Perinatal and Infant Mental Health Programme Board minutes: 2 July 2019

Attendees and apologies

Author

• Ms Eilidh Cunningham                 

Present

• Roch Cantwell, Lead Clinician Perinatal Managed Clinical Network, National Services Division (NSD)
• Ruth Christie, Head of Perinatal and Early Years Mental Health Team, Scottish Government
• Eilidh Cunningham, Business Support Administrator, National Services Scotland
• Jemma Davis, Perinatal and Early Years Mental Health Team, Scottish Government
• Maria Docherty, Executive Director, Nursing, Midwifery and Allied Healthcare Professionals
• Kevin Duckworth, Programme Support Officer, NSD
• Aman Durrani, Consultant Perinatal Psychiatrist, Royal College of Psychiatrists
• Fiona Fraser, Consultant Clinical Psychologist, Perinatal Mental Health Services Glasgow City Health and Social Care Partnership
• Ann Holmes, Chief Midwifery Advisor and Associate, Chief Nursing Officer, Scottish Government
• Catriona Johnson, Programme Associate Director, NSD
• Jackie Kerr, Assistant Chief Officer for Adult Services, Health and Social Care Partnership
• Katy Lister, Perinatal and Early Years Mental Health Team, Scottish Government
• Hugh Masters, Chair  Scottish Government
• Rebecca Macpherson, Perinatal and Early Years Mental Health Team, Scottish Government
• Hugh McAloon, Deputy Director Children and Young People’s Mental Health          Scottish Government
• Anne McFadyen, Infant Mental Health Lead  Perinatal Managed Clinical Network for Infant Mental Health
• Eileen McKenna, Associate Director, Royal College of Nursing
• Lesley Metcalf, Senior Programme Manager, NSD
• Karen Ozden (TC), Chief Nurse & General Manager REAS, Mental Health Nurse Leads Scotland
• MarieClaire Shankland, Deputising for Judy Thomson  Programme Director, NHS Education for Scotland (NES)
• Helen Sloan, Chair Maternal Mental Health Scotland, Maternal Mental Health Scotland
• Clare Thompson, Change Agent, Maternal Mental Health Scotland

Apologies

• Jeff Ace, Chief Executive, NHS Dumfries and Galloway
• Lesley Jackson, Lead Clinician, National Neonatal Network
• Sally Ann Kelly, Chief Executive, Aberlour
• Mary Ross-Davie, Director, Royal College of Midwives
• Judy Thomson, Director of Psychology, National Education for Scotland

Items and actions

Welcome, apologies and introductions

Hugh Masters (Chair) welcomed everyone to the Perinatal and Infant Mental Health (PNIMH) Programme Board (PB) meeting.

Apologies were noted as above for the purpose of the minutes.

Minutes of previous meeting and matters arising

The minutes of the previous meeting (28 May 2019) were agreed as an accurate record of the meeting.

Policy context and task force update

Hugh McAloon (Deputy Director for Children and Young People’s Mental Health, Scottish Government) was invited to provide the PNIMH Programme Board with an update of the Mental Health Policy context and the Children and Young People’s Mental Health Task Force. He informed the group that there were four areas of national focus for mental health and PNIMH sat comfortably within these. The four main areas of focus were:

• children and young people’s mental health
• adult mental health - 21st century approach
• suicide prevention – National Suicide Prevention Leadership Group
• rights and legislation – underpinning the approach to mental health in Scotland

Hugh acknowledged that mental health issues often resulted from untreated trauma and that interaction with the public sector e.g. the justice system or assessments for benefits, can be a cause. The focus in future would be to identify potential causes in order to provide acute NHS mental health services that are as accessible and effective as possible.

Hugh explained that mental health problems relating to emotional distress and as a reaction to modern life often present in young people and are referred to the Child and Adolescent Mental Health Service (CAMHS) but this is not really what CAMHS was established to do. He noted that the Children and Young People’s Mental Health Taskforce was established as a direct response to the number of rejected referrals to the CAMHS service and reports that the service was overloaded. The aim is to focus on prevention and building resilience through universal services such as schools, colleges, social work, family support and GPs.

Hugh advised that following the resignation of Denise Coia (taskforce Chair) a decision was reached to move the work to an implementation phase. A new implementation board would be established to progress the task force recommendations, published in July 2019, using a whole system approach. This work was to be jointly chaired by Scottish Government and the Convention of Scottish Local Authorities (COSLA). Hugh discussed the blueprint which had been developed for reforming systems in response to reports of acute services being overloaded and under developed. He highlighted that the taskforce had not looked in depth at mental health issues affecting under five year olds. but it was acknowledged that focusing on this age group could potentially be an effective measure to prevent problems later in life.

Ann Holmes queried how the Implementation Board would facilitate upstream interventions to support prevention of mental health issues. Hugh McAloon agreed that this would be difficult to achieve as it would involve moving funds from services that support current need to those aimed at prevention.

Roch Cantwell (Lead Clinician Perinatal Managed Clinical Network, NSD) highlighted that NHS Greater Glasgow and Clyde (GG&C) were now seeing one in 20 pregnant women which supported the case for investing in prevention.

Maria Docherty (Executive Director, Nursing, Midwifery and Allied Healthcare Professionals) highlighted that with the introduction of universal pathways there was an opportunity to align the aims of the PNIMH Programme Board to universal services and health visiting. Maria suggested partnering with the Coalition of Care and Support Providers in Scotland (CCPS) to explore how the Programme Board could support this work.

Hugh Masters agreed that the PNIMH vision was about more than just specialist services and this was a key feature of the delivery plan. The group identified the need to develop simple, clear messaging for mental health along the lines of the “five-a-day” campaign for increasing fruit and veg consumption. Anne McFadyen (Infant Mental Health Lead, Perinatal Managed Clinical Network for Infant Mental Health) emphasised the need to reflect the importance of infant MH being embedded within society and the need for it to be relationship based.

Action: Hugh Masters to provide context and to look out for recommendations

Chair update

Hugh Masters updated the PB regarding the Evaluability Assessment (EA) progress and discussed with the group the 2019/20 key actions which had been shared with the Minister for feedback. Hugh Masters and Ruth Christie (Head of Perinatal and Early Years Mental HealthTeam) were travelling to the North of Scotland (NoS) Wednesday 3 July to Thursday 4 July 2019.

Draft delivery plan

Hugh Masters discussed the latest draft of the delivery plan; no further comments had been received from Programme Board members. Hugh proposed to bring some time frames forward to shorten before April 2020 and to provide a further draft to the Minister before summer recess. The focus of the delivery plan was to progress some early activity which would then inform requirements for further scoping, planning and evidence.

Hugh went through each of the overarching actions contained in the draft delivery plan to identify actions and responsibilities:

• this item was addressed later under item six on the agenda
• Hugh and team would progress
• Katy Lister (Perinatal and Early Years Mental Health Team) would draft a CEL to boards to establish need for this work

Action: Katy Lister

NSS team were to consider several aspects regarding funding; how this would flow, how long for, in what way and how would funding would cease as well as identifying leads by January/February 2020; add this into action.

Action: NSS Team

The PB suggested linking with the Best Start programme board and Procurement and Commercial Improvement Programme (PCIP), Ruth Christie agreed and told the group that links were being made but would need to be looked at over the summer 2019 period to ensure activity was only happening once.

Hugh discussed his and Ruth’s trip to NoS to help clarify this overarching action. The group discussed whether additional capacity in the NoS meant a dedicated MBU or another model of care more suited to the unique geography of the area. There was debate as to whether, if a dedicated MBU was not felt appropriate in the NoS, there would be additional capacity there through another model in addition to increasing bed numbers in the existing MBUs. Aman Durrani (Consultant Perinatal Psychiatrist, Royal College of Psychiatrists) highlighted that increasing bed capacity was one of the recommendations of the Perinatal Mental Health Network Needs Assessment which was accepted by the Minister. Hugh Masters acknowledged what had been originally accepted but noted that if an options appraisal identified additional MBU beds were not required then introducing them would not be the appropriate thing to do.

Action: NSS Team

Anne McFadyen discussed a paper from 2018 outlining principles of infant mental health and highlighted the option to enhance this paper. It could then inform assessment of the need to commission something else. Action: Anne McFadyen/ Roch Cantwell

Scottish Government had asked for applicants for a three month research internship to look at peer support services and models.

Hugh Masters discussed time he had spent meeting with third sector organisations, ensuring this was a real focus. Action: NSS Team

Clare Thomson (Change Agent, Mental Health Scotland) suggested combining actions seven and eight, as action seven could be a subset of action eight, which the board agreed. Action: NSS Team

Hugh queried funding arrangements and if PNIMH was to support third sector if this would be through IJBs as he wanted to encourage a collaborative approach. Jackie Kerr suggested a model known as alliance commissioning could be used.

Hugh Masters discussed that if PNIMH was going to train and develop specialist staff they would need to ensure that they had the workforce required as this could potentially be a fragile workforce.

Hugh Masters welcomed feedback from the group regarding the overarching actions; Ann Holmes suggested that zero to three years should be changed to - nine months to three years, as the group needed to understand the impact of fetal development and the links to how stress on mothers impacts unborn children.

Action: NSS Team to update

Aman Durrani asked what work was being carried out regarding GPs and primary care. Hugh Masters acknowledged that this was something which would need to be carried forward and considered in 2020. This would allow conversations with primary care colleagues about work already being carried and how to successfully interface with it.

Anne McFadyen queried work carried out surrounding substance misuse parents and highlighted to the group there was a lot of third sector work being done around this by Aberlour and PNIMH should consider making links. Hugh Masters this was part of the third sector mapping.

Proposal for framework to support role of MMHS change agents

Hugh Masters presented the proposal to the Programme Board and sought endorsement of it. The grant would support a participation officer. This would be for 14 hours a week, at a cost of up to £30,000 per year. This was to do three things; ensure change agents were supported properly which allowed them to gain wider views of women; to feedback to boards and help boards gain further insight of issues; and undertake pieces of work focused on the experience of women and families. The group agreed to support this in principle and Ruth Christie confirmed that her team would work with Maternal Mental Health to finalise the funding proposal. The group also agreed the need for clarity regarding governance and reporting back to the Programme Board as this was not currently explicit in the proposal.

Action: Perinatal and Early Years Mental Health Team

NES - workforce plan

Marie-Claire Shankland referred to the paper tabled that outlined the three areas of NES planned work with infrastructure costs.

Whilst on the job training will be provided for the existing workforce (both PNMH and General workforce) there is a need for additional workforce to increase provision of psychological interventions.

NES had previously worked alongside the Scottish Government to expand the Psychological Therapies and CAHMS workforce and acknowledged that there was a challenge to ensure that increased workforce resources lead to increased access to psychological therapies. Marie-Claire discussed an approach which had been developed with the Scottish Government involving tracking individual post holders to ensure that resource invested in upskilling this workforce leads to increased capacity within services. Marie-Claire recommended this approach to the Programme Board in an attempt to maximise benefit from any investment.

NES aimed to increase workforce capacity, via a number of routes.

To train staff from the Multi-disciplinary workforce in Perinatal mental health and Maternity services in Cognitive Behavioral Therapy on Masters level courses taking two years.

To train staff to have a focus on parent/infant relationship work. NES currently commissions the training of Child Psychotherapists, a four-year training period with new intake once every four years. The next intake is in September 2021 when an additional space could be negotiated if the funding was available.

The third area Marie-Claire presented was proposed training with aligned Clinical Psychology trainees on the Doctoral Degree course It was suggested that aligned trainees could carry out core and specialist placement activity and research/service evaluation in PNIMH during the year training course.

Marie Claire also described the option of one year Clinical Associate in Applied Psychology courses which would fulfill the requirement of the recommendation of ‘Delivering Effective Services’ to have a psychological interventions workforce (60-80 posts) delivering in primary care. With funding additional CAAPS could be trained over the next four years – from a mix of existing and new provision.

Hugh Masters advised that work needed to be done with NES regarding timescales and progressing options. The Programme Board was happy, however, to support the proposal from NES in principle.

Catriona Johnson (Programme Associate Director, NSD) highlighted that there was some funding included in the proposal that NES have agreed to cover for the current financial year.

Action: Figures and timelines within NES proposal to be finalised with Programme Working Group.

Any other business

The Terms of Reference (ToR) had been circulated and accepted by the Programme Board. It was noted that a Cosla, Social Work Scotland and academic representative were still required. Hugh Masters had upcoming meetings with suggested academic representatives.

Action: Hugh Masters meet with suggested academic representatives for Programme Board.

Action: Cosla and Social Work Scotland representatives to be confirmed by NSS.

Date and time of next meeting

Thursday 26 September, 2:00 to 3:30 p.m., COLSA offices, Verity House, 19 Haymarket Yards, Edinburgh EH12 5BH.

Tuesday 26 November, time and venue tbc.