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

Key Messages

Over the last 12 months the Independent Oversight and Assurance Group has met with a wide range of staff, third sector and community groups, patients, and families. We are grateful to all of them for their time, commitment and insight.

Our job has been to provide assurance to the Minister for Mental Wellbeing and Social Care on the progress being made by Tayside Executive Partners and the Scottish Government against the 51 recommendations made by Dr David Strang in the Trust and Respect report. The establishment of the Oversight Group, in October 2021, followed Dr Strang's progress report which was published in June 2021.

Progress has undoubtedly been made by Tayside Executive Partners in some important areas and in very difficult circumstances. We recognise the significant changes in leadership across mental health and learning disability services in Tayside since Trust and Respect was published in February 2020. We have seen that the Integrated Leadership Group, in particular, is working well together and is committed to taking forward the change agenda positively.

In addition, we welcome the significant progress made in providing more clarity around roles and responsibilities for mental health and learning disability services in Tayside, a key feature of the original Trust and Respect report. The 3 Integration Schemes have been reviewed and revised, and it is now absolutely clear where responsibility lies for the strategic planning of mental health services. Importantly, we have been impressed by the early action from the Perth and Kinross Chief Officer in fulfilment of her strategic planning role for mental health, working alongside her counterparts in the other Integration Joint Boards and NHS Tayside.

Commendable progress has also been made in respect of the approach to Significant Adverse Event Reviews and crucial areas of patient safety, including de-escalation, Distress Brief Intervention and the introduction of a new Observation Protocol.

At the same time, there are some areas where progress has been less good. For example, some important areas relating to the workforce still have a long way to go, including strategic planning, staff appraisal and exit interviews.

There is also an urgent need to improve some aspects of governance and public performance reporting, as a means of developing a more open and transparent culture and building trust among the communities of Tayside.

The final submission we received from the Tayside Executive Partners signals a welcome shift in tone in some places, with evidence of more self-reflection and self-awareness. The main submission acknowledges the problems that have existed, and there are some important areas where the partners have reflected on progress and changed their RAG assessments from Green to Amber. This is particularly the case for recommendations 1-4, which are central to issues of culture and engagement and underpin much of the improvement required across the 51 recommendations. That said, there are other areas where we continue to be apart in our assessments of progress. In total, Tayside Executive Partners have reported 33 Green, and 16 Amber. We have rated 20 Green, 29 Amber and 2 Red. The Scottish Government has reported a RAG rating of Amber for Recommendation 12 and Green for Recommendation 32. The Oversight Group has rated both of recommendations as Amber. Appendix 1 to this report details the final RAG rating assessment in full.

The Tayside Executive Partners were not able to provide evidence of plans to respond to the three specific recommendations we raised with them at out meeting in May and which subsequently appeared in our Second Quarterly Report, published in June 2022.

We believe that Tayside Executive Partners now have an opportunity to move beyond the 51 recommendations made in the Trust and Respect report, almost three years ago. While some good progress has been made, there remains a lot to do. The key task now is to ensure that there is a clear, prioritised plan for delivery of Living Life Well, supported by a robust financial and resourcing framework.

The increased clarity provided by the new integration schemes will help with this, with strategic planning responsibilities resting clearly with Perth and Kinross Integration Joint Board.

In this context, we have discussed many times the continuing role of Tayside Executive Partners in relation to mental health services in Tayside. We are in complete agreement with colleagues in Tayside that Tayside Executive Partners do not have a formal governance role. We believe there is a need for Tayside Executive Partners to continue to provide collaborative leadership across Tayside, to ensure that staff working across organisational boundaries have the support they need to make the improvements required.

This must include a clear articulation of how the culture across mental health and learning disability services in Tayside needs to shift, again supported by effective collective leadership by the Tayside Executive Partners. Openness, transparency and meaningful engagement with patients, families, partners and communities will be central to this.

Finally, we have heard many times from people across Tayside that they have been here before. People - staff, patients, families, and partners - are concerned about what's going to happen next. It is incumbent on the Tayside Executive Partners, working within and across their respective organisations, to work closely with the Scottish Government to ensure that momentum for change is sustained.