Independent Oversight and Assurance Group on Tayside's Mental Health Services: letter discussing integration on 22 July 2022

To

Jacquie Pepper
Chief Officer
Perth and Kinross Health and Social Care Partnership

22 July 2022

Integration work plan - final question set

Dear Jacquie,

Thank you for giving Steph and I your time on 12th July, it was incredibly helpful to hear your perspective and anticipated approach to your new responsibilities in Mental Health and Learning Disability. In terms of the Independent Oversight and Assurance Group's categorising the 49 recommendations into a small number of work plans, we were advised by TEP that you have been given the role on behalf of TEP as the Executive Lead for our Integration work plan and it is in this context that I now write to you setting out the final question set and information that we require in respect of the six recommendations that we have bundled into the Integration work plan. For clarity these are recommendations 2, 5, 13, 14, 16 and 26. 

We have indicated to TEP that we will be asking them to update for us their assessment and status of the 49 recommendations relevant to Tayside and to do so by the end of September. I would therefore suggest that much of the detail that I describe below will be contained within that response unless otherwise indicated.

We will want to meet with you again in early September and whilst we recognise your lead role in Mental Health and Learning Disability within Tayside, together with the lead Executive role on our Integration work plan, we feel it important that this meeting also involves Vicky and Gail. Steph will be in touch shortly to organise this.

We addressed recommendations 2, 5 and 13 in the round within the presentations recently made to the respective Chairs, Vice Chairs and COs of the IJBs, and also to TEP.

Recommendation 2

An implementation plan and financial framework in relation to Living Life Well remains outstanding. We are of the view that the Tayside approach which is endeavouring to deliver on all workstreams set out within LLW concurrently is unrealistic and is contributing to a system paralysis with planning and development effort spread too thin to achieve anything meaningful and robust. The governance structures also continue to be overly complex and unclear in terms of who has responsibility for what, and more particularly needs further reflection to ensure that it aligns appropriately to the clear roles and responsibilities set out in the revised Integration Schemes and avoids duplication of effort. We would wish to see the Terms of Reference for all of the groups set out in the presentation on governance structures, made to us by TEP in our meeting with them in January, can I ask you to submit these to us by the end of September please. In our meeting on 12.7.2022, you were able to indicate in general terms the broad direction of travel that you believe to be necessary in order to deliver on LLW. Thank you for this. As indicated above, we will wish to meet with you again in early September in order to hear how this work is progressing and what changes have been made in order that an appropriately prioritised implementation plan is able to be pulled together in relatively short order. An update on the development of a financial framework, together with an indication as to when the IJBs can expect to be presented with the implementation plan and financial framework for approval, would be welcome.

Recommendation 5

We now require all Parties to set out how they are going to respond to and take forward the roles and responsibilities that have been clearly laid out in the revised Integration Schemes. Within this, the Powerpoint presentations made recently to Chairs, Vice Chairs and COs of each IJB, and also to the TEP, highlighted some areas of potential ongoing confusion and it would be helpful if particular attention is given to the first bullet at section 6.6 of the revised Scheme and how that is enacted in respect of particularly the Lead Partner responsibilities for Primary Care set out in Annex 1 Part 3. This is of course relevant for Mental Health and Learning Disability given the role of Primary Care in these areas. It would also be helpful to have detail from the IJBs and the Health Board about how the formers' responsibilities set out in section 5 are to be carried out in respect of the children's and young people's services set out at Annex 1, Part 4. We would like to receive this response by the end of September.

Recommendation 13

Whilst all three IJBs are progressing strategic and operational community mental health, it is clear that there remains quite some way to go to align these plans and actions with the overarching Living Life Well that is pan-Tayside. It is our view that only by doing this can Tayside reasonably pronounce that it has a genuinely connected whole system Mental Health and Learning Disability provision. It would be helpful if your response to us by the end of September were able to set out how this is going to be achieved. 

Recommendation 14

In our view, MAT Standard 9, if achieved, delivers on this recommendation. It would be helpful therefore if the Tayside Plan to deliver Mat Standard 9 could be provided to the IOAG by the beginning of September. We would also like to meet next month with some of the staff delivering the Corra funded test of change initiative in Dundee.

Recommendation 16 

We will be meeting with Gail Smith on 4th August and will seek from her at that point, data and evidence of the impact that opening up a 24/7 service in Angus has had on its population.

Recommendation 26

We will be meeting with representatives from a selection of advocacy organisations across Tayside over the coming weeks to hear their perspective. It is likely that we will wish to discuss this further with you when we meet in early September

Yours sincerely

David Williams

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

Copy to

• Vicky Irons
• Gail Smith
• Grant Archibald
• Greg Colgan
• Phil Davison
• Thomas Glen
• Margo Williamson