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.


The wealth of data gathered from the rapid literature review, questionnaires and interviews has served to provide a real sense of strengths and gaps that exist in current systems and processes. The literature highlighted areas of good practice that facilitated strong scrutiny and assurance, including national standards of care, regular inspection of services, regular reporting of service performance to local and national government, publicly available performance indicators and benchmarking. The survey with stakeholders produced mixed results. It indicated that external scrutiny does capture key issues and involvement of people with lived experience improves the process. It also flagged areas of improvement in relation to communication and intelligence sharing between scrutiny bodies, follow-up and support to services following inspections and the frequency and equity of inspections across services and Boards. A shared passion and desire for success was evident from all respondents, and an eagerness to achieve more and provide a better service for the people of Scotland was at the heart of each conversation. There were however clear differences of opinion in relation to how successful current practices are, and strong views on the need for change and improvement.

A number of common issues emerged through the stakeholder interviews, namely:

  • the complex landscape of multiple scrutiny bodies and a need to improve the collective leadership and accountability;
  • uncertainty as to whether the focus of scrutiny activity is on people or services and some examples of disconnect with what is happening ‘on the ground’;
  • a need for improved joint working and communication between scrutiny bodies;
  • the issues caused by a lack of power held by scrutiny bodies, as well as limited resources;
  • a role for the meaningful involvement of people with lived experience and the prominence of their voice within reporting;
  • the important role of internal governance in improving quality and safety, including creating opportunities for learning and follow-up on scrutiny recommendations;
  • the improvements needed regarding measurement and data availability, access and sharing.

Positive action is needed to address shortcomings in the current system. Recommendations are outlined overleaf.



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