Independent Review into the Delivery of Forensic Mental Health Services: Scottish Government response

Theme Three: Capacity and Transitions - Recommendations 5 - 21

Data Collection and Reporting

Recommendation 5. The Scottish Government should commission the Information and Statistics Division (ISD) of NHS National Services Scotland to develop a data management system to accurately collect, monitor and report on performance across forensic mental health services, including on service capacity and the timeliness of people's transitions.

The Scottish Government recognises the importance of good quality data and information in managing services, transitions and in improving the quality and performance of services. We will work with Public Health Scotland, the Forensic Network and providers of forensic mental health services to assess what is needed in data management systems, in the context of work to improve the availability and quality of performance and outcomes data in all mental health services.

Information and Statistics Division (ISD) is now part of Public Health Scotland. The Forensic Network is conducting a review of data currently collated to consider gaps or information that may be helpful for services in future.

Pressures on Medium Secure Services

Recommendation 6. NHS Greater Glasgow and Clyde plans to extend medium secure provision at Rowanbank Clinic should be progressed.

The Scottish Government will maintain close awareness of NHS Greater Glasgow and Clyde's progress on the business case developed in 2019 for extension of medium secure provision as part of monitoring the capacity across the forensic estate.

Recommendation 7. The data management system developed for forensic mental health services by the Information and Statistics Division (ISD) of NHS National Services Scotland should collect, monitor and report delays incurred by people assessed as ready to transfer to a different level of security. Any delay of four months or over must be reported to the Scottish Government.

We will work with Public Health Scotland, the Forensic Network and providers of forensic mental health services to assess what is needed in data management systems, in the context of work to improve performance and quality outcomes data in all mental health services.

Delays Affecting Discharges into the Community

Recommendation 8. The data management system developed for forensic mental health services by the Information and Statistics Division (ISD) of NHS National Services Scotland must collect, monitor and record delayed discharges in a way that is as transparent as data collected in the acute (physical health) sector.

Scottish Government agrees that definitions and recording of delayed discharges requires reform to assist with improving patient flow through secure mental health services. We will work with Public Health Scotland, the Forensic Network and providers of forensic mental health services to assess what is needed in data management systems, in the context of work to improve performance and quality outcomes data in all mental health and social care services. Learning from existing data management systems will be an important part of this work.

Recommendation 9. The management bodies of all forensic mental health services must identify anyone waiting for accommodation or support packages in the community to the extent that their discharge from these services - or their eligibility to start the process towards conditional discharge - has been delayed for six months or more.

Recommendation 10^*. The new Forensic Board must work with social work teams and local authority housing departments to ensure that the commissioning process in each area provides appropriate support services and accommodation options for people with the need and risk profiles typical of individuals within the forensic mental health system.

Recommendation 11^*. The new Forensic Board must work with social work teams and local authority housing departments to develop an accommodation strategy that ensures individuals have access to community accommodation.

The Scottish Government will work with territorial Health Boards, Integrated Joint Boards and Local Authorities to ensure that suitable accommodation and support packages are in place to address delayed discharge of patients and to work on an accommodation strategy for people leaving forensic inpatient services. Scottish Government is currently progressing work to improve delayed discharge data pertaining to forensic inpatients.

Recommendation 12. Commissioners of community support and accommodation services should ensure that remuneration for people working in these services reflects the complexity of the forensic cohort and the need to retain skilled staff.

The Scottish Government supports this recommendation in line with our commitment to promote Fair Work.

Recommendation 13. We recommend that people in low secure units should be given the right to make an application to the Tribunal where they are being detained in conditions of excessive security.

Recommendation 14. A legal duty must be put on a relevant authority to provide appropriate accommodation, services and support for people who are due to be discharged from a secure hospital into the community. The Review considers the relevant authority should be the local authority.

The Scottish Government will give thorough consideration to amending the primary legislation so as to develop an appeal process against excessive security conditions for patients detained in low security. However this work must be cognisant of the recommendations of the Independent Scottish Mental Health Law Review.

The Scottish Government agrees ensuring that people who are approaching readiness to leave inpatient forensic mental health care can access appropriate accommodation, services and support promptly is vital to their successful reintegration into the community.

There are already legal duties on local authorities in the Mental Health (Care and Treatment) Scotland Act 2003 and the Scottish Government will work in collaboration with service providers and those with lived experience to explore why these existing duties are not sufficient and develop any necessary changes to legislation. However, legislative change is only one available route to improve provision of care in the community. It is therefore important that we work with local authorities to explore a range of ways in which this could be achieved.

Recommendation 15. The Scottish Government should review with clinicians in both inpatient and community teams, as well as MAPPA and police representatives, the current discharge planning process for restricted patients to identify any aspects that can be streamlined while continuing to protect the public and supporting the best chance of a successful and sustainable discharge for people.

The Scottish Government is taking forward a programme of reviewing all of the processes and procedures for restricted patients. The aim of this review is to ensure all processes and procedures are as effective and efficient as possible. This will include the discharge planning process. All of those involved in the process will have the opportunity to be involved with the completion of the review expected by December 2022.

Recommendation 16. The update of the Scottish Government's Memorandum of Procedure on Restricted Patients should be available in an accessible format to increase transparency around the processes and the flexibility within it, and the role of Scottish Ministers more generally. This work should be prioritised.

The Scottish Government is taking forward a programme of reviewing all of the processes and procedures for restricted patients. The Memorandum of Procedure will be revised as part of this programme. This is an iterative process and chapters of the Memorandum will be made available after each process is reviewed.

The complete Memorandum will be available when the review programme has concluded. Scottish Government expects the updated Memorandum of Procedure to be accessible to any interested person and for there to be regular updating of guidance in the future.

Recommendation 17^*. The Scottish Government and the new Forensic Board need to identify funding to ensure that no one leaving forensic inpatient services has to go into debt for housing costs to complete overnight stays to accommodation as part of their required pre-discharge plan.

The Scottish Government agrees that no-one should be in debt because of housing costs incurred as part of their pre discharge plan from forensic inpatient services. We will work with Integrated Joint Boards, Health Boards and Local Authorities to facilitate pre-discharge plans and to address underlying financial challenges

Community Forensic Mental Health Teams

Recommendation 18^*. The new Forensic Board should define the service remit of Community Forensic Mental Health Teams (CFMHTs).

The Scottish Government agrees that community provision is a crucial component of the forensic mental health system and the principle of providing least restrictive care. In the Coronavirus (COVID-19): mental health - transition and recovery plan we committed to supporting the collaborative development, implementation and assessment of quality standards for mental health services. The Forensic Network is gathering information on current provision as a starter for this work.

Recommendation 19. CFMHTs should be appropriately resourced based on future projected demand as bottlenecks in low and medium secure services are eased.

The Scottish Government will write to all territorial Health Boards and Integrated Joint Boards to establish capacity planning mechanisms for community provision.

Prison Issues

Recommendation 20. The data management system developed for forensic mental health services by the Information and Statistics Division (ISD) of NHS National Services Scotland must be able to collect, monitor and report on transfers and delays to transfers into forensic mental health services from prisons.

The Scottish Government recognises the importance of good quality data and information in managing services, transitions and in improving the quality and performance of services. We will work with Public Health Scotland, the Forensic Network, Scottish Prison Service and providers of forensic mental health services to assess what is needed in data management systems, in the context of work to improve performance and quality outcomes data in all mental health services.

Recommendation 21^*. The system of multiple assessments to facilitate transfers from prison should be reviewed with the aim of streamlining the process to the benefit of the person in need of forensic inpatient services. At the latest this should be reviewed by the new Forensic Board, however the Review considers that this could be reviewed sooner than that.

The Scottish Government agrees that this work should begin as a priority to examine and address the extent and causes of multiple assessments. We will work with the Forensic Network and other partners to understand the causes and work on solutions to improve the system of assessment and admission for the benefit of persons in need of forensic inpatient services. A plan to move toward an 'admission first' approach for persons who need treatment in a mental health setting and there is disagreement on level of security or location of service is needed. The aim should be to ensure that admissions to forensic mental health inpatient services are not delayed.

^* This recommendation refers to a new Forensic Board having responsibility. See response to recommendation 1