Chamber and committees

Thank you for coming. Our previous witnesses told us about some of the difficulties with the picture that the data that is collected gives at a national level vis-à-vis the local level. The committee issued a survey to integration authorities to get a feel for the data gathering that is undertaken. It has proven to be challenging to draw firm conclusions from the data that is gathered, and it is not clear that the data is comparable across different IJBs or health and social care partnerships because of the variation in delegation of mental health services and the different formats in which it is gathered.

I would like to get an understanding of how and where you report on mental health spending and of how you categorise that spending as part of your wider financial controls process.

We know from the survey that the committee carried out how difficult it is to get robust figures and how difficult it is to collect consistent data that enables sufficiently detailed comparisons to be made to provide an insight into how mental health budgets are allocated. What needs to be done to ensure consistent reporting of mental health spending at a national level? How can we get that functioning for IJBs and health and social care partnerships?

In previous evidence sessions, the committee has discussed the idea of PBMA models, which could allow us to have real-time assessments of incremental changes in performance and would allow financing to be adjusted in a more consistent way. One of our frustrations is that we have heard anecdotal evidence that programmes are funded one year and then switched off the next year. There seems to be a reactive approach to overspends or saving requirements, which might not measure value, as opposed to cost savings.

If you were designing the system and you had total control over what you could do to optimise its performance, what improvements would you make? Could you give us a flavour of what you find frustrating, from your perspective, in trying to deliver a high-quality public service?

It was helpful. Do you have any insights into how the reporting process could be optimised? How can we make it consistent at a national level?

That was an interesting insight into the extent to which demand has increased and how that constrains your freedom in relation to resource allocation. We will need to consider that further.

Capital and revenue budgets have been split since 1998, and there is a proposal to have preventative expenditure as a third component. In Glasgow, the situation around homelessness services is particularly acute—I understand that there is an overspend in the current financial year of £27 million, and that is forecast to increase next year. Preventative expenditure could act almost as a kind of automatic stabiliser, because there is a statutory obligation to meet that need, which can create an uncontrolled spiral in expenditure. We must also consider the opportunity cost with regard to capital investment in housing stock and the expansion of housing acquisition and supply and so on—I accept that that is not necessarily within the control of an IJB-HSCP. We want to achieve our mental health goals, but one of the foundations of good mental health involves meeting the hierarchy of needs—shelter, housing and so on.

It is quite clear that we are treating a symptom of a wider structural problem, and the essence of preventative spend would involve punching through that silo and taking a cross-cutting approach to dealing with the immediate crisis. How is the particular scenario that I mentioned playing out? It seems to me like there is quite a looming crisis in Glasgow, and it is probably the case in other parts of Scotland as well. However, we appear to be in a straitjacket with regard to our capacity to bring public resources to bear to deal with homelessness in a structural and preventative way by, for example, building new stock rather than simply treating the symptoms by renting hotels.

My thanks to the panel. I am finding this really interesting, because in the mental health context, it can be quite tricky to reconcile different approaches. What might suit a logistically rational top-down approach—say, a diabetes screening programme or vaccination programme—might not work as neatly with a mental health programme. There might be much more gradual and interrelated impacts with regard to housing, urban planning, the community, employment, training and so on. How rich is our data on mental health budgets and their impact on and interfaces with other public services to support the use of a top-down, analytical, gradual, PBMA approach to allocating resources at a local level?

Okay. I am just thinking about this from an urban planning perspective, which is a personal interest of mine. An American urban planner in the 1960s, Jane Jacobs, contrasted what she called cataclysmic money—that is, a sudden influx of capital spending to do something like slum clearance and building a new housing estate—with gradual money, or community-based investment made over a longer period. The latter might preserve a lot more of the rich, organic, intangible activity that is valuable, but it is the sort of activity that does not trigger any signals that might be recognised by urban planners looking down, godlike, on a situation. They might see building new housing as the simple solution, but it actually destroys rich activity and value in the process. From your own perspectives, are there any such risks in using PBMA in a mental health setting, given the much softer and more gradual and intangible aspect to how it works?

Who would own the gathering of that data? Does that need to happen at every level at which the data is gathered? Central Government, local government, local health boards and so on often dispute who is responsible for gathering such information. Moreover, is it always appropriate for transparency—including, say, putting it in the public domain—to ensure accountability with regard to the data picture?

Okay. Thank you.

Are there, from a mental health perspective, risks in how you calculate cost avoidance, because you are trying to prove a negative that is, in some instances, hypothetical? Supporting people to stay in a home setting through giving them cooking and other lifestyle skills, companionship and so on might avoid addiction issues or entry into the justice system. However, it is very hard to say, hypothetically, that we have saved the country X thousands of pounds by investing a relatively small sum now in stabilising someone’s situation.

Anecdotally, when I was at HMP Barlinnie two weeks ago, the governor was telling me about a young man who was back in on a short sentence. He had been so humiliated at not knowing how to pay his rent that he ran away from his accommodation, took drugs and ended up back in prison. What if someone had been there to support that young man to deal with the stress of a setting that most citizens would be able to deal with? He just could not deal with it; because of how he had been brought up, he was not taught that stuff. How do you prove that sort of thing? It might be a situation particular to that individual, but it has created a spiral of costs for the country that could have been avoided. It is hard to put that into a spreadsheet.