Veterans Mental Health and Wellbeing Pathway Advisory Group Minutes: June 2024

Attendees and apologies

Lynne Taylor (Chair), Principal Psychology Advisor, Scottish Government

Jacqueline Berry, Allied Health Professionals/Occupational Therapy Lead, NHS Grampian

Thelma Bowers, Mental Health Lead for HSCP in Ayrshire and Arran

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

Lindsay Kirkwood, V1P NHS Ayrshire and Arran Clinical Lead

Linda McAuslan, Lead Nurse Psychological Therapies/Adult Psychological Therapies Manager, NHS Forth Valley

Kari Magee, Veterans’ Lived Experience Group

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

Neil Morrison OBE JP, Health and Wellbeing Lead, Veterans Scotland

Julie Murray, Chief Officer, East Renfrewshire HSCP; and Secretary of the Chief Officer Group for Health and Social Care Scotland

Jenny Pope, Deputy Director of Workforce NHS Golden Jubilee

Michelle Ramage, V1P NHS Tayside Clinical Lead

Robert Reid, Defence Medical Welfare Service

Caroline Robertson, Head of Operations for Scotland, Combat Stress

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

Vicky Henderson, Aberdeenshire HSCP

Dougie Morgan, Fighting with Pride LGBT+ Military Charity

Jennifer Ring, V1P NHS Lanarkshire Clinical Lead

Tommy Watson, Walking with the Wounded

Pauline Winchester, Midlothian Local Authority Armed Forces and Veterans Champion

Items and actions

Welcome and recap of previous meeting

The chair welcomed everyone to the meeting and thanked group members for their feedback on the mapping exercises for the previous Implementation Plan and Veterans Mental Health and Wellbeing Action Plan which informed the options paper to be discussed later in the meeting.

The chair reminded members that dates for advisory group meetings for the remainder of the year are now in the diary. Days/times will alternate between Monday afternoons and Friday mornings based on the poll completed by members. (The next dates are Friday 23 August, Monday 7 October, and Friday 6 December).

The chair reviewed the Action Log. This is up-to-date with nothing outstanding.

Terms of reference – final draft

The chair asked group members if they are content with the final draft of the terms of reference which was included in the papers for the meeting. The only amendment was that Julie Murray is on the group to represent the National Chief Officer Group for Health and Social Care Scotland.

The group were otherwise content with the final draft.

Action: SG officials to amend Julie Murray’s title.

Update on operational working group

The chair confirmed that David Dent and Thelma Bowers have been confirmed as co-chairs for the operational working group. The chair thanked the group for their feedback at the previous meeting on how the operational working group should work alongside the advisory group. The chair invited SG officials to give an update on this.

SG officials informed group members that there will be a stakeholder network with over 50 members who will meet for the first time on 28 June 2024. Separate from this, approximately ten people will form the operational working group. A key agenda item at the first stakeholder network meeting will be that members can suggest who would best represent their sector on the smaller operational working group and understand their valuable contributions. 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. Additionally, when embedding and implementing the new pathway, the stakeholder network will be able to work locally to implement plans and, if necessary, make the necessary adjustments to ensure they fit their local arrangements.

The chair invited the new co-chairs to give their thoughts. They stated that the key aim is inclusivity both geographically and in terms of type of stakeholder. Key factors in determining who are represented on the smaller operational working group will be sector and geography so there is good representation of both. However, the consultation that will also take place outside the operational working group will ensure as inclusive an approach as possible. They added that the new governance arrangements will reflect the diversity of Scotland and ensure that everyone can influence and shape the new pathway plan.

A member stated that her organisation are setting up a group to discuss veterans mental health in Greater Glasgow and Clyde and it would be helpful to know who from our geographic area is on the stakeholder network group.

Action: SG officials to set-up a separate meeting to discuss further.

Action: SG officials to send membership details of the stakeholder network group to advisory group members. Advisory group members can then make any suggestions for additions to the network.

Review of options appraisal paper

The chair thanked the members again for their input to the mapping exercise which informed the options appraisal content and stated that the key themes that emerged from the feedback will be considered throughout the discussion. The chair acknowledged that, at this stage, the appraisal only describes options in broad terms so as to allow group members to consider the direction of travel. The options were:

• option A: standardised national approach

• option B: national framework to be applied locally

• option C: national framework to be applied locally with a centralised referral hub

The chair noted that option A is similar to the model used in England while option C is more akin to the approach taken in Wales. The chair stated that it is hard to consider any options without considering the financial landscape and invited SG officials to provide comment on this.

SG officials confirmed that the Scottish budget for Veterans Mental Health as a whole in 2023/24 was £2.4 million and is the budget SG are working with for 2024/25 as plans for the pathway develop. However, in the current financial climate budgets are always subject to change. If the group identify a priority areas that will require additional funding, recommendations for additional funding can be put forward to the Minister.

It was commented that it would be helpful in future for the group to have a better idea of where SG funding is split, what is ring-fenced and what may be changeable. SG officials responded that the Minister can consider various options in terms of funding based on what the group recommend in the options appraisal.

The chair invited feedback on options appraisal. SG officials opened the discussed by stating that during their engagement in the past few months with various stakeholders from both the statutory and third sector across Scotland, the view has been that the preferred option is for some local autonomy.

It was stated that funding being released at local level has a big impact on local IJB or HSCP planning and we should be conscious of this. Workforce plans are already in place that should include support for veterans from a primary care mental health perspective.

It was commented that even with a local model, commitments still need to measured and tracked. This shows the importance of business continuity planning. The chair responded that the NHS Wales model is a good example of this – there is centralised oversight while still maintaining local ownership which includes local third sector partners.

A member of the group raised the issue of regional differences in Scotland bespoke support for veterans. For example, only six Health Boards currently run Veterans First Point (V1P) services. In the last year, the third sector in Scotland had around 5900 clients, of which 500 were in clinical support. This support is not typically constrained by geography because of virtual support available. For this reason, option C was favoured. It was added that the options appraisal was lacking detail and requires costings.

The chair acknowledged that further detail is required in the options paper, but that the aim is to bring the group towards an in principle agreement.

It was stated that regional disparities could create obstacles to achieving equitable services for veterans across Scotland. For this reason, the Group should think in more detail about what an optimal service specification should look like. Once this is agreed, the Group can consider how each geographical area can achieve this. Additionally, particular issues specific to certain regions can be explored, such as difficulties in recruiting staff.

It was also commented that there needs to be an ask of local systems under any new framework to describe what they can deliver with the resources they have available and demonstrate partnership working. The Group can then identify gaps. It was added that a preferred option depends on funding available. If no funding is available, option B seems most appropriate, but option C is preferable if funding is available.

It was stated that the Veterans' Places, Pathways and People (VPPP) programme has been undertaking data scoping exercises in remote parts of Scotland. This data indicates that no area is equal and further feedback was offered to the Group on this at a future date if necessary. It was added that there should be more emphasis on prevention and support. These are the two key areas the third sector do very well. Additionally, we must avoid just thinking about intensive intervention as often more basic support is required and this is shown in the existing data. Additionally, we should look at support currently on offer from existing groups before creating new ones.

The chair responded that she fully agrees that social connection can be just as valuable as therapeutic support and the challenge will be looking at where the demand lies for both.

It was stated that we must remember the importance of co-morbidities. For example, the impact on mental health of chronic pain from service-related injury. It was added that 70% of veterans with serious physical injury will develop some sort of mental health injury. For this reason, there is a requirement to create a linkage between the data being gathered of both physical and mental health and to identify causal links. The chair agreed we must be data-driven but acknowledged that there are significant practical difficulties in data sharing between various health care systems.

A group member noted the vast amount of non-clinical work done by V1P services including peer support and third sector partnership working. The group member also referred back to comments from SG officials about stakeholder engagement and asked if there had been a sense of buy-in from stakeholders about this new project. SG officials responded that statutory and third sector organisations they spoke with were pleased to be consulted and many informed them that they were waiting for launch of new pathway before launching any new activities themselves.

It was stated that building informal networks of support are crucial, especially given current financial constraints. Additionally, we need to be mindful of governance and for this reason option C is the most desirable as it leaves room for scrutiny of local systems and their performance with regard to veterans care.

It was stated that any future model must have an emphasis on prevention rather than intervention. The chair responded that we have three approaches in the SG Mental Health and Wellbeing Strategy around promotion, prevention and provision and the importance of all these three key areas will have focus.

The chair noted that the Group’s preference seemed to be towards options B or C. She invited group members to indicate their preference in the chat bar. Most group members indicated a preference towards B and C (with most backing option C). However, the chair acknowledged that the group require further information before they can make a fully informed decision.

Action: SG officials to draft new options appraisal paper focussing on options B and C which will include costings and feedback form. This will be discussed at the next meeting.

Action: The chair to include the model from the national psychological specification in the options appraisal papers after adapting language.

Any other business

The chair asked the group if they were content with the minute of the previous meeting as this was missed during the first agenda item. The group confirmed they were content.

Date of next meeting: Friday 23 August