Veterans Mental Health and Wellbeing Pathway Advisory Group minutes: August 2024

Attendees and apologies

• Lynne Taylor (Chair), Principal Psychology Advisor, Scottish Government
• Jacqueline Berry, Allied Health Professionals / Occupational Therapy Lead, NHS Grampian
• Thelma Bowers, Head of Mental health, Addiction and Learning Disability services, NHS Ayrshire and Arran/North Ayrshire HSCP
• David Dent MBE, Vice President (Global Head of Integrated Strategy) Clinical Research, Board Advisor Help for Heroes, Trustee RBLI, Professor (Hon), former Army Nurse, Lecturer RDMC, and CISD Practitioner and Mental Health First Aider, War Disabled Veteran
• Vicky Henderson, Service Manager, Aberdeenshire HSCP
• Lindsay Kirkwood, V1P NHS Ayrshire and Arran Clinical Lead
• Linda McAuslan, Lead Nurse Psychological Therapies / Adult Psychological Therapies Manager, NHS Forth Valley
• Stewart McKay, Deputy Head of Operations in Scotland. Combat Stress
• Kari Magee, Veterans’ Lived Experience Group
• Dougie Morgan, Operations Manager Scotland and Northern Ireland, Fighting with Pride LGBT+ Military Charity
• Neil Morrison OBE JP, Health and Wellbeing Lead, Veterans Scotland
• Jenny Pope, Deputy Director of Workforce NHS Golden Jubilee
• Michelle Ramage, V1P NHS Tayside Clinical Lead
• Robert Reid, Director of Services Scotland and Overseas, Defence Medical Welfare Service
• Mark Fergusson, Scottish Government
• Lesley McDowall, Scottish Government

Apologies:

• Jennifer Borthwick, Director of Psychological Services and Head of Clinical Services, NHS Forth Valley
• Linda Irvine Fitzpatrick, Strategic Programme Manager, NHS Lothian
• Gerri Matthews-Smith, Director of the Edinburgh Napier University Centre for Military Research, Education and Public Engagement / Scottish Armed Forces Evidence and Research (SAFE and R) HUB
• Theresa Mitchell, Head of Hidden Wounds, Help for Heroes
• Julie Murray, Chief Officer, East Renfrewshire HSCP; and Secretary of the Chief Officer Group for Health and Social Care Scotland
• Caroline Robertson, Head of Operations for Scotland, Combat Stress
• Tommy Watson, Director for Veterans Affairs, Walking with the Wounded
• Pauline Winchester, Midlothian Local Authority Armed Forces and Veterans Champion

Items and actions

Welcome and update from SG on spending constraints

The chair welcomed everyone to the meeting and invited SG officials to review the action log. It was confirmed that this is up-to-date with nothing outstanding.

The chair invited SG officials to provide an update on recent spending constraints that had been reported in the media. SG officials confirmed that all but essential and unavoidable spending (i.e. where SG would otherwise breach its legal obligations, fail to provide essential or emergency support, or cause significant economic damage) has been paused with immediate effect.

In May 2024, Combat Stress informed the Scottish Government that it will not be continuing its contract with SG on renewed terms to provide mental health services for veterans resident in Scotland beyond 4 September 2024. Officials had been exploring as a matter of urgency alternative options for veterans beyond this period. However, discussions with potential service providers, which were at an advanced stage, have now been paused with immediate effect. SG officials are now preparing an impact report for senior management which outlines the implications of pausing this funding, SG officials confirmed they will keep the Advisory Group updated on progress.

The chair invited comment from the group following this update. It was commented that commitment to physical and mental health support for veterans is tied to the Armed Forces Covenant which has been signed by the Scottish Government. Additionally, it was noted that the original financial envelope for veterans mental health was £2.4 million for 24/25. It was confirmed by SG officials that Veterans First Point funding and funding for the clinical contract with Combat Stress up to 4 September is legally committed, but all other spending is currently paused.

It was commented that the funding cause could have implications when selecting the most appropriate model for the pathway project. The chair stated that the group should continue evaluating the options appraisal as planned and that the aim is still to make a business case to Scottish Ministers for the best future model possible.

A number of group members expressed concern and stated that pausing funding would create significant risk with regard to the safety and wellbeing of veterans across Scotland.

It was noted that Combat Stress are an established charity that have existing pathways to statutory mental health and addiction services so should still be well embedded as a charitable organisation after the conclusion of the contract with SG on 4 September. Additionally, they are developing a new online support service. Clinical leads for Veterans First Point services open to creating systems and processes for clinical handover of veterans necessary. Combat Stress have provided SG with an in-depth exit plan which provided an assurance that veterans currently engaged with their services will continue to receive this support.

The chair confirmed that the group will progress knowing that the pause in funding remains a risk and that SG officials will work on the impact report, welcoming any contributions group members may wish to provide.

Action: SG officials to update group members on the impact report being prepared.

Review of the draft risk register

SG officials presented the draft risk register to the group. It was acknowledged that the risk register will have to be updated in light of the new spending constraints.

It was suggested that a new risk should be created which reflects the financial challenges (e.g. recruitment freezes) for HSCPs and Health Boards which may impact on veterans mental health. It was also suggested that a risk of NHS Health Boards withdrawing their dedicated Veterans First Point services due to financial constraints should also be noted on the register.

A group member also suggested that a risk of veterans not choosing to engage with a new pathway should be included. The chair added that we may wish to document her contract coming to an end in March 2025 as being an additional risk to project continuity.

Action: SG officials to update risk register and circulate to the group for further feedback at the next meeting.

Review of the project purpose and outcomes document

SG officials presented the project purpose and outcomes document. The chair invited group members to provide SG officials with written feedback.

Action: group members to provide SG officials with feedback by 30 August.

Update on operational working group and stakeholder network 

The Chair invited the co-chairs of the Veterans Mental Health and Wellbeing Pathway Operational Working Group and Veterans Mental Health and Wellbeing Stakeholder Network to provide an update on both groups.

The Veterans Mental Health and Wellbeing Pathway Operational Working Group will hold its inaugural meeting on 6 September. The first meeting will include a review of the draft terms of reference and an overview of the governance structure for the whole project.

Invitations to nominated members have been sent and confirmation of all attendees for next month’s first meeting expected imminently. It is expected that there will be ten members of the group who will have experience and expertise in the delivery of clinical and non-clinical services for veterans.

While the advisory group will provide the parameters as to how the plan should look, the operational working group will consider the practical, operational requirements for and implications of the implementation and delivery of the pathway. The group will provide any necessary recommendations to the advisory group, prior to the plan being presented to the Minister. The group will also assess current veterans mental health provision in Scotland and flag any identified gaps to the advisory group.

The Veterans Mental Health and Wellbeing Pathway Stakeholder Network brings together statutory and third sector organisations, and veterans from across all sectors and areas of Scotland. In terms of governance, the stakeholder network group will act as a ‘sense checker’ for all recommendations produced by the advisory group and the operational working group. This group will also provide a forum for sharing models of delivery and practices from across statutory and third organisations and from all locations across Scotland. The network will provide an opportunity to share learning and allow different communities to consider adopting practices which have been proven to be effective in improving mental wellbeing outcomes for veterans.

The group held its first meeting on 28 June. At the meeting, the purpose of the network was agreed. The network will bring together statutory and third sector organisations and veterans from across all sectors and areas of Scotland.

Further meetings will be held throughout the course of the year, with the next one scheduled for 30 September. Unlike the advisory group and operational working group, there is no cap on numbers and at the moment there are over 50 members. Those nominated by the advisory group to join the stakeholder network will be invited to join the next meeting on 30 September.

The co-chairs invited feedback on their updates. Some group members suggested that the operational working group should be expanded to include all 14 NHS health board areas. It was also commented that the operational working group should focus on how local services within each area will coordinate the delivery of mental health and wellbeing services for veterans.

The co-chairs stated that representation of all health board areas is covered in the stakeholder network. The priority of the operational working group is to provide an appropriate level of both geographical and disciplinary representation.

Action: SG officials to confirm with advisory group the final membership list for the operational working group.

Review of options appraisal paper

The chair provided an overview of the options appraisal paper. The paper outlines three options for the future direction of the project:

• option A: standardised national approach
• option B: national framework to be applied locally
• option C: a national framework to be applied locally with a centralised referral hub

The consensus from the group was that option C was the preferred model.

It was commented that although the fundamentals are covered in option B, option C would be the preferred option on the condition that more detail is provided on how the centralised hub will operate.

One group member raised the risk of developing national standards, only for some areas to fail to engage with them in any meaningful way. The chair acknowledged this concern and stated that the centralised aspect of option C may provide a way of managing this.

SG officials added that option C could provide a single point of entry via a website, with the solution then being delivered at local level via this central website. This would also allow for the capture of valuable data. Several members of the group commented that a single point of entry would be desirable. However, it was acknowledged that further details would be required.

One group member commented that there needs to be appropriate resources in the central hub to direct the veteran to the correct resource.

Action: SG officials to prepare new options appraisal paper for the next meeting which will set out greater details on themes covered in option C.

Action: SG officials to send the operational working group a summary of the options appraisal discussed at this meeting to give them an overview of what has been agreed.

Any other business

The chair asked the group if they were content with the minute of the previous meeting. The group confirmed they were content with one amendment: a group member had been incorrectly noted as being in attendance.

Action: SG officials to amend the minutes from previous meeting accordingly.

Date of next meeting: Monday 14 October