Independent Oversight and Assurance Group on Tayside's Mental Health Services and the Tayside Executive Partnership minutes: July 2022

 

Attendees and apologies

Present

• Fiona Lees, Chair of the Oversight and Assurance Group
• Fraser McKinlay, Member of the Oversight and Assurance Group
• David Williams, Member of the Oversight and Assurance Group
• Grant Archibald, Chief Executive, NHS Tayside
• Greg Colgan, Chief Executive, Dundee City Council
• Phil Davison, Divisional Commander, Tayside, Police Scotland
• Thomas Glen, Chief Executive, Perth and Kinross Council
• Margo Williamson, Chief Executive, Angus Council

Secretariat

• Stephanie Cymber, Mental Health Division, Scottish Government

Items and actions

Welcome

The chair of the meeting, Fraser McKinlay, welcomed colleagues, thanked them for their attendance and thanked Dundee City Council for hosting the meeting at their offices. This was a hybrid meeting with Greg Colgan, Phil Davison, Fraser McKinlay, David Williams and the secretariat attending in-person. Grant Archibald, Thomas Glen, Margo Williamson and Fiona Lees attended virtually. The chair apologised for the IT issues which had led to a delay with the start of the meeting.

Minutes from the previous meeting and matters arising

The minutes from the previous meeting on 23 May 2022 were agreed.

There remained an outstanding action for Tayside Executive Partners (TEP) to provide the oversight group with a copy of their response to the Clare Haughey letter, dated 1 June 2020, regarding the review of integration schemes. Action:  Grant Archibald will look into locating the letter.

Review of integration schemes

David Williams delivered a presentation which provided feedback to the TEP from the work that the oversight group had undertaken on their integration work plan. It covered progress to date and outstanding issues in respect of the draft revised integration schemes, in advance of their submission to the Scottish Government. David explained that he had also attended meetings of the three IJBs and his presentation therefore also included general observations on how they operate, in relation to mental health and learning disability.

The key points that were highlighted were:

• 6.6 in the revised schemes, lead partner: the first bullet states where a chief officer is the lead partner for a service, they will have operational management responsibility for those services across Tayside. This aspect is an addition which has been introduced subsequent to the public consultation on the draft revised schemes. Consideration will need to be given about how this explicitly stated responsibility will be achieved by the Angus chief officer having a lead partner responsibility for primary care (annex 1 part 3)
• annex 1 part 4 reflects no change from the previous schemes, however, its inclusion and retention clearly sets out a role and responsibility for IJBs about which there is no evidence that they have hitherto discharged their duties in the previous six years. IJBs and the health board will have to consider how the former are going to take forward the discharging of this delegated function
• IJBs are required to lead the planning and commissioning of health and social care services in their area including for mental health/learning disability, not to simply receive updates which they note at their meetings. IJBs are going to have to reflect on how they conduct their business going forward to respond positively to the revised integration schemes. Health board and councils will also need to reflect on and respond positively to this more overt leadership role from the IJBs

It was noted that IJB chairs, vice-chairs and chief officers had received similar presentations for their respective areas. Some members of the TEP stated that the oversight group’s comments on the draft revised schemes were useful and noted the positive feedback as well as where there is a need for clarification and potential room for improvement. There was some discussion about comparing the operation of Tayside IJBs to those in other parts of the country.

The TEP also referenced conversations they had previously about taking a collegiate approach to inpatient mental health services; and that chief officers are progressing this, working with colleagues across Tayside. On that basis, the TEP advised that - given the clear points that need considered - they would reflect and discuss the oversight group’s feedback with their chief officers, particularly in respect of agenda planning and ensuring that IJBs consider relevant business.

This led to a conversation about roles, responsibilities and accountabilities. Members of the TEP stated that the integration schemes are much clearer about responsibilities and accountabilities and that relationships are stronger as a result. It was also suggested that there is a misunderstanding between what the TEP themselves, see their role as being, and what the oversight group understand this to be, albeit TEP were reminded that it was themselves or their predecessors who, on behalf of their organisations, indicated that they would lead the response to Trust and Respect, and that this remains their public position as set out on the health board’s website and within Living Life Well.

The oversight group advised that they would welcome a further open and frank discussion about the purpose of the TEP, their future role and public expectations about their collective commitment in respect of achieving the ambitions of Living Life Well and delivering mental health service improvements. The group will shortly be commencing work on their culture and engagement work plan and suggested this was the natural place to progress these conversations, as the work plan will include a focus on cultural change and leadership.

In conclusion, the oversight group advised that they are sharing their emerging thinking at this point and that the integration work plan is not yet concluded, so there is an opportunity for the TEP to give their views in their final submission to the group, at the end of September. It was acknowledged that these conversations can be challenging and therefore, the chair invited feedback, either in the meeting or post meeting, on how to make these discussions more effective.

Oversight group updates: themed work plans, milestones, final report

Patient safety - this work plan is almost concluded. The oversight group has issued a final question set in advance of meeting with Claire Pearce, the executive lead for this work plan, on 28 July. The focus is largely upon SAERs, with some additional information needed on the operation of Tayside’s new policy. The oversight group is engaged with two subject matter experts who will review the completed SAERs in Tayside in terms of their compliance with the new policy. There is also a request to see all available data in support of the operation of the enhanced observation protocol. Finally, the oversight group are looking to meet with local advocacy organisations.

Integration - the focus, as discussed, has been on the draft revised schemes and the operation of the IJBs because the Trust and Respect recommendations within the work plan are in relation to strategy, roles and responsibilities and the operating environment. The oversight group have had very helpful discussions with chief officers and IJB chairs and vice-chairs, particularly in relation to strategic intent and ownership of work in the different localities. Good work had been observed, however there is a disconnect between that and Living Life Well. Recommendation 14 in relation to a single pathway for dual diagnosis appears to have been superseded by the implementation of MAT Standards and a lot of work is clearly going on in this area, but it appears fragmented.

Workforce - meetings on this work plan took place on 28 and 29 June. The oversight group members gave their thanks to the teams for making themselves available and for putting together a programme of visits and meetings. In particular, there was a good session with community staff and visits to Carseview and Strathmartine. This presented a clear picture of dedicated people doing a remarkable job in difficult circumstances, with covid and challenging staffing levels. The matter of a ‘single site’ for inpatient mental health services is still a pressing issue for staff and the oversight group heard frustration that a decision hasn’t been made and that clarity is needed. There was also a good session with the ILG.  Information on some follow up actions will be provided shortly.

Culture and engagement - will start to be progressed with a programme of visits and meetings on Tuesday 2 August. Gail Smith is pulling a programme together. The group highlighted that they would also like to meet with TEP members on an individual basis. The next meeting between the oversight group and the TEP, on 29 August, will discuss both the workforce and the culture and engagement work plans.

There was a question from the TEP about the National Care Service and to what extent this has come up in conversations with staff, as part of the workforce work plan. The group advised that this wasn’t raised at all - possibly because it still feels a long way off and staff feel there are more pressing matters in relation to service delivery (including the issue about a single site for inpatient mental health).

Key milestones and final report

The oversight group will be producing their final report by the end of October as previously advised. The group will shortly set out how they would like to receive further information from the TEP, including a reassessment of progress against all 49 recommendations. This will give an update on the progress report that was provided by the TEP in November 2021. The update should set out what was understood by each recommendation and therefore what was in scope, what the intended outcome (rather than output) was, what actions are going to achieve this, what progress has been made and what still needs to be done (acknowledging that not everything will be complete).

The oversight group will set everything out in a letter to the TEP following the meeting and are looking for final submissions by the end of September, to allow the group to conclude their final report for the minister at the end of October. The oversight group will also need some time with TEP members individually and the secretariat will make arrangements accordingly.

No September meeting is currently planned between the oversight group and the TEP but that will be reviewed should the need arise. Otherwise, following the meeting in August which will cover emerging thoughts on workforce and on engagement and culture, the final meeting will be on 26 October which will look at the end-September progress reporting from the TEP, the oversight group’s final report and the communications plan around this.

In his closing remarks, the chair thanked colleagues and again invited colleagues to give their suggestions to ensure that our time together is as productive and constructive as it can be.

Any other relevant business

There was no other business.

Future business

• meeting on 29 August: focus on workforce and engagement and culture
• meeting on 26 October: focus on final report