The main sections of this report set out our detailed consideration of each of the 51 recommendations. We would expect Tayside Executive Partners to be assured that account is being taken of them all by the responsible and accountable Bodies in their forward planning.
Rather than creating another long list of recommendations, we highlight below six areas for increased strategic focus as Tayside Executive Partners and the Scottish Government move ahead with the process of change.
1) Progress on 'single site'; Strathmartine; and delayed discharges - In our second quarterly report, published in June, we highlighted three specific areas that required urgent attention. We have not yet seen plans to take these issues forward. It is now imperative that Tayside do so with pace and ambition and in a way that engages with patients, families, partners and communities. The three issues were:
- Progressing the decision around about single site provision in Tayside for inpatient mental health care.
- The physical environment in Strathmartine, which raised concerns for both patients and staff.
- Addressing the issue of significant delayed discharges, meaning that patients were being kept in inpatient beds longer than they needed to be.
2) Streamline and prioritise the change programme in support of Living Life Well - As we describe later in the report, the change programme related to Tayside's mental health and learning disability strategy, Living Life Well, is overly complex. There is therefore a need for Tayside to simplify governance arrangements, prioritise areas for improvement and put in place a clear resource framework to support delivery. This will give staff, partners and communities clarity and confidence that the new strategy will be delivered.
3) Making integration work - Having clarified the roles and responsibilities for mental health through the revised integration schemes, the partners must now focus on collaborative working to make the new arrangements work in practice. This needs to include a clear understanding of how each partner will work together and, importantly, the role of the Tayside Executive Partners in providing the right leadership environment to ensure that innovation can flourish and that sustainable change can take place.
4) Engaging the workforce - We have met many highly skilled and committed staff across Tayside. They need the resources, support and leadership to ensure they can do their jobs effectively, while looking after their own wellbeing. They also need to be effectively engaged in the major decisions affecting service delivery.
5) Engaging with patients, families, partners and communities - There is an opportunity to build - and in some cases rebuild - relationships with people with lived experience of mental health services in Tayside. Their voices deserve to be heard and engagement needs to be meaningful. There is a rich and diverse third and community sector in Tayside. The statutory partners need to redouble their efforts to work with these organisations to shift the balance of care, away from inpatient services and into the community.
6) Continued focus on patient safety - We recognise the progress that is being made in many aspects of patient safety. Staff are committed to doing the best job they can often in difficult circumstances. Tayside Executive Partners need to ensure that their respective organisations' systems, processes and physical infrastructure support continued improvement in patient safety across Tayside where appropriate.
1. Over the last 12 months, Members of the Oversight Group have valued the time we have spent with Tayside Executive Partners and the communities they serve. We have appreciated hearing from colleagues who work in mental health and learning disabilities and from people with lived experience of those services. We are grateful to them for trusting us with their stories and we are the better for their insight and challenge.
2. In 2018, following widespread concerns raised in the Scottish Parliament about the provision of mental health services in Tayside, NHS Tayside commissioned an Independent Inquiry and appointed Dr David Strang to lead the review. Dr Strang published his report in February 2020. NHS Tayside and partners welcomed the report and accepted its recommendations. There were 49 recommendations for Tayside and two for the Scottish Government.
3. The Tayside Executive Partners comprising the Chief Executives of NHS Tayside Angus, Dundee and Perth and Kinross Councils, and the Tayside Police Scotland Divisional Commander, issued a joint statement of intent committing their organisations to work collaboratively to deliver the improvements identified in the Trust and Respect Report. The statement of intent is set out below:
"The Independent Inquiry Report sets out a clear and urgent need for improvement in the mental health care, treatment and support for people across our communities in Tayside
The Tayside Executive Partners are committed to making all the necessary improvements so that people from all communities across Tayside receive the best possible mental health and wellbeing care and treatment and those with mental ill health are supported to recover without fear of discrimination or stigma.
Together with people living with mental ill health, their families and carers, and our staff, we will immediately work on addressing the issues raised in the Independent Inquiry Report to build good quality mental health services that meet people's needs and build a working environment that supports our staff.
As leaders of the response to the Independent Inquiry, we will:
- Immediately establish a Collaborative Strategic Leadership Group to oversee the urgent and essential actions required to improve mental health services and begin to restore public trust, respect and confidence in mental health services in Tayside.
- Strengthen our engagement and participation so that the voices of people with lived experience and their carers are amplified and remain strong as we co-design improvements to services to deliver a truly person-centred Tayside-wide Strategy for Transforming and Improving Mental Health and Wellbeing.
- Drive the development of the Tayside-wide Strategy which delivers support and services built on our commitment to fostering respectful relationships with people who use and work in our services.
- Commit to strengthening the Tayside Mental Health Alliance as a collaborative which brings together all partners and all aspects of mental health - from prevention and recovery, to community and hospital-based services.
- Reach out to, learn from and engage with other mental health systems, external experts and professional bodies to further develop leadership, culture, behaviours and attitudes which will strengthen the learning culture across mental health in Tayside.
- Work in partnership with 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.
We believe that through these commitments and the recognition of people's lived experience, we will put people at the centre of decisions about their support, care and treatment. We understand that good mental health contributes to improvements in people's life circumstances and we are committed to working with people to ensure trusting, respectful relationships are at the heart of what we do."
4. Tayside Executive Partners developed the Listen Learn Change Action Plan in August 2020 which brought together responses to all 49 recommendations for Tayside. Separately, the Scottish Government developed responses to the two recommendations which applied across all of Scotland.
5. In February 2021, the commitment from Tayside Executive Partners was enhanced further still by the Collective Leadership Promise they made as part of Living Life Well, the new mental health and wellbeing strategy for Tayside. This included, amongst other things, a commitment to strengthening engagement and participation, creating the conditions for change and fostering respectful relationships.
6. When Trust and Respect was published, the Scottish Government asked the Independent Inquiry team to revisit Tayside's mental health services after 12 months, to review and report on progress made against the Trust and Respect recommendations.
7. Dr Strang commenced his follow-up review in February 2021 and the Progress Report was published in July 2021. One year on, Dr Strang found a great deal of positive changes and was impressed with the commitment of staff, partner organisations and others seeking to make a difference. However, he also reported that there remained a long way to go to deliver the required improvements and that some key relationships were still problematic and unresolved. Finally, and of particular concern, Dr Strang questioned the level of confidence which could be placed upon the accuracy of the reported progress against the Tayside's Listen Learn Change Action Plan.
8. Throughout this period, the Scottish Government has had cause to escalate NHS Tayside to Level 3 on the Board Performance Escalation Framework, in respect of their delivery of mental health services. The description of Level 3 escalation is where there has been 'significant variation from plan, risk materialising, tailored support required'.
9. By way of background, NHS Tayside was one of the three original Boards escalated in terms of the Board Performance Escalation Framework in 2016. Having been at Stage 5 in April 2018 for Finance, Governance and Leadership, NHS Tayside was then de-escalated in this regard, to Stage 2 in March 2021. In June 2017, NHS Tayside was also escalated to Stage 4 on the Performance Framework in respect of Mental Health Services, and subsequently de-escalated in this respect to Stage 3 in June 2021, reflecting progress up to this point. NHS Tayside currently remains at Stage 3 with regard to the performance of Mental Health Services. Going forward, the Oversight Group expects NHS Tayside and the Scottish Government to work together on next steps, in the context of the feedback in this Final Report and the key points for actions contained within.
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