Mental Health Quality and Safety Board minutes: March 2021

Attendees and apologies

Attendees:

• Clare Haughey, Chair, Minister for Mental Health 
• Hannah Axon, Policy Manager, COSLA (also representing for SOLACE’s interests)
• Dr Jane Cheeseman, General Adult Consultant Psychiatrist (IPCU) and Quality Improvement Lead for Lothian Mental Health, Royal College of Psychiatrists
• Ruth Stocks, ACP-UK Director and representative for Scotland, Association of Clinical Psychologists
• Ross Sanderson, Policy Officer, Royal College of Nursing
• Ruth Glassborow, Director of Improvement, 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
• Martin McKay, Secretary, Grampian Health Branch, UNISON
• Dr Munro Stewart, East Scotland Faculty Board Member, Royal College of General Practitioners (RCGP)
• Michelle Miller, Improvement Adviser and Portfolio Lead: Dementia and Mental Health, Healthcare Improvement Scotland
• Carol Potter, NHS Fife Chief Executive, representative for territorial NHS Board Chief Executives
• Julie Lusk, Chief Social Work Officer and Head of Adult Services, Argyll and Bute Health and Social Care Partnership, Chief Social Work Officers
• Alison White, Head of Adult Services and Chief Social Work Officer for Midlothian 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

Officials in support:

• Hugh McAloon, Deputy Director, Adult Mental Health
• Laura Farquhar, Head of Care, Quality and Standards Unit
• Alastair Cook, Principal Medical Officer
• Anne Armstrong, Mental Health Nursing Advisor
• Stephen McLeod, Professional Advisor
• Cara Rosie-Cameron, Policy Manager, Quality, Scrutiny and Assurance Team
• James Niven, Team Leader, Quality, Scrutiny and Assurance Team
• Siobhan Mackay, Head of Workforce, Digital and Primary Care
• Clare Armstrong, Performance and Improvement Adviser
• Lynne Taylor, Mental Health Psychology Advisor
• Michelle Miller, Improvement Adviser and Portfolio Lead: Dementia and Mental Health, Healthcare Improvement Scotland

Apologies:

• Willie Duffy, Secretary and Head of Bargaining for Health, UNISON
• Angie Woods, Chief Officer for Aberdeenshire Health and Social Care Partnership, representative for IJB Chief Officers

Items and actions

Welcome and introductions - Minister for Mental Health

The Minister welcomed everyone to the third meeting of the Quality and Safety Board. She apologised that restrictions still prevent the board from meeting in person and thanked the board for continuing their work virtually.

The Minister highlighted that today’s meeting would bring another opportunity to continue the important work of the board to ensure that it could better support high quality and safe services in the context of remobilisation, renewal of services and to support the transition and recovery from COVID-19.

She highlighted that the focus would be on the development of quality standards and benchmarking work, which are crucial drivers of improved quality and safety of mental health services and improved experiences of service users and their families and carers.

Developing Quality Standards. Laura Farquhar, James Niven and Cara Rosie-Cameron

Laura outlined the aims of the presentation and background to the quality standards. 

Laura recapped the aims discussed at the previous meeting. She highlighted that the standards are an essential action in the transition and recovery plan and that they will be a key mechanism to close the gap between policy and practice.

Laura recapped the previous feedback given from the Q+S board and highlight NHS mental health leads have fed back that national standards are essential. The standards more widely support clearer care pathways, communication transition of services and reduce unwanted variation.

Cara explained that draft top level aims of the standards have been developed based on the feedback from the Q+S board and discussions with professional advisors. She summarised the aims and reiterated that they were draft in nature and that input from the board was welcome in shaping them.

Laura elaborated on links between the standards work and other works-streams relating to the workforce.

Siobhan Mackay  provided a review of discussion with workforce leads.  An assessment of future workforce needs  is at scoping stage and will be looking at recruitment and retention in the challenges of the current environment. She and her team are keen to work with the Q and S Board on this going forward. 

Laura highlighted links to the Equalities and Human Rights Forum being set up in directorate. The ambition is to provide input on equalities, reduction in inequalities and rights impacts of work on transition and recovery plan.

Laura explained the scope of the standards. There was consensus that development of standards is a complex large task and therefore it makes sense to stage development of a suite of standards.

Secondary Adult Services is the largest service area and there is therefore potential for a large impact. A whole system approach will be taken to support communication, transition (between community and inpatient) and integration of services.  

Discussion

The board were largely in agreement with regards to the draft aims identified and saw them as a positive development.  In particular, members highlighted it was good to see reduction in equalities and sustainability mentioned. 

It was agreed that the standards should not add pressure to frontline staff and that there needs to be acknowledgment of workforce issues generally.

Members highlighted the importance of linking standards to existing Health and Social Care Standards. It was agreed that the Health and Social Care standards are helpful in framing language but that they can be difficult to gather information and report on. It was agreed that it is crucial we collect data on what is important to measure not on what is easy to measure. 

The issue of the mental health estate was raised and it was agreed that for standards to be met it needs to be fit for purpose.

It was agreed that the standards should be person-centred and that a PANEL (Participation, Accountability, Non-Discrimination and Equality, Empowerment and Legality) (approach, which is human rights based could be used to do this.  It was agreed that the aim of standards should be better mental health for people not better services and that language is key. There should be a shared approach where people take ownership of their care.

It was agreed that Mental Health Care is too big an area to develop standards across it all and that secondary adult services make sense as a starting place due to the urgent need for link between adult secondary inpatient and community services.

The critical role of social workers in keeping people safe in the community was agreed.  It was agreed that social workers need to be referenced specifically in the standards. 

The Minister thanked the board for an Interesting and useful discussion and invited them to take a quick comfort break.

Development process of the quality standards – Laura Farquhar, James Niven 

James outlined the process of developing the standards, highlighting that this will be split into two distinct stages. He gave detail on the scoping stage which will potentially include mapping, a rapid evidence review and engagement with experts.

James described the second stage and the potential of a pilot.  He described the importance of evaluating standards and the importance of not just focussing on services but on people’s outcomes. This data collection might be a large task. He stated that we are very keen that process is shaped by the board.

Laura explained that in light of feedback at the last Quality and Safety Board, we are looking for the standards to be co-produced. As such, we would be looking for stakeholders to be working in partnership to ensure all voices are heard. We would be looking for the process to have those with lived experience at its centre and include the voices of a range of mental health professionals and providers.

Discussion

Laura began a conversation about potential governance options using the key questions on the slide.

Members suggested looking to SIGN for scoping research as they are  well respected and robust. 

It was agreed that there are currently issues around where outcomes are recorded and that this can cause difficulty for professionals. It was agreed that professionals need the correct tools and infrastructure to gather data and that they should see the outcome of data they collect. 

It was greed that clinical data should be balanced with lived experience data. Members emphasised the need for experiential data directly from those using services. Examples were provided if current/past examples of this approach e.g. the patient climate tool and the “What Matters to You” Framework.

Board members were  encouraged to share knowledge work already been undertaken. 

Board members emphasised the need to take into account the journeys mental health staff are on when developing standards.

The Minister thanked members for the helpful and fruitful discussion.

Benchmarking update – Stephen McLeod

Stephen provided an overview of the benchmarking network and its purpose. He highlighted the importance of collecting meaningful data.

He gave a live example from the benchmarking network to illustrate the importance of undertaking benchmarking. It will improve our understanding of unwarranted variation, data helps us understand where gaps and priorities are and improvement is the third element. 

Stephen outlined the research findings for UK mental health services in response to the  COVID-19 pandemic. He highlighted that these are important as they allow comparisons between similar areas e.g. Tayside, only real comparable area is UK wide. 

Stephen highlighted that there will be an event on the 24th March which will launch the benchmarking UK wide on reporting a  limited data set. He highlighted that the network facilitates shared learning and place where different areas can ask questions of each other. 

Stephen presented several examples to illustrate the use of benchmarking data and illustrate the importance of understanding variation. 

The Minister thanked Stephen and invited questions from the group.

Discussion

Members were interested in the admissions trend on decreasing bed numbers and highlighted some of the potential implications for this. Safe occupancy is important, if we were at 100% occupancy then there are concerns regarding infection control in particular. It would be good to consider minimum standards in this context, such as nursing level per patient. NICE had been exploring this but it may have been stopped. 

Stephen responded acknowledging these comments and highlighted that express demand for population services is important. Stephen stressed that we have to consider a range of factors to understand what is desirable or not. 

Members highlighted the importance of the benchmarking network and would like to see other areas join this beyond Glasgow. 

Members highlighted the importance of admitting patients to the right setting, not just a bed. We need to balance the number of beds with the right care in the community, so people have the best outcomes. People who require beds are often the most vulnerable. 

AOCB and closing remarks – Minister for Mental Health

The Minister provided a summary of the key points discussed and actions that would be taken forward. Board members were thanked for their attendance. 

The Minister let board members know that the next meeting would be held after the Scottish Parliamentary Elections in May. 

Summary of actions:

• explore evidence review with SIGN - James and Cara
• discussion on separate outcomes data work stream - James, Laura and Stephen
• Irene to share details of What Matters to You review with Scottish Government to support scoping exercise - Irene Oldfather
• review Health and Social Care Standards and Links - Cara Rosie-Cameron
• check if NICE have been exploring minimum standards in context of infection control - Cara Rosie-Cameron