Perinatal and Infant Mental Health Programme Board minutes: 4 December 2019

Attendees and apologies

Present

• Hugh Masters, Chair, Scottish Government (SG)
• Sally Amor (TC), Child Health Commissioner & North of Scotland representative, NHS Highland
• Alex Brown, Programme Support Officer, National Services Division (NSD)
• Ruth Christie, Head of Perinatal and Early Years Mental Health Team, SG
• Jemma Davis, Perinatal and Early Years Mental Health Team, SG
• 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 & Associate Chief Nursing Officer, SG
• Catriona Johnson, Programme Associate Director, NSD
• Sally Ann Kelly, Chief Executive, Aberlour
• Jaqueline Lambert, Professional Midwifery Advisor, SG
• Katy Lister, Perinatal and Early Years Mental Health Team, SG
• Rebecca Macpherson, Perinatal and Early Years Mental Health Team, SG
• Carsten Mandt, Senior Programme Manager, Perinatal Network, NSD
• Anne McFadyen, Infant Mental Health Lead, Perinatal Mental Health Managed Clinical Network, NSD
• Eileen McKenna, Associate Director, Royal College of Nursing
• Lesley Metcalf, Senior Programme Manager, NSD
• Jessica Moran, Perinatal and Early Years Mental Health Team, SG
• Mary Ross-Davie, Director, Royal College of Midwives
• Helen Sloan, Chair Maternal Mental Health Scotland, Maternal Mental Health Scotland
• Judy Thomson, Director of Psychology, NHS Education for Scotland (NES)
• Clare Thompson, Participation Officer Maternal, Mental Health Scotland
• Harriet Waugh, Senior Policy Manager, Perinatal and Early Years Mental Health, SG
• Carolyn Wilson, Lead Policy officer, Family Nurse Partnership, Scottish Government

Apologies

• Jeff Ace, Chief Executive, NHS Dumfries and Galloway
• Roch Cantwell, Lead Clinician, Perinatal Mental Health Managed Clinical Network, NSD
• Marie-Claire Shankland, Programme Director, NHS Education for Scotland
• Elaine Clark, Nurse Lead, Perinatal Mental Health Managed, Clinical Network, NSD
• Jackie Kerr, Assistant Chief Officer for Adult Services, Health and Social Care Partnership
• Marion MacAulay, Chief Social Work Officer, East Ayrshire Local Authority

In attendance

• Andrew Wyllie on behalf of Lauren Kennedy, Lead Nurse for Mental Health & Learning Disabilities, Mental Health Nurse Leads Scotland

Items and actions

Welcome, apologies and introductions

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

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

Minutes of previous meeting and update paper

The minutes from the 26 September 2019 were agreed as an accurate record of the meeting. The Chair reviewed the actions and updated the group, noting that many of the items would be discussed as part of the agenda, and were included on the update paper that had been circulated prior to the meeting.

Actions from September Programme Board meeting, and updates:

• Lesley Metcalf to arrange meeting with North of Scotland representatives and PNIMH-Working Group members to discuss plans. Action completed, meeting has taken place and plans were progressing well
• Scottish Government to circulate the minute of the Children and Young People’s Programme Board. An update paper regarding infant mental health has been submitted to the Children and Young People’s Programme Board and Dr Anne McFadyen will attend the meeting in early 2020 to discuss this work in more detail
• programme board to submit comments on IMH to A.Mcfadyen. None received; work has now progressed to establish an implementation and advisory group. Full update provided within minutes.
• Rebecca Macpherson to circulate EQIA presentation and questions. Programme Board to feed back their views to R.Macpherson. Work is still ongoing on the EQIA and data catalogue and a full update/ discussion will be included in the January programme board meeting.
• Programme Board to send comments on MBU Family Fund paper, and L.Metcalf to bring a revised draft to the next meeting. Comments received during the meeting have been incorporated into the draft fund and a full update will be given at the January programme board
• Scottish Government to issue the latest version of the data catalogue in advance of the next Programme Board meeting. See above
• programme board to submit any comments on the Working Group Terms of Reference to L.Metcalf. None received; terms of reference now considered complete

The Chair brought attention to the update paper which was structured around the 10 Key Actions laid out in the 2019/20 delivery plan.

Action one: offer support to ensure that the experience of women and families is the central driver of the PNIMH board

The Chair congratulated Clare Thompson on her new role as participation officer with Maternal Mental Health. C.Thompson will meet with the programme management team and Scottish Government to discuss how to increase the input from women with lived experience.

Action two: set out vision for perinatal and infant mental health care and support in Scotland, including steps required to reduce stigma

The Chair informed the group that, this would be progressed in January 2020. It would be continued in the 2020/21 Delivery Plan, and would include Infant Mental Health.

Action three: work with NHS Boards to establish regional networks and identify service leads

Discussed under agenda item three.

Action four: MBUs staffing funding framework and process agreed and national role described and agreed

Discussed under agenda item six.

Action five : north of Scotland/additional specialist capacity – options appraisal commissioned leading to a set of recommendations

Discussed under agenda item six.

The Chair informed the group that an expenses fund was in development to support the families of women admitted to an MBU with travel, accommodation and subsistence costs, and cover the costs of visits home for the woman. The aim of this fund is to address some of the current barriers to admission from the North of Scotland to existing MBU beds. The Chair advised that a further update on the fund would be provided at the January 2020 Programme Board meeting.

Action six: infant mental health evidence appraisal and mapping of current interventions and evidence commissioned leading to a set of recommendations

Discussed under agenda item four.

Action seven: a preferred national peer support model identified via an in-depth review of the evidence

The Chair told the group that research was underway, and Jessica Moran would present a final report at the January 2020 meeting.

Action eight: initial funding for Third Sector organisations, and mechanism for dispersing funding identified

Discussed under agenda item five.

Action nine: education, universal and specialist roles

Discussed under agenda item six.

Action ten: conclude EQUIA and evaluability assessment

The Chair expressed that the review of evidence had highlighted several areas where more evidence and stakeholder engagement was required. The process of engaging with equalities groups and gathering further evidence would be ongoing through the life of the Programme Board, and an update paper would be available at the January 2020 meeting.

Action three: work with NHS Boards to establish regional networks and identify service leads

The Chair informed the group that the Cabinet Secretary for Health and Sport had written to all Health Board Chief Executives and Integrated Joint Board (IJB) Chief Officers on 28 October 2019 requesting the nomination of a Board executive lead for Perinatal & Infant Mental Health.

The nominations returned during November, and an event will be organised for 30 January 2020 to bring executive leads together and introduce the programme and expectations regarding delivery over the next three to four years. The Chair invited the Programme Board members to attend the event and/or networking lunch, which will be held prior to the Programme Board meeting and in the same venue (COSLA, Edinburgh)

Action: Health Board nominated Executive Leads to be shared with the PNIMH-PB.

Action six: infant mental health

The Chair invited A.Mcfadyen to provide an update on the establishment of the Infant Mental Health Implementation & Advisory Group (IMH-IAG), which will report directly to the PNIMH Programme Board and be Chaired by A.Mcfadyen.

A.Mcfadyen informed the group that a meeting zero was held where the evidence outlined and suggested model of service delivery received general support. Membership had been confirmed for continuing involvement in the work, and a Terms of Reference drafted and tabled at the meeting. It was agreed that there was a good range of representatives in the group, but there was need for the voice of lived experience.

A.Mcfadyen explained that 2019/2020 funding was to be provided to NHS Lanarkshire and NHS Fife to establish pathfinder roles following the guidance within the draft model paper.

The group was also informed of the work being done between the NSPCC and A.Mcfadyen to map the current provision of infant mental health services across Scotland. This report was due for completion in early December 2019.

A.Mcfadyen advised that further discussion into the development of a model and pathways would take place at the IMH-IAG on the 10 of December 2019.

Action: High level IMH-IAG paper to be circulated, when approved, to the PNIMH-PB and Children and Young People’s Programme Board (CYPB).

Sally Ann Kelly, Chief Executive at Aberlour, expressed concern regarding the age range focus of the group which had been confirmed as from conception to 3 years old in the first instance. It was agreed that there would be discussion between PNIMH Scottish Government policy lead and the CYPB leads.

Action: Ruth Christie to discuss potential gap in service provision for three to fiveyear olds with Jacqueline Campbell/ CYPB.

Action eight: third sector funding

The Chair invited Harriet Waugh to provide the group with an update on 2019/2020 funding for Third Sector organisations.

H.Waugh explained that invites were issued to organisations that had a perinatal mental health focus in their direct service delivery. The competition opened on the 4 October for one month and at the closing date in early November, a total of 15 applications had been received. Two applications were removed as they did not meet the base criteria, with 13 going through the main scoring. Each application was scored twice and the results of the scoring, and recommendations for allocation of funding, were presented to an independent panel for ratification. £225,000 was divided between 11 successful organisations, and the grant allocation letters were due to be issued in December 2019.

Action: News release on third sector funded organisations to be circulated to PNIMH-PB.

H.Waugh informed the group that Inspiring Scotland would be working with both the successful and unsuccessful organisations to build capacity and support development of plans which align to the aims of the programme of investment for future rounds of funding.

Judy Thomson, Director of Psychology at NES, enquired into the details of what the funding would be used for by the successful organisations, and H.Waugh and R.Christie agreed to create a high level summary paper with the funding breakdown.

It was explained to the group that Understanding Perinatal Mood Disorders Training was to be provided by CrossReach to funded organisations.

Action: Programme Management team to circulate high level summary of how third Sector organisations are using funding, when drafted by R.Christie/H.Waugh.

S.Kelly asserted that whilst some of the organisations were small, the Third Sector operates across all levels and there may be larger organisations that need less assistance from the public sector. These organisations have evidenced programmes that should be considered as experienced models for care. It was agreed that the Health Boards and the Third Sector should not be planning future perinatal and infant mental health developments in isolation.

Action: The next tranche of third Sector funding to be discussed at January 2020 meeting.

Action nine: education, universal services and specialist roles

NES

The Chair invited J.Thomson to provide the group with an update from NES. J.Thomson informed the group that procurement specification had been drafted and the process begun for the Essential Perinatal Mental Health module. A Reference Group had met and Terms of Reference approved. Membership had been discussed and it was agreed that more representatives from the Third Sector and with lived experience were needed. S.Kelly offered to be in attendance at the Reference Group as a Third Sector representative.

A second draft of the outline was discussed at the first meeting of the Reference group on 2 October 2019. J.Thomson confirmed that NES had received confirmation of funding to recruit a Principal Educator and administration support which would further enable the module creation process. J.Thomson assured the group that a detailed Gant Chart would be available for the January 2020 PB.

J.Thomson updated the group on workforce developments.

• the Clinical Associates in Applied Psychology (CAAP) course recruited 10 CAAPs who were allocated to Health Boards, and training was to begin in January 2020. Planning for the additional curricular elements for PNIMH was underway, along with discussions about how trainees would gain experience of working with parents in the perinatal period
• the Cognitive Behavioral Therapy course would have five trainees commencing in January 2020 from backgrounds in primary care and perinatal mental health
• three higher trainees in Psychiatry had been funded to attend the five-day Royal College of Psychiatry bespoke PNMH course in 2020

MBU funding

The Chair informed the group that following discussion with regional planning/IJB colleagues from the East and West of Scotland, a proforma was issued outlining the criteria for allocating funding to support increased MBU staffing levels. Submissions were received from both MBUs in mid-November and, at the time of the meeting, were being considered by Scottish Government and the programme management team.

Action: MBU decisions paper to be circulated to the PNIMH-PB when allocations have been finalised.

Nos community services

The Chair reported that, following discussions with representatives from NHS Grampian and NHS Highland, a proforma was issued outlining the criteria for allocating additional funding to support development of community based services to meet the needs of the local population. Submissions were received in late November and, at the time of the meeting, Scottish Government were in the process of considering and arranging the allocation of funding.

Options appraisal

The Chair reminded the group of the NSS Case for Change paper that looked at the need for additional MBU inpatient capacity, and considered the current impact on other mental health services when patients are not cared for in an MBU. A virtual Short Life Working Group (SLWG) was convened to review and input to the paper, and make recommendations to the PNIMH-PB regarding appropriate next steps.

It was explained to the group that the SLWG decided the Case for Change had not yet been made and that more evidence needed to be gathered in order to make a fully informed decision. This included work on data to better understand current admission patterns and potential barriers, more information on costs, and more consideration on how the expansion of community services might impact on inpatient care.

The Chair informed the group that further work would be undertaken to refine the case for change paper before agreement by the SLWG and the PNIMH-PB, before moving to the formal options appraisal next stage. A paper will be presented at the March 2020 PB meeting.

Action: As part of 2020/2021 delivery plan, consider workforce implications and discuss at the March 2020 meeting.

Programme for Government (PfG) commitments and funding announcements for 2020/2021

It was noted by the Chair that the current PfG built on the vision for transforming mental health services for children and young people set out the previous year. It focused on bridging the gap between specialist and general services, enhancing crisis support and adult services and implementing the recommendations from the CYPB Task Force.

Date and time of next meeting

Date of the next meeting is Thursday 30th January, 14.00-16.30 at COSLA, Edinburgh.

Action summary table

• action one: Health Board nominated Executive Leads to be shared with the PNIMH-PB. Katy Lister / Alex Brown. 14/01/2020
• action two: high level IMH-IAG paper to be circulated, when approved, to the PNIMH-PB and Children and Young People’s Programme Board (CYPB). K.Lister / A.Brown. 23/01/2020
• action three: discuss potential gap in service provision for three to five year olds with Jacqueline Campbell/ CYPB. R.Christie. 30/01/2020
• action four: news release on third sector funded organisations to be circulated to PNIMH-PB. A.Brown. 20/12/2019
• action five: draft and circulate high level summary of how third sector organisations are using funding. H.Waugh / L.Metcalf. 23/01/2020
• action six: the next tranche of third sector funding to be discussed at January 2020 meeting. A.Brown / L.Metcalf. 23/01/2020
• action seven: MBU decisions paper to be circulated to the PNIMH-PB when allocations have been finalised. H.Waugh / L.Metcalf. 23/01/2020
• action eight: as part of 2020/2021 delivery plan, consider workforce implications and discuss at the March 2020 meeting. SG / NSS. 28/02/2020