Mental Health and Wellbeing Strategy: Leadership Board minutes - December 2024

Attendees and apologies

• Maree Todd MSP, Minister for Social Care, Mental Wellbeing and Sport – Joint Chair
• Councillor Paul Kelly, Spokesperson for Health and Social Care, COSLA – Joint Chair
• Stephen Gallagher, Director of Mental Health, Scottish Government
• Dr Alastair Cook, Principal Medical Officer for Mental Health (representing the multidisciplinary group of Professional Advisors to the Scottish Government)
• Gillian Russell, Director of Health Workforce, Scottish Government
• Anna Donald, Deputy Director, Criminal Justice Division, Scottish Government
• Claire Renton, Deputy Director, Employability, Scottish Government
• Eddie Fraser, Solace lead for Health and Social Care, COSLA
• Nicola Dickie, Director of People Policy, COSLA
• Eddie Follan, Chief Officer, Health and Social Care, COSLA
• Gary Jenkins, State Hospital, representing Board Chief Executives
• Julie Cameron, representing Scotland’s Mental Health Partnership
• Alan Webb, Chief Officer of Third Sector Dumfries and Galloway, representing the Scottish Third Sector Interface (TSI) Network
• Laura Kerr, Head of Policy and Workforce, Social Work Scotland
• Margaret Callander, Unison, representing NHS National Staff Side
• Daryl Regan, Unite, representing NHS National Staff Side
• Dr Jane Morris, Royal College of Psychiatrists (RCPscyh), representing the Academy of Colleges and Faculties
• Catherine McWilliam, Nations Director, Institute of Directors Scotland
• Gordon Johnston, Chair of Voices of Experience (VOX) Scotland
• Angela Jackson, Diverse Experience Advisory Panel 
• Hussein Patwa, Diverse Experience Advisory Panel 
• Monique Campbell, See Me, representing the Equality and Human Rights Forum
• Siobhan McDill, Portfolio Office, Scottish Government
• Victoria Beattie, Head of Mental Health Workforce, Unscheduled and Primary Care, Scottish Government
• Jane Ford, Public Health Intelligence Principal, Public Health Scotland
• Matthew Smith, Public Health Intelligence Advisor, Public Health Scotland
• Ian MacNeill, Health and Social Care Analysis, Scottish Government
• Ally Winford, Mental Health Directorate, Scottish Government
• Hannah Axon, Policy Manager, COSLA

Items and actions

Minutes and actions from previous meeting

The board confirmed that the minutes were a true reflection of the previous meeting, and were therefore approved. The minutes will now be published on the Scottish Government website.

Councillor Kelly advised that the terms of reference (TOR) had been updated to reflect the comments received from the board, both at the last meeting and via email. Councillor Kelly invited the board to approve the TOR (LB(24)02-01). 

Discussion

• Daryl Regan, NHS Staff Side – highlighted lack of clarity about how the board’s membership was selected – the selection process is not currently covered in the terms of reference

Action

• secretariat will liaise with NHS Staff Side and clarify what amends to the TOR would be helpful. The TOR will then be finalised following those amends.

Councillor Kelly then asked Elaine Kelley and Victoria Beattie to provide an update on the actions from the last meeting. The main points to note were:

• actions 1, 4 and 5 referred to various information that board members were asked to provide to the secretariat. The Equalities and Human Rights Forum provided feedback in advance of the meeting. The secretariat will accept feedback on an ongoing basis
• for action 7, the secretariat produced a network map of the board membership detailing who everyone on the board represents. This will provide a better understanding of how wider groups feed into the governance structure
• for action 2, Victoria Beattie advised that the Mental Health Demand and Policing Strategic Governance Group (SGG) met in September 2024 to discuss governance structures and on the work which is being taken forward through the Partnership Delivery Group (PDG), namely the Framework for Collaboration (FfC) and the Collaborative Commitments paper
• it is proposed that representatives from Police Scotland and Scottish Police Authority should be invited to attend a Leadership Board meeting when relevant agenda items are being discussed, rather than becoming permanent members. Updates of board’s discussions will be provided to the Strategic Governance Group where appropriate. Police Scotland will also continue to be represented on the Scottish Government’s Mental Health Unscheduled Care Network

Discussion

• Hussein Patwa, Diverse Experiences Advisory Panel (DEAP) - highlighted the importance of being mindful of using acronyms

Actions

• board members to provide the secretariat with comments on the network map before it is finalised and circulated
• all board members who are involved in producing papers and presentations to be mindful when using acronyms, spelling each one in full at the first usage

Monitoring and evaluation for Scotland’s Mental Health and Wellbeing Strategy

Jane Ford from Public Health Scotland (PHS) provided a progress update on the development of the evaluation framework for the strategy. Ian MacNeill, Health and Social Care Analysis, Scottish Government, then provided an update on the monitoring work that is progressing, including the setting up of the Monitoring and Evaluation Advisory Group.

Discussion

• Councillor Kelly, Co-Chair – highlighted that there are gaps in the data we have, so how do we ensure we get accurate data? Ian MacNeill confirmed the need to identify what data we have and flag the key areas of absence and this is something that could be generated into the evaluation framework
• Gavin Gray, Deputy Director, Child Poverty and Financial Wellbeing, Scottish Government - noted it would be good to consider how we align what is learnt through this alongside evidence around child poverty as we shape the new delivery plan
• Monique Campbell, Equalities and Human Rights Forum (EHRF) – there is a need to ensure that the public sector equality duties are adhered to and that there will be a comprehensive look at where the gaps are.  We know that we need data around stigma and discrimination as key social determinants
• Laura Kerr, Social Work Scotland – asked whether engagement with social care providers and social work services (that commission social care and also provide direct support to people who experience mental ill health) has been considered. It was confirmed that there is representation from the Health and Social Care Partnership on the group
• Nicola Dickie, Director of People Policy, COSLA – there is a need to ensure we are focussed on the outcomes. Capacity means it is important to consider any new burdens that would be placed on any part of the system and the need to track capacity within Public Health Scotland as an organisation to deliver on the ambitions of what's been set out
• Gordon Johnston, Voices of Experience (VOX) – we should consider data in the widest sense and giving value to different forms is key especially when focusing on outcomes that sit outside of health services
• Jane Morris, Academy of Royal Colleges – universities in Scotland are very keen oo use our data to train people to inform health professionals. The college endorse the need for meaningful outcomes to be measured rather than waiting lists or attendance data only
• Julie Cameron, Scottish Mental Health Partnership (SMHP) – lived experience is central to informing what's looked at within the big data, in terms of what people actually see as positive outcomes rather than what we think are positive outcomes for others
• Hussein Patwa, Diverse Experiences Advisory Panel (DEAP) – we must ensure there is a strong link between outcomes and the evidence that underpins them

Actions

• secretariat to circulate the ‘Developing an Evaluation Framework for Scotland’s Mental Health and Wellbeing Strategy’ presentation
• secreteriat to share the link to the Mental Health Inequality Evidence Report 2023
• secretariat to organise a further session with Equalities and Human Rights Forum to focus on the evidence report
• board members to send the secretariat any further suggestions around membership of the Monitoring and Evaluation Group
• PHS to draft engagement framework in consultation with the Strategy's Monitoring and Evaluation Advisory Group (est. April – June 2025)
• PHS to clarify and agree roles of the Monitoring and Evaluation Advisory Group, PHS and partner organisations
• PHS to provide an update at the april meeting on the two projects underway (mapping exercise of ongoing and planned evaluation and consultation with an expert panel)

Mental health and wellbeing delivery plan and workforce action plan – progress report (LB(24)02-02)

Siobhan McDill, Mental Health Portfolio Office, Scottish Government, provided a summary and high level breakdown of the actions delivery status and gave an update on the equality impact assessment (EQIA) monitoring. Siobhan advised that the Scottish Government committed to ensuring that an EQIA was undertaken on all strategic actions in the delivery plan. An accurate picture of EQIAs recorded will be included in the next progress report.

Victoria Beattie, Head of Mental Health Workforce, Unscheduled and Primary Care, Scottish Government also gave an update on the nursing review and ongoing work on psychiatry.

The board was asked to:

• provide feedback on content; and
• discuss any of the red actions

Discussion

• Jane Morris, Academy of Royal Colleges – while progress is being made around some of the recruitment issues facing the psychiatric workforce in terms of trainee numbers, we have a retention crisis facing consultant psychiatry posts. Encouraged people to look at a report from VOX, which will be launching soon
• Daryl Regan, NHS Staff Side - action point 5.1 in the workforce action plan – ‘to ensure that workloads are manageable and reduce risk’ was noted to be on track. Would welcome more information about who this is in relation to across the wider workforce and how it is being measured because a different experience is being reported on the ground
• Hussein Patwa, DEAP – the board should ensure everything we do is as accessible and inclusive as possible. An update was requested with regards to action point 35.7 in the workforce action plan – ‘Increase the number of GPs by 800, by the end of 2027’
• Gordon Johnston, VOX – noted that the progress report has improved since the first iteration and contains useful additional information particularly in terms of some of the outputs and outcomes. Many actions in the delivery plan have started and it would be good if in future to highlight what’s been achieved so far and what will happen next, specifically around what will happen to the data collected etc.
• Julie Cameron, Scottish Mental Health Partnership (SMHP) – advised that See Me have commissioned a survey to better understand the role of stigma and stigma by association within the mental health nursing workforce. SMHP will keep everyone updated once the findings are out
• Monique Campbell, Equalities and Human Rights Forum (EHRF) – asked what demographic data is disaggregated so that we can see where there might be particular issues around staff retention. It was recognised that there is an issue with workforce data and the Scottish Government is working with NHS Education for Scotland (NES) to try and improve things
• Laura Kerr, Social Work Scotland – highlighted that when working with NES it would be useful to engage with the Scottish Social Services Council and the Care Inspectorate in order to get the whole picture and ensure we are not neglecting key parts of the workforce
• Jane Morris, Academy of Royal Colleges – highlighted that there are many people whose needs are not being met in primary care services as a result of long waiting lists for secondary care. This includes people with neurodiversity. Some of these people could be supported through third sector, however the third sector is also working beyond capacity. These combined factors result in low morale and burnout across the workforce

• Daryl Regan, NHS Staff Side – raised the issue of psychology posts not being advertised due to budget cuts. With regards to NHS specifically, is there data being collected around the posts that are going out for recruitment as well as the difficulties around retention of posts? It was confirmed that the Scottish Government is working closely with Lynn Taylor (Professional Advisor for Psychology) and the Heads of Psychological Services (HOPS) Group to collect this management information

Actions

• secretariat to circulate ‘Your Views: Psychiatrists in Scotland Report’ by VOX, once published

• secretariat will provide the board with further information regarding action point 5.1 in the workforce action plan - ‘to ensure that workloads are manageable and reduce risk’
• secretariat will provide the board with an update to action point 35.7 in the Workforce Action Plan – ‘Increase the number of GPs by 800, by the end of 2027’
• secretariat to circulate the Mental Health in Primary and Community Care Report
• Portfolio Office to include equality monitoring in the April progress report

Mental Health and Wellbeing Strategy delivery plan and workforce action plan – Prioritisation of Commitments (LB(24)02-03)

Councillor Kelly introduced the Prioritisation of Commitments paper. The paper described a revised approach to producing the next iteration of the delivery plans to support the strategy, which were intended for publication in spring 2025. The paper highlighted the significant financial challenges across the system. Taking account of this, and that the key challenges in the progress of the current plans have been funding and capacity, it laid out a revised timetable for the work, as well as a proposal for a prioritisation exercise to inform the revised plans.
The board was asked to: 

• support publication of the next iteration of the Mental Health Strategy Delivery Plan and Workforce Action Plan being delayed in order to ensure that actions can be costed. Potential unintended consequences and appropriate mitigations of any consequences of this delay will be considered as part of the prioritisation and planning process
• consider whether future refreshes of delivery plan and workforce action plan should be closer aligned
• agree that an exercise to prioritise our existing remaining commitments is necessary, including identifying potential new policy options that we are not currently committed to, but that could be included in a refreshed delivery plan. The outputs of that exercise will be integral to informing future refreshes of the plans
• agree the draft underlying principles for the prioritisation exercise
• agree the sequencing for the prioritisation exercise
• consider policy suggestions for potential inclusion in future plans, and return feedback to the secretariat. These could be policy suggestions not currently contained within the plans; a restatement of existing commitments that have not been able to be progressed due to the current budgetary situation; or examples of good practice that are already being taken forward, but where we could go further
• consider the example priority ‘scoring tool’ and provide feedback to the secretariat

Discussion

• Monique Campbell, EHRF – asked who will carry out the prioritisation and costing exercise and what transparency there would be around the process. It was also unclear who would be using the scoring tool and what is meant by the different metrics, such as risk to who and why. It was confirmed that there is an initial proposal for how this could be done in a transparent and consistent way in Annex A of the paper, which is a scoring tool
• Gordon Johnston, VOX – broadly happy with the approach, however need to think about the balance across the various priorities and across the three P’s of the Strategy - Promote, Prevent and Provide. We need to be thinking not just about what we're doing now, but about building towards the vision and outcomes of the Strategy as a whole. Need to consider how we take account of areas that have longer term priorities e.g. law reform work, the forensic review etc.
• Eddie Follan, Chief Officer, Health and Social Care, COSLA – it was recognised that the impact of prevention is difficult to measure. There will therefore be a need to ensure that it being difficult to measure, does not exclude prevention from plans and consider what approach we take to this. It was also highlighted that wider system capacity must be considered as well as internal governance capacity
• Hussein Patwa, DEAP – important to consider capacity constraints within all sectors. What will the process of engagement and consultation look like and all of the governance processes that they need to go through?  How do we determine if an impact is high, low or medium? How do we determine where that sits in terms of the scoring metrics and where does that fit in to the work of the monitoring and evaluation group? The panel welcomed the scoring tool but asked how it will be decided what to take forward where something has very high impact but very low sustainability or vice versa? 
• Claire Renton, Deputy Director for Employability, Scottish Government – with regards to evaluation or prioritisation, it is crucial to use our collective resources better and take a systematic approach to joining up policies and working closer together
• Gavin Gray, Deputy Director, Child Poverty and Financial Wellbeing, Scottish Government - A new Tackling Child Poverty Delivery Plan is being developed and will be published in early 2026, to set out a pathway towards meeting their statutory targets. poverty is a big driver of mental health and wellbeing issues for people and how can we do better to understand those connections and really focus on the actions
• Alan Webb, Scottish Third Sector Interface (TSI) Network - often where policy interactions are more complex nationally, there is a lot of learning from local ways of working that do integrate policy approaches to meet local need, however there is maybe not enough resource to maximise it
• Councillor Kelly, Co-Chair - lots of initiatives around that economic inactivity
  poverty support, inequality support that ties into mental health so we need to all work collectively
• Monique Campbell - EHRF – the forum were in agreement that stakeholder consultation needs to be proportionate. Rather than just thinking about diversity, we should think in an intersectional way across all protected characteristics. with regards to the scoring tool, the forum agreed it was helpful and welcomed the specific section on equality and human rights, but wondered how that could feed into every other criteria in the tool
• Julie Cameron - Scottish Mental Health Partnership (SMHP) - this should be an opportunity to build on the strengths and the weaknesses of the current delivery plan e.g. the lack of specificity to some of the actions which makes it difficult to know whether it's been achieved and what the measure of achievement is
• Margaret Callender, NHS Staff Side – would like to see key performance indicators and an idea of what we’re aiming towards and have a specific set of outcomes

The board agreed:

• to delay the publication of the next iteration of the Mental Health Strategy Delivery Plan and Workforce Action Plan so that actions can be costed
• that future refreshes of the delivery plan and workforce action plan should be closer aligned
• that an exercise to prioritise our existing remaining commitments is necessary, including identifying potential new policy options that we are not currently committed to, but that could be included in a refreshed delivery plan
• to the proposed sequencing for the prioritisation exercise

Actions

• secretariat to add specific material to the underpinning set of principles to reflect that all commitments included in future versions of the delivery plan and workforce action plan should contain specific timelines and clear outputs
• secretariat to explore how to develop the scoring tool further, doing so in partnership with stakeholders (including the EHRF)
• board members to send the secretariat policy suggestions and feedback on what they see as early priorities for potential inclusion in future plans

Close

• Councillor Kelly and the Minister thanked everyone for attending and for their substantial contributions
• the date of the next meeting is 30 April 2025