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

Independent Oversight and Assurance Group - Our Approach

10. Independent Oversight and Assurance Groups are by their very nature an exception: they are not a routine part of Scotland's governance landscape, nor should they be. From the outset we were clear that our role should be time limited and that we should not become part of the governance landscape in Tayside.

11. Our remit has been to provide assurance on the progress made by Tayside Executive Partners in implementing the recommendations from Trust and Respect and in doing so, to provide advice and support to the Tayside Executive Partners. It is not our role to undertake an inspection or audit, although our work has required us to make assessments on progress and arrive at judgements on prospects for future improvement.

12. We wanted to have a sound understanding of the operating environment within Tayside and the issues they face. We have valued spending time with colleagues who work in mental health and learning disability services, in both community and hospital settings, and we are grateful to them for their time, insight and candour.

13. Importantly, we have heard from people with lived experience of mental health services in Tayside. We have met regularly with the Stakeholder Participation Group which was brought together through the Independent Inquiry. We say much more about this group and the role it plays elsewhere in this report. For now, we would simply record our thanks to them: they have been our regular sounding board; their stories will stay with us; and our work has been the better for their support and challenge.

14. Since pandemic restrictions eased in the Spring of 2022, we have engaged widely with community and third sector organisations across Tayside. We have been so impressed by the organisations who serve local communities across the region. Many have come together through bereavement and grief, which they are still experiencing, and yet they devote their time to supporting others and creating hope. The groups we have met with have demonstrated empathy, kindness, creativity and great resourcefulness. Importantly, the work they do provides the very cornerstone for support in the community, early intervention and prevention, and shifting the balance of care. Appendix 2 to this report references the groups with whom we have engaged.

15. We have talked to many others with lived experience and despite us having no powers to investigate, to take evidence or become involved in individual cases, a significant number of people, including former employees in mental health, have sought us out. We have met with everyone who asked to meet with us: our purpose has been to listen to their stories and their experience, which in turn, could point to wider lessons which would inform our work.

16. We have met with the Chair of the Health Board and the Chairs and Vice-Chairs of the Integration Joint Boards. We have observed meetings of the Health Board and its relevant Standing Committees and attended meetings of the Angus, Dundee and Perth and Kinross Integration Joint Boards. We are grateful to colleagues for facilitating this and for welcoming us to their meetings.

17. We have met with parliamentarians and made ourselves available to them, following publication of our Quarterly Reports. We wanted to ensure they were aware of our work, and we have also found it helpful to better understand what matters most to them and their constituents.

18. In short, we have talked to many people, but we have listened even more. What we have heard has continued to inform our approach and helped us reach the judgments we have made.

19. From the outset we identified three clear tasks:

• Undertake a reassessment of the 51 recommendations from Trust and Respect, given one of the key findings from the Progress Report was concern over the credibility of Tayside's own assessment.
• Address any additional recommendations arising from Dr Strang's Progress Report.
• Give attention to Living Life Well, the new Mental Health and Wellbeing Strategy For Tayside published in February 2021.

20. Our approach has been designed to be both supportive and challenging. Throughout our engagement in Tayside, we have sought to be a helpful presence.

21. We asked Tayside Executive Partners in November 2021 to provide realistic updates on all 49 recommendations for Tayside and we made the same request to the Scottish Government in respect of the 2 recommendations for all of Scotland.

22. Tayside Executive Partners and the Scottish Government had, since the development of the Listen Learn Change Action Plan, adopted a Red, Amber, Green (RAG) rating system to assess and report on progress. The use of this system, and the interpretation of the ratings, has changed over time, a point highlighted in Dr Strang's Progress Report. This has made direct comparisons over time difficult to make and progress harder to track. We therefore issued our own RAG status definitions for use by Tayside Executive Partners, and these also apply in respect of this report:

Green – actions are complete and the intended outcomes have been achieved or actions are on track and the intended outcomes are very likely to be achieved in the timescales required.

Amber – actions are marked as complete, but have not achieved the intended outcome – additional action required or actions are underway but are unlikely to achieve the outcomes in the timescales required – additional action required

Red – actions are not now considered sufficient to achieve the intended outcomes or actions are not underway and / or not on track and urgent remedial action is required to achieve the intended outcomes

23. In our first Quarterly Report we reported the outcome of Tayside Executive Partners' assessment of progress in January 2022 alongside our own independent assessment. It is fair to say we had some way to go to reach a shared view on progress. Tayside had 28 recommendations rated as Green and 21 as Amber. Our independent assessment had 9 recommendations rated as Green, 38 as Amber and 2 as Amber/Red. We rated both recommendations for the Scottish Government as Amber.

24. Having established a baseline and a solid foundation for the work ahead, we wanted to develop a deeper understanding of those areas where we were apart from Tayside in our respective assessments. We identified four priority areas and published the themed work plans we would undertake. The four priority work plans were:

• Health and Social Care Integration
• Patient Safety
• Culture and Engagement
• Workforce.

25. Tayside Executive Partners appointed a senior sponsor for each area of work, and we are grateful to the Executive Director of Nursing and the Chief Officers of Angus, Dundee and Perth and Kinross Integration Joint Boards respectively, for their leadership and for the way we have been able to work together.

26. In addition to these primary work plans, our work also considered progress against recommendations relating to children and young people, performance and governance.

27. For each work plan we set out what we needed to better understand and the evidence we wanted to see in support of improvement. We prepared question sets and spent time with teams in both hospital and community settings across Tayside. We also met with partners, including from the third sector and other stakeholders. Upon conclusion of each work plan, we issued a final question set on any remaining issues, setting out what we needed to see from Tayside in their final submission.

28. This, our Final Report, is based on what we have learned from our work with Tayside and from the final submission from Tayside Executive Partners to the Oversight Group.

29. We asked Tayside Executive Partners to provide current and realistic assessments of progress across the 49 recommendations for Tayside, as well as an assessment of the commitment and capacity for change and continuous improvement. We also asked the Tayside Executive Partners to provide a collective assessment of their own delivery as a leadership group against their Joint Statement of Intent and their Collective Leadership Promise, contained within Living Life Well.

30. In this report we set out what we have learned from our work with Tayside, our findings and our assessment against each of the 51 recommendations. We are also publishing Tayside's own assessment of progress and leadership, including the further action they propose. This is included in Appendix 3 to this report.

31. The remainder of this report sets out our findings and conclusions under each of the work plan headings.