommendation was specifically on trauma which is a limited focus.  What do good psychological therapies look like and is the Psychological Therapies Matrix being used to inform this?  What is the baseline here and how are the TEP able to take assurance that the intended outcome has been achieved?

RAG Assessment

TEP:  Amber

Oversight Group: Amber

Recommendation 29: Reduce the levels of ward locking in line with Mental Welfare Commission for Scotland guidelines

Feedback: The stated outcome does not deliver on the recommendation. The Group would like to see reportable evidence that there has been a trend in reducing levels of ward locking established since the guidance has been updated and shared with staff.

RAG Assessment

TEP: Green

Oversight Group: Amber

Recommendation 37: Support junior doctors who are working on-call and dealing with young people’s mental health issues

Feedback: The Group would like to know what feedback the TEP have had from junior doctors on the processes implemented in this recommendation.

RAG Assessment

TEP: Green

Oversight Group: Amber

Recommendation 40: Ensure comprehensive data capture and analysis systems are developed to appropriately manage waiting lists and service users’ expectations. Work should be undertaken to look at what data is available and what could be useful to inform decision making on service development/monitoring of services. This should be aligned to national reporting requirements

Feedback: The Group would like to know what the data reveals about this recommendation and what it says about wait times and service user’s expectations.

RAG Assessment

TEP: Green

Oversight Group: Amber

Recommendation 41: Consider offering a robust supportive independent advocacy service for parents and carers of young people who are engaged with Child and Adolescent Mental Health Services. This may include carer support groups

Feedback: The Group would welcome some additional assurance on the impact of the services that are available – most of the progress update focuses on the existence of links on the website.

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

Recommendation 43: Prioritise concerns raised by staff by arranging face-to-face meetings where staff feel listened to and valued

Feedback: The recommendation highlighted face-to-face meetings however the plans do not have a provision for this, how will the TEP ensure that this is addressed?

RAG Assessment

TEP: Green

Oversight Group: Amber

Recommendation 44: Arrange that all staff are offered the opportunity to have a meaningful exit interview as they leave the service. This applies to staff moving elsewhere as well as those retiring

Feedback: The Group would like to see what themes arise from exit interviews and how any relevant data gathered from them is acted upon or addressed.

RAG Assessment

TEP: Green

Oversight Group: Amber

Recommendation 45: Prioritise recruitment to ensure the Associate Medical Director post is a permanent whole-time equivalent, for at least the next 2 years whilst significant strategic changes are made to services

Feedback: The Group would like more information about who the AMD is in post as well as clarity on the difference between an Operational Medical Director as referenced in the June update versus an Associate Medical Director as referenced in the recommendation and November progress update noting that the need for an AMD was also a recommendation from HIS in 2017.

RAG Assessment

TEP: Green

Oversight Group: Amber

Recommendation 46: Encourage, nurture and support junior doctors and other newly qualified practitioners, who are vulnerable groups of staff on whom the service currently depends

Feedback: The Group would welcome further evidence of how junior doctors feel ‘encouraged, nurtured and supported’. This isn’t clear from the actions in the progress update, which focus mainly on inputs and outputs, rather than outcomes. RAG Assessment

TEP: Green

Oversight Group: Amber

Recommendation 47: Develop robust communication systems both informally and formally for staff working in mental health services. Uses of technology are critical to the immediacy and currency of communications

Feedback: The Group recognises the work underway, but was a bit puzzled by the final comment in the progress update that there is an apparent need to ‘Strengthen comms and engagement at all levels of the Mental Health system, for all stakeholders (within and outside of the system of care). We would welcome some more information on what is being to progress that.

RAG Assessment

TEP: Amber

Oversight Group: Amber

Recommendation 48: Ensure that bullying and harassment is not tolerated anywhere in mental health services in Tayside. Ensure that staff have confidence that any issues or concerns they raise, will be taken seriously and addressed appropriately

Feedback: The Group would be interested to see the numbers behind this and evidence that it is having an impact. Again, feedback of staff would be an important measure related to a green assessment.

RAG Assessment

TEP: Green

Oversight Group: Amber

Recommendation 49: Ensure there are systems analysis of staff absences due to work related stress. These should trigger concerns at management level with supportive conversations, taking place with the staff member concerned

Feedback: The Group would also like to see what impact this is having on staff absence due to stress.

RAG Assessment

TEP: Green

Oversight Group: Amber

Recommendation 50: Ensure there are mediation or conflict resolution services available within mental health services in Tayside. These services should exist to support and empower staff in the rebuilding of relationships between colleagues, between managers and their staff, and between the services and the patients, during or after a period of disharmony or adverse event. This includes NHS Tayside’s mental health services’ relationship with the local press

Feedback: The Group feels there is a gap between the actions and the intended outcome. For example, there is no mention of relations with the local press and it isn’t clear whether mediation or confict resolution services are indeed available to staff? The Group would therefore welcome some addition assurance to support the TEP’s Green assessment.

RAG Assessment

TEP: Green

Oversight Group: Amber

Recommendation 51: Ensure that all external review processes are embraced wholeheartedly and viewed as an opportunity to learn and develop. Managers should ensure that all staff receive details of the Recommendations from reviews and are included in the analysis and implementation

Feedback: Overall, give the concerns expressed by the Inquiry follow up report, shared by the Oversight and Assurance Group, about the credibility of some of the RAG assessments, we remain unsure as to whether this recommendation can be assessed as Green.

RAG Assessment

TEP: Green

Oversight Group: Amber/Red