Veterans Mental Health and Wellbeing Pathway Advisory Group minutes: May 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
• Linda Irvine Fitzpatrick, Strategic Programme Manager, NHS Lothian
• Vicky Henderson, Service Manager, Aberdeenshire HSCP
• Lindsay Kirkwood, Veterans First Point Clinical Lead, NHS Ayrshire and Arran 
• 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
• Dougie Morgan, Operations Manager Scotland and Northern Ireland, Fighting with Pride LGBT+ Military Charity
• Neil Morrison, Health and Wellbeing Lead, Veterans Scotland
• Margaret Partridge MBE, NHS Greater Glasgow and Clyde Veteran Support Coordinator, Defence Medical Welfare Service
• Jenny Pope, Deputy Director of Workforce, NHS Golden Jubilee
• Robert Reid, Director of Services Scotland and Overseas, Defence Medical Welfare Service
• Caroline Robertson, Head of Operations for Scotland, Combat Stress
• Tommy Watson, Director of Veteran Affairs, Walking with the Wounded
• Julie Crawford, Scottish Government (secretariat support)
• Mark Fergusson, Scottish Government (secretariat support)
• Suzi Macpherson, Scottish Government (observing)

Apologies

• Jennifer Borthwick, Director of Psychological Services and Head of Clinical Services, NHS Forth Valley
• Theresa Mitchell, Head of Hidden Wounds, Help for Heroes
• Julie Murray, NHS Greater Glasgow and Clyde Armed Forces and Veterans
• Michelle Ramage, Veterans First Point Clinical Lead, NHS Tayside
• Jennifer Ring, Veterans First Point Clinical Lead, NHS Lanarkshire 
• Pauline Winchester, Midlothian Local Authority Armed Forces and Veterans Champion
• Lesley McDowall, Scottish Government

Items and actions

Welcome and recap of previous meeting

The chair welcomed everyone to the meeting and apologised for the papers being sent out late. A group member suggested that due to the lateness of the papers that discussion around the two spreadsheets should come after the meeting in order to allow members time to review.

Margaret Partridge from DMWS introduced herself and advised she was standing in for Robert Reid who is currently unwell and unable to attend. The chair reminded the group that the current draft terms of reference do not allow for members to invite deputies. This is to ensure consistency of membership. However, this requirement is open for discussion.

Introductions came from Julie Crawford (Survivor Support and Veterans’ Mental Health Team, Scottish Government) who is taking the minute and Suzi Macpherson (Unit Head – Trauma, Survivor Support and Veterans’ Mental Health, Scottish Government) who was there to observe. The chair asked the group if there were any objections to Suzi observing and there were none.

The chair asked the group if they were content with the minute of the previous meeting. It was advised there was an error on page five – ‘mood’ instead of ‘mode’ of delivery. Also, Jenny and David’s titles are incorrect and need to be amended.

Action: SG officials to correct the minute accordingly.

The chair reviewed the action log. This is up-to-date with nothing outstanding.

The chair provided an update on the Scottish Veterans’ Treatment Pathway. The chair will join the group and the Joint Board that oversees the pathway and will give an update at the need meeting to ensure that the links between to two groups are more aligned.

Advisory group terms of reference review

The chair provided an update from the previous discussion. The Advisory Group will come up with and design the overarching plan in terms of equitable access for veterans across Scotland. The group will provide the parameters as to how this plan should look, while the Working Group is there to feed in if what is being proposed is deliverable and how.

A group member advised of an inaccuracy in the background of both terms of reference. It should say the ‘key principles of the action plan were agreed’. The chair acknowledged this was an error and thanked him for noticing this.

It was acknowledged that there is a need for clarity with regard to budgets before scale and boundaries are agreed. It was stated that there has to be acknowledgement that investment in supporting veterans wellbeing and mental health has dependencies in other parts of strategy e.g. NHS Health Boards and Health Social Care partnerships. It needs to be seen in this broader context that this is a whole system commitment.

The chair acknowledged she has received feedback on the use of ‘evidence based’ in wording and reassured members the plan agreed will be inclusive. The national specification for the delivery of psychological services and wider supports centres around two elements – psychological care and psychological practice. These two things are equally important and we should be conscious of this. The term evidence-based relates to clinical psychological practice, and evidence such as qualitative feedback is important when considering psychological care (e.g. from third sector partners).

It was advised that evidence on the third sector is often quantitative too and we should acknowledge this. The chair agree this was important.

The group were content with the purpose and term section.

It was stated that there is an assumption that the priority commitments and the sustainable governance for developing them are already there and, in reality, they may not be. Another group member suggested that the solution is to change the wording in the ‘scope’ section to state that the Advisory Group will primarily focus to ‘identify’ or ‘develop’. The group agreed with this suggestion.

In relation to governance, it was noted that there is potential for confusion if we do not separate operational governance of the pathway from SG governance.

Action: Scottish Government to amend the TOR accordingly.

Membership section – David’s title to be changed.

Roles and responsibilities section - the group were content.

Core principles of the Advisory Group section – a group member will send suggested wording to SG officials by e-mail to be added in.

Commitments section - the group were content.

Expectations section – it was suggested that the line “open collaborative and honest discussions” is included in core principles section.

Recommendations section – there was a question about whether final recommendations will have to come from a single voice (e.g. the Chair or a politician). It was confirmed in line with the terms of reference that recommendations will be put forward from the group, for approval by Ministers.

There was also a question about the extent to which information will go out to the public domain. It is for the group to agree what to share. Main themes and topics are usually captured, but the minutes will always be reviewed before the next meeting.

The chair stated that we will add in a sentence to say we will agree in the group what is internal discussion and what can be shared publicly. It was suggested this could this go in the meeting section.

The chair advised that Agenda item four would be moved off the agenda as lived experience group was postponed.

Review of operational group terms of reference

A concern was expressed that Veterans Scotland was not consulted on the third sector element of member selection.

Action: Scottish Government officials to set up meeting with the Veterans Scotland representative to discuss these concerns further.

It was noted Scottish Government officials had been informed that there is no Combat Stress representative yet.

The chair confirmed that she is unable to comment on membership of the group. Scottish Government officials confirmed they will review membership of this group.

It was noted no one from NHS Greater Glasgow and Clyde is currently represented.

It was stated that we need to understand broad range of expertise and landscape across Scotland important. Important to be linked in with Chief Officers Group network to be able to advise a representative who could link in with services and areas across Scotland.

A group member advised that his organisation has been involved in building the veterans mental health pathway in England which took four years. The veterans journey is a joint clinical, social and holistic journey. Operational group membership should therefore reflect this.

It was stated that the group should see if there are examples of best practice anywhere else and if we should look at an adaption of this and invite relevant speakers to the group.

It was commented that membership may be fluid and we should ask members where there are gaps. The chair agreed and said the group should have ownership in terms of identifying the guardrails.

It was stated that the discussion needs to grounded in reality of funding limitations for health and social care partnerships.

It was noted that some V1P leads were missing from the membership section. SG officials apologised for the omission and advised that all V1P leads were invited to join the group.

Action: SG officials will update the list.

A group member noted the importance of mentioning the importance of safety as well as equity in the service.

The chair thanked members for their feedback. Once chairs identified, they will have ownership to design and agree on the group membership and will report back to the Advisory Group. We will then identify if there are further gaps.

Review of mapping exercises for previous implementation plan and veterans mental health and wellbeing action plan

The chair agreed with members that they would be given until 17th May to provide SG officials with their feedback on both spreadsheets. On the Veterans Mental Health and Wellbeing Action Plan, the chair asked members to pay particular attention to the RAG ratings. On the implementation plan, the chair reiterated the point that the hard work done previously should not all be lost.

Action: SG officials to provide group members with more background information on the two plans.

Action: This will be an agenda item at the next meeting.

Any other business

Action: Scottish Government officials to find date for next meeting in eight weeks.