NHS Tayside bosses told 'urgent action' needed in mental health services

Efforts to address “long-standing issues” in mental health care at NHS Tayside have “not yet delivered significant change”, Scotland’s public spending watchdog has warned.

Auditor General for Scotland Stephen Boyle said “urgent action” is needed, adding the health board must be clear on its priorities for making improvements.

Responding to the report, First Minister John Swinney ruled out bringing in external leadership to take over the board, but said he would revisit that position in January.

His comments came as Audit Scotland published the latest report on mental health services in the area, which revealed that while a decision to move all inpatient mental health care to one site was taken in 2018, it is “not clear” if this is on track.

There is also a “disconnect” between the views of staff and NHS leaders on the plans to move Murray Royal Hospital in Perth, the report added, with Audit Scotland finding “most staff had indicated they were not willing to transfer”.

NHS managers are “engaging with staff” on the issue, with measures planned to “encourage staff to transfer” and to take on new workers if needed.

However, Audit Scotland said these plans “were not yet costed to determine if they were affordable”.

The report comes more than five years after a highly critical independent inquiry made 51 recommendations for improvements in mental health care in NHS Tayside.

The inquiry, which published its findings in 2020, was carried out after families raised concerns about the care their loved ones received.

It heard from more than 1,500 patients, their relatives, staff and other organisations, and found services had consistently failed to meet guidelines for care, with the report revealing some patients who talked about suicide reported being told to “get a grip” by staff.

In 2021, ministers appointed an Independent Oversight and Assurance Group (IOAG) to monitor NHS Tayside’s progress, with this body’s final report in January 2023 identifying six priority areas to focus on.

Audit Scotland said its latest review gave a “high-level overview of progress” since the final IOAG report more than two years ago.

It found the mental health and learning disabilities Whole System Change Programme (WSCP) put in place in Tayside “has made some progress in addressing the issues identified”.

But the watchdog added: “Substantial issues and challenges remain.”

Audit Scotland said leadership arrangements for the WSCP “remain complicated and unclear and are not yet working well”.

While an executive leadership group was set up to “provide collaborative leadership of the change programme”, Audit Scotland said it had been told by NHS Tayside this group had been disbanded, although papers in June this year still referred to it.

The watchdog also complained there were no minutes taken of meetings of the WSCP board, with verbal updates given to the board without accompanying papers.

“This means that the context, scrutiny and rationale for decisions was not documented,” Audit Scotland said.

Mr Boyle said: “Long-standing issues with the provision and delivery of mental health services across NHS Tayside remain, impacting patients, their families and staff.

“Efforts to address this have made some progress, but haven’t yet delivered significant change.

“Urgent action is needed to be clear on the priorities for improvement, with specific actions, timescales and costs detailed.

“It must be made clear who is responsible for delivering on this, and progress monitored and reported publicly.”

The First Minister was asked about the report at Holyrood on Thursday by local MSP Michael Marra, who expressed his “utter dismay” at its findings and pushed for “external leadership” to be put in place.

Mr Swinney said: “There has been a whole load of external scrutiny, and that should be enough – frankly – for it to all happen.”

The board gave an assurance to take action on the issue by December, with the First Minister saying he will reserve judgment until early in the new year.

“What I will undertake to Mr Marra is that I will review this issue in January, once I see the conclusions of the work that has been committed to by NHS Tayside and then address the point that he has raised with me.

“Because we need to expect the leadership of health boards to get on with meeting the challenges they’ve got to face.

“So I’m not dismissing Mr Marra’s suggestion, but I will return to it once I see what progress has been made by December.”

NHS Tayside welcomed the report, saying while “challenges remain in terms of the complicated structures and governance arrangements which are currently in place”, there had been “recognition that progress has been delivered in terms of the work of our frontline teams”.

A spokesperson said there had been “positive improvements” for patients in Mental Health and Learning Disability Services.

However, the health board accepted “more work needs to be done to accelerate the pace of change and make a consolidated effort to tackle the long-standing challenges which are related to complicated governance and reporting”.

The spokesperson said: “NHS Tayside board agreed an organisational objective for 2025-26 around integrating mental health and learning disability services which will promote effective and efficient use of all resources, improve outcomes for patients, reduce complexity and enable a clear platform to work at greater pace on change.”