Health and Sport Committee

Meeting date: Tuesday, January 23, 2018

Official Report 489KB pdf

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Petition

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Mental Health Services (PE1611)

Item 3 is consideration of petition PE1611, in the name of Angela Hamilton, on mental health services in Scotland. Members will be aware that we have considered the petition previously, as part of the committee’s work on mental health. The committee’s work on the petition included writing to Sir Harry Burns, in his role as the chair of the review of targets and indicators, to make him aware of the petition and the petitioner’s call for a reduction in mental health waiting times. We have also heard from the Scottish Government on its mental health strategy.

Members will have seen the paper from the clerks, which invites us to consider whether to close the petition in the light of the commitment that was made by the Scottish Government in its mental health strategy to a change of approach in developing a system of indicators for mental health provision. Are members minded to close the petition?

I am not entirely clear on whether the Government’s refreshed strategy and Sir Harry Burns’s work have answered the petition. Sir Harry Burns’s review simply said that waiting time targets

“should be subject to clinical prioritisation”.

His review has not called for any change to those targets.

The Government is obviously increasing the level of investment—it has spoken about having 800 more workers, and its commitments include a change of approach in developing a system of indicators for mental health prioritisation. I am not clear that that will impact on waiting times. That is my concern about closing the petition—I am not entirely sure that the points that it raises are being addressed elsewhere.

I share Alison Johnstone’s concern about closing the petition prematurely. Although the rhetoric from the Government, tying in as it does with the review of targets by Sir Harry Burns, is welcome, I think that we need to keep a watching brief on the matter. I think that the petition still stands—we are not reducing mental health waiting times; if anything, they are travelling north.

For example, at our last meeting, I raised the fact that although £17 million in the budget is certainly welcome additional spend, it is trying to do rather a lot at the same time. The £17 million is an initial investment towards those 800 new members of staff—I remind the committee that 800 members of staff will cost £20 million a year—yet it is also to deliver a transformation in child and adolescent mental health services. I am not entirely convinced that it can do that, although I hope to be proved wrong. I would be very reluctant to close the petition until we see some tangible progress in relation to waiting times.

To add to what Alex Cole-Hamilton said, the direction of travel is very welcome and all the rhetoric is very positive. However, before we can close the petition, we have to have some indication of outcomes. Like others, I would rather have a bit more of a watching brief before we close the petition so that we understand that the direction of travel is being adhered to and is having an impact. I would be reluctant to close the petition at this point.

The petition specifically refers to

“Reducing the mental health waiting time target from 18 weeks to 14 weeks for adult therapies”.

I imagine that the Government is not going to do that. Should we keep the petition open if that is not going to happen? The Government’s response is that it is trying to improve outcomes with regard to the targets that we already have, and Harry Burns has suggested maintaining the targets as they are and not making any changes to them.

The petitioner also refers to reducing the mental health waiting time target

“to 12 weeks for child and adolescent mental health services”.

As we know that five health boards, including Fife, are not meeting the 18-week target, are we not better off saying that we should hang on a bit and try to hold the Government to account on the current numbers, which it is not reaching?

There is a judgment to be made about how we proceed. Members have indicated that the responses have been broadly positive but have not yet reached the point at which they can make a decision.

I think that everyone would agree that we want to keep the Government’s propositions on mental health treatment and treatment times under review. The only question is whether the petition, which is somewhat dated because of developments since it was submitted, is the right vehicle or whether we should close the petition and look at finding other means of maintaining that review process in the months ahead.

Jenny Gilruth made a good point about the fact that we are not achieving the 18-week target so we should focus on that. However, the petition reflects the public’s expectation of where the agenda should be driven further. They throw our metaphorical cap over the wall. We do well not to lose sight of that and to be reminded of what the public would like to happen on waiting times. That is all the more reason to hold on to the petition, irrespective of the fact that we are not even meeting the Government-set waiting times.

Are there other views?

I point out that, in a previous letter to the minister, the committee said:

“we make no recommendation on a reduction to 12 weeks as we think the target needs a fundamental rethink.”

I am not entirely sure that that has happened. However, we also said:

“we cannot see the justification for a continuation of different waiting time targets between mental health and physical health conditions.”

I am reluctant to close the petition in case it is thought that we accept the current situation. The fact that the current waiting times targets are not being met is, I am sure, of huge concern to all members of the committee. It is not good enough for any young person to have to wait for the number of weeks that they are currently asked to wait, and most of us would agree that being seen within 12 weeks is not exactly a speedy service.

If we are going to address targets and indicators, we need to do that in a structured, coherent fashion. We cannot just pick this one or that one based on whatever petition comes in on a given day. We have gone through a process, and that process has more ways to run in terms of determining what the targets and indicators should be. However, that is the forum for doing that, rather than looking at things randomly. We could have 100 petitions on any old indicator and we could sit here all day asking whether the indicator should be this, that or the other.

NHS Dumfries and Galloway is 95 per cent meeting its child and adolescent mental health services target, so it is doing really well. There are services that need to perform better and others that are doing okay. I am not sure that keeping the petition open is the way to hold the Government to account. Ivan McKee makes the point that there could be lots of petitions on targets, but we are already examining targets that we are not meeting. Therefore, I am not sure that the petition is the best way to proceed, but we still need to keep an eye on a process for analysing the information.

On Ivan McKee’s point, the call for a reduction in the target waiting times is one part of the petition, and it is probably the part with which I am least engaged given that we are not hitting the original targets. For me, it is more about getting some sort of feel for whether what is said in the response to the petition from the Government and agencies is coming to fruition—that is, whether we are moving in the right general direction. For that reason, I am hesitant to let the petition go. There have been a lot of positive and welcome indications from the Government, but I would like to see some movement.

There are clearly different views around the table. If we do not close the petition, what else do we need to do with it? It has been well used as a vehicle for raising questions and has allowed the committee to keep a focus on the issue for some 16 months, for which I give credit to the petitioner, but is there anything further to be done with it? Alternatively, are there further steps to take to hold the Government to account on its strategy and the priorities that it will set?

That poses a wider question to the committee and the Parliament about the use and life of petitions. I am struck by Alison Johnstone’s point that if we close the petition now, we are admitting defeat—it would be an admission that what it calls for is unachievable or that we have done all that we believe it is possible to do on the matter.

I am yet to hear an argument from committee members about the negative consequences of keeping the petition open. The committee could agree to revisit the petition in a year to benchmark progress. If at that point we are closer to achieving its aims, I would welcome the opportunity to close it as a sign that the nation was doing something tangible to close the gap that the petition addresses. We are not there yet. I do not see any cost in keeping the petition open, and I think that it is important that we keep it open as a demonstration of our view that we do not think that much progress has been made.

11:45  

Your point is valid in the sense that there is no negative consequence of keeping the petition open. The only negative is the fact that the petition was lodged before the Burns review took place and before the mental health strategy was published. Therefore, I am not sure that it is the most useful basis for the committee’s future consideration of the issue. In itself, keeping a petition open does no harm but, as time progresses and as things roll out, the petition will become less and less related to circumstances.

We will continue to hear directly from the NHS boards about their performance and I am sure that we will have the minister, Maureen Watt, in front of us in the future so that she can answer on targets. I agree that there is no negative consequence of keeping the petition open. The question is: what is the best process for assessing mental health, physical health and wellbeing? It is all part of what we heard about this morning.

I think that we are coming close to a consensus.

The petitioner has gone to the trouble of raising the issue with the Parliament. The Government has said that it will develop new mental health indicators, but I cannot see how developing that new system of indicators relates to any clear commitment to change the targets. Sir Harry Burns’s review has not called for such a change, so I would like the committee to have more information on what the Government intends to do. Will the new indicators impact on the targets? If so, we would at least be able to give the petitioner a clearer answer, instead of just closing the petition.

In light of what members have said, I suggest that we do not close the petition today but await the development of the indicators. There is no great advantage in getting ahead of ourselves on that. Let us see what is developed and produced and then ask the questions that we must ask. In any case, Alex Cole Hamilton’s suggestion that we use the petition as a benchmark to return to in January 2019 if we are not satisfied that progress has been made by then seems reasonable.

It was pointed out that a progress review is planned for 2022. I am specifically concerned about that. That will be halfway through the Government’s 10-year strategy, but issues are already being highlighted to MSPs about the strategy. We should discuss whether there can be an earlier progress review to ensure that we maximise effectiveness.

That is helpful. If that is agreed, we will proceed on that basis and continue to keep a watching eye on the matter.

Members indicated agreement.

That concludes the committee’s public business.

11:48 Meeting continued in private until 12:45.