 The next item of business is a statement by Clare Haughey on mental health, quality and safety of services. The minister will take questions at the end of her statement so there should be no interventions or interruptions, and I call on Clare Haughey for 10 minutes, please minister. Thank you very much, Presiding Officer. The independent inquiry into mental health services in Tayside, commissioned by NHS Tayside, was announced by the Cabinet Secretary for Health and Sport in June 2018 following a debate in the Scottish Parliament. The interim report of this inquiry released this morning sets out what David Strang, the independent chair of the inquiry, has heard from a range of partners so far. This interim report signals an important milestone in the work of the inquiry. The final report will provide further analysis and recommendations. The inquiry is being guided by the five principles agreed in the Scottish Parliament debate, which are to be open and transparent, be truly independent, include and involve staff from NHS Tayside, its partners and third sector providers, include and involve patients, families and carers, include a public call for evidence to ensure that everyone's voice is heard. In David Strang's own words, it is important to recognise that this report identifies only the issues that have been raised in the evidence submitted to the inquiry. Investigation and detailed analysis will be required before any conclusions can be drawn or recommendations made to the inquiry. A wide range of individuals and groups have contributed to the work of the inquiry so far. Following the announcement of the inquiry, a group was established to represent patients, families, carers and third sector organisations that would enable stakeholders to engage with the inquiry and to ensure a high level of transparency in its work. This group, known as the stakeholder participation group, was co-ordinated and chaired by the Health and Social Care Alliance Scotland. In addition, an employee participation group, known as EPG, was also established chaired by a representative from Unison. The EPG consists of representatives from all NHS-recognised trade unions, professional bodies and employee relations representatives. Over 200 submissions of written evidence were received by post, email and in person between September and November 2018. The Alliance held focus groups across the NHS Tayside area to capture the voices of those with lived experience of mental health services in Tayside. This was a significant piece of community research that produced a range of valuable recommendations. The EPG conducted an online staff survey during November and December 2018 and held focus group meetings for all those employed to work in NHS Tayside mental health services. 53 per cent of all staff surveyed responded to the survey, a total of 524 individual returns. The EPG submitted its report as evidence to the inquiry in April 2019. Over 70 oral evidence sessions were held with families, patients, carers, NHS employees, other health professionals and third sector organisations in Angus Dundee and Perthin Cynros. Evidence was also submitted oral and written from the other organisations such as Police Scotland, university student welfare teams, Dundee Fairness Commission, Dundee Drug Commission and third sector organisations. Additional meetings were also held with a range of healthcare professionals and clinicians such as consultant psychiatrists, psychologists, GPs, allied health professionals, staff at the car's view centre, student nurses and trainee GPs. The team also met with the integrated joint board representatives and key personnel from local authorities. That enabled the inquiry to gather views on mental health provision in Tayside. I would like to record my thanks to David Strang and his team for the work that they have done and also to the range of individuals and organisations that have taken the time to contribute to David's considerations. I would also like to thank the staff and the families who I had the privilege to meet in January when I visited the inquiry for giving me their insights. The interim report outlines six key themes where improvement is required. Patient access to mental health services, patient's sense of safety, quality of care, organisational learning, leadership and governance. The narrative presented in the report raises significant concern. David Strang has not sought to provide recommendations at this stage, but I must make it clear to the chamber that the Scottish Government will not wait to receive recommendations before we act. For that reason, yesterday, along with the chief executive of the NHS in Scotland, I met with the chief executive and chair of NHS Tayside and their senior team, as well as representatives of the integration joint boards of Perth and Kinross, Dundee and Angus. During that meeting, I set out my clear expectations of them, specifically that the pace of change needs to be faster and that the quality and safety of their services needs to improve further. They are in agreement with those expectations and have welcomed the interim findings of the inquiry. To support them in their efforts to accelerate the pace of change and improvement, the Scottish Government will augment their local team to ensure that they can deliver on those expectations. My officials will be meeting with the senior leadership team to assess the additional resources required in the coming days. That is likely to include additional clinical input, programme management support and community and staff engagement resources. That has been welcomed and has met with strong commitment to delivery from the leadership locally. David Strang makes one specific point in his interim report, which refers to halting service redesign until a comprehensive review of the mental health strategy has been undertaken. I have sought specific assurance about the risks associated with that work. To better assess that point, I have asked the local leadership team to urgently review the risks and impact of the redesign programme, placing that fully in the context of the transformation programme. I am clear that any redesign of services must consider the needs of all service users, and the Scottish Government is keen to ensure that the voices of people with lived experience are at the forefront. Presiding Officer, I am also committed to take the learning from this inquiry and ensure that it informs our national approach. The interim report raises significant issues about quality and safety. For that reason, I will give further consideration to our national approach to the quality and safety of mental health services. We need to bring coherence to our arrangements for quality planning, quality improvement and quality assurance for mental health. Arrangements are varied and I am keen to ensure that the issues raised in Tayside are not present elsewhere. I will therefore create and chair a quality and safety board for mental health. The board will consider the arrangements for quality planning, improvement and assurance and be informed by the work of the independent inquiry. That will include issues such as focusing on coherent multi-agency planning to ensure that quality and safety is at the heart of our approach to mental health services, creating the right conditions to develop and spread excellence. We know that many areas already have high quality services in place and we want to see those approaches replicated across the country so that people can access high quality services when they need them, wherever they are, and examination of our quality assurance arrangements. We will bring together all agencies that are currently involved in providing assurance on mental health services. That will ensure that we have clarity and certainty that the correct arrangements are in place to assess the quality and effectiveness of services. Many issues of safety and patient care will be included. For example, the use of restraint, administration of medicines, use of risk assessments and wider-ranging issues as agreed by the group. We know that work is already under way on many issues of safety. For example, the Scottish patient safety programme for mental health has led to reductions in self-harm, seclusion, violence and aggression and restraint across a number of areas. Collaboration and innovation from staff, service users and carers and the use of quality improvement and improvement signs has been essential in achieving those improvements over the past six years. We will build on that work and ensure that it is given greater national profile and prominence. The Scottish Government has a rights-based approach to mental health services and I will ensure that this ethos is embedded in the new group. I am clear that alternatives to physical restraint should always be considered first. Those may include nursing interventions, medical, psychological or other treatments and or modifications of observation policies, care regimes, the person's activities or even buildings. Appropriate and personalised risk assessments play an important part in identifying alternatives suitable for each individual and that should be a dynamic and on-going process by clinicians in collaboration with the patient. After assessment and with fully trained and qualified staff should restraint be used and as a last resort. I recently wrote to seek reassurance from all health boards that they have the appropriate policies and training in place for all staff who may be involved in any sort of restrictive practice. I have specific questions about reporting and recording and the clinical review of incidences of restrictive practice and I have also made it clear that training records for all staff involved in those interventions must be maintained and training kept up to date. I will provide further information on the membership of the group and the terms of reference in due course. I am absolutely clear that the safety of our patients and the quality of the services that they receive is paramount. Presiding Officer, in conclusion, I welcome the interim report from the independent enquiry in Tayside and restate the commitment of this Government to improving the quality and safety of mental health services for the people of Scotland. It is absolutely vital that people feel safe when they are engaging with their mental health services, whether they are using them or delivering them. We must ensure that there is a high level of confidence in our mental health services and that people know that they will be able to receive the right help when they need it. That is why I have given the interim report the serious consideration that it deserves and I stand fully behind the work of the independent enquiry alongside the people who are delivering these crucial services. Importantly, when the enquiry has concluded its work, I will ensure that the lessons learned and its recommendations will be shared widely across Scotland. Before I move on, can I gently remind members that the timings that are given in the business bulletin are indicative only and that business all runs on? Thank you to those who have sent me notes of apology for being late and we will now move on to the questions on the issues raised in the minister's statement. Allow around 20 minutes for that and then we will move on. Those who wish to ask questions, please press the request-to-speak buttons. First of all, please, Annie Wells. Thank you, Deputy Presiding Officer, and thank you to the minister for early sight of her statement. I also wish to put on record my thanks to David Strang and his team for their work, as well as to everyone who has informed the enquiry or gave evidence. The whole basis of the report is to examine end-to-end mental health services, which means addressing from the first point of contact with the health service to the best possible outcome for the patient. In the interim report, serious concerns were raised by GPs regarding the referral process and there were also concerns around ambiguous CAMHS thresholds, just as examples. That highlights that we need a whole system approach to design and delivery of services, while all future actions take that into consideration. The minister has assured us that the Scottish Government will not wait to take action. Can I ask the minister when she will report back on the meeting with the senior leadership team in the coming days? When will she report in progress? The minister has described the interim report as a milestone moment, but the milestone moment will not come until patients in Tayside see better mental health services. Clare Haughey. I thank Annie Wells for those questions. If I can try and take them in order, my apologies if I miss anything here because there was quite a lot of questions there. The long waits for support and treatment are unacceptable and this Government is investing £54 million to help boards to improve their performance against waiting times. The Government expects those who need help to get help at the time that they need it. NHS Tayside board has stated that their policy is for patients to be advised of the likely waiting time if they have to wait to be seen. The Scottish Government has also committed to providing additional funding for 800 additional mental health workers in key settings, which includes GP practices. With regards to the meeting with senior leadership, my apologies if I wasn't clear in my statement. I thought I had covered that, but the meeting with senior leadership of Tayside health board and the integrated joint boards was to set out my plans for a response to the interim report and my expectations of how they were going to accept that report and respond to that. In terms of the raised CAMHS as well and the difference in the CAMHS thresholds in NHS Tayside, it assurms me that it has plans to change the age threshold for children to 18 to come in line with most of the other health boards across the country. Monica Lennon. Thank you. I thank the minister for advance sight of her statement. Squat usually welcomes the interim report. We called for this inquiry and our thoughts are with the patients and families affected in a peer tribute to everyone who has taken part in the inquiry. I am surprised that there are no immediate recommendations. Can the minister provide a further update on the timeline for when she expects recommendations to be brought forward by David Strang? As risk to patient safety is an urgent concern right now, does she agree that NHS Tayside should be escalated back to the highest level and placed under special measures? Can she confirm if the quality and safety board of mental health, which she announced moments ago, will report to Parliament? Will it be carrying out a national review of mental health services, which is what Scottish Labour and campaigners have been calling for? Clare Haughey. I thank Monica Lennon for her questions. The safety of those using and delivering our mental health services is absolutely paramount. NHS Tayside has outlined to me the work that they are undertaking within their quality improvement programme on a range of activities aimed at improving the care and the safety of patients, which I think we agree is extremely important, and central to this is the on-going feedback from staff, patients and carers. There is current improvement activity in NHS Tayside, and that is focusing on improving observation practice, which is a national healthcare improvement Scotland priority. With regard to Mr Strang's inquiry, it is an independent inquiry. I have no influence over when that inquiry will report and what his recommendations will be, nor should I. Mr Strang, I am sure, will provide us with details of when he will come forward with his final recommendations to us. This is an interim report. I echo Monica Lennon's thanks to those who have been involved in the inquiry. I met personally with family and service users. I met with staff involved in that inquiry. Their words have stayed with me, and it is important that we thank them for their contribution to the evidence that we have had today from Mr Strang's report. I move to the open questions. I have Ruth Maguire, followed by Miles Briggs. Minister, how health services can work together more closely to ensure that the support given to those who need it is coherent and effective? There is a need for transformation to a whole-system approach to mental health by all public services, including GPs and other primary care workers. That needs to be done in partnership with people who use the services and their families with the mental health workforce and delivery partners across the public and third sectors. Multidisciplinary and multi-agency working is key to the transformation and will ensure that the delivery of a whole health model of care for individuals accessing services. As I announced today, the new quality and safety board for mental health, which I will chair, will look at creating the right conditions to develop and spread excellence across Scotland. Miles Briggs, followed by Gil Paterson. Thank you, Deputy Presiding Officer. The interim report states that patients report telling staff that they were suicidal, but the risk was not taken seriously until they made a serious attempt to take their own life. Minister, I do not believe that this is just a situation specific to NHS Tayside. Can I therefore ask what investigation will take place into the service redesign in other health boards across the country, which is on-going? If the Scottish Government is truly going to regain the confidence of families with the establishment of the quality and safety board for mental health, why is that not going to be independently chaired? Clare Haughey. I thank Mr Briggs for his question. I am quite disturbed by the assertion that he is making at the start of his question there about patients reporting feeling suicidal and thinking that this is widespread, that the mental health professionals or healthcare professionals are ignoring people when they are in distress, or with mental health problems involves risk assessment, every single interaction, it does not have to be a formal risk-screen assessment. I accept what Mr Strang has put in his report. I am not refuting what he has put there, but I refute the assertion that Mr Briggs has made at the start of his question. I accept what Mr Strang has put in his report. I am not refuting what he has put there, but I accept what the assertion that Mr Briggs is making about mental health services across the country. Gil Paterson is to be followed by Jenny Marra. Thank you very much, First Minister. Can I ask the minister how the Scottish Government is working across wider public services to improve access to mental health services and to reduce mental health inequalities? Clare Haughey. Felly, wrth yr ychwanegwyr ddwyg, ac rwy'n ddwy i'n ddwy i'n ddwy i'r ysgolffiannig, gan y drefnodau hirth o'r prifysgol yng Nghymru? Rydw i ddweud y cyfnodd i'r gyflowdoeddau, atlu, sektuau wrth iddodau, o bobl yn ymgwrdd, yn mythiau cyd-tymu o ddwy ysgolffiannig o'r teimlo mewn ar bleidwyr mewn cyfnoddau, bwrdd, o bobl yn rhaid i'r prifysgol hirdol, ac yn ddiwrm ni'n iddo, health needs of individuals in a person-centred, safe, effective and respectful way. Up to 2019-20, we are investing £54 million to help boards improve access to mental health services, our programme for government also sets out a £250 million package of measures to support positive mental health and prevent ill health. That funding aims to ensure that high quality mental health services are accessible to everyone. Jenny Marra, followed by Mark Ruskell. My thoughts are with every family affected by the issues raised in this report. You said that safety is paramount. There are huge patient safety issues in this report, but there are no actions in your statement today that will guarantee patient safety over the next weeks and months before the final report is published. I would reiterate Monica Lennon's call for you to re-escalate NHS Tayside to level 5, so that the board gets the supervision and support that it needs to guarantee patient safety. David Strang was very clear that the change on service redesign should be halted before there is a comprehensive review. Will she instruct NHS Tayside to halt those changes before the final report is published? I thank Jenny Marra for her question and I am aware of her interest in this over the time in this Parliament that she has raised issues. I addressed the issue of Mr Strang's recommendation in my report. What I have asked is that the board come back and report to me on the risks of progressing service redesign and the risks of not progressing service redesign and come back to me with that report shortly. Will you ask me the questions so that I am trying to answer what you have asked me? NHS Tayside has been responding to the recommendations that came out of the HIST report and has also been responding to some of the recommendations that came out of the inquiry following the BBC programme and using that as a way of helping them to improve the quality of their care. Some improvements have been made but, as I said, the pace of change is not what I expect and that is why we will be looking at providing additional outside support in terms of programme management and clinical support to ensure that those changes are made in a speedy fashion. The inquiry report revealed that GP referrals to mental health services are frequently rejected on the basis that the patient in question did not meet the required criteria, despite GP's not being informed what those criteria actually are. So what steps will the minister take to ensure that there are clear referral guidelines and that those are urgently communicated to GP's? I thank Mr Ruskell for his question. If he is aware of the response that NHS Tayside has made to today's report, he will be aware that he has accepted what Mr Strang has said. My expectation would be that it would ensure that referral criteria to services is made clear to referers. Alex Cole-Hamilton, followed by David Torrance. Gilly Murray, who is the niece of David Ramsey, who very sadly took his life after being failed by Carsview, tweeted this morning to say, I have been and I'm going through hell and none of this benefits me or my family. David is still dead. So can I ask the minister what support will be given to families who are sadly left behind because patients have taken their lives in Tayside? Secondly, given the concerns about the use of restraint and disbelief among staff about crisis situations, what comfort can she extend to patients today in crisis in Tayside that they will be taken seriously? Clare Haughey. My sympathies and my thoughts go to any family who has been bereaved through suicide in Tayside, in particular today, because I'm sure that this report will stir up a lot of emotion, not that they don't feel that pain every day. I would imagine a particularly difficult day for them, but also for families across the country. Mr Cole-Hamilton asked me about restraint. As I said, the Scottish Government is absolutely clear that alternatives to physical restraint should be considered first, that the use of physical restraint should only be a last resort and for the shortest periods of time to ensure safety. I have written to all health boards seeking assurance that they have policies in place that cover all forms of restricted practice and that staff should receive that appropriate restraint. I covered that within my statement. You also asked me about support for bereaved relatives. Obviously, services are available in Dundee for bereaved relatives counselling services and bereavement support services, but part of the suicide prevention leadership group's work is looking at support that can be given to all families when they are all who are touched by bereavement from suicide. It is a really important area to look at. David Torrance followed by Brian Whittle. Can I ask the minister what action the Scottish Government is taking to improve access to primary care services for people who suffer from mental and physical ill health? It is important to consider that all health is interconnected. There are clear links between individuals' physical and mental health and the quality of their life and the overall quality of their health outcomes. As part of the mental health strategy, the Scottish Government has committed to providing funding to support the employment of 800 additional mental health workers to improve access in key settings. That includes GP practices. We are investing significantly to develop that, and funding will rise to £35 million in 2021, 2022 and beyond. In delivering patient safety, the minister would agree with me that it is really important that we look after the needs of our healthcare professionals. I ensure that they have the support in place in what is a very stressful environment. Can I ask the minister, as part of the final report, what consideration will be given to the healthcare professionals? The report by David Strang is an independent report, so I cannot predict or influence what would be in that report. One of the things that the inquiry team has done is to ensure that there is a separate workstream for staff, which was led by an official from Unison. There were representatives from all of the major trade unions and professional bodies there, so that staff employed by NHS Tayside working and mental health services could have their voice heard, could do that in a way that they felt safe and supported, and that they also felt that they were able to be open about their concerns and would feel supported within that. That is really important. It is crucial not only to NHS Tayside, as an employer, to ensure that their staff are safe and supported in their work through their duty of care as employers, but that staff-side organisations and trade union bodies and professional organisations have a pastoral role to ensure that staff are supported and feel safe at work, and that they are not able to raise that in a way that they feel reassured. Tom Arthur, followed by David Stewart. Can the minister set out what action the Scottish Government is taking to reduce the stigma of mental health and suicide to ensure that people who are at risk of suicide feel able to ask for help? Claire Hawke I thank Tom Arthur for raising that extremely important question. We want a Scotland where people can get the right help at the right time, expect recovery and fully enjoy the rights free from discrimination and stigma. Action 3 of the suicide prevention action plan commits the Scottish Government to work with the national suicide prevention leadership group and partners to encourage a co-ordinated approach to public awareness campaigns that maximise impact. The Scottish Government provides funding to CME, which is Scotland's national programme to end mental health stigma and discrimination, and has quickly established a reputation as internationally groundbreaking in its scope, ambition and delivery. It has put the issue of mental health stigma firmly within the public arena and is working to challenge stigma and discrimination at its roots, where people experience it at work through health and social care and education at home or in our communities. David Stewart, followed by Fulton MacGregor. Thank you, Presiding Officer. The minister referred to patient restraint in her statement and in reply to an earlier question. Can the minister outline the training that staff receive on restraint? How confident is the minister that only fully trained and qualified staff exercise restraint? Finally, it is a record-kept of each and every time an individual is restrained. I used to train physical restraint myself, Mr Stewart, so I could give you a demonstration. There are accredited training courses provided by accredited trainers. When I had my meeting yesterday with NHS Tayside, I was informed at that point in time that 95 per cent of their training records were up to date. It is vitally important that staff are appropriately trained so that it is safe for the patient who is being restrained and it is safe for the staff who are carrying out that restraint. Restraint, as I said, should only be used as a last resort. And after other considerations have been made in terms of trying to manage a very difficult situation. With regard to training records, as I said in my statement, I have written out to all the health boards to set out my expectations of training records and to ensure that they are keeping records as they should. We have a data system within the NHS and all physical restraint should be recorded within that system. Those data records are then approved by management and if there are any incidents of injury, that would be reported also to management and there would be an incident review. Any incidents of serious injury would be reported to the Mental Welfare Commission but, in addition to that, any incidents of restraint would be recorded in a patient's clinical notes. Can I ask the minister what steps the Scottish Government and COSLA will take to implement the work of Dr Dane De Meese-Coyer and the children and young people's mental health task force? I have recently met with councillor Stuart Curry, the COSLA health and social care spokesperson to discuss our joint approach to build on the work that Dr Coyer began. We are considering the best way to move forward and we will make an announcement shortly. That concludes portfolio questions and we will move on to the next item of business. Or sorry, it wasn't portfolio questions at all, was it? See what happens when I don't have a script in front of me. That concludes the questions on the minister's statement. Sorry about that. I will move on to general questions if people could sort themselves.