Speech : Scottish Parliament
27 November 2019
Yesterday, the Health and Sport Committee took evidence from senior management of NHS
On Monday evening we met members of the public and people who work in healthcare in Tayside to find out what they think about local services.
Lots of critical issues came up at those meetings, but the issue that stood out above all others was the crisis in mental health.
It is not confined to Tayside, but it is urgent in a region in which there are exceptional levels of drug and alcohol dependence, suicide risk and mental illness.
When crisis point was reached, NHS Tayside asked Dr David Strang to carry out an independent inquiry into mental health services in the region.
His interim recommendation was that the board should call a halt to its planned centralisation of services until the whole way in which services were delivered had been properly reviewed.
Despite that recommendation, the board has pressed on with its planned changes.
The chief executive, Grant Archibald, told the Health and Sport Committee yesterday that the board had no choice: if it did not make drastic and immediate changes, its ability to deliver training in the relevant disciplines would be jeopardised, and a far worse crisis would ensue.
He also told the committee that there was simply no way of filling all of Tayside’s vacancies for consultants in psychiatry, and that the board therefore intends to set aside 10 of those vacant posts and instead seek to recruit 10 nurse consultants.
If the chief executive of NHS Tayside is right in his analysis, there could hardly be a starker example of urgent and fundamental service redesign under the pressure of events being the only way for a broken service to continue to deliver at all.
That means, by implication, that the people of Tayside have been let down over an extended period by an operating model of mental health services that was no longer fit for purpose—if it ever had been.
Looking forward, David Strang’s final report in the new year will be critical to what happens next. His recommendations must surely carry weight, not just with NHS Tayside but with Government ministers.
The case for reform of delivery of services is also clear from child and adolescent mental health services in NHS Grampian, which was mentioned by Mark McDonald.
Eighteen months ago, only 27 per cent of young people in Grampian were being seen within the 18-week target, which is significantly less than in other areas and in other services.
One of the causes of that has been addressed in the course of this year. Mental health services for young people in and around Aberdeen used to be spread across three locations on two sites.
Children and young people might have needed two or three appointments just to access services, and mental health staff spent far too long travelling between sites, when they could have spent the time seeing more patients. It is no wonder that waiting lists were so long.
The whole service is now together on one site, which used to be the site of the City hospital in Aberdeen—as the cabinet secretary knows from her visit there.
It is a custom-built and user-friendly unit that has been designed in part by young people. I visited the new Links unit this past month, on the day on which Jeane Freeman opened it.
The change in how services are being delivered is clearly already making a real difference.
NHS Grampian, of course, faces a different challenge from that of NHS Tayside.
Funding per head of population and staffing levels in mental health services in NHS Grampian are barely half what they are in NHS Tayside, and the young people’s mental health service in NHS Grampian remains the lowest staffed in Scotland.
However, although NHS Grampian services faces such fundamental challenges, service redesign has clearly made a huge difference in only a few months.
Percentages can fluctuate from month to month; the latest figure that I have seen is that 70.8 per cent of young people across Grampian now access services within 18 weeks, which is more than twice as many as in 2017.
That is real progress, but more needs to be done in NHS Grampian and elsewhere.
I also acknowledge a remarkable example of a contribution by young people to the improvement of mental health services.
For their 10th birthdays in 2017, Jago and Carmen, from Banchory, got to see Ariana Grande at the Manchester Arena.
They were not injured in the terrorist atrocity that happened that night—at least, not in any physical sense—but how they view the world was, of course, changed forever.
They resolved to turn their traumatic experience to the benefit of other people of their age.
Together with their friends, they set up the #kidsforcamhs campaign to raise funds for kids’ mental health services in and around Aberdeen.
They have already raised £14,000 and have been recognised for their efforts as finalists in the Scottish health awards in Edinburgh earlier this month.
That was a fantastic achievement for a group of youngsters who are between nine and 12 years old.
They are determined to raise even more money next year.
For those young people, as well as for the NHS across Scotland and the Scottish Government, there is still a lot more to do.
In different ways, NHS Grampian and NHS Tayside demonstrate the urgent need for reform, and local leaders who make change happen deserve support.
That leadership needs to be national as well as local, and that urgency must inform the whole approach to mental health services across the country in the future.