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.


Scottish Mental Health services use a governance framework through which organisations and their staff are accountable for continuously improving the quality of patient care. Staff are required to ensure that appropriate systems and processes are in place to monitor practice and protect high quality care. Scrutiny and governance frameworks provide mechanisms to do this by requiring Scottish Mental Health services to provide evidence that standards are upheld in the processes, systems and structures they use to deliver care. Importantly, governance is required to reassure the public that the care being received and delivered is of the highest standard. Scottish Mental Health services have a duty to the communities they serve to maintain the quality and safety of patient care.

Within Scotland most scrutiny and assurance activity takes place within the Boards, for example, each Board accept responsibility for measurement against key performance indicators, undertaking audits and internal investigations. There are also external scrutiny and clinical governance processes undertaken by organisations such as HIS, MWC, the Care Inspectorate (CI), and Scottish Public Services Ombudsman (SPSO). This means reviews, visits and inspections of services are undertaken in order to assess and capture quality, safety and satisfaction with services and adherence to standards of care provision. In essence, these organisations seek to provide the quality assurance required to give people confidence in the services they use, and support improvement initiatives undertaken by services, whether they are NHS hospitals and services or independent healthcare services (HIS, 2022). In addition, these organisations carry out statutory duties by monitoring the law and its requirement for people providing care and treatment.

David Strang’s (2020) Independent Review of Mental Health Services in Tayside noted that at a national level, there is currently limited scrutiny and oversight of mental health services in Scotland. He drew attention to HIS and the MWC, who currently have limited powers to monitor and enforce the recommendations they make. He recommended that the Scottish Government conduct a national review of the scrutiny and assurance of mental health services, including the powers of HIS and MWC. The Scottish Government (2020) publicly committed to delivering this recommendation in the Mental Health Transition and Recovery Plan.

For the purposes of this review, we are focussing on mental health and learning disability services provided by Health Boards. The aim is to inform the Scottish Government’s, scrutiny bodies and other relevant partners, considerations around the scrutiny and assurance of health-care provided mental health services, identifying current arrangements and possible improvements to strengthen these. In order to achieve this, current governance and scrutiny arrangements in Scotland were examined both at a local and national level. This included the statutory roles, functions and powers of HIS, the MWC, as well as the CI, although the role of CI is less relevant as they do not scrutinise services provided by Health Boards.

The review looked at international evidence and best practice, establishing what good scrutiny and assurance could and should look like for mental health services within Scotland. As part of this work, engagement was carried out with key stakeholders through a survey and a series of interviews, to gather the views on current practice, identify gaps and explore how best to strengthen scrutiny and assurance arrangements in the future. Ultimately, this programme of work is important and will contribute to the future of scrutiny and assurance of mental health services in Scotland, ensuring they are safe, timely, effective, person-centred and delivered for service users in equitable ways.

This review has been undertaken with similar timings to the Independent Review of Inspection, Scrutiny and Regulation (IRISR) by Dame Sue Bruce which was recently published in September 2023. The IRISR looked at how social care support and linked services are inspected, scrutinised and regulated across Scotland. The IRISR considered how to ensure a human rights-based and person-centred approach is central to the inspection, scrutiny and regulation of social care support and linked services, including how this can be applied to deliver improved outcomes for people. Both reviews were undertaken independently of each other. These reports both examine inspection, scrutiny and regulation, but focused on different sectors (mental health and social care support and linked services) and their recommendations are tailored to specific sectors of focus.



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