Independent inquiry into mental health services in Tayside: speech by Minister for Mental Health

Last month Dr David Strang published the final report of the Independent Inquiry into Tayside Mental Health Services. I would like to thank Dr Strang, the Inquiry team, and the Health and Social Care Alliance for their hard work.

In particular, I also want to thank everyone who contributed to this inquiry. Over 1,500 people shared their, often incredibly painful, experiences and personal testimonies.

Far too many people have been let down - and while it’s not enough on its own - I would like to offer my apology on behalf of the Scottish Government for what they have endured.

Many Tayside patients, their families and friends - including those who have lost loved ones – will have found the report challenging. Their bravery, courage and candour was vital to shaping this report.

I also want to thank staff who participated - and who are committed to ensuring delivery of excellent services in the future.

Recommendations

The report, outlines a range of issues and calls for a new culture of working across NHS Tayside and the 3 Health and Social Care Partnerships.  

It makes 51 recommendations across 5 key areas:

• Governance and Leadership;
• Crisis and Community Services;
• Inpatient Services;
• Child and Adolescent Mental Health Services

NHS Tayside and its local authority partners have accepted the report, its findings and recommendations in full.

At NHS Tayside’s Board meeting on 27 February, the Chief Executive – Grant Archibald – also apologised to anyone whose experience of Tayside’s mental health services had fallen short of the expectations we all, rightly, have for these services. The Board also agreed to collaborate with partners to deliver a Tayside-wide response to the Inquiry’s findings.

Partnership working and leadership

Partnership working is the cornerstone of the approach that will be taken to respond to the Inquiry Report. A Tayside ‘Collaborative Strategic Leadership Group’ has been established, comprising of Chief Executives from NHS Tayside, Angus Council, Dundee City Council, Perth & Kinross Council and the Police Scotland Tayside Divisional Commander.

Collective responsibility, and accountability, are emphasised in their published ‘Statement of Intent’. It commits to implementing necessary improvements through the development and delivery of a Tayside-wide Strategy and Change Programme for improving mental health and wellbeing.

Integration

One of the recommendations of the Inquiry Report relates to delivery of mental health and wellbeing services in the context of health and social care integration. It recommends that the NHS Board and the three Integration Joint Boards review the delegated responsibilities for the operational delivery of these services across Tayside, to ensure clarity of understanding and commitment.

In line with the Inquiry report, and the views of NHS trade unions and professional bodies, both the Health Secretary and I have made no secret of our concerns about the approach to operational management of inpatient mental health services in Tayside. These arrangements have been unduly complex and are unique to Tayside.

That is why, I am clear that operational management of general adult psychiatry services must now be led by NHS Tayside, rather than an integration authority. NHS Tayside will now implement this change, and will work closely with its integration partners in doing so.

I believe this simplification will bring welcome clarity to the local arrangements and allow the partnership to focus on improved services for patients.

Whole system approach

The issues identified by the inquiry cannot be resolved by one single agency. It is crucial that there is a whole system review of services.

Last week, I received a progress report from NHS Tayside, published on the Board’s website, which outlines activity to drive change.

I have been clear that a comprehensive action plan to detail how each recommendation will be met must be taken forward. That work is underway.

For this to happen in a way that delivers the change we need to see, NHS Tayside and its partners must listen to service users, families, carers and staff.

I am encouraged that they have set out a commitment to ensure they listen to the voices of people who work in mental health services, service users, families and carers so future services can be co-designed and co-produced.

The Inquiry report recommends that a full plan be developed in partnership and published by June 2020 – I expect this timescale to be met.

Later today, I will also meet with members of the Tayside Stakeholder Participation Group, chaired by the Health and Social Care ALLIANCE Scotland.   I look to NHS Tayside and their partners to continue to build upon this, keeping patient needs at the heart of their discussions.

Organisational development across the system

Organisational development is vital. The report found many staff did not feel valued, listened to or treated with respect. Staff reported a lack of clarity around line management and accountability, and a culture of blame rather than an organisation open to learning from adverse events. This is unacceptable.

Engagement is the first step and work with staff is already underway to support this. I am encouraged to hear “Safe Space” meetings are happening, enabling staff to discuss concerns confidentially.

Workforce support and development across the system

The report explores the impact of workforce changes on delivery of mental health services. This includes the ability of staff to participate in training and supervision requirements.

It raises questions around how we ensure people have the right skills and experience to do their jobs. And, how they are involved in helping find solutions to workforce challenges across social work, social care; clinical settings and; the third sector.

I am encouraged that Tayside are working with staff, unions and professional bodies to develop a response. It will form a key part of their whole-system strategy.

We are also pursuing action in this area. There are psychiatry recruitment challenges right across the UK which require collaborative concerted action. We are working with the Royal College of Psychiatrists, NHS Education Scotland and medical schools to promote psychiatry as an attractive career to address these fundamental challenges.

We are also on course to deliver our commitment to 800 extra mental health workers in Scotland by the end of 2022. As of 1 January this year, 375 posts had been recruited.

Scottish Government Intervention

To help deliver improvements in Tayside, I announced a support package on 31 January. This package includes multi-disciplinary clinical and practice support - bringing specialists from across a range of specialities and backgrounds to provide support and challenge.

I very much welcome that colleagues who helped produce a highly regarded Lanarkshire Mental Health Strategy are now also working with NHS Tayside.

This multi-disciplinary support will:

• develop a mental health strategy for all of Tayside;
• strengthen governance and reporting arrangements;
• improve consultation and engagement;
• enable delivery of Tayside’s improvement plans;
• create a ‘Culture and Change’ Tayside-wide programme for all mental health and care staff;
• And, undertake a review of current service provision.

• This will be complemented by programme management expertise provided by NHS Information Services Division.

• The multi-disciplinary team will work with NHS Education Scotland to engage with the NHS Tayside Organisational Development team, ensuring they respond to the Inquiry’s recommendations to support staff.

Additionally, the Royal College of Psychiatry’s UK College Centre for Quality Improvement (CCQI) will independently assess the quality of clinical services in Tayside. This CCQI focus on four key areas: quality networks, accreditation, national clinical audits, and research and evaluation.

Through the Scottish Government’s former Principal Medical Officer, Dr John Mitchell, we have also facilitated expert clinical support and guidance through the Royal College of Psychiatrists.

Finally, Healthcare Improvement Scotland will offer specific support to Tayside in addressing the quality of adult community health services.

Assurance

Let me be clear, this is not a one-off support package. We will continue to work closely with NHS Tayside and local partners through the Tayside Oversight group, seeking assurance that improvements are being implemented. We will also continue to work with COSLA to ensure NHS Boards, Councils and Integration Joint Boards are supported to work together across Scotland.

I am also very grateful that the Chair of the Independent Inquiry, Dr David Strang, has also agreed to undertake a progress update in Tayside in February 2021. This will provide an independent assessment of improvements.

Quality and Safety Board

 I have already committed that the learning from the Inquiry will be fed into our national approach to quality and safety.

We want to bring greater coherence to the arrangements for quality planning, improvement and assurance for mental health. This is why we have now established a Quality and Safety Board for Mental Health.

I chaired the first meeting of that Board on 19 February. It will have an important role in taking forward two of the national recommendations contained with the Inquiry final report.

The first is for a national review of the assurance and scrutiny of mental health services across Scotland, including the powers of Health Improvement Scotland and the Mental Welfare Commission Scotland.

The second is for a national review of the guidelines for responding to substance misuse on inpatient wards.

With regard to the latter, there are commitments in our Mental Health Strategy, and in this year’s Programme for Government, which will drive service improvements for people with comorbid mental health and substance misuse.

I look forward to updating parliamentary colleagues on the work of the Quality and Safety Board in due course.

Quality and Safety Issues in Tayside and across Scotland

We must work to ensure that the concerns raised in Tayside are not being experienced elsewhere.

It is vital that we continue to put people at the centre of this work. The safety of our patients, and the quality of the services that they receive, is paramount.

Conclusion

I would like to finish by reaffirming this Government’s commitment to support Tayside to deliver the services the people need. I am also committed to learning from the experiences in Tayside. It is vital that people in Tayside have access to high quality, safe and effective service - and that they have trust and confidence in their care. That is what they – and all communities across Scotland – deserve.