Meeting of the Parliament

Meeting date: Wednesday, March 11, 2020

Official Report 1066KB pdf

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Mental Health Services in Tayside (Independent Inquiry)

The first item of business is a statement by Clare Haughey on the independent inquiry into mental health services in Tayside. The minister will take questions at the end of her statement, so there should be no interventions or interruptions.

Last month, Dr David Strang published the final report of the independent inquiry into mental health services in Tayside. I thank Dr Strang, the inquiry team and Health and Social Care Alliance Scotland for their hard work.

In particular, I also thank everyone who contributed to the inquiry. More than 1,500 people shared their often incredibly painful experiences and personal testimonies. Far too many people have been let down. Although not enough on its own, I offer my apology on behalf of the Scottish Government for what they have endured. Many Tayside patients and their families and friends, including those who have lost loved ones, will have found the report challenging. Their bravery, courage and candour was vital to shaping the report.

I also thank staff who participated in the inquiry and who are committed to ensuring the delivery of excellent services in the future.

The report outlines a range of issues and calls for a new culture of working across NHS Tayside and the three health and social care partnerships. It makes 51 recommendations in five areas: governance and leadership, crisis and community services, in-patient services, child and adolescent mental health services and staffing.

NHS Tayside and its local authority partners have accepted the report, its findings and its recommendations in full. At NHS Tayside’s board meeting on 27 February, the chief executive, Grant Archibald, apologised to anyone whose experience of Tayside’s mental health services had fallen short of the expectations that we all rightly have for those services. The board agreed to collaborate with partners to deliver a Tayside-wide response to the inquiry’s findings.

Partnership working is the cornerstone of the approach that will be taken to respond to the inquiry report. A Tayside collaborative strategic leadership group has been established, comprising chief executives from NHS Tayside, Angus Council, Dundee City Council and Perth and Kinross Council, as well as the Police Scotland Tayside divisional commander.

Collective responsibility and accountability are emphasised in the group’s published statement of intent, which commits to implementing necessary improvements through the development and delivery of a Tayside-wide strategy and change programme for improving mental health and wellbeing.

One of the recommendations of the inquiry report relates to the delivery of mental health and wellbeing services in the context of health and social care integration. It recommends that the NHS board and the three integration joint boards review the delegated responsibilities for the operational delivery of those services across Tayside, to ensure clarity of understanding and commitment.

In line with the inquiry report and the views of national health service trade unions and professional bodies, the Cabinet Secretary for Health and Sport and I have made no secret of our concerns about the approach to the operational management of in-patient mental health services in Tayside. The arrangements have been unduly complex and are unique to Tayside. That is why I am clear that the operational management of general adult psychiatry services must now be led by NHS Tayside, rather than an integration authority. NHS Tayside will implement that change and will work closely with its integration partners in doing so. I believe that that simplification will bring welcome clarity to the local arrangements and allow the partnership to focus on improved services for patients.

The issues that were identified by the inquiry cannot be resolved by a single agency, and it is crucial that there is a whole-system review of services. Last week, I received a progress report from NHS Tayside, which is published on the board’s website and outlines activity to drive change. I have been clear that a comprehensive action plan to detail how each recommendation will be met must be taken forward, and that work is under way.

For that to happen in a way that delivers the change that we need, NHS Tayside and its partners must listen to service users, families, carers and staff. I am encouraged that NHS Tayside has set out a commitment to ensure that it listens to the voices of people who work in mental health services, service users, families and carers, so that future services can be co-designed and co-produced. The inquiry report recommends that a full plan be developed in partnership and published by June 2020, and I expect that timescale to be met.

Later today, I will meet members of the Tayside stakeholder participation group, which is chaired by Health and Social Care Alliance Scotland. I look to NHS Tayside and its partners to continue to build on that and to keep patient needs at the heart of the discussions.

Organisational development is vital. The report found that many staff did not feel valued, listened to or treated with respect. Staff reported “a lack of clarity” around line management and accountability, and a “culture of blame”, rather than an organisation that is open to “learning from adverse events”. That is unacceptable.

Engagement is the first step, and work with staff is already under way to support that. I am encouraged to hear that safe space meetings, which enable staff to discuss concerns confidentially, are happening.

The report explores the impact of workforce challenges on delivery of mental health services, which includes the ability of staff to participate in training and supervision requirements. That raises questions about how we ensure that people have the right skills and experience to do their jobs and how they are involved in helping to find solutions to workforce challenges across social work, social care, clinical settings and the third sector. I am encouraged that NHS Tayside is working with staff, unions and professional bodies to develop a response, which will form a key part of its whole-system strategy.

We are pursuing action in that area. Psychiatry recruitment challenges across the United Kingdom require collaborative, concerted action. To address those challenges, we are working with the Royal College of Psychiatrists, NHS Education for Scotland and medical schools to promote psychiatry as an attractive career. We are also on course to deliver our commitment to 800 extra mental health workers in Scotland by the end of 2022. As of 1 January this year, 375 posts had been recruited.

On 31 January, I announced a support package to help to deliver improvements in Tayside. That package includes multidisciplinary clinical and practice support and brings together specialists from across a range of specialties and backgrounds to provide support and challenge. I welcome the fact that colleagues who helped to produce a highly regarded Lanarkshire mental health strategy are now also working with NHS Tayside. That multidisciplinary support will develop a mental health strategy for all of Tayside, strengthen governance and reporting arrangements, improve consultation and engagement, enable delivery of Tayside’s improvement plans, create a Tayside-wide culture and change programme for all mental health and care staff, and undertake a review of current service provision. That will be complemented by programme management expertise that will be provided by the NHS Information Services Division. The multidisciplinary team will work with NHS Education for Scotland to engage with the NHS Tayside organisational development team, in order to ensure that it responds to the inquiry’s recommendations to support staff.

The Royal College of Psychiatry’s UK college centre for quality improvement—CCQI—will independently assess the quality of clinical services in Tayside. The CCQI will focus on four key areas: quality networks, accreditation, national clinical audits and research and evaluation.

Through the Royal College of Psychiatrists and the Scottish Government’s former principal medical officer, Dr John Mitchell, we have also facilitated expert clinical support and guidance, and Healthcare Improvement Scotland will offer specific support to Tayside to address the quality of adult community health services. That is not a one-off support package. Through the Tayside oversight group, we will continue to work closely with NHS Tayside and local partners, to seek assurance that improvements are being implemented. We will also continue to work with the Convention of Scottish Local Authorities to ensure that NHS boards, councils and integration joint boards are supported to work together across Scotland.

I am grateful that the chair of the independent inquiry, Dr David Strang, has agreed to undertake a progress update in Tayside in February 2021, which will provide an independent assessment of improvements.

I have already committed that learning from the inquiry will be fed into our national approach to quality and safety. We want to bring greater coherence to the arrangements for quality planning, improvement and assurance for mental health. That is why we have established a quality and safety board for mental health. On 19 February, I chaired the first meeting of that board. It will have an important role in taking forward two of the national recommendations that are contained in the inquiry’s final report. The first is for a national review of the assurance and scrutiny of mental health services across Scotland, including the powers of Health Improvement Scotland and the Mental Welfare Commission for Scotland. The second is for a national review of the guidelines for responding to substance misuse on in-patient wards. With regard to the latter, there are commitments in our mental health strategy and in this year’s programme for government that will drive service improvements for people with comorbid mental ill health and substance misuse. I look forward to updating parliamentary colleagues on the work of the quality and safety board in due course.

We must work to ensure that the issues about which concerns were raised in Tayside are not being experienced elsewhere. It is vital that we continue to put people at the centre of that work. The safety of our patients and the quality of the services that they receive are paramount.

I reaffirm this Government’s commitment to support Tayside to deliver the services that people need. I am committed to learning from the experiences in Tayside. It is vital that people in Tayside have access to high quality, safe and effective services, and that they have trust and confidence in their care. That is what they and all communities across Scotland deserve.

I thank the minister for advance sight of the statement.

The report of the independent inquiry into mental health services in Tayside is a shocking indictment of mental health services failing some of the most vulnerable people in our society, and it reveals a culture in NHS Tayside that has resulted in staff who are demoralised and are not supported in providing the care and services that people desperately need. Families will, therefore, welcome the public apology that the minister has given today. However, the most important thing is for us now to see real change. How will the recommendations to restore trust be benchmarked beyond 2021 in Dr Strang’s work, which the minister has outlined today?

In other parts of Scotland, similar concerns are being expressed about pressures in mental health services and about overworked and demoralised NHS staff, and the Royal College of Psychiatrists has warned that services are facing a workforce crisis. Therefore, what steps will ministers take, following this inquiry, to guarantee that we do not see a repeat of these failings across other boards? Will the quality and safety board outline any of those problems when they are highlighted, so that we see early intervention with regard to the reporting of staff and patient concerns?

Mr Briggs raises some important issues. We need to ensure that NHS Tayside and its partners listen to those who use the service and to the staff who provide the service, as well as to the trade unions and professional bodies. NHS Tayside and its partners have made a commitment to do so, and I will be scrutinising the work that they do in that regard to ensure that they deliver what they have said that they will deliver. We will work closely with all of the organisations that are involved in that.

I am heartened to hear about the on-going work that is being done with organisations such as the alliance to ensure that all service reviews in NHS Tayside and its partners will be advised by service users and their carers, and that they will have a voice in the development of those plans.

With regard to the benchmarking beyond 2021, I cannot commit Dr David Strang to that. To provide a measure of assurance to the people who have participated in this inquiry—I again sincerely thank them for doing so—I have asked him to independently scrutinise what has been done after a year. I am aware that people would be concerned if there was no such scrutiny. I am happy to engage in discussions on how we can continue to ensure that NHS Tayside and its partners deliver high quality healthcare from 2021 onwards.

I thank the minister for advance sight of her statement. Scottish Labour welcomes the Government’s apology to the families for what they have endured. We are pleased that NHS Tayside and its partners have accepted the Strang recommendations in full. Any resistance to positive change must be left in the past.

The minister set out her expectations around implementation, but can she give a guarantee that the action plan that she has instructed will meet the 51 recommendations in full? What action will the Government take if progress is too slow or is not comprehensive?

The minister said that we must work to ensure that the concerns that were raised in Tayside are not being experienced elsewhere. I know constituents in Lanarkshire who are working with some of the families in Tayside because of their common experiences. They include Karen McKeown, who met the minister following her partner’s death by suicide. What guarantee can the minister give people across Scotland that they will not have to fight as hard as the families in Tayside for whole-system changes to be made in their areas?

I thank Monica Lennon for her questions—there were several questions, and I apologise if I do not answer them all. I will be happy to come back to her with more detail if what I say does not satisfy the questions.

I welcome her statement welcoming NHS Tayside’s and its partners’ acceptance of the report. There should be no resistance to change or to acceptance of the recommendations of the independent inquiry, and I am assured by the reassurances that I have had from the Tayside collaborative strategic leadership group that it accepts them and wants to work together to change and ensure that there is quality and safety and that people feel reassured about accessing those services.

One reason why I set up the quality and safety board, which includes members from the royal colleges, NHS chief executives, COSLA, the Mental Welfare Commission for Scotland and Healthcare Improvement Scotland, was to ensure that we have an overview of mental health services across Scotland and that we can look at areas where we perhaps need to improve, and also at areas of best practice and how we can spread that across the country.

I assure Ms Lennon that I will certainly not be taking my eye off the ball in relation to quality and safety across mental health services in Scotland.

Eleven members want to ask a question and we have 13 minutes left, so I ask for self-discipline and, if possible, shorter answers.

I thank the minister for her statement and I welcome the changes to the governance arrangements for in-patient beds. I thank David Strang for the meeting last week, and I particularly thank those who shared personal experiences with the inquiry.

How will NHS Tayside take forward the 51 recommendations, particularly those that relate to the building of trust and respect between patients and their families, staff and NHS Tayside? What capacity does the board have in mental health leadership to drive forward the changes that are required? Finally—

No—

What oversight will the Scottish Government provide to make sure that the changes happen?

I appreciate that you are a member for the area, but we have to move on.

I thank Shona Robison for her questions. I am really grateful to David Strang for agreeing to undertake a further review, which will build on the Scottish Government’s Tayside oversight group and continue to monitor the progress there. The member spoke about trust and respect, which are absolutely key in ensuring that all the voices that need to be heard by NHS Tayside and its partners are heard. I am encouraged by what the Tayside collaborative strategic leadership group and the key stakeholders are saying in that regard.

It has been recommended that the NHS board and the three integration joint boards review their delegated responsibilities. How can the minister ensure that NHS Tayside will provide the protected training time for its staff that is required in order to ensure that that becomes a reality?

I thank Mr Stewart for that question. It is key that we ensure that staff feel adequately trained, have capacity to reflect on their work, have supervision and can express their concerns in such a way that they do not feel judged but, rather, feel that they will be supported. That is why I welcome the sessions that NHS Tayside has introduced, in which staff are able to express their concerns. The driving forward of quality and safety and service redesign within NHS Tayside will need to include those staff-side partners.

I remind members that I am co-convener of the cross-party group on mental health. Can the minister clarify for those with lived experience what role they will have in ensuring that the report’s recommendations are delivered, so that patients can remain central to that process?

As I said in answer to an earlier question, I welcome the involvement of all stakeholders in the on-going and previous discussions about NHS Tayside’s care and treatment of people who access mental health services. Their voices are absolutely key to future work. I welcome NHS Tayside’s continuing engagement with the stakeholder group.

I and other members across the chamber have been aware of pressures on mental health services in our areas, so a commitment to a national review by the Government is very welcome. Can the minister outline the expected timescale for the completion of the work and when she expects to update the chamber on the quality and safety board’s work?

I am sorry if Mr Stewart has misunderstood what I said. I am not carrying out a review of mental health services across Scotland. The quality and safety board is there to draw organisations together to look at quality and safety across the country. However, I am happy to make a commitment, as I did in my statement, to come back and provide further updates on the quality and safety board’s work. Two of the Strang report’s recommendations are national recommendations, and they will be key parts of the quality and safety board’s work.

How can the report’s findings and NHS Tayside’s response to them help to address recruitment challenges in mental health services on Tayside?

The development of the whole-system approach to the mental health and wellbeing strategy will create new roles and new opportunities for staff, such as advanced nurse practitioners, and I hope that that will create more capacity and attractive opportunities. As I said earlier, we are working with the Royal College of Psychiatrists, NES and medical schools to promote psychiatry as an attractive career. In looking at its services and service redesign, I am sure that NHS Tayside and its partners will consider how to use the skills that they already have in their workforce to maximum effect, which will also be good for staff development.

The report states that patients were sometimes dismissed by staff as

“troublesome, antagonistic, problematic and not to be trusted”.

It is clear that staff at NHS Tayside were under enormous pressure and that compassion fatigue may have been a factor in the service. Can the minister outline how staff will be supported to develop positive relationships with patients and actions to address staff wellbeing more broadly in NHS Tayside?

The Scottish Government has regularly engaged with staff representatives and it was clear from our most recent meeting with them on 28 January, where I was in attendance with the Cabinet Secretary for Health and Sport, that significant concerns remain. We welcome NHS Tayside’s commitment to working in partnership with its staff and staff representatives to ensure that everyone has the opportunity to contribute, learn, influence and shape the future of mental health services in Tayside. As I said in my statement, I am encouraged to hear that the safe space meetings are running; they will enable staff to raise concerns in an environment that they feel is a confidential space in which they are supported.

The catalyst for much of that work was the tragic circumstances under which David Ramsay was twice turned away at Carseview before he sadly took his own life. What assurance can the minister give the chamber that, should somebody appear today at Carseview in a state of mental health crisis, they would not also be turned away?

I expect that anyone who presents in a state of mental health crisis is given a thorough mental health assessment and that a proper risk assessment is carried out by the person who did the assessment, whether a doctor, nurse or allied health professional, as happens day in, day out across the country in mental health teams, accident and emergency departments and in-patient settings.

I expect that people would be thoroughly assessed, and, if it was felt that admission was not the best course of treatment for them at that point, appropriate treatment services would be put in place for them—whether those were crisis, community or third-sector organisations’ services. I also expect that people would be appropriately signposted and given the support that they need to deal with whatever crisis they are going through. I expect that across our NHS.

The report states that

“honest scrutiny is a powerful tool leading to improvements in service”.

How can the Scottish Government assist NHS Tayside to create a culture of greater openness, allowing greater scrutiny?

One of the findings of the report was that, as an organisation, NHS Tayside was not open to learning from adverse experiences, and staff reported a “blame culture”.

Organisational development is vital. NHS Tayside is already taking steps to better engage with staff, and with service users and their families.

The package of measures that I announced in January, and the work that is being done between NHS Tayside, Healthcare Improvement Scotland, NES and the Royal College of Psychiatrists, along with the oversight work of the new quality and safety board, will support that.

People from Tayside and further afield were given the gold standard of acute treatment at the Mulberry unit’s bespoke, friendly centre. The end of that service sent them all to the overloaded Carseview unit in Ninewells.

Does the minister agree that the Government and NHS Tayside—now that the buck is stopping with NHS Tayside, instead of the IJBs—should reintroduce the gold standard Mulberry facility for the benefit of the people in Angus and Dundee whose relatives are crammed into the overcapacity Carseview?

NHS Tayside halted changes to its reconfiguration programme in line with the inquiry’s interim report recommendations, in May 2018.

The cabinet secretary and I made it clear that we would not support NHS Tayside’s proposals for changing in-patient services until we were satisfied that they were framed by consideration of the whole system, including local community services. As I described in my statement, I expect NHS Tayside’s strategy for transforming and improving mental health and wellbeing to give careful consideration to all available resources at its disposal to ensure the best outcome for staff, and for patients and their families.

The minister mentioned the Royal College of Psychiatry. David Strang was clear that nursing and allied health professional leadership should also be involved in designing a balanced and sustainable mental health service in Tayside. Does the minister agree that that recommendation is very important, and how will it be delivered?

I absolutely agree, and I am sure that that will come as no surprise to Mr Macdonald. AHPs, nurses and others play a key role in delivering mental health services day in, day out across the country. As I mentioned, the use of advanced nurse practitioners can expand services and provide additional support in situations when, perhaps, there are not as many medical staff or psychiatrists as we would like. AHPs, occupational therapists and nurses provide vital care, day in, day out, to our mental health services. We need to use their skills more effectively and to have those professionals working to the top of their licence so that they are able to free up capacity in other parts of the service, and provide quality service, which is key.

Will the minister set out what impact improved recruitment in mental health in Tayside might have on achieving the recommendations in the report?

Recruitment plays a part. In an earlier answer, I set out the steps that the Scottish Government is taking to increase the number of medical students who are taking up training in psychiatry. The issue of the number of students studying psychiatry is not exclusive to Scotland, or to Tayside; it is faced across much of the western world.

We need to look at investing in, and improving the capabilities of, our other healthcare professionals, and at ensuring that our services are provided with quality and safety, regardless of the profession that is delivering the service.

That concludes questions on the statement. I thank the minister and members; we got through all the questions, which is excellent.