Meeting of the Parliament

Meeting date: Wednesday, February 8, 2023

Official Report 1297KB pdf

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NHS Tayside Mental Health Services

The final item of business is a members’ business debate on motion S6M-07514, in the name of Michael Marra, on the final report of the independent oversight and assurance group on NHS Tayside’s mental health services. The debate will be concluded without any question being put.

Motion debated,

That the Parliament welcomes the publication of the final report from the Independent Oversight and Assurance Group on Tayside’s Mental Health Services; understands that the report tracks progress against the 51 recommendations made by Dr David Strang in his report, Trust and Respect; recognises that the group has met with staff, third sector and community groups, patients and families while compiling the report; notes the view that progress has been made, including on changes of leadership and clarifying of roles; believes that the report also highlights key areas where recommendations have not seen sufficient action taken, including in the areas of strategic planning, staff appraisals, governance and public performance reporting; thanks the oversight group and all those who contributed to its work, and notes the calls for reassurances that outstanding recommendations will be enacted.

18:53  

I thank members for giving me the opportunity to hold a debate on this important issue. I also thank the independent oversight and assurance group that was appointed by the Scottish ministers for the report that we are here to discuss. In addition, I thank the stakeholder participation group for its work over the past few years and for finding the time to meet me in advance of the debate.

In the past five years, 345 people in Tayside have lost their lives to suicide, 158 of whom have done so in my home city of Dundee. As a result of those 345 lives lost, 345 families have been thrown into turmoil and grief. Those families needed better of their services, their Government and all of us. Those deaths speak to a mental health service in crisis. For every soul that was lost, dozens more were hanging on by their fingernails.

In the context of that crisis, an independent inquiry into mental health services in Tayside—led by Dr David Strang—was launched. It reported in early 2020, with 49 recommendations for NHS Tayside and two for the Scottish Government. Dr Strang went on to publish a progress report in 2021, which, damningly, found that there remained

“a long way to go to deliver the improvements that are required”

and, significantly, noted concerns about

“the level of confidence in the accuracy of the reported progress”.

I will return to that later.

Yet another report is now in front of us, from another group of experts. Again, they have noted some improvements and the urgent work that is still needed. The pace of change is far too slow. All urgency is missing.

Eight months ago, here in the chamber of the Parliament, I raised with the First Minister the delayed discharge of my constituent Ryan Caswell. The First Minister called his situation “unacceptable”. There has been no change. Ryan has been living in Carseview hospital for three years. He has complex care needs, including autism spectrum disorder and learning disabilities. For three years, his desperate parents have been unable to find suitable accommodation or care packages. For three years, therefore, he has been forced to stay in a hospital that is completely inappropriate for his needs—and, for three years, his parents have worried day and night about his care, his safety and his future.

Dozens of people in Tayside are waiting for the health board, the Government and the minister to get their acts together and deliver the care that they need—the care that we all promise. I would like to hear from the minister a commitment and a plan to end the scandal of delayed discharge in our mental hospitals that is identified in the report.

However, of course, services cannot just be wished into existence; they have to be planned, managed and resourced appropriately. An analysis that was provided to me by the Royal College of Psychiatrists shows that Tayside has the highest rate of consultant psychiatrist vacancies in Scotland—fewer than half of all posts are filled. In one service, only one in five posts is filled—80 per cent are unfilled. Some of that huge weight is picked up by hugely expensive locum staff. Those staff do not fill out-of-hours shifts or provide staff development and they play no part in the planning for any future robust services in our communities.

For years, we heard from service users that people with a dual diagnosis of mental ill health and substance use struggled to access services. We heard from the Dundee poverty commission’s interviews with hundreds of citizens in Dundee, and from the Dundee drugs commission. The authorities denied them all, until the evidence became overwhelming. That was a feature of Dr Strang’s reports. At that point, they promised to do better.

So, where are we now? The oversight and assurance group reports that dual diagnosis

“will be addressed at a later date.”

The Strang report was delivered not three weeks ago but two years ago. After all those previous years of denial, “we’ll get to it when we get to it” is nowhere near good enough. Delayed discharge, workforce planning and dual diagnosis are just a few of the urgent challenges that the service faces, which are identified in the report to ministers and to which we require a full response.

I will close with what I know must be a central question for the minister. NHS Tayside has had to be dragged kicking and screaming to the reform process. It is of huge concern that the oversight and assurance group’s report shows that serious doubts remain about its commitment to that process. After Dr Strang’s second report called into question the accuracy of the reported progress from the local leadership, the oversight group reported, in January last year:

“Tayside had 28 recommendations rated as Green and 21 as Amber. Our independent assessment had 9 recommendations rated as Green, 38 as Amber and 2 as Amber/Red.”

Those are worlds apart—it is literally incredible. Can the NHS Tayside board really be trusted to mark its own homework? The evidence says no. Can it be left alone to deliver the change that we need? The city of Dundee says no.

I hope that the minister will set out tonight his plans for the future of governance. He clearly believed that additional oversight was required, or he would not have appointed that external group.

The oversight and assurance group does not believe that it should become permanent, but previous measures have proven to be entirely insufficient, so to whom will NHS Tayside be accountable? Who will hear its reports? Who will ensure that echoes of the loss are heard, the silence of the helpless is known and the cries of the bereaved are answered? If we are back here in three years with another report and another set of recommendations, that will have been an abject failure that shames us all, and it will be measured out in many more lost lives.

19:00  

I will begin with a few thank yous. First, I thank Michael Marra for bringing this incredibly important topic to the chamber for debate; and, secondly, I thank the minister for setting up the independent oversight and assurance group, because without that intervention, I seriously question whether we would have seen any meaningful progress in addressing the state of the mental health services that NHS Tayside provides.

However, with due respect to Mr Marra and Mr Stewart, the biggest thanks must go to the independent oversight and assurance group for the job that it has done. I had the privilege of meeting Fiona Lees and her team during their work and I do not mind admitting that I was hugely impressed, not only by their commitment and approach but, more importantly, by their candour. They answered every question that I put to them in a way that left me reassured that those people intended to leave Tayside’s mental health services in far better shape than they found them and that they were not going to be fobbed off or kidded by cosmetic improvements. That is why, like others, I have every confidence that what their final report says—good and bad—is credible.

I admit that, initially, I was a little conflicted about how I viewed the picture that the report paints. I wanted to take heart from the progress that is highlighted. However, the more that I reflected on it, the more that I came back to the fact that—as Michael Marra alluded—the oversight group operated for a year but, prior to that, NHS Tayside had ample opportunity to drive the progress that was demanded by Professor Strang in his initial report and in his follow-up progress report in June 2021. Therefore, when I look at areas that still require attention, I cannot help but feel deeply disquieted that we are not far further forward and I wonder what it will take for NHS Tayside to get its house in order.

The oversight and assurance group’s report notes:

“For example, some important areas relating to the workforce still have a long way to go, including strategic planning, staff appraisal and exit interviews.

There is also an urgent need to improve some aspects of governance and public performance reporting, as a means of developing a more open and transparent culture and building trust among the communities of Tayside.”

Why on earth is the group still having to highlight a need for those at the top to properly support and lead a highly skilled and committed staff to ensure that they can do their jobs properly, not to mention involve them in major decisions on service delivery? Why has transparency and rebuilding trust and confidence within that wider community not already been placed at the heart of everything that the board does around mental health?

Is it any wonder that NHS Tayside has the worst record for recruiting general adult psychiatry consultants in Scotland? When those skilled individuals are in such demand, why would they choose to work for a board with a reputation like that of NHS Tayside? Yes, progress has been made, but there remains much more to do to improve the mental health offering and rebuild trust and, in so doing, we hope, make recruitment easier.

For me, as we look to the future, there are two obvious questions. First, how confident can we be that the momentum for change will be maintained? Secondly, how will progress—or lack of progress—be monitored from here on in? How will NHS Tayside’s feet be held to the fire?

As the MSP for Angus South, I have confidence about the intent and direction of travel around community mental health service provision in that part of Tayside. I have engaged directly with the Angus health and social care partnership on that and been able to make some suggestions to ensure that all cohorts are captured, and I believe that the partnership is on the right track. To be honest, under the leadership of Gail Smith, I would not expect anything else.

However, the Angus situation is inextricably linked to that of wider Tayside. For example, we need a decision about single site provision. I understand that the lease on Carseview is up in around 18 months’ time, and the physical environment of Strathmartine has been raised as a source of concern for patients and staff.

Having praised the minister for the action that he took in setting up the group in October 2021, I also look to him, in closing, to provide assurance that there will be no backsliding in Tayside now that the oversight group has produced its final report, and that we will emerge from the mess that—following on from the initial work that Jeane Freeman set in train—he has set about sorting, so that the NHS Tayside mental health services properly and fully meet the needs of those who require them.

19:04  

I thank my friend Mr Marra, a member for North East Scotland, for lodging this vital motion for debate in the chamber. I was happy to support it.

Three years ago, Dr David Strang set out a list of 49 recommendations for NHS Tayside and two for the Scottish Government. It was a clear list of remedies to solve Scotland’s mental health crisis but, as we debate this important motion three years down the line, well over half of those 49 recommendations for the health board are marked by failure. That is a worrying sign of the lack of urgency and the complacency that define Scotland’s mental health crisis.

In the two years following Strang’s report, there were 144 probable suicides in Tayside. When reading the report and listening to the speeches this evening—harrowing as they have been in some cases—it is all too easy to find oneself lost in the numbers and statistics, but it is crucial to remember that behind those figures were 144 lives lost to suicide in Tayside. Had more urgency been shown in enacting the recommendations, how many of those vulnerable lives would still be here today, still with their families and friends and still a part of their communities?

The Tayside mental health report paints a disturbing image of how we are willing to treat our most vulnerable. However, the problems facing NHS Tayside do not exist in a bubble. I ask members who are in the chamber whether they can confidently say that mental health patients in their constituencies receive the treatment that they deserve.

The mental health crisis that threatens Dundee and its surroundings is prevalent in many post-industrial Scottish cities. Stark comparisons can be made between the experiences of Glaswegians and Dundonians over the years. Both Dundee and Glasgow have stubbornly high suicide mortality rates that stand well above the Scottish average. Those higher-than-average suicide rates in our cities can be put into context by some of the cruel ways that inequality impacts health and social outcomes in Scotland. Indeed, National Records of Scotland highlights the point that the rate of suicide in the most deprived areas of Scotland was almost three times higher than the rate in the least deprived areas.

That relationship between poverty and poor mental health is the ultimate reminder of how hard life can be for those who find themselves at the bottom of our social hierarchy and of how unfair our system can be. Against that backdrop, it is deeply disappointing that funding for mental health services in the next financial year will be frozen despite the health budget overall increasing by 6.2 per cent, which means that the Scottish Government’s is failing on its aspiration for mental health expenditure to be a 10 per cent share of the entire national health service budget.

Although mental health is a difficult topic to discuss, the general trend in Scotland allows for optimism in some cases. In 2021, the number of people dying from suicide fell to its lowest level since 2017. That was partly driven by an improvement in outcomes for female mental health patients. A noticeable decrease in suicide rates for any group should be acknowledged. However, it is imperative that we remain cognisant of the disproportionate impact of suicide among young men.

Last week, I spoke in the chamber about the effects that the cost of living crisis is having on young men’s mental health. Samaritans reports that demand for its call lines has skyrocketed, with more and more people mentioning finance and unemployment concerns as stressors.

The Tayside mental health report shows clearly that we cannot become complacent. Despite a recent decrease in suicide numbers overall, the mental health crisis is far from solved in Scotland. We know the effects that poverty has on mental health and suicide rates. The cost of living crisis is driving more Scots into poverty and making life more and more difficult each day.

Scotland faces a growing crisis: a mental health crisis that is being compounded by our failing economy. We must act now. We must ensure that the report’s recommendations are seen as essential, not optional, and that adequate resource is dedicated to implementing them. Only by putting words into action can we protect our most vulnerable in Tayside and across Scotland.

19:09  

I, too, thank Michael Marra for securing the time for the debate so quickly after it was postponed a couple of weeks ago.

Given the findings of David Strang’s 2020 report “Trust and Respect—Final Report of the Independent Inquiry into Mental Health Services in Tayside”, it is vital that parliamentarians continue to shine a light on the provision of those services. Grave concerns were first raised in the Scottish Parliament in 2018, and I am encouraged to hear Graeme Dey’s passion for change.

I was not a member of the Scottish Parliament in 2018, but I knew about the public campaign for an inquiry into Tayside’s mental health services. I read about the tragic story of David Ramsay, who hanged himself after a second emergency assessment at Carseview. I was horrified by the 61 per cent increase in suicides in Dundee.

My own family has experienced the devastating impact of suicide. My heart goes out to all the families across Tayside who have lost loved ones that way.

As an MSP for the north-east, I have seen Carseview through the eyes of constituents and I have felt their fear as they tried to navigate a frightening system that they felt was so stacked against them. I not only looked at the final report of the independent oversight and assessment group on Tayside’s mental health services with interest but had personal and professional investment in it.

Reading between the lines, I can see that a tremendous amount of work is still to be done. I particularly struggle to understand why Tayside executive partners and the IOAG “continue to be apart” in their assessment of progress. As Michael Marra rightly pointed out, the report states that Tayside executive partners have reported 33 green recommendations, and 16 amber. The IOAG has rated 20 green, 29 amber and two red. That is a gulf in assessment, not a gully. How can that be?

There are two other areas in the latest report that I find extremely concerning. The first is on the workforce; the second is on culture. On workforce, as the report emphasises, there is still a “long way to go”. That seems to be an understatement, given that it was reported just a couple of weeks ago that

“Tayside is at the epicentre of a ‘national scandal’ in adult psychiatry care”,

with serious issues in recruiting consultant psychiatrists. I hope that the minister will address that in closing.

On culture, the report identifies an “urgent need” to improve governance and public performance reporting as a

“means of developing a more open and transparent culture”.

We have heard that so many times, and it has been raised with me by constituents time and time again. Those are fundamental points that still require significant improvement.

The essence of David Strang’s report is trust and respect. He said:

“The successful delivery of healthcare services depends on good levels of trust between healthcare providers and patients, their families and carers.”

That is the gold standard, but Tayside falls well short.

Mental health services in Tayside still have a huge way to go. This might have been the IOAG’s final report, but it is definitely not the end of the line. The process still needs oversight and accountability, from Grant Archibald and his team to the highest levels of the Scottish Government. It cannot be brushed under the carpet any longer.

19:13  

I thank Michael Marra for bringing this debate to Parliament. In so doing he has performed a democratic service not just for his own constituents but for all our constituents. The way that families in Tayside have been let down by failed mental health services for a decade now is not just a local scandal, it is a national scandal.

That is the reason why I pressed the First Minister to set up the Strang review, back in 2018, and that is why I pressed her to implement all the recommendations in full when the report “Trust and Respect” was published two years later.

What has been a recurring failure here—and we saw it once again with the report of the independent oversight and assurance group last month—is what David Strang described in 2021 as an “over reporting of progress”.

Of his 51 recommendations, there are 33 where the oversight group agrees with the assessment of the Scottish Government and Tayside executive partners. But, of the 18 recommendations where the independent review group disagrees with the Government’s assessment, the group found that, in all bar one of them, the situation is much worse than the health board and the Government claim. It has found that there is, at best, optimism bias and, at worst, a culture of denial and an indifference to the truth. Listen to some of the language that the authors of the report choose.

On the new mental health strategy in Tayside, “Living Life Well”, the report calls workstreams “unrealistic” and says that they are “spread too thinly”. It says:

“The governance structures for mental health also continue to be overly complex and unclear in terms of who has responsibility for what”.

On the treatment of patients, the report is highly critical of the “three strikes and out” approach regarding appointments, which results in what it calls a “closed case outcome”. It says that psychological therapy services still exist in a “somewhat confused landscape”. There is “a plethora of activity” on stakeholder engagement, but

“much of it is fragmented with no real sense of people working together on shared priorities.”

Advocacy organisations are still underresourced, understaffed and underfinanced. To quote the report again, NHS staff feel that it is “ground-hog day” with “reviews upon reviews”. One of the most damning findings is that a report with the title “Listen”—yes, “Listen”—which was a survey of the views of people who used mental health services in Tayside, has not been listened to at all. The report says that

“there has been no formal consideration of the Report by the Board”

and “no formal response” from Tayside executive partners.

I will conclude with this. Two days ago, I met again with Mandy McLaren, whose 28-year-old son Dale tragically completed suicide eight years ago. Mandy is one of the most courageous women I have ever met. When we spoke, the first thing she said was, “Where’s the action? We’ve had enough bad reports on bad reports.” She told me that, as recently as last week, someone in crisis had to phone Wedderburn house 67 times to get through. She knows of others who have had a three-year wait for a psychologist and who are still waiting.

Mandy McLaren’s message is simple: enough is enough. It is time that this Government was part of the solution instead of being part of the problem—because I tell the minister that the Government is on the wrong side of this argument with the people. The Government is on the wrong side of this argument over a health service, including a mental health service, that is supposed to be freely available at the point of need. The Government is on the wrong side. This is not just about governmental duty; it is a moral and social duty. It is time to end this shameful betrayal of a community in need—to act, to plan, to show respect and to finally bring hope in place of despair.

Thank you, Mr Leonard. I now invite the minister to respond to the debate. You have around seven minutes, minister.

19:18  

I thank members for their contributions tonight and Mr Marra for bringing this debate to the chamber. I will do my best to respond to as many of the points that have been raised as I can in the short time that we have.

First, I again put on record my appreciation of the oversight group’s work and the inclusive approach that it has taken throughout its tenure. My thanks go to Fiona Lees, Fraser McKinlay and David Williams for all that they have done.

I appointed the oversight group because I did not want folk marking their own homework, to use Michael Marra’s words. That is why the group went into NHS Tayside. The group has had a huge amount of engagement with front-line staff, which is commendable, and I am conscious that those conversations often painted a difficult picture. However, those views must be heard. They are views that I have heard when I have been out and about in Tayside. I have probably spent more time in Tayside’s mental health services than I have in any other mental health services in the country. That is because I want to ensure that we get it right for the families who have been spoken about here today.

It is important that the oversight group has also listened to the voices of lived experience of mental health and learning disability services in Tayside. We must also listen to what their experiences tell us. One of the most frustrating things for me is that the people I have talked to feel that they have not been listened to at the right time—that is wrong. From this job, I know that the services that are performing best in the country are those in which people are being listened to and which people are helping to shape. That should also be happening in Tayside.

In implementing the oversight group’s recommendations, we must ensure that individuals and their families are empowered to make meaningful contributions that shape the future of services in Tayside. I also recognise that there are a wealth of organisations across Tayside that are doing fantastic work to promote mental health and wellbeing across the region, and I am pleased that the oversight group was able to meet many of them. I accompanied Fiona Lees to a mental health festival in Perth, which was extremely well attended. Again, many of the stories that I heard from folks who attended that festival were extremely frustrating. Without a doubt, those people must be listened to.

I welcome the contributions to the oversight group’s final report. It is comprehensive and clearly articulates how we move forward and where we must focus our efforts. I am encouraged to see the progress that has been made so far on strategic planning, clarity around roles, responsibilities and accountabilities in delivering services and in patient safety, including the approach to significant adverse event reviews, distress brief intervention and the introduction of a new observation protocol. However, as has been highlighted in the debate, there is much work to be done across many of the original recommendations from the “Trust and Respect” report and the six key areas for priority action that were highlighted by the oversight group’s final report.

Therefore, I have been seeking assurance that the necessary outstanding actions will be taken. I have met with the Tayside executive partners and chief officers in order to set out my clear expectations of the importance of their role in delivering the improvements that are required. They have committed to producing an improvement plan by the end of March, which will set out clear actions and milestones to deliver on the key priority areas. I assure the chamber that the improvement plan will be gone through with a fine-tooth comb in order to make sure that what needs to be done will be done. I will continue to meet with the Tayside executive partners to review progress, and my officials will provide an on-going package of support to colleagues across Tayside as they develop and implement the improvement plan. In tandem, we will work together to agree on the criteria to de-escalate the health board from its current level 3 status for mental health services in the NHS board performance escalation framework. That will not happen until real improvements have been made.

I greatly appreciate that, minister. I apologise, Presiding Officer—I will speak through the chair.

It is right that we have an improvement plan, but to whom will Tayside mental health services be held accountable? Will the plan be published, and who beyond the minister—and in a public forum—will have the opportunity to question the lead partners so that they will be held to account for the delivery of the points that will be set out in that plan?

The service will be accountable to me, because I will be looking at the matter very closely. I will not be putting in another oversight group or anything like that. Now is the time for action. We have stopped the service from marking its own homework, and, as some have said, it has overpromised in what it has delivered in some cases. It could be said that some things have been a tick-box exercise. That is not good enough. That cannot be the case. The service will report to me.

I say to every member in the chamber and to those who represent Tayside, whom I have already written to, that I am more than happy to keep folk apprised of what is happening and to share all the information that I receive as we move forward, because there has to be openness and transparency. We owe that to the people whom Mr Marra, Mr Leonard and others have talked about.

Additional scrutiny in that respect, and of the improvement plan, will be provided by the Scottish Government’s national planning and performance oversight group. In the coming weeks, I will also meet with the chair of the board of NHS Tayside, the chairs and vice-chairs of the three integration joint boards, and members of the lived experience stakeholder participation group. Those meetings will serve to further reflect on the conclusions that the oversight group has reached in the final report.

I will also set out my very clear expectation that the chair’s role in scrutinising and supporting the improvement plan will be vital to ensuring that we make improvements for the people of Tayside who rely on these mental health and learning disability services.

Before I conclude, I would like to thank, in particular, the members of the stakeholder participation group for their tireless work in recent years in extremely difficult circumstances. I know that none of this has been easy for them. We owe it to them to get this right, because members of the group have shown bravery and openness in sharing their experiences. I will therefore take this opportunity to say to them that we are listening and we will continue to work with them to ensure that the improvements that are required in Tayside are delivered.

There is a clear collective interest here. I welcome having had the chance to debate these important issues today, and I am very clear in my commitment to make sure that the findings of the report are implemented. I want to continue these conversations and work across the Parliament over the coming weeks and months, to support the delivery of the high-quality mental health and learning disability services that the communities and people of Tayside deserve.

Meeting closed at 19:27.