Chamber and committees

To summarise, Professor McKay, are you saying that we need more qualitative data and perhaps more contextual data?

I have heard that there is data that is not being utilised to give a picture but that there is an audit trail that could be potentially helpful in drilling down into outturns. Who takes responsibility here? The issue is the span of control. Often, there is a dissonance between local IJBs, health and social care partnerships or boards and the collation of data at a national level . Where does the optimum balance sit? Does anyone have a view on what that should look like for the control, collation and publication of data?

Thank you. The rest of the panel members are nodding.

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.

I thank the members of the panel for attending today. I think that we have already heard consensus among the panel that the current data on mental health budgets does not give a clear picture of activity at a national level and that there could perhaps be an improved connection between budget allocations and stated priorities for mental health at national and local levels. Feel free to correct me if I am wrong in that assessment.

Our main source of data is Public Health Scotland’s costs book, and the latest figures are for the financial year 2023-24. The 2023 report from Audit Scotland on adult mental health highlights that

“Limited data and inconsistency in how spending is categorised make it difficult to track spending on adult mental health.”

The Mental Health Foundation’s submission also highlighted the issue of data gaps and inconsistencies, and it is not clear that the Government has responded to those data gaps.

Perhaps Mr MacLeod could highlight what we need to do, or what the Government needs to do, to improve the data picture. It is one thing to criticise the lack of data, but what would good look like? Could you hint at what that should look like? Are there other countries or other methodologies that we should emulate?

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?