Perinatal and Infant Mental Health Programme Board minutes: 26 September 2019

Attendees and apologies

Author

• Catriona Johnson

Present

• Roch Cantwell, Lead Clinician Perinatal Mental Health Managed Clinical Network, National Services Division (NSD)
• Ruth Christie, Head of Perinatal and Early Years Mental Health Team, Scottish Government
• Jemma Davis, Perinatal and Early Years Mental Health Team, Scottish Government
• Maria Docherty, Executive Director, Nursing, Midwifery and Allied Healthcare Professionals
• Judy Thomson, Director of Psychology, NHS Education for Scotland
• Aman Durrani, Consultant Perinatal Psychiatrist, Royal College of Psychiatrists
• Fiona Fraser, Consultant Clinical Psychologist, Perinatal Mental Health Services Glasgow City Health and Social Care Partnership
• Lesley Jackson, Lead Clinician, National Neonatal Network, NSD
• Catriona Johnson, Programme Associate Director, NSD
• Jeff Ace, Chief Executive, NHS Dumfries and Galloway
• Mary Ross-Davies, Director, Royal College of Midwives
• Hugh Masters,Chair, Scottish Government
• Rebecca Macpherson, Perinatal and Early Years Mental Health Team, Scottish Government
• Carolyn Wilson, Lead Policy officer, Family Nurse Partnership, Scottish Government
• Sally Ann Kelly, Chief Executive, Aberlour
• Lauren Kennedy, Lead Nurse for Mental Health & Learning Disabilities, Mental Health Nurse Leads Scotland
• Sally Amor, Child Health Commissioner & North of Scotland representative, NHS Highland
• Phil Raines, Head of Children and Young People’s Mental Health Delivery Unit, Scottish Government
• Marie-Claire Shankland, Programme Director, NHS Education for Scotland
• Helen Sloan, Chair Maternal Mental Health Scotland, Maternal Mental Health Scotland
• Clare Thompson, Change Agent, Maternal Mental Health Scotland
• Neil Guy,  Children and Young People’s Mental Health Enhanced Services Team Lead, Scottish Government

Apologies

• Jackie Kerr, Assistant Chief Officer for Adult Services, Health and Social Care Partnership
• Anne McFadyen, Infant Mental Health Lead, Perinatal Mental Health Managed Clinical Network NSD

Items and actions

Welcome, apologies and introductions

Hugh Masters (Chair) welcomed everyone to the fourth Perinatal and Infant Mental Health (PNIMH) Programme Board (PB) meeting.

Apologies were noted as above for the purpose of the minutes.

Minutes of previous meeting and matters arising

The minutes of the previous meeting (2 July 2019) were agreed as an accurate record of the meeting. The Chair reviewed the actions and updated the group, noting that many of the items would be discussed during the meeting. The group was also referred to the Chair’s update which was circulated with the meeting papers for information.

Delivery plan and funding 2019/2020

The Chair updated the group on implementation progress since the final version of the PNIMH delivery plan was sent to all members on 29th August, in line with the launch by the Cabinet Secretary. He outlined plans to distribute £1M funding in 2019/2020 to specific priorities within the initial delivery plan i.e.  to bring staffing in MBUs up to levels recommended in the Needs Assessment Report (NAR); funding for existing third sector services to enhance community support; developing plans for services in the North of Scotland. The ensuing discussion focused on clarification and assurance around process and sustainability.

It was confirmed that a 2020/2021 delivery plan would be produced. It was anticipated this would take the form of an update to the 2019/2020 document rather than a completely new plan. When drafted, the updated plan and funding proposals would be presented to the Programme Board in advance of the 2020/2021 financial year.

It was hoped funds would be issued before the beginning of the fourth quarter of the current financial year. It was expected that funds would be issued in line with existing funding flows and therefore that they should be spent in year.

A number of concerns were raised, including that organisations would be challenged to spend initial funds in year; reluctance by boards to appoint to permanent posts and that Boards might disinvest from third sector to fund their own workforce. The Chair noted awareness of these issues and committed to record them and progress them. The Chair also confirmed that work was under way with boards and other structures, including IJBs, to define the detail of mechanisms for accessing and distributing the funds, aligning with existing local implementation teams and ensuring sustainability of posts and services beyond the lifetime of the PNIMH- PB.

It was agreed that third Sector organisations should be treated as equal partners in terms of how quickly funds would be distributed.

It was noted that the model for improving access to MBUs for women in the North of Scotland was yet to be agreed. NHS Highland were liaising with the Perinatal Mental Health Network to explore how the available funding should be best utilised and wanted to ensure the model took into account the views of women with lived experience. A meeting was to be scheduled between the North of Scotland and the PNIMH PB Core Team to facilitate discussions.

Action: LM to arrange a meeting between NoS representatives and PNIMH-Working group members to discuss plans.

Programme for Government (PfG)

It was noted that the current PfG built on the vision for transforming mental health services for children and young people set out the previous year. It focused on bridging the gap between specialist and general services, enhancing crisis support and adult services and implementing the recommendations from the CYP MH Task Force.

Action: Scottish Government to circulate the minute of the Children and Young People’s Programme Board.

Ruth went on to outline that the PfG committed to delivering improvement in four areas relating to perinatal MH; 3rd sector support; increased staffing in MBUs; community services (details around this require development); Infant Mental Health (IMH) and developing an IMH Hub. The role of the Programme Board was to determine how the developments should be delivered

Infant mental health

Hugh noted that following publication of the PfG and the Task Force recommendations

the parameters for the three to five year group remained unclear.  The CYPMH- PB that had replaced the Task Force had agreed a prioritised programme of work (nine actions). It was confirmed that the £3M committed to IMH for 2020/2021 and £90,000 for 2019/2020 would be met from the £52M investment announced in March 2019.

The group expressed a range of opinions in relation to what might be considered an appropriate IMH age range and emphasised the need for the PB to ascertain the implications of considering infant mental health beyond the context of perinatal care. It was noted that Anne McFadyen had established an IMH PB sub group which was scheduled to meet for the first time on 14 October. It would take the form of a “Meeting Zero” to share and explore ideas and requirements and the Chair confirmed that while ultimately the decision on scope would lie with the Minister the PB was mandated to make recommendations.

The group raised a number of points for consideration, including the need to “get it right for every infant in order to get it right for every child” (GIRFEC) and were in general, not in favour of including three to five year olds in the PB remit. Roch Cantwell highlighted that there was a scientific basis for the scope of the current service being dedicated to the 1001 days plus parenting/relationships.

Hugh explained that further to the publication of the PfG and Task Force recommendations it had been necessary to rapidly design a model of IMH service delivery and invited Roch Cantwell to introduce the IMH paper, circulated with the meeting papers, which set out the evidence base and a proposed model for IMH. The group discussed the paper briefly and acknowledged that the sub group would need to consider where the recommended model would fit with what was emerging from the CYP MH Task Force.

The Chair asked the PB to submit comments on the paper to inform discussions with policy colleagues and the IMH sub group meeting on 14 October. These outputs would inform a recommended position which would be shared with PB members in advance of the next PB meeting. This would provide clarity on which groups were doing what

Action: PB to submit comments to Anne McFadyen.

Equality Impact Assessment

Rebecca MacPherson presented her work on the EQIA to date, outlining the questions that still needed answered and how this work would be continued during the lifespan of the programme.

To date the focus had been on evidence gathering from literature and Rebecca highlighted that she would be looking for recommendations from the PB on which groups she should be engaging with.

Key messages:

• barriers to accessing antenatal care
• potentially at risk groups – e.g. gypsy/travellers
• common themes

The proposed approach for consulting with stakeholders was to ask a series of questions in a series of small group meetings rather than a large workshop.

Rebecca asked the group to consider which are the right stakeholder groups and if the questions she had chosen were the right ones.

Action – Rebecca to circulate the presentation and questions. PB to feed back their views to Rebecca

Catriona suggested that Rebecca contact Health Scotland’s Pregnancy Screening / Ready Steady Baby Teams to seek their advice

Mother and Baby Unit (MBU) family fund

Lesley Metcalf outlined plans for the establishment of an expenses fund to support families of women receiving specialist in patient care in MBUs. She provided background and the rationale for the initial draft proposal circulated with the meeting papers and directed the group to the key questions within the cover sheet. The answers to these questions would inform further work to refine the proposal and discussions with Boards in anticipation of establishing the fund from April 2020.

It was noted that that although the paper indicated a much shorter average length of stay compared to neonatal admissions the findings of a recent review of the Neonatal Unit fund and an evaluation of the Social Work Emergency Fund would provide useful information about what works and what does not.

Assurance was given that the system would avoid any potential detrimental impact to families on benefits.

Action – PB to send comments on the paper and Lesley to bring a revised draft to the next meeting.

Data work update

Roch Cantwell shared work under way by the PNMHN to identify and track all women admitted to general adult psychiatry wards within one year of giving birth, with a view to then undertaking more detailed work to ascertain why they were not referred/ admitted to an MBU. The aim was to achieve a comprehensive understanding of access and quality of care.

The Chair demonstrated work that had already begun within the programme to develop a data catalogue – using exist data sets that will capture the picture of what happens and whether the PB is making a difference. Available data included demographic and third sector pertinent to MH.

Action: Issue the latest version of the catalogue in advance of next PB.

PNIMH-WG update                 

Hugh invited the group to note the written update and terms of reference for the working group and advised that any queries or comments on the terms of reference (ToR) should be sent to Lesley Metcalf.

Action: PB to submit any comments on the Working Group ToR to Lesley

Date and time of next meeting

Date of the next meeting is Wednesday 4 December, 14:00 to 15:30, Apex Hotel, Grassmarket, Edinburgh. Please note this is a change to the date previously circulated and an updated calendar invite has been issued.

Programme board members are asked to note that the final evaluability assessment session will take place in the same venue in the morning of 4 December, 10:00 to 13:00. Programme Board members are welcome to attend. Lunch will be provided.