Independent Oversight and Assurance Group on Tayside's Mental Health Services

Performance Work Plan

Recommendation 8

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

Context of Oversight Group assessment: The arrangements that are in place for public performance reporting, including the Tayside Executive Partners' assessment of the progress being made to "rebuild public trust" in the delivery of mental health and wellbeing services.

320. Tayside Executive Partners have reported a significant number of actions taken in response to this recommendation (13 in total), of which only two relate to public reporting of performance. There is reference to a range of committees, and regular officer and strategic planning meetings which are now in place, the latter of which includes some service user representation and at which there is a provision of progress updates on developments and activity.

321. There is also reference to the revision of the Integration Schemes and the activity of the Integration Joint Boards, including noting that the latter are public meetings and that papers are published 7-10 days in advance of meetings of Integration Joint Boards. There is performance reporting included in Integration Joint Board papers, albeit this is primarily the performance information that is already publicly available.

322. Conversely, Health Board meetings are held in public and the Performance and Resources Committee (like all Standing Committees) is public facing to the extent that agendas and minutes of the previous meeting are published on NHS Tayside's website in advance of a meeting, and on the morning of the meeting the papers for the meeting are published. Following each standing committee their minutes are presented to the public session of Tayside NHS Board along with a standing committee Chair's Assurance Report. It is our view that meetings simply being 'public facing' is not the same as using public performance reporting and good governance to engage the public with a view to establishing the level of public trust in services.

323. As evidence of progress, Tayside Executive Partners cite the 'extensive information and performance dashboards available to NHS Tayside staff' and the Oversight Group has seen the datasets that are produced for this purpose. That is a key issue. Other than the performance reports to the Health Board and Integration Joint Boards, and the annual infographic which contains 5 pieces of information, the position which appears to be taken by the Partners in Tayside is that these datasets cannot be shared publicly because they are for internal use only.

324. Dr Strang stated that improvement in this area is expected to 'rebuild public trust in the delivery of mental health and wellbeing services'. Tayside Executive Partners' response in their final submission contains very little reflection of this.

325. The nub of this recommendation is that public trust in services in Tayside can significantly be improved if there is accurate and transparent public reporting of performance. Tayside Executive Partners should consider collectively and for their own organisations, which of the available local management information datasets could and should be available to public scrutiny through committees and Integration Joint Boards as appropriate.

326. The Oversight Group considers that there is still some way to go in respect of public reporting of performance and therefore, RAG rate this recommendation Amber.

Recommendation 12

Conduct a national review of the assurance and scrutiny of mental health services across Scotland, including the powers of Healthcare Improvement Scotland and the Mental Welfare Commission for Scotland.

Context of Oversight Group assessment: That action for all of Scotland has been informed by a national review of assurance and scrutiny, and that this has taken into account the need to increase the powers of Healthcare Improvement Scotland and the Mental Welfare Commission. For completeness, we have also included the work of the Care Inspectorate within the scope of this recommendation.

327. The Independent Inquiry, in terms of Recommendation 12, catalogued the occasions where NHS Tayside and Integration Joint Boards had failed to implement the recommendations of successive inspections and reviews.

328. The Independent Inquiry also noted that there appeared to be no consequences for Boards if they publicly accept any such recommendations but do not proceed to implement them. This led the Inquiry to question whether the national oversight and scrutiny bodies should have stronger powers to monitor the results of their recommendations. This, therefore, was the backdrop to Recommendation 12 which placed a requirement on the Scottish Government to lead on this national recommendation.

329. It is clear from the meetings we have had with officials from the Scottish Government that whilst discussion had taken place with national scrutiny and inspection bodies, little progress had been made and what activity there was, lacked focus and pace. We appreciated the conversations we were able to have with officials and welcomed their candour and willingness to revisit their approach.

330. We have met with each of the scrutiny and inspection bodies. Notwithstanding lead responsibility for Recommendation 12 rests with Scottish Government, these bodies have a responsibility to respond to changing circumstances and emergent risks. We wanted to better understand how, individually and collectively, they had responded to the findings of the Independent Inquiry and the Progress Report of July 2021.

331. Once again, we have been mindful of the requirements which have been placed upon national bodies particularly Healthcare Improvement Scotland and the Care Inspectorate, in response to the pandemic. However, we were concerned that Tayside did not appear to feature more prominently in their respective work programmes. At the same time, there was a high level of prior knowledge and awareness of the difficulties being experienced in Tayside, but in terms of action to date, no real sense of what needs to happen next. We are aware of the work of the Sharing Intelligence Group and we have looked at annual review letters issued to Tayside. We did not consider these to be all that helpful, a view with have shared with the national bodies.

332. Colleagues have responded to our feedback and we welcome recent developments and their proposals for further action. The Scottish Government has advised in their final submission to the Oversight Group (Appendix 4) that a review of the scrutiny and assurance of mental health services has been commissioned and is due to report in February 2023. This should provide an independent and robust assessment on the extent to which current scrutiny and governance of mental health services is comprehensive and effective. The outcome of this work will inform support for improvement and any future changes to policy in relation to mental health scrutiny and assurance.

333. The Scottish Government has established the Mental Health and Learning Disability National Scrutiny and Assurance Coordination Group with membership coming from Mental Welfare Commission, Healthcare Improvement Scotland and Care Inspectorate. This group will provide a platform to share emerging themes and issues arising from their ongoing scrutiny activity. The Scottish Government will act as Secretariat and the group will be chaired by the Chief Executive of the Mental Welfare Commission. Work in mental health and learning disability services needs this level of focus. Whilst we may have expected this type of action to have been taken before now, it is nonetheless a positive development.

334. Scottish Government officials have set out the work they have commissioned Healthcare Improvement Scotland to develop and roll-out in respect of intelligence-led and risk-based inspections of mental health settings, with a focus on infection prevention and control. This will bring much needed parity between mental health and physical health settings, something we were concerned to learn was not in already place.

335. Finally, the Scottish Government has set out its intention to ensure that activity being taken forward is closely aligned to that which will be advanced in response to both the Scottish Mental Health Law Review and the recently established Social Care: Independent Review of Inspection, Scrutiny and Regulation. Again, this is to be welcomed.

336. What as yet remains unanswered, however, is the question posed by the Independent Inquiry - what happens when any Board accepts findings and recommendations but then does not implement them? This is something we continue to be asked in Tayside: it needs to be addressed in the forthcoming work that is now set out by the Scottish Government.

337. Whilst there have been issues regarding progress and pace in terms of implementing this recommendation, accepted by officials and the national scrutiny bodies, it is clear these matters have now been addressed, particularly in terms of next steps proposed. The Oversight Group has assessed this recommendation as 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.

Context of Oversight Group assessment: What the data-capture and analysis programmes is telling Tayside, in terms of community need and service requirements in the community mental health teams.

338. Tayside Executive Partners have provided the Oversight Group with a comprehensive dataset regarding need, demand, and response for community mental health services They have highlighted three examples where the data has been used to make changes to service provision to improve the care provided to patients, rejected referrals in Angus, a revised model of triage in Dundee, and work to validate and cleanse waiting lists in Perth and Kinross.

339. These are positive examples of how the use of data can improve service provision. It would be useful for the partnerships to consider how the good work in each of the three Health and Social Care Partnerships could and perhaps should also apply in the other two areas, to ensure a consistency of approach and experience for patients across Tayside.

340. Nevertheless, the recommendation has been actioned by Tayside Executive Partners and the Oversight Group RAG rate this Green.

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 and monitoring of services. This should be aligned to national reporting requirements.

Context of Oversight Group assessment: The need to demonstrate that there is comprehensive data capture in place.

341. Tayside Executive Partners have provided the Oversight Group with a comprehensive dataset which is sent out as monthly reports by the Business Unit at NHS Tayside, to respective parts of the Mental Health system. We have covered elsewhere, the need for Tayside to increase its use of data in respect of benchmarking and to inform decision making. For the purposes of this recommendation, however, data is clearly available and as such the Oversight Group RAG rate this recommendation as Green.