Independent Oversight and Assurance Group on Tayside's Mental Health Services minute: 26 January 2022

Attendees and apologies

Present

• Fiona Lees, Chair of the Oversight and Assurance Group
• Fraser McKinlay, Member of the Oversight and Assurance Group
• David Williams, Member of the Oversight and Assurance Group
• 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

In attendance

• Paul Arbuckle, Service Improvement Lead, NHS Tayside
• Vicky Irons, Chief Officer, Dundee Health and Social Care Partnership
• Gordon Paterson, Chief Officer, Perth & Kinross Health and Social Care Partnership
• Claire Pearce, Executive Director of Nursing, NHS Tayside
• Gail Smith, Chief Officer, Angus Health and Social Care Partnership

Secretariat

• Stephanie Cymber, Mental Health Division, Scottish Government

Items and actions

Welcome

There was a brief discussion about the number of agenda items and how to make best use of time in order to get through all the necessary business during the meeting.

The Chair thanked partners for their correspondence ahead of the meeting which had proposed a structure and topics for discussion.

In preparing for the meeting, Tayside Executive Partners (TEP) had met with Chief Officers to review feedback and RAG ratings. There are recommendations where feedback from the Oversight Group has been accepted and RAG ratings adjusted accordingly.  Differences in assessment were recognised, alongside the willingness to work together on those areas, in order to reach a baseline against which assurance can be taken and support provided.

It was noted that responses to some questions, which has been posed by the Oversight Group in correspondence over recent weeks, were still required by w/b 7 February.

Minutes from the previous meeting

The minutes from the previous meeting on 13 December 2021 were agreed. There were no matters arising.

Structures and oversight

TEP colleagues delivered a presentation showing the structure of the Tayside Mental Health and Wellbeing Change Programmes. This was to provide clarity on planning, governance and accountability, noting that these had been revised by TEP colleagues to take account of assurance and operational experience.

It was acknowledged that the landscape had been cluttered so this was a simplification and refinement based on learning and feedback. A reconciliation exercise is still needed to avoid confusion about the same groups having different titles, within the structures of governance and scrutiny. It was noted that these arrangements would operate within existing mechanisms which have been established by the Board, Local Authorities and IJBs.

This update and steps taken by TEP colleagues to streamline the operating environment, was welcomed by the Oversight Group who also asked about an engagement strategy, including those with lived experience, to underpin this work.

Presenting evidence

The Chair welcomed Chief Officers and colleagues from NHS Tayside who joined the meeting at this point.

The discussion focused on a detailed review of 5 recommendations (9, 15, 19, 24 and 45) where assurance had been taken by TEP colleagues, and which offered colleagues the opportunity to present their evidence repository to the Oversight Group.

The group were shown how information and evidence was logged and organised in the repository, across the 49 local recommendations. It was demonstrated how evidence had been aligned with steps in the implementation plan for each recommendation and its intended outcome, with detail on key activities, risks and mitigating actions and options that have been explored or pursued.

It was noted that the matrix of governance structures outlined in the previous agenda item, should provide clarity and aid understanding of who has responsibility for taking forward the actions for each recommendation. Those actions would work their way up the various levels of the governance structure to the TEP colleagues, who can then, as leaders, provide challenge back through the matrix when required, when taking collective assurance.

There was a discussion about the interpretation of certain recommendations and a question about the necessity, or not, of going further than what the recommendation asks for (e.g. where a recommendation simply asks for a process or strategy to be implemented but then whether there is a need to go further and assess what difference/impact it has made). It was agreed that this issue needs to be looked and discussed further. The Chair confirmed that it will be for Tayside Executive Partners to take collective assurance that any action being delivered, is achieving the intended benefit and outcome.

In concluding this agenda item, the Oversight Group acknowledged the amount of work that had gone into developing the repository and stressed the importance of being able to draw upon this, when submitting statements of progress to the Oversight Group. The Oversight Group also committed to spend time exploring the repository in further detail, in order to have sight of the evidence base which Tayside Executive Partners are reliant on and to better understand the difference and impact it has made.

Health and social care: review of integration schemes

The Chair invited Chief Officers and colleagues from NHS Tayside to stay for this agenda item.

TEP colleagues provided an update on progress with regards to the review of Integration Schemes and on any areas that still need to be agreed. In doing so, they advised that work was in a reasonably good place and nearing a conclusion. It was acknowledged that some detail still needed to be finalised around finance and risk sharing.

It was noted that relevant Local Authority officers had met the previous day and that a further meeting with Chief Executives was planned for the following day to further discuss the review. Thereafter, Chief Executives will assess the final draft and agree arrangements for consultation ahead of approvals by Councils and the NHS Board respectively, prior to submission to the Scottish Government.

It was acknowledged that the Omicron wave of coronavirus, and resulting staff absences, had affected delivery against the Scottish Government deadlines for this. The challenge of future timescales was also discussed, with less than 100 days until local elections take place, in terms of conducting meaningful engagement and consultation, as well as the ability to make decisions on integration schemes before council elections.

Discussion followed about the ‘light touch’ parameters of the review. TEP colleagues advised that the review is not looking at fundamental changes that would involve a longer timescale, but focusing on updating what is already there. This has involved an audit of the functions which could or should be delegated to IJBs, what is already delegated and what, if anything, should be different.

This then gave rise to discussion on what extent this approach satisfies the Trust and Respect recommendation on clarifying roles and responsibilities of the Board and IJBs and how that is being reflected in the information TEP colleagues are being presented with on the review. It was also acknowledged that while there are specific mental health aspects, this can’t be considered in isolation and the issue is about the totality of the integration scheme.

It was noted that the Oversight Group had raised some points for consideration with the lead officer for the review and that this would be for consideration at forthcoming meetings.

As time was running short, the Oversight Group committed to follow up in writing with specific points for consideration on the review of Integration Schemes. TEP colleagues also committed to share a letter that they signed on 1 June 2020 to then Minister, Clare Haughey, which articulated their understanding of the ask.

Next steps, including reporting arrangements

The Oversight Group are required to provide their first quarterly report to the Minister for Mental Wellbeing and Social Care at the end of this month (January), reporting on work undertaken to date including reassessment of progress on all recommendations. It will be sent directly to the Minister in the first instance but will then become a public report.

The Oversight Group have asked to meet the Minister in advance of submitting the report and will request that there is a pause in publication to allow TEP colleagues to discuss the report with their Chair and Council Leaders prior to it becoming public.

The content of the report will also include plans for moving forward to take assurance, and to reduce the gap in the assessment of progress by the next reporting period. This should be considered a milestone because it is the point when the next formal review of progress will take place and is also when the second quarterly report to the Minister is due.

There was discussion about whether the gap in assessment of progress could be closed further in advance of reporting to the Minister. It was acknowledged that the gap does need to be presented but the report will focus on the future and the clear commitment to address this.

The next phase of work will focus on specific areas or themes and may involve some recommendations being considered collectively, while others may be reviewed in smaller, focused groups. The Oversight Group agreed to revert to TEP colleagues in respect of taking a focused look at these areas.

Any other business

No further points for discussion were raised under AOB.

The Chair thanked attendees for their time and brought the meeting to a close.