Veterans Mental Health Pathway Advisory Group minutes: January 2025

Attendees and apologies

• Lynne Taylor (Chair), Principal Psychology Advisor, Scottish Government
• Martin Bell, Health and Wellbeing Lead, Veterans Scotland
• 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 Health and Social Care Partnership
• 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 1st aider, War Disabled Veteran
• Lindsay Kirkwood, Clinical Lead, NHS Veterans First Point Ayrshire and Arran
• Kari Magee, Chair, Veterans Link Scotland
• Dougie Morgan, Operations Manager Scotland and Northern Ireland, Fighting with Pride LGBT+ Military Charity
• Julie Murray, Chief Officer, East Renfrewshire Health and Social Care Partnership and Secretary of the Chief Officer Group for Health and Social Care Scotland
• Michelle Ramage, Clinical Lead, Veterans First Point NHS Tayside
• Robert Reid, Director of Services Scotland and Overseas, Defence Medical Welfare Service
• Caroline Robertson, Head of Operations for Scotland, Combat Stress
• Pauline Winchester, Midlothian Local Authority Armed Forces and Veterans Champion
• Mark Fergusson – Scottish Government
• Lesley McDowall – Scottish Government

Apologies

• Jennifer Borthwick, Director of Psychological Services and Head of Clinical Services, NHS Forth Valley
• Vicky Henderson, Service Manager, Aberdeenshire Health and Social Care Partnership
• Linda Irvine Fitzpatrick, Strategic Programme Manager, NHS Lothian
• Gerri Matthews-Smith, Director of the Edinburgh Napier University Centre for Military Research, Education and Public Engagement / Scottish Armed Forces Evidence and Research (SAFE&R) HUB
• Linda McAuslan, Lead Nurse Psychological Therapies / Adult Psychological Therapies Manager, NHS Forth Valley
• Theresa Mitchell, Head of Hidden Wounds, Help for Heroes
• Jenny Pope, Deputy Director of Workforce, NHS Golden Jubilee
• Tommy Watson, Director for Veterans Affairs, Walking with the Wounded

Items and actions

Welcome and recap of October 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 welcomed Martin Bell, Health and Wellbeing Lead at Veterans Scotland, who joins the group after Neil Morrison OBE JP retired from his role in December 2024.

The chair provided a recap of the key points of the October meeting. The main achievement was that the group had reviewed the proposed model of delivery paper. After feedback had been received from the operational working group and stakeholder network, the chair presented a revised proposal model of delivery to the Minister for Social Care, Mental Wellbeing and Sport at her quarterly meeting with the Minister. The chair confirmed that the Minister has approved the proposed model of delivery and that the next stage will be for Scottish Government (SG) officials to draft an implementation plan. This will be shared with the advisory group before the next meeting.

The chair invited SG officials to update the group on the tests of change pilot. SG officials confirmed that funding for a three-tiered tests of change pilot has been approved in principle and agreements with service providers are at an advanced stage. Final sign-off from Procurement is required to determine if the funding will be in the form of a grant agreement. The planned three tiers for the pilot will include a basic level of support (e.g. practical support and befriending); a middle tier of more intensive clinically-informed peer support which is likely to be the standard point of entry); and an upper tier of complex clinical support. The plan is for this pilot to run in three NHS health board areas: NHS Dumfries and Galloway; NHS Grampian; and NHS Greater Glasgow and Clyde.

The chair invited SG officials to update the group on recent developments with regard to the NHS Lothian Veterans First Point (V1P) service. Press reports on week commencing 28 October stated that NHS Lothian are withdrawing from joint funding with SG for V1P services following a financial review. 

NHS Lothian have stated that the service will cease to exist in its current form by April 2025 and that they are no longer accepting new referrals or commencing any new episodes of treatment.

SG has allocated its agreed share of the funding for V1P. SG are currently working with NHS Lothian to understand the circumstances behind the decision and to help them to address the issues currently affecting services.

In December, the Minister for Social Care, Mental Wellbeing and Sport and the Minister for Veterans met with the NHS Lothian Chief Executive and the board chair to discuss their concerns about the decision. At the meeting, NHS Lothian officials confirmed they would undertake a consultation with veterans in Lothian. The findings from the consultation will determine future services.

Review of advisory group action log  

The chair invited SG officials to lead the review of the action log. It was confirmed that this is up-to-date.

Review of advisory group risk register

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

A group member suggested that the mitigating actions in risk entry six should be strengthened.

Another group member stated the risk likelihood score in risk entry nine should be increased owing to recent developments in relation to the NHS Lothian V1P service.

SG officials acknowledged that the wording in several risk entries should be updated to reflect recent developments.

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 14 February.

Action: SG officials to circulate updated risk register.

Update on the operational working group and stakeholder network

The chair invited the co-chairs of the operational working group and stakeholder network to provide an update on both groups.

The stakeholder network met for the third time on 26 November 2024 and the proposed model of delivery paper was the main agenda item.

One of the biggest talking points was around veterans’ families. This conversation started with feedback from one network member who referred to the referral flow-chat in section 2.8 of the paper and suggested veterans’ families should be included on the grounds that they may be the ones encouraging the veteran to access services.

However, another network member who represents the Royal British Legion Scotland cautioned against using the term “families” at all and stated that the term “dependant” is used by the Royal British Legion Scotland instead in order to define the parameters of support available. In written feedback provided after the meeting, another network member also cautioned against defining the word 'family' too prescriptively as some veterans have no immediate family still alive and may receive support from, for example, a carer or a neighbour.

Another network member stated that clarity is required with regard to the inclusion of families in any pathway. She stated that the focus of the pathway has hitherto been with veterans in mind and any inclusion of family has only been viewed through the lens of support to the veteran. If this shifts to a separate obligation towards families, this could be seen as a big shift in focus.

Additionally, a network member noted that, while the paper refers to peer support, no reference is made to independent/individual advocacy. It was acknowledged that this is an important area that will have to be considered as a detailed implementation plan is developed. Additionally, local implementation groups will have to be consulted because, at a local level, advocacy plans differ.

The operational working group met for a third time on 10 January. The main agenda item was the paper on Veterans Link Scotland, the veteran lived experience group hosted by SG. Feedback was invited from the group on the paper and associated topics.

A group member praised the section of the paper on peer support workers and commented that Help for Heroes are currently developing a similar role. Another group member spoke about the peer support provided by the Defence Medical Welfare Service (DMWS) which includes veterans and spouses of veterans and covers six NHS health board areas in Scotland, working alongside other groups.

Another group member stated that It would be good to ensure that veterans know about the nationwide NHS Pharmacy First service which allows access to healthcare via pharmacies without the patient needing to be registered with a GP.

A group member commented that it will be important to raise greater awareness among medical professions of the third sector support available for veterans in Scotland. Unforgotten Forces have designed a one-hour online programme raising awareness for veterans and support available to them which draws attention to partner organisations. This could be a starting point as a resource for raising awareness among medical professionals.

Another group member stated that DMWS, in partnership with NHS Highland and NHS Greater Glasgow and Clyde, have developed a training package for clinicians in acute hospital settings and could be adapted if required. Additionally, DMWS will work in partnership with Edinburgh Napier University on the Affirm programme which aims to inform first responders about veterans issues. It is a two-year programme which starts in April and this training could also be repurposed.

The chair invited feedback on the updates from the group.

A group member informed the group that the Turas learning platform (which can be accessed by NHS, Health and Social Care Partnership and Integrated Joint Board staff) has modules on GP awareness with regard to veterans support and that these modules will be updated following publications of the Etherton report recommendations.

A group member stated that many veterans, especially younger veterans, do not like the term “dependant” and that this should be avoided. Another group member suggested that the term “care partner” might be more suitable and is used in medical research. A group member added that if the pathway is to aim for consistency across all regions in Scotland, levels of support available to family members must be considered as there is a risk this could be an area of inequality. 

Review of Veterans Link Scotland paper

SG officials provided an overview of the paper on Veterans Link Scotland, the veterans lived experience group hosted by SG, which included the group’s feedback in the following areas:

• barriers to veterans accessing mental health services
• key elements required for a veterans mental health pathway
• key specifications for a veterans peer support worker

The chair invited feedback from the group. A group member referred to the person specification for the peer support and suggested that, in line with specifications for peer support workers in other health mental services, reference should be made to lived experience of accessing mental health support. Another group member commented that other organisations already have peer support programmes and we should aim to keep the best aspects of these to avoid duplicating work.

A group member commented that adapting existing peer support posts may be the most effective approach if additional funding is not available for the roles. For this reason, we should avoid making the role specification too prescriptive.

A group member stated that the type of peer support worker required may depend on the trauma experienced by the veteran. For example, a female veteran who has suffered gender-based violence may require a female support worker. Additionally, the group member noted that experience from other peer support projects has shown that significant age gaps can also create challenges. Another group member gave an example of a transgender veteran who faced challenges after being allocated a peer support worker with little understanding or experience of LGBT+ veterans.

The chair asked the group if they were content for the feedback to be given to Veterans Link Scotland and for Veterans Link Scotland to work on an updated specification. The group confirmed they were content.

Action: Veterans Link Scotland to consider feedback and provide the group with an updated peer support specification at a future date.

Any other business

The group agreed that the model of delivery paper (discussed at the October meeting) can be shared with Veterans Link Scotland.  Date of next meeting: Friday 21 March.