Perinatal and Infant Mental Health Programme Board minutes: 31 August 2022

Attendees and apologies

Author:

• Alex Brown

Present:

• Hugh Masters, Chair, PNIMH-PB, Scottish Government

• Roch Cantwell, Vice Chair, PNIMH-PB, Lead Clinician, Perinatal Mental Health Managed Clinical Network, Scottish Government, NHS National Services Scotland

• Leanne Anderson, Performance Advisor, Inspiring Scotland

• Lizzy Archibald, Service Development Advisor, Scottish Government

• Rach Barlee, Participation Officer, Parent and Infant Mental Health Scotland

• Alex Brown, Assistant Programme Manager, NHS National Services Scotland 

• Helen Cheyne, Professor of Maternal and Child Health Research, University of Stirling

• Ruth Christie, Workstream Lead Children, Young People, Families and Relationships, Scottish Government

• Aman Durrani, Consultant Perinatal Psychiatrist, Royal College of Psychiatrists

• Fiona Fraser, Consultant Clinical Psychologist, NHS Greater Glasgow and Clyde

• Rebecca French, Everyone’s Business Campaign Coordinator for Scotland, Maternal Mental Health Alliance

• Catherine Holmes, PIMH Project Manager, NHS Highland

• SallyAnn Kelly, Chief Executive, Aberlour

• Lauren Kennedy, Lead Nurse for Mental Health and Learning Disabilities, NHS24

• Marion MacAulay, Chief Social Work Officer, Social Work Scotland

• Carsten Mandt, Senior Programme Manager, Scottish Perinatal Network, NHS National Services Scotland

• Kat Masterson, Participation Officer, Parent and Infant Mental Health Scotland

• Susan McConachie, Regional Nurse Consultant, NHS Lothian

• Anne McFadyen, Chair, IMH-IAG, Infant Mental Health Lead, Perinatal Mental Health Managed Clinical Network, Scottish Government, NHS National Services Scotland

• Clare McGuire, Head of Programme, NHS Education for Scotland

• Marie Claire Shankland, Programme Director, NHS Education for Scotland

• Helen Sloan, Nurse Consultant, NHS Greater Glasgow and Clyde

• Joanne Smith, Policy and Public Affairs Manager, NSPCC Scotland

• Harri Waugh, Perinatal and Early Years Mental Health Team Lead, Scottish Government

In attendance:

• Scott Arnott on behalf of Lisa Malcolmson, PIMH Service Manager, NHS Grampian

• Ross Cowan, Perinatal and Early Years Mental Health Team, Scottish Government

• Alastair Douglas, Perinatal and Early Years Mental Health Team, Scottish Government

• Katy Lister, Perinatal and Early Years Mental Health Team, Scottish Government

• Irene Permaul, Perinatal and Early Years Mental Health Team, Scottish Government

• Kelsey Sclater, Perinatal and Early Years Mental Health Team, Scottish Government

• Christina Smiley on behalf of Sheila Gordon, Managing Coordinator for Perinatal Counselling Services, CrossReach

Apologies:

• Emma Currer, National Officer, Royal College of Midwives
• Selena Gleadow-Ware, Consultant Psychiatrist, Royal College of Psychiatrists
• Sheila Gordon, Director, CrossReach
• Lisa Malcolmson, Regional Nurse Consultant, NHS Grampian
• Ross McGuffie, Cheif Officer, Health and Social Care, NHS Lanarkshire
• Eileen McKenna, Associate Director, Royal College of Nursing

Items and actions

Welcome, apologies and housekeeping

Hugh Masters (Chair) welcomed everyone to the nineteenth Perinatal and Infant Mental Health Programme Board (PB) meeting. Deputies and apologies were noted as above.
The minutes were agreed as an accurate representation of the May 2022 joint meeting of the PB and the Infant Mental Health Implementation and Advisory Group (IAG), and would be made available on the group's webpage.

• PB leads are meeting with the team working on the refresh of the Mental Health Strategy and providing feedback on how perinatal and infant mental health should inform the strategy

• Anne McFadyen (IAG Chair) followed up with Karen Lamb (Head of Specialist Children's Services) shortly after the last PB meeting around the unanticipated demand across all agencies in relation to the new infant mental health (IMH) service in NHS Greater Glasgow and Clyde (GG and C). The IMH team are progressing making links with the perinatal mental health and maternity and neonatal psychological intervention services

• Anne attended the most recent meeting of the Children and Young People’s Mental Health and Wellbeing Joint Delivery Board’s 3-5 year old task and finish group, and advised that the engagement feedback mentioned at the last PB meeting would be made available soon

• the Chair and Anne agreed that an update of work on the Voice of the Infant subgroup would be on the agenda for the next PB meeting in October

Scottish Government team update

Harri Waugh (SG Team Lead) gave an update on behalf of the SG Perinatal and Early Years Mental Health policy team:

• the Mother and Baby Unit (MBU) in-patient capacity consultation analysis has been published, and the team are working on next steps for the options appraisal, which is hoped to be completed by spring 2023

• Harri thanked Irene Permaul (Senior Policy Officer) for her input to the MBU options appraisal and other workstreams and wished her all the best for her upcoming maternity leave

• the Minister for Mental Wellbeing and Social Care, Mr Kevin Stewart, is visiting NHS GG and C on 16th September to see all of the perinatal and infant mental health services that have been recently developed or expanded

SallyAnn Kelly (Aberlour) and Christina Smiley (CrossReach) raised concerns around the delay to third sector funding allocations, and the impact on the workforce and service provision.  Harri advised that SG is currently reviewing all 2022-2023 budget plans in light of the known conclusion of in-year Covid-19 consequentials, which has placed unprecedented pressure on existing Health and Social Care budgets. Ruth Christie (SG Workstream Lead) and the Chair advised that the Perinatal and Early Years policy team are continuing to review options for future funding so the process can be put in place quickly and effectively when Ministerial approval to proceed is announced, and decisions will be communicated as soon as is possible.

Action: Scottish Government policy team

Regional guidance

Roch Cantwell (Vice-Chair) presented the draft Regional Guidance paper, which had been shared with the group ahead of the meeting. The current iteration of the paper addresses regional provision for statutory community perinatal mental health services not MBUs or IMH services, which will require separate consideration. The three Nurse Consultants in the lead Health Boards (NHS GG and C, NHS Lothian and NHS Grampian) have a lead role in regional service provision, and there are other posts already recruited to in those areas which also have dedicated time for regional work (Consultant Psychiatrists, Consultant Psychologists and Parent-Infant Therapists).

The paper discusses two levels of regional service provision; level one is for all Boards and level two is directed at the smaller Boards who may struggle to meet the full range of statutory services expected from specialist care. Level one provides advice, support and leadership on education, training and pathways, and occasionally a second opinion may be provided to another Board area. Level two provides clinical support, second opinion clinical assessment for complex cases, and occasionally supervision to meet the needs of the smaller Board areas, and this would be led by the Nurse Consultants with support from the other regional roles.  

The Perinatal Mental Health Network Scotland (PMHNS), of which Roch Cantwell is the Lead Clinician, is engaging with the Nurse Consultants around development of an explicit Regional Nurse Consultant role definition, as the three posts currently have differing job descriptions. PMHNS hope that this can be implemented by March 2023. Helen Sloan (Nurse Consultant, NHS GG and C) has written a SBAR with proposed adjustments to the current role. The Vice-Chair advised that the next steps for this workstream are to continue consultation on the guidance paper with the three Nurse Consultants, and to engage with the lead Health Boards around the two levels of provision.

Anne McFadyen mentioned the challenge of developing a similar model for IMH services, as this was not outlined in the Delivering Effective Services report or funded by the PB like it is for community perinatal mental health services. Anne agreed to meet with Joanne Smith (NSPCC Scotland) around potentially using the NHS Lanarkshire IMH Needs Assessment as a template to inform the work.

Health board progress update

Lizzy Archibald (Service Development Adviser) and other PB leads have made an in-person visit to every Health Board area over the past few months focusing on meeting members of the clinical teams and the MBUs. Information collected from the visits has been collated alongside data from the monitoring returns into progress updates that the SG team hope to publish in 2022, so that women, families and clinicians can see what services are available in their local area and across Scotland (subject to approval by the Board Executive Leads).

Meetings are being organised between PB leads and Executive Leads to follow up on any outstanding issues raised at the visits and to discuss innovative practice and the sustainability of the programme in local areas. Other meetings with a focus on the perinatal and infant mental health teams’ engagement with the third sector and people with lived experience are also being organised for the coming months, and external representatives who have already contributed to local service development are invited to join the call to talk about how they have been involved and their perspective on the relationship with statutory services.

Lizzy gave a presentation on the workforce data that has been collected from the visits, the monitoring and from conversations with the Boards. Initial manipulation of the data suggests that there has been a:

• 54% increase in MBU staffing

• 185% increase in Community Perinatal Mental Health Team staffing

• 581% increase in Maternity and Neonatal Psychological Intervention services staffing

IMH teams are developing across Scotland so there is no reported increase figure. In August 2022, the approximate head count across all the whole programme of statutory services is 270 people (203.49 WTE), including those in the teams whose posts are not PB funded. Other data, specifically around the total number of people seen and qualitative information on the difference it has made, is still being collected from the Boards and will be shared with the group at future meetings.

Towards March 2023 and from April 2023

The Chair advised that the timeline for the ‘Towards March 2023’ report had been brought forward to the start of September at the request of the Minister for Mental Wellbeing and Social Care.

The report will summarise PB achievements to date and make recommendations for continuing the work after the PB comes to an end in March 2023, including suggestions about a delivery oversight group to take over from the PB. The report will also raise thoughts around reconceptualising from perinatal and infant mental health to pre-conception to five years old. Feedback from the Minister on the report and thoughts on what future iterations of the group may look like will be shared at the next PB meeting.

Next meeting:

Wednesday 12 October 2022