Mental Health Quality and Safety Board minutes: December 2021

Attendees and apologies

Attendees

• Kevin Stewart, MSP, Meeting Chair, Minister for Mental Wellbeing and Social Care
• Dr. Jane Morris, Vice Chair, Royal College of Psychiatrists
• Ruth Stocks, ACP-UK Director & Representative for Scotland, Association of Clinical Psychologists
• Ruth Glassborow, Director of Improvement Support and ihub, Healthcare Improvement Scotland
• Julie Paterson, Chief Executive, Mental Welfare Commission
• Irene Oldfather, Director of Strategy and Engagement Health and Social Care Alliance
• Gordon Johnston, lived experience representative, VOX
• Alan White, Interim Head of Profession for Occupational Therapy, NHS Fife, Allied Health Professionals Federation, Scotland
• Dr Munro Stewart, East Scotland Faculty Board Member, Royal College of General Practitioners (RCGP)
• Michelle Miller, Improvement Adviser and Portfolio Lead: Dementia & Mental Health Healthcare Improvement Scotland
• Karen Martin, Mental Health Co-ordinator, Carer’s Trust
• Mark Richards, Director of Nursing and AHPs; Deputy CEO, The State Hospitals Board for Scotland, Scottish Executive Nurse Directors
• Martin McKay, Grampian Health Branch UNISON
• Stuart Russell, Head of Architecture & Design, NHS Services Scotland
• Craig Collins, Principal Information Analyst, Public Health Scotland
• Samantha McEwan, Principal Educator Mental Health, Learning Disabilities and Dementia, NHS Education for Scotland
• Haylis Smith, Suicide Prevention Lead Officer, COSLA
• Fiona Davies, interim Chief Officer, Argyll and Bute health and social care partnership, NHS Chief Executives Officials In Support
• Gavin Gray, Deputy Director, Adult Mental Health
• Alastair Cook, Principal Medical Officer
• Ewan Patterson, Senior Policy Advisor, Standards and Assurance Team
• Catherine Totten, Professional Advisor, Mental Health and Social Care Directorate
• Cara Rosie-Cameron, Policy Manager, Standards and Assurance Team
• James Niven, Team Lead, Standards and Assurance Team
• Julie Lusk, Professional Advisor, Mental Health and Social Care Directorate
• Sarah Martin Statistician, Performance, Remobilisation and Renewal Unit
• Stephanie Cymber, Senior Policy Advisor, Clinical Care Team
• Lawrence Jolley, Policy Officer, Standards and Assurance Team
• Alpana Mair, Head of Effective Prescribing and Therapeutics Division
• Lucy McDonald, Business Assistant, Care, Quality and Standards Unit
• Rachel Tatler Policy Officer, Standards and Assurance Team
• Lynne Taylor Psychology Advisor, Performance, Remobilisation and Renewal Unit
• Luska Jerdin, Head of Mental Health Performance and Improvement
• Stephen McLeod, Professional Advisor, Mental Health and Social Care Directorate
• Rebecca Dey, Policy Officer, Clinical Care Team

Apologies

• Hannah Axon, Policy Manager, COSLA
• Carol Potter, NHS Fife Chief Executive, NHS Chief Executives

Items and actions

Opening remarks and introductions

Minister for Mental Wellbeing and Social Care welcomed returning members to the meeting as well as new members, Public Health Scotland (PHS) and NHS Education for Scotland (NES) to the Quality and Safety Board. The Minister recapped on the discussion from the previous meeting around the themes of lived experience, workforce and leadership and culture. He highlighted the importance of the meeting’s discussions around the development of quality standards and work to improve scrutiny and assurance and the key role the board would play in this work moving forward.

Revised terms of reference for the board

Ewan Patterson (EP) highlighted minor changes to the Terms of Reference for the board, following an internal review of governance groups and ensure that the board has a well-defined focus moving forward. These included:

• adding PHS and NES as members of the group
• removing themes around “Data and Evidence” and “Improvement” from the TOR as these are encapsulated by other themes and the work of the board more generally
• adding a theme relating to the development of quality standards

Members suggested some minor amendments, including:

• inclusion of carers replacement costs to be included under expenses

Members approved the new Terms of Reference of the board.

Development of quality standards

The Minister introduced James Niven (JN) and Cara Rosie-Cameron (CRC) to discuss the development of quality standards.

JN introduced the Scottish Government professional advisors, Alastair Cook and Catherine Totten, who are assisting with this work. He highlighted that the Mental Health Transition and Recovery Plan commits the Scottish Government to developing a set of quality standards for adult secondary mental health services. There are currently no measurable national standards, establishing these will allow for more effective scrutiny and will help to address unwanted variation in the quality of services.

CRC highlighted that the focus of the standards work would be on adult secondary mental health services, as advised by the board at a previous meeting. This work will be taken forward by a newly created short life working group. A timeline was shared of the main milestones of the quality standards work, including engagement with the board. CRC then discussed the work to develop a set of overarching principles that will inform the standards development, that would link the suite of standards across mental health to ensure a joined-up approach.

Finally, Rachel Tatler (RT) discussed the anti-ligature work that has commenced under the standards umbrella. She highlighted that the quality of mental health estates was variable and often poorer than the quality of estates found in physical health settings. She noted the policy work was at a very early stage, but outlined the proposed work, including commissioning an assessment of the clinical environment in terms of anti-ligature compliance and develop of an assessment tool. The aims of this work would be to develop a consistent approach to assess all mental health facilities across the estate and record the data in Estates and Asset Management System and ISD databases to enable a joined-up approach.

The meeting was then opened up to discussion around three questions:

• is there anything the board can bring to drive development of the standards?
• do board members foresee any challenges with the proposed plan?
• do board members have any feedback on the proposed timescales?

Board members positively noted the anti-ligature work and standards. Many members of the board noted that they were keen to support work and commence it as soon as possible.

The ambitious timescales around the standards were noted and the need for adequate resourcing and project management to deliver this were highlighted. Minister recognised this and stated that membership is well placed to deliver this, as well as the importance of getting standards in place quickly to address this gap.

The importance of lived experience in the development of the standards was recognised as central. The Minister reflected this and the key aspiration of the standards about enabling people to understand what they can expect and to develop accountability.

A joined up approach to other related areas of work was noted as essential. The development of a suite of standards was welcomed but the importance of the set of principles in linking different areas was seen as crucial. The Scottish approach to service design was mentioned as a means of addressing this.

It was also noted by board members that the creation of standards was just the beginning and that building services and having an appropriate workforce to meet those standards will take time and necessitates an incremental approach, with appropriate support given to areas that need it. Appropriate funding, staffing and beds is also needed to ensure that the workforce are able to deliver the new standards, as well as a consideration of sustainable healthcare in the context of the climate and ecological crisis. 

The importance of families being listened to should be part of the standards as in Tayside this led to some issues due to misinterpretation of data protection policies.

The Minister noted the importance of ambition and ownership and that the standards would help future decision-making and funding allocation by developing a better understanding of quality issues in the system.

Scrutiny and assurance

The Minister introduced JN and EP to discuss the work to improve scrutiny and assurance.

JN highlighted that this work would look to improve scrutiny and assurance at both a local and national level. At the local level, the aim of the work will be to strengthen local governance, leadership and accountability, to allow for good governance practice to be shared and for meaningful data to be collected to identify common issues and themes. At the national level, the work aims to ensure that external scrutiny bodies undertake regular inspections and visits and are able to follow-up on findings, and intelligence is shared so that early warnings are communicated. There was an awareness that the work will be complex, take time to implement and the need for a joined up approach with ongoing work in relation to the National Care Service (NCS) and Mental Health Law (Scott) Review.

EP gave more detail on the 3 step approach to the scrutiny and assurance work: development of quality standards, strengthening local governance and strengthening external scrutiny.

Under the local governance work, EP highlighted the collection and analysis of local governance arrangements to provide an understanding of what local governance exists, how it varies across Scotland and how it compares to guidance. Secondly, work to collect and analyse local ‘quality related’ data through an evidence template, to identify common themes and issues and form the basis for follow-up improvement conversations with Health Boards regarding service quality.

In relation to external scrutiny, EP highlighted the commissioning of a literature review, compiling evidence of best practice found locally, nationally, and internationally. He also noted work with HIS to establish routine tailored inspections of mental health settings, with an initial focus on infection prevention and control. Lastly, a final report with recommendations for changes to local and national scrutiny and assurance, informed by the findings from other work strands.

EP shared a proposed timeline for this work and the meeting was opened up discussion around three questions:

• do board members see any gaps in the proposed approach?
• do board members foresee any challenges with the proposed approach?
• is there anything the board can bring to drive the scrutiny and assurance work?

Simplicity was highlighted as crucial in governance and the perceived aim to streamline where possible to create more effective and clear accountability. The importance of this point was reflected by the Minister.

The importance of patient outcomes was seen as critical in ensuring the data we collect is meaningful. The board emphasised the importance of including the experience of carers and family within the data collection, not just patients. Lastly, members highlighted the need for clarity on what data was being collected and why and to not just to collect what was easy. The Minister highlighted the importance of streamlining data whilst addressing gaps, and the importance of the work in highlighting this.

The importance of access to services was highlighted by members and the Minister. There will be an opportunity through the creation of the NCS to improve access which lived experience will be part of. The board highlighted that while information about complaints, incidents, and delays are important data points, it was also important to compile information on good outcomes and performance as part of the evidence template. This was underpinned by a general agreement of the board that the process should be collaborative and positive, enabling staff to feel understood, supported and empowered to ask for resources where needed.

The importance of independent scrutiny was highlighted and praise was given around the use of an international evidence review to inform this. This independent scrutiny is essential to drive progress.

Quality prescribing advice

The Minister then introduced Alpana Mair (AM) to discuss the work in relation to quality prescribing work. Her presentation highlighted recommendations from the short life working group (SLWG) on prescription medication dependence and withdrawal. Among the recommendations were:

• the need to make data available for all prescribers, health and social care partnerships, and patients to allow monitoring of data and improvement in practice
• the development/renewal of quality prescribing guides for all classes of drugs covered by the SLWG
• work with NHS Inform and NHS 24 to develop online guides and resources to support patients suffering from withdrawal and make them available to patients and clinicians through the polypharmacy app
• develop decision aids for medicines covered by the SLWG, involving people with lived experience in their development
• the promotion of SLWG recommendation for further research

The board noted the positive benefit of empowering people with information, especially patients, to enable them to make informed decisions about their own care. There were some concerns about the way certain medications were labelled “antidepressants” when those drugs are also prescribed for conditions other than depression, while other drugs not called antidepressants are used to treat depression. They also noted interest in a sub analysis of this, if possible.

Close and next steps

The Minister thanked the board for their time and invited JN to recap and highlight next steps.

JN reiterated the need for the work discussed to be linked in with ongoing work including the NCS and Scott Review, as well as the importance of simplicity. He also reinforced the board’s position that lived experience and carers voices are of central importance to the work being carried out and that balanced and realistic standards and expectations would inform the work being carried out. 

JN highlighted that a work plan will be circulated to the board for future meetings and will ensure that all slides and papers are circulated to board members in advance of meetings. He closed with assurances that the board Secretariat will be in touch with dates for the next meeting.