Veterans Mental Health and Wellbeing Pathway Advisory Group minutes: October

Minutes from the meeting of the group on 14 October 2024.


Attendees and apologies

Lynne Taylor (Chair), Principal Psychology Advisor, Scottish Government

Jacqueline Berry, Allied Health Professionals / Occupational Therapy Lead, NHS Grampian

Thelma Bowers, Head of Mental health, Addiction and Learning Disability Services, NHS Ayrshire and Arran/North Ayrshire HSCP

David Dent MBE, Vice President (Global Head of Integrated Strategy) Clinical Research, Board Advisor Help for Heroes, Trustee RBLI, Professor (Hon), former Army Nurse, Lecturer RDMC, and CISD Practitioner and Mental Health First Aider, War Disabled Veteran

Linda Irvine Fitzpatrick, Strategic Programme Manager, NHS Lothian

Vicky Henderson, Service Manager, Aberdeenshire HSCP

Lindsay Kirkwood, V1P NHS Ayrshire and Arran Clinical Lead

Gerri Matthews-Smith, Director of the Edinburgh Napier University Centre for Military Research, Education and Public Engagement / Scottish Armed Forces Evidence and Research (SAFE and R) HUB

Theresa Mitchell, Head of Hidden Wounds, Help for Heroes

Dougie Morgan, Operations Manager Scotland and Northern Ireland, Fighting with Pride LGBT+ Military Charity

Neil Morrison OBE JP, Health and Wellbeing Lead, Veterans Scotland 

Julie Murray, Chief Officer, East Renfrewshire HSCP; and Secretary of the Chief Officer Group for Health and Social Care Scotland

Robert Reid, Director of Services Scotland and Overseas, Defence Medical Welfare Service

Caroline Robertson, Head of Operations for Scotland, Combat Stress

Mark Fergusson, Scottish Government

Lesley McDowall, Scottish Government

Apologies:

Jennifer Borthwick, Director of Psychological Services and Head of Clinical Services, NHS Forth Valley

Linda McAuslan, Lead Nurse Psychological Therapies / Adult Psychological Therapies Manager, NHS Forth Valley

Kari Magee, Veterans’ Lived Experience Group

Jenny Pope, Deputy Director of Workforce NHS Golden Jubilee

Michelle Ramage, V1P NHS Tayside Clinical Lead

Tommy Watson, Director for Veterans Affairs, Walking with the Wounded

Pauline Winchester, Midlothian Local Authority Armed Forces and Veterans Champion

Items and actions

Welcome and recap of August meeting

The chair welcomed everyone to the meeting and asked the group if they were content with the minute of the previous meeting. The group confirmed they were content.

The chair provided a recap of the key points of the August meeting. This included the group reaching consensus on a preferred model of delivery for the pathway (a national framework to be applied locally with a centralised referral hub); the review of the first draft of risk register; and updates on the operational working group and stakeholder network.

The chair invited SG officials to lead the review of the action log. It was confirmed that this is up-to-date. An outstanding action was for SG officials to provide the advisory group with a list of members of the operational working group. This will remain on the Action Log and will be provided when all names have been confirmed.

Update from SG on funding for veterans mental health   

At the previous meeting, the chair invited SG officials to provide an update on spending constraints and SG officials informed the group that all but essential and unavoidable spending (i.e. where SG would otherwise breach its legal obligations, fail to provide essential or emergency support, or cause significant economic damage) had been paused with immediate effect.

In May 2024, Combat Stress informed the Scottish Government that it was not in a position to deliver on a proposed new contract and terms with SG to support veterans with mild to moderate issues beyond 4 September 2024. Combat Stress will continue to deliver care and treatment to veterans in line with their charitable objectives across Scotland. Officials had been exploring as a matter of urgency alternative options for veterans beyond this period. However, discussions with potential service providers, which were at an advanced stage, had been paused with immediate effect.

SG officials stated they have now received confirmation that funding will be made available. Officials are in discussions with potential service providers to create a three-tiered tests of change pilot in three NHS non-Veterans First Point Health Board areas. Officials are working towards launching the pilot in November 2024 to last until at least the end of the financial year.

The chair invited comment from the Group following this update. One group member asked for confirmation that Scottish Government funding for NHS Veterans First Point will continue this financial year and SG officials confirmed that this would be the case.

Another group member asked for further information on the three tiers of the pilot scheme. SG officials responded that the plan is for the lower tier to provide practical support, a middle tier of more intensive clinically-informed peer support; and an upper tier of complex clinical support.

A group member recommended the Veterans Scotland Health & Wellbeing Group Activity and Support Matrix which is ranked by tiers and suggested SG officials should review this against the tiers set out in the pilot proposals. Another group member asked how the pilot would be evaluated. SG officials stated that this is still to be confirmed.

The chair noted that the advisory group agreed at a previous meeting a set of themes and principles which includes reference to a whole systems and evidence-based approach which will also be relevant to the pilot.

Action: SG officials to update the advisory group on plans for the pilot once this has been finalised.

Action: SG officials to hold meeting with Gerri Matthews-Smith about evaluation opportunities.

Action: SG officials to meet with Neil Morrison to discuss the Veterans Scotland Health & Wellbeing Group Activity and Support Matrix.

Review of the project risk register

SG officials presented the updated version of the risk register and thanked group members for their feedback following the August meeting.

A group member suggested the volume of future work may be a risk worth noting depending on agreed timelines for the forthcoming months and expectations of the group.

Another group member stated the control in risk entry nine on NHS health boards and HSCPs should be updated to include the next tranche of funding for the Communities Mental Health and Wellbeing Fund for Adults.

A group member suggested that the control in risk entry ten should be updated to include veterans voice being considered through engagement with Veterans Scotland (in addition to Veterans Link Scotland).  

The chair invited group members to provide SG officials with any further written feedback.

Action: group members to provide SG officials with further feedback by 25 October.

Update on the operational working group and stakeholder network 

The Chair invited the co-chairs of the Veterans Mental Health and Wellbeing Pathway Operational Working Group and Veterans Mental Health and Wellbeing Pathway Stakeholder Network to provide an update on both groups.

The Veterans Mental Health and Wellbeing Pathway Operational Working Group held its inaugural meeting on 6th September. As it was the first meeting, agenda items included a review of the draft terms of reference and an overview of the governance structure of the project including the remit of this group. It was explained to attendees that, while the advisory group will provide the parameters as to how the plan should look, the operational working group will consider the practical, operational requirements for and implications of the implementation and delivery of the pathway.

The operational working group were also provided with an overview of the options appraisal papers the advisory group considered at the meetings in June and August, leading to agreement on a preferred model of delivery. This news was welcomed by the operational working group and a further update has been promised at the next meeting which takes place on 1 November.

The chairs hope to finalise the group membership list and terms of reference at next month’s meeting. The priority was to ensure that there was good representation geographically and across sectors.

The Veterans Mental Health and Wellbeing Pathway Stakeholder Network held its second meeting last month. The meeting included an overview of on the Defence Medical Welfare Services (DMWS) Pilot in NHS Greater Glasgow and Clyde (NHS GGC).

NHS GGC formed a partnership with the DMWS in April 2022 to provide veterans in acute services with both clinical and non-clinical support. This pilot project was funded by the Armed Forces Covenant Fund Trust and concluded in March 2024. The NHS GGC Healthcare Charity then agreed to continue funding this service on a recuring basis allowing for the creation of an NHS GGC Veterans’ Support Service to commence in April 2024. The service provides a point of contact and offer of support to veterans seeking help including access to NHS GGC’s mental health services.

The main agenda item was an update on the options appraisal paper considered by this group at the meeting in August. The stakeholder network offered the following feedback:

  • it was commented that, within any model created, third sector organisations should be invited to collaborate and made aware of opportunities on offer. The chairs provided assurances that third sector involvement will be fully considered throughout the process
  • concern was expressed with regard to the viability of any new pathway in light of the current financial constraints. The chairs stated that they are of the view that the advisory group should not curtail their aspirations in the design stage to something sub-optimal because of financial constraints. Financial decisions will be for Scottish Ministers to consider further down the line
  • a network member asked for specific details about plans for any central hub. The member stated that performing the duty of being the first point of contact in any referral system will be highly skilled work and will need to be funded accordingly. The chairs responded that the options paper to be discussed at the advisory group meeting today and they will explore these themes further. Additionally, part of the purpose of the ongoing mapping exercise is to understand and identify funding challenges in Health Boards, HSCPs and local authorities
  • another network member shared his reflections after being involved in a referral hub pilot in NHS West Midlands for primary care talking therapies. These were:

 

  • a way of easing tensions between national and local; and between third sector and statutory services was to recruit from around the network. This way, individuals who can work well together can be identified rather than going down the path of outsourcing recruitment to an agency
  • having highly skilled administrative staff was crucial to the integrity of the referral pathway. In some cases, the quality of the content of referral notes was so poor that it defeated the purpose of the system and this can be avoided by having well-trained staff
  • additionally, all services felt they were involved in the process as a consequence of using a policy of rotating service officers across organisations

The co-chairs invited feedback on their updates. A group member mentioned the Scottish Veterans Treatment Pathway, a holistic health pathway for veterans in Scotland that is currently in development which NHS Highland has been nominated to host. It was suggested that this model could be discussed at a future operational working group and/or stakeholder network meeting. The chairs agreed this should be showcased at a future meeting.

Another group member commented that the new census data will be useful for the mapping of services across Scotland and also relevant to the evaluation of any services.

A group member discussed work being funded by the Armed Forces Covenant Trust. This included the Alert programme aimed at reducing suicide risk, the Affirm programme for first responders and new funding for the Scottish Veteran’s Wellbeing Alliance. The group member offered to speak at a future stakeholder network meeting about these three programmes to ensure connections are being made.

Action: SG officials to confirm with advisory group the final membership list for the operational working group. 

Action: SG officials to liaise with relevant colleagues about future stakeholder network presentations.

Review of proposed model of delivery paper

The chair provided an overview of the paper which followed the group’s decision at the previous meeting to agree on the preferred option of a national framework to be applied locally with a centralised referral hub.

A group member suggested amending the wording in the paper to “a national framework to be applied locally or virtually” and the chair agreed with this suggestion.

Another group member referred to the sentence in section 3.13 which states “local pathways may include established support services which are not veteran specific such as Community Link Workers and Mental Health Workers who are based in primary care settings”. It was stated that consideration must be given to the responsibility these roles will carry and the type of training and cover that will be provided in order to allow these responsibilities to be taken on safely. SG officials confirmed that these concerns are being fully considered and next steps will be to draft a skeleton implementation plan that will put more detail around the expectations of each of the different disciplines. This will be circulated around the three groups for their input.

A group member welcomed the plan to involve support workers who are in established roles and therefore already have links. For example, community link workers would already have links to clinicians.

Another group member referred to paragraph 2.8 and expressed concern that the responsibility for referral may sit with each health board in Scotland. This was raised as a concern as some health boards do not currently have veterans-specific services and may lack the experience of other boards in supporting veterans. The group member proposed that the initial triage should instead be done by a central hub who could establish the veteran’s need.

The chair responded that the learning so far has been that veterans typically do not want to have to tell their story multiple times and prefer veteran-to-veteran interaction. Additionally, feedback from stakeholder engagement has revealed that local delivery areas and the third sector stakeholders in the same areas all want to be part of the development of the local plan to ensure veterans can get access to local third sector support. Furthermore, questionnaires to assess need have been used previously in the statutory services and has been proven to be helpful in identifying and categorising level of need. Doing this centrally is likely to be expensive and divert resources away from the local provision.  

An SG official stated that the consensus from Veterans Link Scotland, the veterans lived experience group hosted by SG, was that their preference was for an online hub linking veterans to local services rather than a physical hub. The operational working group and stakeholder network should also be asked for their views.

Another group member commented that an important task for the group will be to outline the elements and principles needed across the statutory services and third sector to make sure there is equity in local responses across Scotland. It was added that there is likely to be opportunities for engagement and learning through the stakeholder network.

A group member stated that giving ownership to each health board is more likely to prevent veterans from being lost within the system. This is because health boards have different services and different inclusion/exclusion criteria and health boards are best placed to navigate these differences. Additionally, many health boards have good knowledge of local third sector provision as they will often have to refer patients to these services. Another group member added that community link workers can also differ by HSCP and that NHS Greater Glasgow and Clyde are undertaking a mapping exercise across their six HSCP areas.

Another group member commented that it may be worth exploring how the Veterans Champions role in every NHS health board could be enhanced to make them the facilitators of services.

A group member suggested replacing the word “befriending” with “comradeship” in the paper. Additionally, the group member suggested removing the names of organisations in paragraph 3.9; and replacing the term “peer support workers” with “veterans” in paragraph 3.15 to emphasise the importance of veteran to veteran interaction.

Action: Officials to amend wording in next version of paper accordingly.

Action: Any further feedback to be sent to SG officials by e-mail by 25 October.

Any other business

Neil Morrison OBE JP will be retiring from his role as Health and Wellbeing Lead at Veterans Scotland in December 2024.

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