Veterans Mental Health and Wellbeing Implementation Board minutes: March 2023

Attendees and apologies

• Charles Winstanley, Chair
• Martin Bell, NHS NSS 
• Susan Bomphray, Scottish Government
• Thelma Bowers, North Ayrshire HSCP
• Sharon Findlay, Defence Primary Healthcare Services
• Lesley McDowall, Scottish Government
• Mairi McKinley, NHS Fife
• Neil Morrison, Veterans Scotland
• Julie Murray, Chief Officer Group
• Michelle Ramage, Veterans First Point
• Gerri Matthews-Smith, Edinburgh Napier University
• Maura Lynch - Combat Stress
• Mark Fergusson, Scottish Government
• Aleksandra Brokman, Scottish Government

 

Apologies

• Alastair Cook - Scottish Government
• Eddie Follan - COSLA
• Eric Fraser - Ex-Veterans Commissioner
• Jim Miller - NHS Chief Executive

 

Items and actions

Apologies

CW noted that Eddie Follen has missed all the Board meetings to date and hasn’t been in touch with the Board.

Action: CW to contact Eddie Follan and enquire if another representative from COSLA should join the Board.

 

Introductions

CW invited Board members to introduce themselves and welcomed Lesley McDowall to the Board.

 

Declarations of interest

No conflicts of interest were declared.

Minutes of last meeting

CW asked the Board to review the draft minutes of the 15 December 2022 meeting.

No inaccuracies were raised. The Board approved the minutes.

 

Matters arising

NM asked for the minutes to be issued earlier. CW agreed but asked the Board not to discuss minutes via email and to bring their comments to the next Board meeting.

Action: CW and AB to arrange earlier issuing of minutes.

 

Budget update 

MF and LM presented a paper with a budget update. MF advised that Mental Health Directorate budget won’t be confirmed until 27 March but the expectation is that the funding will remain at 2022/23 level. LM explained that implementation team budget underspend was due to unsatisfactory market conditions that delayed recruitment of the implementation team. Although savings were made it is now too late in the financial year to deploy the funds.

CW asked when the funds for 2023/24 will be available. MF advised that he doesn’t expect the wait of 2022/23 to be repeated this year.

CW drew the Board’s attention to the unequal distribution of funds between Health Board areas, with Health Boards without V1P service not currently receiving funds to provide mental health support for veterans. He proposed that the Board brings V1P and Combat Stress clinical services closer into its governance.

Action: The Board supported CW asking the Minister to allocate governance of the SG contribution to the six V1Ps' operational budgets, and of the Combat Stress Scottish clinical services budget to the Board.

 

New members of the implementation team

CW informed the Board that the complete implementation team is now in place. It is led by Jane Menzies and includes Maura Lynch as Consultant Manager, Hayli McClain as Project Manager and Stacy Pettiford as Project Support Officer.

 

Review of the implementation plan

CW invited the Board to comment on the draft of the implementation plan. 

MB observed that the plan was very high level and asked for more details regarding the operation of the helpline. He stressed the importance of linking with other services (NHS Inform, NHS 24) and educating the NHS, so that they could direct veterans to the new service. He also asked the Board to engage with Health and Social Care Scotland. ML explained that work on linking all communications was behind due to delay in recruiting a project manager for the implementation team.

MM asked how referral into clinical services will work in Health Boards without a V1P, indicating that it may be challenging. JM added that there was a need to agree who will provide the navigators locally. MR suggested including NICE guidelines for Scotland in the plan and stating clearly that clinical interventions will be delivered by suitably trained clinical professionals. She and CW agreed that evidence-based treatments should be offered. NM and SB noted the challenges of maintaining rigour without losing the goodwill of third sector providers.

MM advised that some veterans might feel alienated by the phrase “Scottish veterans.” She suggested using “veterans living in Scotland” instead.

NM suggested that instead of having MDTs in every Health Board area, initially a single national MDT is created. In response, TB advised that clinical need might be higher than expected and that a high level MDT would lack links to local services. MR agreed local MDTs could develop closer links with services and added that one national team could become overwhelmed with the number of decisions it needed to make.

TB asked about the band level of the navigator role. CW advised that this is still to be discussed by the implementation team.

The implementation plan will take into account the board’s comments for an updated version.

 

Communications update

CW presented logos developed by the Leith Agency and tested with focus groups of veterans. MR and NM expressed preference for “Scotland” being added at the end of the name of the service. NM suggested removing “service” from the name. TB and LM agreed.

The Board agreed to adopt the name Veterans Mental Health and Wellbeing Scotland.

CW informed the Board that SG colleagues are working on finding a home for the website. NHS Inform and Mind to Mind are currently considered as possible hosts. LM suggests seeking ministerial approval for the creation of a standalone website.

MB advised that even fully funded primary care websites often lack proper, timely maintenance. He expressed preference for finding a home on an existing official website and stressed the importance of assuring that there is sustainable ability to keep the website up to date.

MM and MB suggested repurposing now defunct SVCN website, hosted by the NSS.

Action: SG colleagues to continue exploring options for the website.

Research update

CW informed the Board that research work was not yet taken forward due to a professional disagreement on the role of research between the management team and the Scottish Government.

 

Scottish Armed Forces Research Hub update

GMS updated the Board on the development of the Scottish Armed Forces Military Research Hub. All the universities across Scotland have now joined the Hub and the first meeting of the network was held in January. The steering group and advisory board for the Hub are currently being set up. The board will involve both researchers and practitioners.

SF offered to support GMS with establishing links to the Armed Forces.

 

Board discussion: Clinical pathway

ML and MR presented developmental notes on accessing clinical tiers of the service, asking Board for initial thoughts and comments. They proposed that a short life working group is established to work on clinical pathways.

TB recommended paying more attention to addiction and substance abuse. She also advised that access points to secondary services will be different in different places. MR agreed that that it will be necessary to link with local areas to operationalise the model working group will produce.

CW noted that proposed pathways might challenge how V1Ps have been operating so far. MR stressed the importance of involving clinicians and SG professional advisers in conversations about restructuring the services.

MB suggested that veterans experiencing low to mild mental health issues soon after transition might not need clinical help but in the first instance could be signposted to other support services.

SF stressed the importance of making sure veterans’ needs aren’t missed as they transition to civilian life. She expressed an interest in joining the working group.

Action: The Board approved establishment of the short life working group. MR to chair it, supported by ML. They are to invite interested Board members to join.

 

Risk register

CW informed the Board that risk register, actions log and delivery plan will be used to track the Board’s work since the next meeting. The risk register will be divided into sections for governance and operational risks.

Action: The Board members are invited to contribute to the section for governance risks. AB to send a reminder when she issues the minutes.

 

AOB

NM raised a point that Veterans Mental Health and Wellbeing Scotland might not be aligned with Scottish Veterans’ Treatment Pathway in all areas. He suggested that more work with Lindsey Restrick was needed to establish how the two pathways will align.

 

Date of next meeting

The next meeting will take place on 15th June 2023 via Microsoft Teams.