Mental Health Scrutiny and Assurance Evidence Review

This is a national review of the scrutiny and assurance of mental health services in Scotland. The aim of this review is to map and assess current scrutiny arrangements, and to inform the Scottish Government’s considerations for how these may be strengthened.


1. Ensure a managed overarching framework that leads to a cohesive and coordinated approach to external scrutiny is implemented. This could be achieved through adjustment of the existing role of the Mental Health and Learning Disability National Scrutiny and Assurance Coordination Group (NSACG) or creation of a new group. A clear remit for external scrutiny dedicated to mental health and learning disability requires to be adopted.

2. If the NSACG were to function in the capacity described above, rather than create a new group, it should review and strengthen the role and remit in order to optimise efficiency and minimise duplication of work. Consider and enhance collaboration between NSACG and SIHCG. Position MWC as permanent chair, replacing the existing rotating chair, due to their extensive focus on mental health and learning disability. This should be done recognising and respecting each organisations’ independence and their own governance arrangements. The NSACG will require authority to support accountability of NHS Health Boards, which may require legislation.

3. Review and improve the way in which inspections/visits are scheduled collectively, to minimise duplication of work for both scrutiny bodies and Health Boards/IJBs. Co-ordinate joint and co-produced themed visits, with an agreed joint methodology to maximise resources.

4. Scrutiny bodies to support the full implementation of the new Mental Health Quality Standards and utilise the standards as a common framework to support the coordination of scrutiny activity.

5. Improve public awareness and increase visibility of all scrutiny bodies and their individual and collective roles, remits and responsibilities. Methods through which this could be achieved should feature on the workplan of the NSACG.

6. Review and strengthen the role and responsibilities of people with lived experience within scrutiny bodies, with a view to introducing roles at Board/senior level in order to ensure greater involvement and focus on people with lived experience. Influence at senior level is more likely to ensure the people with lived experience voice is respected and suggestions from people with lived experience in reports are safeguarded.

7. Ensure employees of scrutiny bodies have the opportunity and accept responsibility for keeping themselves abreast of changes in practice and appreciate current context to maintain credibility. Also, to give greater consideration to the wider context when undertaking inspections/reviews and reflect this more strongly in final reports, to give a greater focus on systemic issues.

8. Increase support from scrutiny bodies in the follow up of recommendations arising from reports, for example, through offering suggestions and sharing examples of good practice. Encourage the exploration of existing evidence captured in the literature; learning from tried and tested methods is both logical and pragmatic.

9. Review and improve existing data sharing mechanisms that exist at NES (Azure) with a view to implementation, as opposed to creating or purchasing new systems in order to expedite sharing of intelligence. Safety and security of data sharing is of critical importance.

10. Improve the equity of scrutiny across the lifespan, with a renewed focus on Community, Intellectual Disability (ID) and Child and Adolescent Mental Health Services (CAMHS).

11. Refocus on how and what is measured across the lifespan extending to use of softer outcomes, such as wellbeing and quality of care.

12. Explore any additional powers aligned to MWC in order to enable recommendations to be enacted in a timeous manner.

13. Provide awareness training for staff in Health Boards/IJBs in governance and assurance related issues.

14. Implement a two-strand approach to scrutiny, involving a regular cycle of reviews in addition to risk-based and intelligence led inspections. It is recognised that this recommendation may have resource implications for scrutiny bodies.

15. Continue good practice of engaging in rigorous review through thorough internal and external governance processes for mental health and Intellectual Disability services.



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