Mental Health Quality and Safety Board minutes: July 2021

Attendees and apologies

• Kevin Stewart, Chair, Minister for Mental Wellbeing and Social Care
• Aidan Reid, Policy Officer, Royal College of Psychiatrists
• Ruth Stocks, ACP-UK Director & Representative for Scotland, Association of Clinical Psychologists
• Amy Dalrymple, Policy Manager, Royal College of Nursing
• Ruth Glassborow, Director of Improvement Support and ihub, Healthcare Improvement Scotland
• Alison Thomson, Executive Director (Nursing) 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 Healt, Healthcare Improvement Scotland
• Gabrielle Coyle, Policy Officer, Health and Social Care Scotland
• Julie Lusk, Chief Social Work Officer and Head of Adult Services, Argyll and Bute Health and Social Care Partnership, Chief Social Work Officers
• 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
• Nicola Gillespie, Service Manager for Mental Health and Addictions, Argyll and Bute Health and Social Care Partnership, Chief Social Work Officers
• Martin McKay, Grampian Health Branch, UNISON
• Susan Grant, Chief Architect, NHS Services Scotland

Officials in support

• Gavin Gray, Deputy Director, Adult Mental Health
• Laura Farquhar, Head of Care, Quality and Standards Unit
• Ewan Patterson, Senior Policy Advisor, Standards and Assurance Team
• Stephen McLeod, Professional Advisor
• Cara Rosie-Cameron, Policy Manager, Standards and Assurance Team
• James Niven, Team Lead, Standards and Assurance Team
• Siobhan Mackay, Head of Workforce, Digital and Primary Care
• Clare Armstrong, Performance and Improvement Adviser
• Lynne Taylor, Mental Health Psychology Advisor
• Lawrence Jolley, Policy Officer, Standards and Assurance Team
• Alastair Cook, Principal Medical Officer
• Fiona Fraser, Principal Research Officer
• Lucy McDonald, Business Assistant, Care, Quality and Standards Unit
• Rachel Tatler, Policy Officer, Standards and Assurance Team
• Stephen McLeod, Professional Advisor: Mental Health and Social Care Directorate
• Kim Gallacher, Mental Health and Substance Use Policy Manager, Clinical Care Team

Apologies

• Eileen McKenna, Associate Director (Professional Practice), Royal College of Nursing
• Susan Aitkenhead, Director (Scotland) Royal College of Nursing
• Dr. Jane Cheeseman, General Adult Consultant Psychiatrist (IPCU) and Quality Improvement Lead for Lothian Mental Health, Royal College of Psychiatrists
• Julie Paterson, Chief Executive, Mental Welfare Commission
• Eleanor McCallum, Policy Manager, Health and Social Care Scotland
• Hannah Axon, Policy Manager, COSLA
• Fiona Davies, interim Chief Officer, Argyll and Bute health and social care partnership, NHS Chief Officers
• Carol Potter, NHS Fife Chief Executive NHS Chief Executives
• Linda Findlay, Chair, Royal College of Psychiatrists
• Willie Duffy, Secretary and Head of Bargaining for Health, UNISON

Items and actions

Welcome and introductions - Minister for Mental Wellbeing and Social Care

The Minister welcomed everyone to the meeting and members introduced themselves. He passed over to James Niven briefly to agree the minutes and progress against actions from the last meeting of the Board in March 2021. The Board signed off the minutes and actions.

The Minister noted that this is the first meeting of the Quality and Safety Board since he came into post as the Minister for Mental Wellbeing and Social Care and that he is looking forward to working with members. The Minister discussed the original remit of the Board arising as a result of the interim Strang report. He noted that the Transition and Recovery plan is central to the Board’s work and highlighted the need for the Board to work closely with service providers and users to improve the quality of mental health services in Scotland.

The Minister highlighted the need for care to be person-centred and to be underpinned by dignity, fairness and respect. He noted that he had met with multiple stakeholders, including those with lived experience, since coming into post. Through those discussions a number of issues emerged as priorities for him and of critical importance to improving mental health services.

The Minister introduced the three agenda items for discussion: lived experience of service users, workforce, and leadership and culture.

The Board was in general agreement that these three areas were key considerations for improving services. Some Board members noted the need to include the lived experience of unpaid carers and families of those with mental ill-health as stated in the Strang report.

Lived experience

The Minister spoke about how the Transition and Recovery plan committed the Board to embedding the voice of lived experience at the heart of its approach. He recalled his previous experience as Minister for Local Government and Planning, specifically regarding the homelessness portfolio, as an example of where centring lived experience made a significant positive impact on decisions made. The Minister also noted recognition by the World Health Organisation (WHO) of the National Suicide Prevention Leadership Group (NSPLG) as a good example of where including the voices of those with lived experience has a positive effect on policy decisions. He also spoke about the work already underway to establish a Lived Experience Panel to advise and inform mental health policy.

To start off the discussion, the Minister introduced three main questions to the Board:

• across mental health services, to what extent does the board see the voices of those with lived experience being listened to and acted on. How has the board engaged these voices in its work so far and where can we improve?
• how can we ensure that people with lived experience can shape services both at a local and national level in a way which is meaningful and not tokenistic?
• what practical steps can we take as a board to ensure voices of those with LE are central to our work?

A number of members supported the view that that there is a gap between policy and practice with regards to listening to service users. The complaints system was also highlighted as being too complex for service users to navigate, with work necessary to address how complaints are addressed by health boards.

Members representing clinical care groups noted that it is routine practice to bring the voice of their patients into their care plans. They also noted that a psychosocial approach to bringing the voices of those with lived experience into clinical care can help influence the wider systems of the healthcare environment.

The discussion moved to ensuring how the voices of lived experience can help shape services. There was general consensus that improving access to feedback would have a positive impact on centring those voices, however there was a need to provide resources to facilitate this. There was also a need to tailor lived experience engagement around the needs of the user, especially involving those whose voices have been less involved in discussions around person-centred care such as ethnic minority groups and LGBT+ service users.

This tied in with the third question around the practicalities of involving those with lived experience in the work of the Board. Members noted the need to properly resource and provide adequate time and (possibly) payment for people to be involved. They also highlighted the perceived power imbalance that occurs when service users meet with clinicians and officials and some practical steps to address this. One option discussed was to involve third sector organisations who already had well-established lived experience groups and that attending those meetings as a guest could give valuable insights.

The Minister thanked everyone for their views and discussion and introduced the next agenda item.

Workforce

The Minister introduced this agenda item, highlighting how our health and social care workforce are central to our efforts to improve mental health service delivery. He emphasised the need for the right workforce with the right skills in place at the right time. He also noted that the wellbeing of the workforce is crucially important in order to deliver the high standard of care we are aiming for. The Minister noted his alarm at hearing feedback from service users around the lack of empathy some had experienced while accessing care.

The two questions for discussion were:

• what workforce planning arrangements need to be in place – nationally and locally – to create the right capacity to deliver service improvements and give confidence to people receiving services?
• how do we ensure that the right infrastructure / culture is in place at a local level to foster strong collaboration and good wellbeing practices, building on significant national investment in this area?

There were several issues highlighted by the Board. First were problems around future resourcing, where health services were losing experienced staff to retirement at concerning rates, resulting in a high use of locum staff which can be detrimental to patient experience through a lack of consistency with their primary or secondary care contact.

The Minister was aware of workforce pressures and highlighted that it required work at all levels to combat, including the Scottish Government, health boards and IJBs.

The second issue was funding. Members highlighted that demand continues to be a challenge to meet, especially due to staffing numbers. Some members noted a need to look at what good care is and base resources on providing that level of care. They also noted that leadership needed to be flexible to respond to the possible increase in demand for mental health services as a result of the pandemic.

The Minister echoed their concerns and noted the difficulty in long term workforce planning under the constraints of a yearly budget. At the same time he highlighted that funding for mental health care is at its highest ever level. He was open to suggestions about how to include the views of front line staff in how funding is allocated to best help their work. The Minister also noted he would not shy away from making unpopular decisions where necessary and suggested a shift in focus to preventative care where possible.

The Minister thanked the Board for their discussion points and introduced the third agenda item.

Leadership and culture

The Minister opened the third agenda topic with a few areas for discussion:

• hearing the Board’s perspective on the reality of partnership arrangements in Scotland – what is working well and what are the challenges?
• different areas will be at different stages of reviewing and updating their Integration Schemes. Is there anything else that you think we can do to support this process and improve partnership working arrangements?
• how are local leaders ensuring their perspectives and experiences of service providers and services users are shaping their local plans? Is there anything more they should be doing?

Members representing IJBs noted engagement is ongoing with leadership and leadership structures to support services on the ground with an overall review of culture. They noted that for a more joined-up approach it was important to include social work colleagues in the discussion as well.

The Minister outlined the importance of identifying issues with leadership and the importance of staff feeling empowered to bring issues forward to leadership. The Minister was concerned to hear from members that some staff felt they couldn’t approach their managers about issues they were having. He highlighted the need for a collaborative approach in order to improve mental health services. He also noted that in services where there were well-known issues with working culture it was much more difficult to recruit, so progress was needed in this area in order to then address recruitment issues.

Some members spoke about their experience of working in health boards. Some noted that when issues arose, having leadership that lacked expertise in mental health care was a barrier to having problems addressed as staff had to spend a lot of time ground through the particulars of the problem before being able to address it.

Another issue highlighted by members was the lack of support for staff. The impact of the pandemic meant that staff who joined recently were exposed to workloads and situations in a short timespan that many more experienced staff saw over years in a career. This is leading to a high rate of burnout among staff because of a lack of space for staff to decompress. Members noted that some front line staff felt they aren’t being heard by managers and there was a gap between the staff and support being offered.

The Minister asked what the board thought could be done to plug the gap in the short term with a view to implementing more longer term solutions. Board members suggested that leadership needed to empower staff to say what they could and could not do and needed to plan for when staff were unable to meet the need.

The Minister concluded the discussion by summarising what he saw as the central aims of the board: reshaping services, changing attitudes and cultures, and driving quality and safety for service users.

Summary and next steps – Deputy Director Gavin Gray

Deputy Directory Gavin Gray gave a summary of the meeting. He noted several key areas of work:

• what can people expect from the quality standards and how can they help to address the gap between policy and practice?
• how to ensure that the voices of lived experience are captured and used to change services, and also understanding what pressures the front lines face?
• how can good practice be routinely learned from and how to ensure that governance fits the role required of it?

The Minister thanked the board for their time and contributions and closed the meeting.