Perinatal and Infant Mental Health Programme Board minutes: 30 April 2019

Attendees and apologies

Confirmed attendees

• Mr Hugh Masters, (Chair)
• Ms Clare Thompson, Maternal Mental Health Scotland Change Agent
• Ms Kirstie Campbell, Scottish Government, Best Start Delivery Group (Deputising for Ms Ann Holmes)
• Ms Tracy Coyle, Mental Health Nurse Lead
• Ms Marie-Claire Shankland, National Education for Scotland (NES) (Deputising for Ms Judy Thomson)
• Ms Ruth Christie, Scottish Government Mental Health Improvement
• Dr Roch Cantwell, Lead Clinician, Perinatal Managed Clinical Network
• Dr Mary Ross-Davie, Director, Royal College of Midwives Scotland
• Dr Aman Durrani, Perinatal Psychiatrist, Royal College of Psychiatrist
• Ms Faith Francis, National Services Scotland (Minutes)
• Ms Sally Ann Kelly, Chief Executive Aberlour Child Care Trust
• Ms Jacqueline Lambert, Best Start Delivery Group
• Ms Katy Lister, Scottish Government, Mental Health Improvement
• Mr Peter Marshall, Scottish Government Mental Health Improvement
• Dr Anne McFadyen, Infant Mental Health Lead, Perinatal Mental Health Network
• Ms Helen Sloan, Maternal Mental Health Scotland
• Ms Alley Speirs, Programme Manager, Perinatal Mental Health Network, National Services Scotland

In attendance

• Ms Claire Haughey, Minister for Mental Health

Apologies

• Mr Jeff Ace, Chief Executive Dumfries and Galloway
• Ms Theresa Fyffe, Director Royal College of Nursing
• Ms Jacqueline Kerr, Glasgow City Health and Social Care Partnership
• Ms Ann Holmes, Chief Midwifery Advisor & Associate Chief Nursing Officer
• Ms Catriona Johnson, Programme Associate Director, national Network National services Scotland 

Items and actions

Welcome and apologies

Mr Hugh Masters welcomed the attendees to the first Perinantal and Infant Mental Health Programme Board (PNIMH-PB) meeting highlighting the importance of the programme; the Minister for Mental Health MS Clare Haughey was also in attendance for the first part of the meeting.

Apologies were as above.

Programme board overview from Health Minister     

The Minister welcomed everyone to the meeting and reiterated the importance and timeliness of programme of work. She highlighted the focus on advocating for women experiencing mental health problems and ensuring they have access to necessary help when they need it across all parts of Scotland.

The Minister commented that it was good to see a broad range of representation from various agencies, including Change Agents and the Best Start Programme.  She noted that mental health stigma is a reality for many women experiencing mental health problems and urged women not to be ashamed to seek help.

Mr Masters asked the Minister how she envisaged the PNIMH programme would interface with the Child and Adolescent Mental Health Services (CAMHS) taskforce and other aspects of Scottish Government mental policy.  The Minister advised that there was a considerable amount of work going on in the area of Mental Health Services As such a Mental Health Strategy Delivery Board had been set up chaired by the Minister, as a means to ensure all strands of work were linked and coordinated and that Mr Masters has a seat on that Delivery Board. 

Mrs Ann McFadyen asked the Minister about the relationship between the PNIMH Programme and Children and Young People’s Taskforce.

The Minister emphasised that it was very important that the various strands of MH policy were coordinated in relation to infant MH and links with the CYP task force were vital she acknowledged that some specialist services were associated with stigma and urged the PNIMH- PB to engage with Universal Services where this was less of an issue.  It was agreed that there is a need to address stigma and transform culture in service provision. The PNIMH-PB will take this forward.

The Minister concluded by wishing the PNIMH-PB well and looked forward to seeing how the Programme progresses. 

Progress to date

Mr Masters explained that the intention was to get the PNIMH-PB started and that the membership would consist of the 14 people represented today.  The plan was to have three meetings in quick succession with the aim of having finalised an initial delivery plan by summer 2019.  He added that he had already met with a few of the PNIMH-PB members and would continue to meet the various representatives.

Programme governance and planning

Mr Masters reported that National Services Scotland (NSS) had been appointed by Scottish Government to provide high level programme management and a Senior Programme Manager would be appointed by the end of May 2019.  He added that the minutes from the meetings would not be recorded as verbatim but would capture discussions and actions.  The PNIMH-PB was in agreement with this.

Terms of reference

Mr Masters invited the PNIMH-PB to review the draft Terms of Reference and feedback comments by 14 May 2019 to allow the document to be finalised for approval at the second Board meeting scheduled for 28 May 2019.

The Board agreed the following changes

Governance

• PNMIH Implementation team to be changed to working group
• projects to be changed to recommendations and actions

Ms Sally Ann Kelly noted the need for absolute clarity about governance from the outset in order to avoid any confusion about the role of the PB in managing and dispersing funding and also clarity around the role and relationship with the Managed Clinical Network

Mr Masters acknowledged the need for clear guidelines and processes in relation to decisions in relation to finance and PNIMH-PB recommendations. These were yet to be agreed with NSS.

There was a discussion around ensuring clarity and effective governance in relation to Health Board responsibilities and in ensuring there was clear distinction between base line and additional funding i.e.what PNIMH-PB funding should be used for and how its use is monitored and evaluated. Mr Masters highlighted that the programme sought to ensure sustainable improvement and the need for investment proposals to identify how this would be achieved in terms of transition from the Programme to Health Board funding.

Dr Roch Cantwell identified two levels of accountability; PNIMH-PB would be accountable for ensuring that the money is used in the right way and that there is evidence that initial aims are achieved whereas local Health Boards would be responsible for ongoing delivery. 

The PNIMH-PB agreed that the most important thing was to ensure that women had access to the help they need when they need it through effective pathways and there should be a robust mechanism put in place for ensuring the money is spent as intended.

The need for robust and up to date evidence to inform the discussion and decisions of the PNIMH-PB was recognised.

PNIMH-PB agreed that while it would be beneficial to convene an academic sub-group to scope the breadth of research, including evidence and models of good practice beyond Scotland.  The need to consider a range of research methodologies, for example qualitative research, was seen as important.  Mr Masters agreed to hold discussions with academic partners and the PNIMH-PB members were invited to suggest suitable academic links.

Action one – the PNIMH-PB to review the draft terms of reference and feedback comments to the programme team in advance of the board meeting scheduled for 28 May 2019.

Action two– the PNIMH-PB to suggest academic links for an evidence base subgroup.

Roles and responsibilities

Mr Masters undertook to revise from bullet point four to end.

Ms Sally Ann Kelly queried whether the cost of NSS providing programme support were to be met from the £52M and that in terms of transparency it would be useful for the PNIMH-PB to have visibility of this.

Ms Ruth Christie advised that the agreed cost for NSS to manage the programme was 1% of the £52M and this was based on the work that NSS has previously done for Scottish Government.

Ms Mary Ross-Davie asked if a workforce planning tool was in place for the staffing recommendations in the report.  The staffing recommendations are based on the RCPsych Quality Standards.The PNIMH-PB agreed that triangulation of the staffing recommendations would be considered as the programme develops further.

Mr Masters noted that in terms of transparency, there was ongoing discussion with NSS on how the programme would be managed and that documentation would be published on a public facing website.

Membership

Discussion took place as to how much the PNIMH-PB would be involved in delivery and whether it was appropriate to extend membership of the group to include operational delivery representation to ensure actions and recommendations agreed at PNIMH-PB were achievable at local Health Board level.

Listed below are the potential gaps discussed in PNIMH-PB membership:

• Head of midwifery – Director of Nursing was favoured as covering both nursing  and midwifery services

• lead nurse for children and community services

• health visitors and GP

• policy representation – Children and Young People

• experts for women with drug and alcohol issues

• psychology representation

• neonatal representation

• baby loss, miscarriage and baby death

• women who have lost children to the care system

Mr Masters agreed to consider all of these recommendations and make approaches as required and to bring recommendations for membership to the next PB meeting.

There was a general discussion around the scope of the programme as perinatal infant mental health may have a different meaning for different people. There was also a discussion around establishing a robust mechanism to support the Change Agents and agreement on the need for synergy between the PNIMH-PB and the Managed Clinical Network (MCN).

Action three – Mr Masters to revise bullet points 4 to the end under roles and responsibilities of the terms of reference.

Action four – SG Policy team to investigate a robust mechanism to support the change agents.

Action five – Mr Masters to consider all the potential gap recommendation in the PNIMH- PB membership and feedback at the next PB meeting.

Action six - SG Policy Team to discuss and agree ways of working with MCN to ensure maximum synergy with the PNIMH-PB.

Perinatal Mental Health Evaluability Assessment

Ms Christie informed the group that ‘Evaluability Assessment’ is a service provided by NHS Health Scotland and has been carried out for various policy and practice initiatives.  A logic model is applied to draw out: the inputs; what the expected outcomes and impacts are; and how these can be measured to evaluate the programme.  Ms Christie added that this is a pre step to inform the evaluation model and good feedback had been received from colleagues who have used this approach.  The morning of 28 May 2019 will be spent with Health Scotland to undertake initial scoping with a view to agreeing an evaluation model for the programme. 

The PNIMH-PB were invited to attend the Evaluability Assessment session and also nominate colleagues that are best placed to attend the session.

Action seven - the PNIMH-PB to attend the Evaluability Assessment session scheduled for 28 May and also nominate colleagues best placed to attend the session.

Draft Initial Delivery Plan

Mr Masters presented the Board with a draft initial delivery plan for the programme, adding that the draft plan is focused on the recommendations from the Perinatal Mental Health Needs Assessment Report but also includes other emerging issues.  The draft aims to pull the various recommendations from the MCN Needs Assessment into a series of key themes/workstreams that will guide the work of the PNIMH-PB.

Mr Masters invited the PNIMH-PB to review the draft action plan and feedback key issues around workstreams and actions before the next PNIMH-PB meeting.  The draft initial delivery plan would be circulated to the PNIMH-PB.

Action eight– the PNIMH-PB to review the draft action plan and feedback key issues around workstreams and actions before the next PNIMH-PB meeting scheduled for 28 May 2019.

Action nine -the Programme team to circulate the draft initial delivery plan to the PNIMH-PB.

Any other business

None raised.

Date of next meeting: 28 May 2019 Evaluability Assessment Session.

10:00 – 13:00 preceded by the Programme Board meeting from 14:00 – 15:30 holding at COSLA’ Verity House 19 Hay Market Yards Edinburgh EH12 5BH.