The Scottish Government's Quality Strategy aims to put NHS Scotland at the forefront of world healthcare through delivery of the highest quality, person centred, clinically effective and safe care. This strategy describes how we aim to take that vision forward in mental health. Our aspirations are high, but the progress we've achieved to date shows we are well placed to make further improvement. However, to deliver world class mental health services, it is not enough just to set aspirational visions and aims. We also need to create the right conditions for change and to support services and individuals to make the specific improvements.
We set out above the seven key themes which will underpin how we deliver services. This section looks at how we will support the work of improving services.
Ensure staff have the skills to deliver effective and person centred interventions. This work is primarily led nationally by NES and includes the current programme of work to increase the number of people trained and supervised to deliver evidence-based psychological therapies;
Ensure staff treat everyone with dignity and respect, supporting them on their unique journey to recovery. This has been a key focus of the Scottish Recovery Network and is a key aspect of an integrated approach to improvement work in mental health;
Ensure our processes are designed to deliver effective, evidence-based interventions. Current programmes designed to support this change work include the Integrated Care Pathways programme, the work currently in place across NHS Boards to align the delivery of psychological therapies against The Matrix and the work of the Scottish Patient Safety Programme in Mental Health;
Ensure our processes are designed to do the right thing reliably and efficiently. Reliably delivering interventions which reduce harm is a key aim of the Scottish Patient Safety Programme. Both the efficiency and productivity work and the systems redesign work attached to the mental health 18 weeks access targets have a focus on doing things more efficiently through reducing unwarranted variation, duplication and waste;
To meet the current financial challenges, whilst maintaining and improving the quality of care delivered, we need to make progress in all 4 domains at the same time. Just focusing on one issue will not be enough and central to this will be the work to redesign pathways of care, making sure that we reliably do the right thing at the right time in the most efficient way.
Further, underpinning all of this work needs to be a focus on information, both quantitative and qualitative. We need information to tell us how well our system currently works and where the opportunities are for improvement. We also need information to tell us whether the changes we are making are actually delivering improvements.
Finally, none of this will happen without effective leadership at all levels creating the right conditions for change and supporting services to make the specific improvements.
The following diagram shows how these link together to ultimately deliver improvements in clinical/care outcomes and improvements in the experience of individuals using our services.
The Improvement Jigsaw - an overall framework for improving the quality of mental health services in Scotland
Delivering the above is not the responsibility of just one part of the system, it will require all parts to work together in partnership to create and sustain a context that enables ongoing improvement in care to be a day to day reality. The Scottish Government, NHS Boards, local authorities, the third sector, academics, service users and carers all have their part to play in supporting the delivery of world class mental health services.
Commitment 35: We will work with COSLA to establish a local government mental health forum to focus on those areas of work where local government has a key role, including employability, community assets and support and services for older people, and make effective linkages with the work to integrate health and social care.
Commitment 36: To support progress on this agenda the Scottish Government will put in place arrangements to co-ordinate, monitor and performance manage progress on the national commitments outlined in this strategy. In doing this we will build on the successful experience of managing the implementation of the Dementia Strategy.
In support of this commitment we will:
Continue to conduct twice yearly mental health performance reviews with each NHS Board, where local progress on delivering improvements is reviewed;
Provide ongoing support for the use of continuous quality improvement approaches across mental health services by:
Funding and supporting Healthcare Improvement Scotland to deliver the Scottish Patient Safety Programme for Mental Health.
Producing a toolkit to support services and clinical teams to diagnose and deliver productivity and quality improvements across community mental health teams.
Putting in place a learning support network for individuals involved in using quality improvement methods to deliver faster access to mental health services whilst maintaining or improving quality of care.
Ensuring clarity on how any new improvement programmes nationally interface with the existing work.
Continue to develop the Adult Mental Health Benchmarking project to provide a tool to aid in the improvement of mental health services in Scotland by using a range of comparative information to compare key aspects of performance, identify gaps, identify opportunities for improvement and monitor progress. The Mental Health Benchmarking Toolkit has been created to facilitate this aim104.
The toolkit is structured to provide a balanced view across the Quality Strategy domains of Efficient, Effective, Person Centred, Safe, Equitable and Timely. The first release of the toolkit contains information on nineteen indicators across the first five Quality Strategy domains. Future releases of the toolkit will contain additional indicators and will populate the remaining Timely domain.