The independent inquiry into mental health services in Tayside, which was commissioned by NHS Tayside, was announced by the Cabinet Secretary for Health and Sport in June 2018, following a debate in the Scottish Parliament.
The inquiry’s interim report, which was released this morning, sets out what David Strang, the independent chair of the inquiry, has heard so far from a range of partners. The interim report is an important milestone in the work of the inquiry. The final report will provide further analysis and recommendations.
The inquiry is guided by the five principles that were agreed in the Scottish Parliament debate, which are that the inquiry must be open and transparent; be truly independent; include and involve staff from NHS Tayside, its partners and third sector providers; include and involve patients, families and carers; and include a public call for evidence, to ensure that everyone’s voice is heard.
As David Strang said:
“It is important to recognise that this report identifies only the issues which have been raised in the evidence submitted to the Inquiry. Investigation and detailed analysis will be required before any conclusions can be drawn or recommendations made by the Inquiry.”
A wide range of individuals and groups have contributed to the work of the inquiry so far. Following the announcement of the inquiry, a group was established to represent patients, families, carers and third sector organisations, to enable stakeholders to engage with the inquiry and to ensure a high level of transparency in its work. The stakeholder participation group is co-ordinated and chaired by Health and Social Care Alliance Scotland.
In addition, an employee participation group was established. The EPG is chaired by a representative from Unison and consists of representatives from all national health service-recognised trade unions, professional bodies and employee relations representatives.
More than 200 submissions of written evidence were received by post or email or in person, and between September and November 2018 the alliance held focus groups across the NHS Tayside area to capture the voices of people with lived experience of mental health services in Tayside. That significant piece of community research produced a range of valuable recommendations.
The EPG conducted an online staff survey during November and December 2018 and held focus group meetings for all those employed to work in NHS Tayside mental health services. 53 per cent of all staff who were surveyed responded: a total of 524 individual returns. The EPG submitted its report as evidence to the inquiry in April 2019.
More than 70 oral evidence sessions were held in Angus, Dundee and Perth and Kinross, with families, patients, carers, NHS employees, other health professionals and third sector organisations. Oral and written evidence was also submitted from other organisations such as Police Scotland, university student welfare teams, the Dundee fairness commission, the Dundee drug commission and third sector organisations. Additional meetings were held with a range of healthcare professionals and clinicians such as consultant psychiatrists, psychologists, general practitioners, allied health professionals, staff at the Carseview centre, student nurses and trainee GPs. The team also met integration joint board representatives and key personnel from local authorities. That enabled the inquiry to gather views on mental health provision in Tayside.
I would like to record my thanks to David Strang and his team for the work that they have done, and my thanks to the range of individuals and organisations that have taken the time to contribute to his considerations. I also thank the staff and families whom I had the privilege to meet in January when I visited the inquiry, for giving me their insights.
The interim report outlines six key themes on which improvement is required: patient access to mental health services, patient sense of safety, quality of care, organisational learning, leadership, and governance. The narrative presented in the report raises significant concern.
David Strang has not sought to provide recommendations at this stage, but I must make it clear to the chamber that the Scottish Government will not wait to receive recommendations before we act.
For that reason, yesterday, along with the chief executive of NHS Scotland, I met the chief executive and chair of NHS Tayside and their senior team, as well as representatives of the integration joint boards of Perth and Kinross, Dundee and Angus. During that meeting, I set out my clear and specific expectations of them: specifically, that the pace of change needs to be faster and the quality and safety of their services need to improve further. They are in agreement with those expectations and have welcomed the interim findings of the inquiry.
To support them in their efforts to accelerate the pace of change and improvement, the Scottish Government will augment their local team, to ensure that they can deliver on those expectations. In the coming days, my officials will meet the senior leadership team to assess the additional resources that will be required, which is likely to include additional clinical input, programme management support and community and staff engagement resources. That support has been welcomed by the local leadership, who have met it with strong commitment to delivery.
In his interim report, David Strang makes one specific point that refers to halting service redesign until a “comprehensive review” of the mental health service strategy has been undertaken, and I have sought specific assurance about the risks associated with that work. To better assess that point, I have asked the local leadership team to urgently review the risks and impact of the redesign programme, placing it fully in the context of their transformation programme.
I am clear that any redesign of services must consider the needs of all service users, and the Scottish Government is keen to ensure that the voices of people with lived experience are at the forefront.
I also committed to ensuring that the learning from the inquiry informs our national approach. The interim report raises significant issues about quality and safety. For that reason, I will give further consideration to our national approach to the quality and safety of mental health services. We need to bring coherence to our arrangements for quality planning, quality improvement and quality assurance for mental health. Arrangements are varied, and I am keen to ensure that the issues raised in Tayside are not present elsewhere.
Therefore, I will create and chair a quality and safety board for mental health. The board will consider the arrangements for quality planning, improvement and assurance and will be informed by the work of the independent inquiry. It will focus on issues such as coherent multi-agency planning to ensure that quality and safety is at the heart of our approach to mental health services. It will create the right conditions to develop and spread excellence, as we know that many areas already have high-quality services in place, and we want those approaches to be replicated around the country, so that people can access high-quality services when they need them, wherever they are.
It will also involve the examination of our quality assurance arrangements. We will bring together all the agencies that are currently involved in providing assurance on mental health services, which will ensure that we have clarity and certainty that the correct arrangements are in place to assess the quality and effectiveness of services.
Issues of safety and patient care will be included, such as the use of restraint, administration of medicines, use of risk assessments and wider-ranging issues as agreed by the group.
We know that work is already under way on many issues of safety. For example, the Scottish patient safety programme for mental health has led to reductions in self-harm, seclusion, violence, aggression and restraint in a number of areas. Collaboration and innovation from staff, service users and carers and the use of quality improvement and improvement science has been essential to achieving those improvements over the past six years. We will build on that work and ensure that it is given greater national profile and prominence.
The Scottish Government has a rights-based approach to mental health services and I will ensure that that ethos is embedded in the new group.
I am clear that alternatives to physical restraint should always be considered first. Alternatives might include nursing interventions, medical, psychological or other treatments, and/or modifications of observation policy, care regimes, the person’s activities or even buildings. Appropriate and personalised risk assessments play an important part in identifying alternatives that are suitable for each individual, and assessment should be a dynamic, on-going process by clinicians in collaboration with patients. Only after assessment by fully trained and qualified staff should restraint be used by such staff, and it should be a last resort.
I recently wrote to seek reassurance from all health boards that they have the appropriate policies and training in place for all staff who might be involved in any sort of restrictive practice. I have asked specific questions about the reporting, recording and clinical review of incidences of restrictive practice. I have also made it clear that training records of all staff who are involved in such interventions must be maintained and that training must be kept up to date.
I will provide further information on the membership of the group and the terms of reference in due course. I am absolutely clear that the safety of our patients and the quality of the services that they receive is paramount.
I welcome the interim report from the independent inquiry in Tayside and restate the commitment of this Government to improving the quality and safety of mental health services for the people of Scotland. It is absolutely vital that people feel safe when they engage with our mental health services, whether they are using them or delivering them. We must ensure that there is a high level of confidence in our mental health services and that people know that they can receive the right help when they need it.
That is why I have given the interim report the serious consideration that it deserves and why I stand fully behind the work of the independent inquiry and alongside the people who deliver those crucial services. Importantly, when the inquiry has concluded its work, I will ensure that the lessons learned and the inquiry’s recommendations will be shared widely around Scotland.