 I welcome everyone to this, the 33rd, and I'm assuming the last meeting of the Public Audit Committee in 2023. The first item on our agenda is for members of the committee to agree or not to take agenda items 3, 4 and 5 in private. Are we all agreed? We are agreed, thank you very much indeed. The main item for the committee this morning is agenda item 2, which is further consideration of the Joint Accounts Commission Audit Scotland report on adult mental health. We've already taken a series of round table evidence sessions, as well as having a session with the Auditor General and his team. This morning, we're pleased to welcome witnesses from the Scottish Government to give us their response to the evidence that we've already taken and to answer some of the questions that we've got. I'm pleased that we're joined by the Accountable Officer Caroline Lamb, who is the chief executive of NHS Scotland and the director general of health and social care in the Scottish Government. Alongside the Accountable Officer, we've got Gavin Gray, who's the deputy director improving mental health services, and Dr Alistair Cook, who's the principal medical officer in the mental health division of the Scottish Government. We have got a number of questions to put to you, but before we get to those, Caroline Lamb, I'd like to invite you to make a short opening statement. Thank you very much, convener, and thank you for the invitation to provide evidence to the committee today. We really welcome the opportunity to discuss such an important topic. Colleagues in our mental health directorate have worked closely with Audit Scotland as they produced their report on adult mental health, and we believe it's comprehensive, clear and wide-ranging, and we recognise the issues that have been raised. Alongside this, we've also engaged widely with a range of partners as part of the development of our mental health and wellbeing strategy, the delivery plan, and the workforce action plan, which I'm sure you're all aware of. Our delivery plan set out specific actions that we're looking to take over the coming months, many of which address some of the issues raised in this report. Actions in both plans therefore cover a very wide spectrum of areas. They recognise that action is required across government to address the underlying causes of poor mental health, as well as ensuring, ensuring that provision of the right support for those who need it. We have rightly set out an ambitious strategy, but we're acutely aware of the deeply challenging financial situation that we currently find ourselves in. Despite record investment in the NHS, we know that there are significant financial challenges across health and social care. The committee will be well aware of this being a result of increased pay settlements, increased demand, inflation, rising energy costs and the ongoing impacts of Covid and Brexit. Despite this context, mental health has seen an overall increase in spending, and we're expecting spending on mental health to be well in excess of £1.3 billion this financial year. I know that the committee will want to explore the impact of this spend in more detail, but we have made significant progress. For example, investing £51 million in our community's mental health and wellbeing fund for adults, developing and rolling out the world-leading Distress Brief Interventions programme and exceeding our commitment to fund over 800 additional mental health workers in key areas. That said, we know there's still much to do, and we're keen to explore all this with you in more detail. Thank you. Thank you very much indeed. I think you alluded to it, but could I just ask you for the record if you accept all of the key messages and recommendations in this report? Yes, we do. Yes, you do. Thank you very much indeed. You also spoke of financial challenges, and we'll get to those in more detail in the course of this morning's meeting. Can I ask you specifically about the announcement in the last couple of weeks of another in-year budget cut to mental health services, which follows on from the in-year cut announced as a result of the emergency budget review last November, which was of the order of £38 million. I think the cut this year is £29.9 million. I mean, the joint report states that, and I quote it, increasing the availability of mental health and wellbeing services in primary care should help to prioritise prevention and early intervention and decrease pressure on specialist services. So how will these recently announced cuts, which include a reprofiling of mental health and primary care programmes, impact on these services? So what I would say in response to that is, first of all, obviously we are absolutely committed to improving mental health services, but we have to balance our budget. And despite the cuts that you've, and the reductions in budget review you've alluded to, we are still spending more than twice on mental health than we were spending back in 2021. So there has been a really substantial increase in the investment in mental health. And I think, and I can discuss with you in some detail, I know my colleagues might want to come on to some of the measures that we've been taking in primary care, but we have made significant investments in terms of the preventative and early intervention aspects around primary care, including NHS 24 and our support to NHS 24 in that overall primary care provision. So we are investing, we will continue to invest, but we're doing that in the context of a very challenging financial climate. And as a result of that, therefore, we need to be really clear, and I think that the recommendations from Audit Scotland and the work that we've been doing on data to ensure that we are able to assess the impact, be really clear about that, the difference that that huge additional investment is making, and to focus on ensuring that we're getting the best value possible from the very largest sum of money that we are investing. But presumably you will concede that taking nearly £30 million out of the budget on top of taking £38 million out of the budget last year will have an impact on the services. So it's obviously disappointing to have to be in the position where we have to reduce any budget. And as I said, that's set in the context of an extremely challenging financial climate and the need for us to absolutely ensure that we can balance our budget at all. So we are having to make very difficult decisions. That doesn't get away from the fact that we are still investing substantially and that we need to ensure that that huge investment is being deployed in the best possible way. So what spend has been postponed because I think that that was the expression used in the letter to the Finance and Committee. What spend has been postponed from the Mental Health Transformation Fund? So the committee will be aware that we've had to step back and pause a little on our commitment to spend more money on mental health workers in primary care. And Gavin, are there other areas of detail that you want to do on that? The other areas I think that we've had to pause development rather than stopping activity that was already happening, not preceding things that were planned. So there was investment planned around forensic mental health on the back of the independent review, again, which we're pausing and we're looking at how we can work with the system to make better use of, again, as it's currently saying, optimising what's in the system. That was probably the other significant area that we've paused work that was planned. But isn't there a bit of an implementation gap here? Because the Government's stated position is to increase mental health funding by 25 per cent, that 10 per cent of all NHS front-line spending will be on mental health. And yet things seem to be going backwards, not forwards, on both of those fronts. So I think that, I'll come back to my point, we are working in an extremely challenging financial climate and I'm sure that this committee would want us to ensure that we're spending the money that we do spend in the best possible way. So a lot of our work is around ensuring that we've got the data and the intelligence so that we can understand where systems are doing really well, where there is room for improvement in what systems are doing within the existing package of resources and making sure that that money is being deployed as well as it possibly can be. Well, we'll get on to data and evidence shortly. Can I just turn to a particular area? One of the clear recommendations of the report that we're discussing this morning is that there is a great inequality in the impact of mental ill health. One of the sessions, we took evidence where we looked at the impact on the minority ethnic community and that we took other evidence of other marginalised groups. Again, don't you think that taking money out of the mental health services budget will also have a disproportionately unequal impact on those communities that are most marginalised and probably most dependent on the services being provided? So we are really clear that there isn't an equal impact on poor mental health across all communities. We're also really clear that the cost of living crisis and the stress that's involved in people trying to manage their budgets adds to the impact of poor mental health and creates mental distress. A lot of our work has been focused on trying to support the alleviation and prevention, but also early intervention around those areas. A lot of our work with Public Health Scotland on data is also absolutely designed at ensuring that we can be really clear about the impact that we're having and that we can use that to address areas where we might be seeing inequalities. Gavin, do you want to add anything to that? I think that the Audit Scotland report recognises as well that we've got a big commitment across the directorate to how we support inequalities. We've got an equality and human rights forum that we've consulted on across the development of the delivery plans and the strategy. I think that within the context, again, Carline is setting out what we're trying to do within the delivery plan is maximise the areas where we really need to make progress. We've tested that with a lot of the quality groups. We've published quite comprehensive EQIAs across the delivery plans as well, and we're continuing to work with people with lived experience from all those groups to make sure that what we're doing is having an impact and not just in developing the plans, but as we go into implementation, those groups will be closely involved in that so that we can keep making progress, as Carline says. We really understand the disproportionate impact that mental health issues have. Dr Cook? I was just going to say that in addition that where we have been able to make investment and the new investment, particularly in the community, mental health and wellbeing fund for adults, then that work, which is largely landing into the third sector, has been specifically targeted towards inequalities groups and they've been asked specifically to look at additional services and additional supports as a priority within those areas. So, where we have been able to make those changes towards earlier intervention and prevention, then the inequalities have been very much at the forefront of that. Okay, but we've got a joint, I think, COSLA, Scottish Government Mental Health and Wellbeing Strategy, which refers to the specific needs of minority ethnic groups. So, we've been told in the course of our inquiries that there is no action in the accompanying delivery plan to provide culturally sensitive mental health services. I mean, can you explain why that is? So, as Gavin's already explained, we work with equalities groups in terms of developing those delivery... But it's these groups that are saying to us that this plan doesn't exist? Yeah, so, I mean, the boards and local authorities delivering services are all subject to the public sector equality duty as well. So, I mean, I think what we're trying to do through our engagement with the boards, through our delivery planning process, not just mental health, but across the board, we're trying to ask around what boards are doing around equality to meet different groups, because I think we're setting the policy intent, but it's, you know, boards that are delivering these services and needing to get to that level of detail. Again, as Caroline said, we're trying to establish the data to better understand what's happening with these groups so that we can then have the conversations to make sure that that delivery is happening. So, there's a lot there where we're constantly trying to understand what's happening and then work with those that are delivering to make sure that they are delivering to the groups that they need to. Yeah, and I mean, I think we accept and we will get into more detail about the data gaps and some of the evidence that we've taken around that, but I guess the question is not so much whether you are talking to various groups or not. The question is, what are the outcomes here? Yeah. Sorry, but I think we need to be clear that actually it is, as Gavin said, for local systems to assess the needs of their population and taking into account those clear inequalities across the system to determine how they best take forward. The actions that are in the plan. So, when you develop a Scottish Government and COSLA joint strategy, it's all down to what happens at a local level. There's no Scottish governmental oversight. No, we're clearly setting, as Gavin said, we're clearly setting the direction and we're also working very closely with Public Health Scotland so that we have enhanced data to monitor progress against delivery. But I think you would agree that it's important that local systems who have that local understanding of their local populations are able to determine what is required in their particular circumstances. But again, I go back to the point I made earlier on that the Scottish Government has set this as a priority to increase mental health funding by 25% to make sure that 10% of all spending on the NHS front line is on mental health services. So I would expect the Scottish Government to take some responsibility to ensure that those outcomes are being met. And that's exactly what we are doing. So we've also published in September, excuse me, our core mental health outcomes framework and our specification for psychological therapies. Excuse me, we're asking boards to self-assess them, self-against their delivery against those standards, and we're also working with Public Health Scotland so that we know that we've got the data that we measure delivery and, as I said earlier, to identify the systems that are doing really well, the systems that have room, and the systems that have room for improvement. Okay, just before I turn to Willie Coffey who's going to come in next, I think, I just wanted to ask you about a proposal that was put to us by the Mental Health Foundation. And what they said was that there ought to be, in order to tackle mental health inequalities, there ought to be an assessment on the impact on mental health of all governmental decision making. Do you accept that that's worth exploring? So I think that's certainly something that we could explore, absolutely. I think that's a cross-government, isn't it? So, as I've said in one of my earlier answers, this is not mental health and mental distress, it's not something just for the health and social care portfolio. It's something that impacts on mental health across all sectors of society, including the areas where Government has an opportunity to intervene. So I think that we would need to look at that in terms of decision making across Government. Okay, I'm going to now bring Willie Coffey in to ask some questions. Willie. Thanks very much, convener. Good morning, Carly, and to your colleagues as well. The convener led on some of the financial issues that I was hoping to touch on, but I would quite like to return there to the committee. We're interested in following the public pound. In your remarks, Carly, you mentioned the £1.3 billion investment in mental health services. In the Auditor General's report, you can see quite clearly where, in terms of the directorate itself, there's been a significant increase in funding in recent years there. But, as the convener mentioned, there's been cuts to various parts of the service. What impact does this ebb and flow of allocations of more money in facing cuts have on you to deliver the kind of services? Does it mean that you have to delay things or you have to cancel work? What are the real impacts and what are the effects of the spending changes that are having? As I explained earlier, we have been substantially increasing the funding of mental health, so it has doubled since 2021. In that context, the impact of having to make reductions is more about slowing down work that hasn't yet started and that we have the ability to do that because we've been on an increasing trajectory of funding. So, whilst it's really disappointing that we're having to slow things down, then what it does mean is that that means we're able to protect all the work that's already been put in place, that we're able to protect the funding to our health and social care partnerships and our NHS boards to carry on delivering the services that are already in place. So, you're confident that we won't lose our intention to fund a certain initiative or other that you might have to slow it down, is that what you're saying? We are really committed to continuing to deliver against the delivery plan but we have to also deliver a balanced budget and as AOI I have to deliver a balanced budget and that does mean that we are challenged in terms of being able to invest in everything that we do. You mentioned the distress and brief intervention programme and so did the Auditor General in his report. Could you tell us a bit more about that? Is there a concern that we've removed dedicated funding for that or is it continuing? Are there recommendations from the DBI programme being taken forward and so on? So, I'll come to my colleagues on the detail of this but my understanding, from my perspective, we are so happy to cover that. The DBI programme particularly the work that NHS 24 do around that, we have already always been clear since the start of that programme with local systems that they would need to start to embed that in terms of their own financial planning. I'm happy to cover that. The DBI programme was set up very clearly with an end point so that the pilot programmes had initial investment which would get the thing off the starting blocks that would come to an end at the end of March 24. We now have I think out of the 32 or 31 health and social care partnerships 29 live with a target to get them all live by March 24 so we're on track to do that. The funding that will continue in DBI will continue to fund the national programme which allows people to access through NHS 24 and through police and ambulance services and some of the central support for the local areas that have done this but all the areas that have had temporary funding now have plans in place to continue the service beyond that initial central funding. Finishing. Good to hear that. Turning to our third sector colleagues we've had many roundtables at the committee and we always hear the plea about sustained funding three-year, five-year and SAMH was no different calling for a shift to a five-year statutory minimum contract length how confident are you, Collin, that we can get to that place? We hear it year and year out at the committee we're pleased for funding to a three-year, five-year and so on I absolutely accept how difficult it is for organisations to manage and to operate really efficiently and well on that almost hand-to-mouth funding I think the challenge for us for me as accountable officer in the portfolio is to be able to move to that sort of longer term funding then we need more assurance around the annual nature of our funding and I think that's quite challenging in terms of the situation in relation to the understanding of how much we're going to be getting in Barnett consequentials just as an example at the moment so I think we would all absolutely like to move towards having at least indicative budgets going forward and being able to give particularly third sector partners a bit more security around that. Do we actually give three-year indicators of funding or do we actually try to do it and have to pull back or what do we do? With some of that I think particularly where there's less smaller amounts but you know it has a proportionally bigger impact I think we do what we can with our third sector partners to recognise that and to give them assurance and comfort as much as we can but as Caroline said that's always usually subject to a bit of a caveat around the parliamentary budget and processes but we do try you know to give us a little bit of experience voice we try our best to give them as much comfort as we can as much protection as we can. We hope to get there one day convener with this big issue that's a really important issue one of the issues that came out in our discussions as well Caroline was that how do we demonstrate and show positive outcomes and benefits to the significant investment that's going in and we've heard some good examples exemplified in the Auditor General's report but also on the roundtables as well how do we capture a bit more of that it's easy to focus on the problems and funding variations and so on but how do we capture the positive benefits that are going in here on this whole area of adult mental health? Yeah so I think that that brings us back to the work that we've been doing with Public Health Scotland and I think you heard from Richard and David in one of your earlier sessions about the work that they're taking forward to try to ensure that we have better data so we have quite a lot of data in the acute hospital sector but actually we struggle a bit more and I've talked to this committee about that on previous occasions and in different contexts but we have made a huge amount of progress in the last couple of years of actually starting to be able to improve our data from the community and social care sector and also from primary care as well and Public Health Scotland to have an on-going bit of work to do that we're also working to ensure that we can gather information around satisfaction levels so Gavin, do you want to say something about the satisfaction survey? So again it's something we've been very aware of we know a lot of collection happens and I think Tracy McKee getting a lot of talk about it and some of the evidence that there is collection there around certain schemes but we've not done that systematically at a national level so that's one of the commitments in the delivery plan that we're going to be looking at this year about a patient satisfaction survey that would tie in there that would give us national oversight of that as well as the local and as we've talked about we engage with a lot of organisations like Vox we've got a diverse experience advisory panel that we do take because the lived experience we're developing policy but it has been a gap that we need something in that end of treatment and understanding what people's experiences are to feed in with all the other more quantitative data of course so that's a commitment we've got for delivering that next year I think other colleagues will come in on the data collection Gavin and issue it and the convener covered the impact of the last emergency budget a moment ago but maybe just finally for me Caroline can you say whether our NHS wards are on track to meet the 2026 commitment that will get 10% of front line health spending will be on mental health still stick with that I think it's difficult for me to say audit Scotland's view was that we're not on track in the context of a really challenged financial position it's difficult for me to say that we will absolutely be on track I would say though is that that commitment was around 10% of NHS spend it's really important to recognise that audit Scotland recognises that this isn't just about the spend that goes through the NHS that what is really important in terms of improving mental health is particularly that work that goes on around prevention and early intervention and actually a lot of our investment has been in communities and around sector, around communities and so it's really important that we look at the spend across the piece and don't just focus on the NHS part of that but you'll still track this one oh yes we're absolutely tracking it we're monitoring it with boards we ask you again in a year one closer to whether that's on track or not absolutely on that point then how do you respond to the evidence that we were given by Dr Sri Reddy when he said we made the shift we shut the asylums and we have moved into the community but then we kind of lost interest I don't think that we've lost interest at all I think that the work that we've been doing to invest in the community not just in the community but actually in the acute sector as well and the work that we've done so recognising that key to improving mental health services is actually having the right workforce and the right skilled people to support folk who need services and just to take psychiatry and Alastair might want to comment but we have invested significantly in increasing the number of psychiatry training places at the same time as investing very significantly in the workforce who support people in the community and who support people with early interventions so I don't think that there's any way in which we can be said to lost interest Well I think one of the measures that was presented to us by the Royal College was the extent to which there's a reliance on locums and I think other people are going to speak about the workforce plan Can I move on to something else that Dr Sri Reddy said to us he said that governance has been a real challenge and he spoke of fragmentation and again he said and you may not agree with this that his view his perspective from his members was mental health was in his word an afterthought we've also got a pretty clear message in the Auditor General Accounts Commission report where they say in key message number three the system is fragmented and accountability is complex with multiple bodies involved in funding and providing mental health services this causes complications and delays in developing services that focus on individuals needs I mean these are quite serious charges are they not I mean how do you respond to those I don't really recognise that picture that's being painted so I accept that we are directing funding as we've just talked about to third sector organisations through primary care and through NHS boards and I think sometimes that can start to make it look difficult for folk to navigate but we are absolutely working and through the whole principles of getting it right for everyone looking at ensuring that our systems are putting the person at the centre and making it as easy as possible for people to navigate those systems Gavin do you want to add to that? Yeah I think on the point of the visibility of mental health so again we work with colleagues across the DGE mental health is one of the priorities and the annual delivery plan guidance and the medium term plan as well so we continually work with colleagues to make sure we are trying to make sure it has that visibility I think we are aware that people have had the concern we've always had that drive to try and get that comparative between physical and mental health and we continue to push on all of that I think we again in the delivery plan we have recognised some of those I think given the complexities of the system we deal with for everything from really the forensic right through to the light touch information will be an advice that we give there's such a broad range of different partners and different interactions with that it can be difficult and as Carolyn said at the start we accept the challenges that are in there at times the difficulty and accessing systems and that have been slower than we would like so that's why again we've got some actions in there that are aimed at how we look at how the systems interact how the digital offers link with the primary care community support I think we've made advances around psychological therapies around CAMHS by establishing the specifications getting a consensus about what a good support looks like and that's one of the things we want to do for the community and the adult secondary mental health over the next year or two as well to really establish a better picture of what the conservatrix should look like so that we can build on that and address some of these issues could I maybe just come back to that point about mental health being an afterthought so as DGE I can assure the committee that mental health absolutely is not an afterthought as Gavin said we include the mental health priority objectives in our annual delivery plan guidance for NHS boards and when we are meeting with NHS boards to complete their performance reviews on a regular basis we include folk from the mental health team so that we are looking not just at performance in urgent and scheduled care, planned care cancer but also absolutely how boards are doing in mental health as well I might just pick up on the bit of the perception of a lack of attention on adult mental health services and I think we would acknowledge that to an extent that is justifiable that Dr Shreddie's point around that I think that there has been a huge focus in the interaction between Government and local systems around the psychological therapies waiting times initiatives and those have been the focus in the last while and that could potentially have led to some perception that the adult services were getting less focus and less attention and as we've moved into this current process of the mental health and wellbeing strategy that's been published and the delivery plan I think we're trying to look to and with the publication of the core mental health standards very much trying to look to rebalance the system so that it becomes while recognising still that waiting times for child and adolescent mental health services and psychological therapies are hugely important actually other things are really important as well and need more attention as we're going into this next phase Yeah absolutely and the Auditor General has obviously chosen to produce this report on adult mental health services because it is a matter of public interest Caroline Lam can I take you back to your initial response when I put to you the evidence that we've taken from the Royal College of Psychiatrists in Scotland and also from the Auditor General I mean at nine o'clock you said you accepted all of the key messages in this report and before the clock got to half past nine you were distancing yourself from the very clear message that there is a view which has been reinforced in I think in all of the round table sessions that we've had that the system fragmented and that there are issues around accountability in the system do you do you not accept any of that? No I have said that I absolutely accept that sometimes people find it very complex to navigate the system some systems are better at joining things up than others and one of the things that we need to do is to learn from the way in which the best systems approach it which is very much rounded on our work so that the person is at the centre of what systems are doing rather than individual aspects of the system sorry if there is something I said that would imply I don't recognise that we know that we have challenges and we are working across systems to address that but I would also say it's not a single homogenous picture either some systems are better than this than others Without batting in defence of homogeneity I think we are looking for a bit of consistency and there seems to be a very mixed picture across the country and that's why I wonder we wonder as a committee whether you have thought about some of the evidence that we took which was a concern about the legal framework that IJBs for example operating are you considering at all reviewing the governance arrangements to see whether they can be simplified made more effective provide better value for money are more accessible to the people who need the services so maybe say two things in response to that first of all that question of consistency absolutely we recognise that and that's why we've published the call mental health standards and that's why we're looking for self-assessments against those standards in relation to the whole position around IJBs as the committees where we've been working with on the development of the national care service which is intended at getting far more consistency and trying to address some of those governance barriers across the piece when we're delivering services in communities in primary care and indeed in the acute sector but you're not looking at primary legislation or the government's not looking at primary legislation or changes to the model of oversight and delivery so as part of the national care service we've been working with COSLA to ensure that we can put in place national oversight and that at the same time we can simplify some of the and potentially remove some of the barriers that currently exist in getting those seamless systems in place okay but I think the answer to my question is no if there's no I mean it will be national care service review but you don't necessarily see any fundamental reform of the architecture in adult mental health services so I think that the architecture around our integrated joint boards which is what we're talking about is absolutely at the centre of the review that with COSLA and the national care service sorry but you think it's working well? no I'm not saying I think it's working well I think there is a lot of room for improvement and that's one of the things that we're looking at through the national care service okay okay can I just go back to a point I alighted on very briefly and again it was the evidence we took from the Royal College of Psychiatrists and you seem to paint a picture of things going pretty well there but we were told that there is a huge overreliance on locums in the system I mean do you have any strategy for tackling that? I'm upset that there is an overreliance of locums in the system and our strategy for tackling that has been to increase the number of training places that we have for psychiatry across the piece Alistair we've got quite a lot of work going on around improving recruitment and retention obviously looking at things like international and domestic UK recruitment trying to improve our work around that retention is also a big issue we had a spell for a while where psychiatry has historically been one of the more difficult medical specialties to attract doctors into and we did go through a spell where we were struggling to fill core training places but for the last three, four years we've had 100% fill rates in core training but of course it's a six year training minimum and actually in reality people actually are nine years to complete that with various different options and part-time working etc so it will take time for that to filter through increasing the core training places over the last couple of years has been successful in that we've filled the places the next phase as those core trainees come through into higher training places will be to ensure that we keep them in Scotland and bring them into the Scottish workforce and that's what the working group that we have which has the College of Psychiatrists Nes and others on are working to look to achieve but you've got a shared perspective on the scale of the challenges I'm going to move on and invite the deputy convener Sharon Dowie to put some questions to you throughout the report it highlights issues with the availability and quality of data and recommends the Scottish Government and IGIB's urgently progressed work to improve the availability, quality and use of financial, operational and workforce data to improve planning, information sharing and monitoring the quality of services and patient outcomes so I can ask how the Scottish Government is addressing the gaps in data to enable better informed planning and decision making thank you and I think that data sits at the heart of a lot of what I've been talking about so far so we are working really closely with Public Health Scotland and not just with Public Health Scotland but with our eHealth and digital leads across boards to ensure that the systems that we have in place are accurately capturing data in relation to mental health activity and indeed that then feeds into data around a cost and Gavin's already told you about some of the work that we're doing around people's experience of services as well so that work continues and it's really at the core of a lot of what we're trying to do not just in relation to mental health but understanding particularly where activity is happening in the community and primary care being able to ensure that we can accurately capture and report on that but also importantly as you've said that that data is then reflected back to local systems so local systems are able to see how they're doing but also importantly to see how they are doing against other systems so that they can identify where their opportunities for improvement are Gavin is there anything you want to add? I think the other side of that is obviously the planning side and we've talked a bit about the annual delivery plan and the medium-term delivery plan so what we look at through that is as we've said mental health is one of the 10 priorities in there so we get reports back on what the local mental health plans look like how that sits with their workforce projections and their plans and then we look at all of that collectively so we try and identify the other national gaps things we need to be doing but also use that to inform the regular engagement with mental health leads in each of the boards and we do that primarily at the board level but there is good representation from IJBs a lot of the functions are delegated to the IJBs so often the mental health lead will be a chief officer or have delegated responsibility so we try and use those mechanisms to understand what the tensions are and the planning and use that to effectively agree with the boards then what national help they need where we can support them against areas that they might be struggling with we've done a lot of this around improvements around camps and psychological therapies for example so around the waiting times when we see boards that are the performance doesn't look as good we'll have those conversations with them try and identify what the barriers are a team of professional advisors there that will go in and give support to boards to look at how we can help them improve I wonder if the government is both saying anything about the benchmarking work again it's one of the things we talk about in the delivery plan but we've also for the last couple years invested in UK benchmarking so we're getting data across all the boards that allow them to look at various things like the number of beds staffing how that compares across Scotland but also with some comparable services in the UK as well so again that's very much now in the moment driving improvement we pay the membership fee and the boards engage in that but we've had some focus on adult services on camps and those three events planned at the start of next year so we're using that across the mental health to try and share that intelligence and planning so that boards can share that intelligence about what's working, what different models look like and how they can learn and use that to help and improve their own services I'll come back to some of that in a wee bit during the third round table evidence session Public Health Scotland explained that it holds robust data on inpatient mental health care however the equivalent data does not exist for adult mental health services in the community are there any lessons that can be learned from the way it's currently gathered in secondary care to improve availability and quality of the audit mental health data is there any medical settings? Yes absolutely and I think as I've said to this committee before then one of our challenges is so we do have good data around the acute sector but we are it is more complex because there are many many more organisations involved including over 900 GP practices in relation to that activity in primary care and more broadly in the community around the third sector but Public Health Scotland have been working with us around primary care data quite broadly because this applies in other areas of activity as well that work is ongoing and we are committed to ensuring that we can get that picture of activity and mental health no matter where that activity is taking place that's really important to us You've spoke about collecting a lot of data and you mentioned a lot about UK benchmarking so how readily available are all these reports for us to see how well we're doing? On the benchmarking information that's not published at the moment because the boards are using that primarily as an improvement tool but we do disseminate that we talk to the boards around that and through the process next year we'll look at if anything we can publish from that I think the what we're trying to do with PHS is in particular so I think Richmond Davis again when he was here talked about the child adolescent psychological therapies national data sets getting that individualised data that will really allow us to interrogate that information in a much stronger way that's part of the regular publication and on the back of the strategy the outcomes of set-out in there we are working and again Richmond talked about this but they have established the outcomes framework we're doing the work on the evaluability assessment at the moment I don't know anything about that this week with PHS so we're on track to that so we'll publish a much broader range of different information that will give a much broader overview just waiting times targets around the two services but a much broader picture against the outcomes that will set out in the strategy and as Caroline's spoken about a couple of times the core mental health standards as well we're looking at how we can measure against them to get better information and quality and again get a more standardised view of that across the boards so the other main areas that we're looking at that will be published over the course of the year we'll bring out more on that over the course of next year you've spoken about all the information that comes from different bodies 900 GPs so do they all feed into one system so that you can get a report or is everybody to get individual systems we have got currently across Scotland there are two systems that are predominantly used in GP we have a single system that PHS are able to use to this isn't right technical, suck data out of those systems and we are continuing to work to ensure that the data that goes into the systems is coded in a way that is consistent so that we are comparing apples with apples rather than apples with pairs so across general practice then we have made huge progress in relation to the not just the data extracts the data extracts is relatively straightforward but then the quality assurance of the data in those systems and that's why I think you heard from Richmond and that's why I think we're confident that we will be able to make those improvements to the data that we have so is there work being done so that everybody's using the same system because one of the complaints are issues that I've heard from consultants etc when I've been out talking to them is the fact that the boards seem to have different computer systems so if patients go between boards then they're spending hours having to phone up to get information so is there any work being done so that everybody's actually using systems that speak to each other? The short answer to that is yes there is a lot of work that is being done to ensure that we can move towards having patient records that contain all the data about an individual I think that in some cases that's about ensuring that all boards are using the same version of the patient management system most boards, almost all boards use the same system I think with technology the issues are really less about being able to join up those systems but making sure that the data is equivalent that was consistently recorded in systems and also managing some of the concerns around information governance because legitimately I think people also need to understand and be confident about who's able to get that information and to be confident that that's being used in the right ways but there is work on going on that under our digital health and care strategy So if there's work on going is there any timelines or anything like that to say when everybody would be using the same system because that would obviously help the mental health of the GPs, the consultants and the patients that it affects? Yes, I think it's less about using the same system but ensuring that we're able to get that information into the mental progress towards that we've described some of the work that's on going and that work will continue to be taken forward Again, some of this is dependent on investment as well So we're not working towards having the same system it's just about getting data collection I think we need to be careful about having the same system because I don't think that this is about one massive big IT system I think some of the history of that goes too well It's about ensuring that we are able to render up so make available data from those systems in a way that is easy for people To give you a simple example and this is a Covid driven one as part of the vaccination programme we were able to pull data from different systems but make it available to individuals so that you could get your own vaccination record Okay, thanks It also states that the Scottish Government in health and social care partners should learn from NHS England which publishes more detailed information on mental health services regularly and it does say that the data is not complete and there's obviously still issues in there as well but it also says that information is now routinely published on service activity and performance spending and inequalities so could you tell us whether you do plan to learn from NHS England and what measures you could implement from there? So I think that we are absolutely committed to improving the data that we have and being able to publish more of that data We're also, as Gavin said, working through the benchmarking work to ensure that we're actually able to compare ourselves with NHS England as well So yes, I think that we are keen to learn from all systems about not just NHS England but NHS Wales and indeed out with the UK around the things that work well for people Yeah, I think that the systems are a bit different so we can't directly lift it but our analysts in the teams at PHS are looking at what's available elsewhere and how they're factoring that into their thinking about what we do in the work that we've talked about that we're taking forward but really clear that we need to be again, you know, we're working with PHS to make sure that we can publish more regular and wider information about what comes as the intent and the strategy and the delivery plan and that's what we'll be working to next year So what's different to their system from our system? That means that they can report it just now So the I think that there's a lot around the way the systems just I mean, I don't know what Alasdor do yet I mean, the big difference is commissioning, frankly that in order for mental health trusts to justify to their clinical commissioning groups what they're doing around certain activities there is a necessity for them to do and it adds a lot of bureaucracy into NHS England that we don't have in NHS Scotland but it means that that there is more data produced and collected and monitored so I think we can learn from it but I hope that we can do it without having to introduce such a bureaucratic commissioning layer in order to make it happen Okay, thank you And final question Whether the Scottish Government has provided funding to NHS education for Scotland to develop the mental health workforce statistical publication that was also mentioned in the report Yes Yes Yes It's part of the considerations in the budget for this year so we'll be discussing it with the minister it's part of the prioritisation for next year So no funding's been given to us yet? Not this year But NHS education for Scotland continue to produce We continue to produce the statistical publication and as Garmin said one of the things that if we're looking at I think there's also a question around NHS education for Scotland best use their resources and what they can do in terms of efficiencies to enable them to further develop that publication within resources and in relation to value for money that's certainly some of the work that we'll be doing with them The report provides detail about a piece of work intended to significantly improve the availability of the mental health workforce data So there will be an implication to mental health if we don't put the money in One of the phrases that's getting used just now is spend to save so we need to make sure that the data that we get ensures that the money that we're putting in is giving us the right outcomes So it's another implication if we don't give the money to this piece of work So I guess what my response to that would be I think we need to be careful not to just automatically assume that every extra bit of work needs extra money there might be things that we would want NHS education to prioritise over other things in order to make sure that we're able to get access to the data that we want so yeah we are very keen to improve that statistical report but we need to be having the conversation around what that means in the context of the overall resource budget that's made available to NHS education for Scotland and how that's deployed Okay right thank you in order to move things along I have a few questions to you Graeme? Thanks very much convener and I'll follow up on what Sharon Dowey has been asking about and she was covering the NHS mental health dashboard which is used in England I've been having a look at that I'm sorry Dr Cook if you feel it's too bureaucratic but you can come back on that but to me some very useful information it is sort of following progress that's what this is all about and actually that links into what Mr Coffey was asking about you know it's follow the money and we'll see what progress is being made that's what this dashboard is all about used to be called the mental health five year forward view dashboard bit of a mouthful that brings together key data from across mental health services I'm just reading from their website anyone can look at this across mental health services it measures the performance of the NHS isn't that something we should be doing here? Sorry can I if I can be clear I think that's what I said I think we should be trying to do something like the dashboard but I think the process that has led to the that being able to be delivered which has resulted in is the bureaucracy that I was referring to which is that whole process of clinical commissioning and contracting between the commissioning groups and delivering bodies introduces a whole layer of administration which one of the side effects is the dashboard which is a great thing and I think we should aspire to that but it would be great to be able to do it without having to add in that whole extra layer of administration to do it that was the point I was trying to make I'm all in favour of doing things simply rather than introducing bureaucracy so are you basically saying yourself Dr Cook and Caroline Lamb that you would like to have a Scottish mental health dashboard? Yes we would look as we've already described a lot of the work we are working really hard with Public Health Scotland to try to ensure that we can get all the data on a consistent basis across Scotland I don't know whether every single trust in England is able to make available data to that dashboard but we would certainly want to ensure that we're being consistent across Scotland so that we are able to make the fair comparisons that we are comparing with like I think that's really important that we make that data available not least in fact most of all so that local systems have the opportunity to see how they compare to other systems and are therefore able to identify their opportunities for improvement Okay so what kind of timescale are you working on here? Public Health Scotland are looking to so for us that dashboard really is around pulling the data and the indicators together against the core mental health standards Public Health Scotland are working on that at the moment and I think talking about next summer 24 I think yes What do you think something will be up and running by next summer? So we are hoping to get something up and running I guess what I would say is that might be and generally what we do when we're starting to get into publishing these new sets of data is that we first of all make them available as management information so that they can be seen by local systems and they have an opportunity to almost locally quality assure that and Public Health Scotland also have a whole set of processes that they need to go through to ensure that the data is statistically correct before they publish so we would generally move into providing that sort of data as management information first and then move to publication after that So the key thing about this is anyone can look at it exactly and that's where we would like to get to So from what you're saying that would be after next summer Yes When? I would need to discuss that with Public Health Scotland because it's about their time frames to actually do the assurance around published data as opposed to management information So initially you want to it will just be for yourselves you and your colleagues can look at it and for local systems because this is about making sure that local systems can understand how they're doing It's really important that we have total transparency on this This is available to the public I absolutely agree with that I think it's just that Public Health Scotland as the statistics regulator have some processes that they need to go through and I would need to ensure that they're happy before I start giving them time scales Okay The other thing I came across down in England when I was looking at the dashboard they have what are described as mental health hubs Have you come across them? I think they seem to be Well they seem to be across England and they're aimed at staff Have you come across them? Not specifically I mean there are lots of mental health hubs of various different sorts If these are about staff well-being support then we established staff mental health and well-being support systems in every board in Scotland and those were accelerated and expanded quite significantly as we moved into the pandemic and are still ongoing So in every board area there are psychologists available for staff well-being and support but we have a mental health and well-being hub for staff which is for Scotland That's a national thing It might be similar Maybe we can go away and have a look at that They seem to be dotted around England You've been following the evidence and you've read the report We have asked in pretty much every session about a model that exists in Italy in Trieste and Dr Cook, you knew I was going to ask about this So if we can just briefly describe it as a one-stop shop if you like open 24 hours a day seven days a week don't need an appointment just call in and pretty much every witness we've had has said this is a good model Do you agree? Yes but you might expect Trieste have said it in context Trieste is 200,000 people It's a city It had a mental health hospital that had two and a half thousand beds It was the changes that they made there were made at a time when there was a radical political leadership together with a visionary clinical leadership and they were able to do something that other places just haven't been able to do They closed 95% of their beds at a swipe Can you imagine us coming in and suggesting that into the Scottish Parliament It's unthinkable that it would not be opposed They then managed to retain those resources in managing those very extensive community services and we have admired them I had colleagues when we were developing our community services in mental health in Scotland a number of colleagues went over to Trieste to look at the models there learn from the models there and the league clinicians from Trieste actually have been relatively frequent visitors to Scotland which is probably why it's been picked up as being something that people in Scotland are interested in I think that our systems have learned from it We have not been in a position where we are able to resource 24-7 community hubs in the same way We rely on general practice out of our services in the out of ours period but we have been able to put mental health wider services to try and expand that and our 24-7 services have still remained a bit hospital based so there are things that we haven't been able to progress nearly as far as they did in Trieste but we have learned from it It's perhaps ironic to talk about Trieste at the moment because all the current literature is about effectively save the Trieste model because it's under huge threat because of financial and political opposition to it at the moment so it's a great example to learn from but not directly applicable I would say in our context but as I say it would be nice So it would be nice if we could have a Scottish version maybe not exactly the same because everywhere is different maybe Dr Cook you could be that visionary clinical leader that you described I think as well that Salist has described it's hard sometimes to just sort of lift and shift things from one system to another they don't necessarily they're not operating in the same in the same context I think what we've been doing with NHS 24 and the mental health hub has been a real attempt to try and provide that initial contact that can then signpost out to other systems and indeed NHS 24 employs skilled clinicians as well to deal with mental health So there's something about what is the best approach for Scotland learning from lots of other systems and also thinking about how we align that with the sort of increasing use of NHS 24 and the urgent and unscheduled care space as well Is that fair? What they didn't have in the 60s and 70s was the ability to think about digital innovation and that may be one of the keys to help us unlock the issue of the rurality and other areas of things so a chest couldn't work except it was place based people had to go to the community hub we may be able to in some way look to a virtual hubs through digital use albeit that has to be then backed up by the ability to people to actually get to face to face help as well Correct, because not everybody could use such a system So the reason I ask about well A, it sounds like a good model but B, and it goes back to what the convener was asking about this sort of fragmented system and I wasn't sure whether you agree with that or not Caroline Lamb because she said two different things but don't we accept that we do have a fragmented system and people fall through the cracks that's what leads to and it's another thing we've been exploring in this committee is the amount of mental health work that the police are having to pick up so you'll know because you've heard it from them that the vast majority of their time is actually taken up dealing with people who have mental health issues and a lot of their time this is the police is taken up sitting in hospitals when they could be out on the beat dealing with crime so that seems to me to not be a good situation we've heard from NHS Lothian that things are maybe a little bit better there they've got a system in place which helps to prevent police sitting in hospitals but that's just NHS Lothian other parts of the country I'm in my own area I represent Central Scotland that includes Lanarkshire that's not in place so we've had situations in Lanarkshire where entire shifts of police are sat in A&E that's ludicrous isn't it so if we had somewhere that police could take people with mental health issues not everybody but some and that would free them up that's got to be better hasn't it yep shall I take that one again so we're doing a lot of work with Police Scotland absolutely acknowledged the problem and we've been working with them around the HMICS report which was published recently there's been work on going for some time around so we mentioned NHS 24 and the availability of clinicians there there's been work to develop what's called an enhanced pathway which means that the police have an ability to contact that NHS 24 mental health hub in situ from where they are with an individual and hopefully avoid the need to convey that person to hospital in the first place then there's a lot of local work going on in liaison groups with local hospitals and Police Lothian example that you picked up but actually in fact Lanarkshire have been working really hard at this I think it's picked up in the Audit Scotland report as an example but certainly they had been doing some joint work with Police around reducing conveyance to hospital and have achieved a 73% reduction in that conveyancing rate through joint working with the police and the mental health emergency assessment service there the mental health assessment service work and where they have I'm not saying the example you gave is untrue because these things do happen that people end up spending the whole shift there but when that happens they then sit down and do a missed opportunity audit with the police to look at what could have been done and what could have been done differently to try and avoid that so I know that's happening in Lanarkshire there is work going on in other places I think we had some reports this week from the police saying they are starting to see a difference we had a very well attended workshop at Tallyallan two weeks ago when all the boards were represented and all the mental health systems were represented and were committed to carrying on working with them to look to improve the joint risk management I think this is crucial here is that there are sometimes different perceptions of risk so that an individual presenting in distress to the police may be regarded by mental health services as either safe because they are well known to the service and have a care plan in place or and but the police feel uncomfortable with leaving that person there so that a better joint management of that risk then that could lead to further improvements we all accept that having the police sitting in EDs waiting for mental health assessment for long periods of time is something that we want to remove from the system completely it's good to hear you had that session at Tallyallan so is that because you want to get to a position Scotland-wide where police will have somewhere that they can refer somebody to actually the key thing is at all times of the day so they do already with the mental health hub and the mental health hub then has the opportunity to refer someone on to local services which function 24-7 but I think it's taking it further than that so it's not just the phone line that actually in a lot of places we have community psychiatric nurse for instance involved in working directly with the police in triage etc so looking to develop all those models where we can it's not about being able to phone somebody it's about being able to take somebody somewhere and it's freeing up police time and actually the example I gave in Lanarkshire is because I speak to the police in Lanarkshire so when I'm saying that entire shifts of police have been in A&E it's because they have I also accept that there is a local arrangement now where if things are getting particularly desperate the police will will phone the NHS and say look can you give us a hand here so the arrangement should be not when it's desperate no it shouldn't no ok I'll leave it there ok thank you very much indeed Graham Simpson mentioned case study 2 in the report can I ask you about case study 4 in the report which is not triest its Tayside I mean there have been some pretty catastrophic failures in the approach of the mental health service in Tayside and the experience of people at Cassaview that produced some very harrowing personal tragedies for families I just wonder what your senses or what your information is about where things have got to in adult mental health services in Tayside so convener as you'll be aware we escalated NHS Tayside because of their performance on mental health and therefore that is something that we continue to keep under review but I'll be asked Gavin to give us the latest we obviously worked closely with him last year we had the independent oversight group led by Fiona Lees who produced the report and then on the back of that again there was changes to the delegation arrangements and a lot of discussions with the previous minister and our current minister now with the leadership there the chairs of the IGP last week so the plans in place I think there's a lot more scrutiny now locally around the progress of that we're nearly keen to promote the engagement with the local lived experience groups as well who've been very involved in this with close contact with them and trying to make sure that again there is that transparency in that oversight of progress in the reporting so there's definitely a way to go but there's a commitment locally around the delivery against the plan that they've set out but this does go back to at least 2018 I mean I remember raising it in Parliament back in the spring of 2018 and so the last time I spoke to those families with that lived experience they were still perplexed at best that insufficient progress appears to have been made and people are still not getting access to the services that they need do you recognise that picture? So I think as Gavin said we did escalate the board we are continuing to work with the board I think that we've had obviously we've got a change of leadership in Tayside and on the back of that I think we've been really clear about where the priorities are for Tayside I was up there with the minister doing the annual review a few weeks ago and we continue to maintain our focus on clearly it's important that Tayside is able to move forward and make positive change and we're continuing to support the board to try to do that but I'd absolutely accept that on the ground people are not seeing the change as quickly as they would want to Okay and the interest of time I'm going to move things on and invite Colin Beattie to put some questions to you Thank you, convener I'd like to cover the area of access to mental health support and services Colin, earlier on you said, if I remember correctly that spending on mental health had doubled since 2021 and yet in the office of general's report he highlights that many people are finding accessing these support and services to be slow and complicated so what are you doing to deal with that? Okay so as I've said earlier as well we've been very focused on trying to make sure that we are investing and supporting services both in terms of avoiding mental health issues and early intervention so for example we need to try and prevent issues or intervene early so the work around the distress brief interventions that we've already touched on but also the support that we've been given to local authority to ensure that there are counselling services provided in all secondary schools as well as that talked about the NHS 24 and that their mental health hub they're taking about 2,500 calls a week so that's a service that was established in 2020 and I think it's dealt with 100,000 individuals since then that's now running about 2,500 a week we've touched on digital as well and the way in which we're trying to make digital so computerised CBT and other opportunities available to people so I guess we have invested a lot in relation to trying to improve access but also make sure that access to different ways is available because there's not a one type suits all here I think one of our challenges is making sure that people are aware of what's available so we've been working with primary care teams in relation to a tool box or a toolkit that people can use to point towards services that are available yeah and just really there was issues guidance issued to primary care last year on the supports available through the different supports available so that's something we'll continue to look at and if it needs updated we need to re-circulate that and make sure that GPs are aware of that we'll try and do it and I think that the other thing again we've recognised this in the delivery plan and there's a specific commitment in there around looking to look across all the areas that Caroline's talked about and you know from a very person-centred approach to make sure that people are able to access what they need more clearly and that will be a priority for us working with partners to do that next year I guess my response there is looking at the Auditor General's report it would appear that despite all these initiatives that you talk about people are still having difficulty accessing a complicated system so what is happening in the future over and above what you've already stated to meet that concern I think this is a it's a complex story that we need to work through some aspects of it which are really positive which are that our population now is much happier to talk about their mental health to recognise that there are mental health issues and come forward and seek mental health support than perhaps they were 20 years ago, 15 years ago and that's a real positive thing that that's happening we are developing multiple different ways in which people can access services but what we've found over the years is that as we have increased and now far more people are being seen for their mental health problems through much in a much better way a much more holistic way so it's not just a case if you get an antidepressant or you don't you get psychological therapies there are lots of different services available for people so we do things a lot better but not to the extent that the demand has increased so going forward what we need to do is find ways in which we can develop services that allow people to easily access lower level of support which means that the more specialist services are able to focus their attention on those with the highest levels of need and the most complex issues and that's I think where we are at the moment in terms of our strategy and delivery plan is trying to get that balance right between those two very difficult calls on the capacity that does exist so I guess is that at the moment we don't actually have a strategy in place yet for dealing with that feedback on the concerns about the complexities of the access I would argue that we have the strategy but we don't yet have the delivery of that so we don't have the capacity just another facet of that the in various evidence sessions we've heard there's been concern raised about the use of digital which you mentioned Karen is the Scottish Government still committed to giving people a choice how they access services and people are not going to be forced to use a digital service partly it was arising from rural concerns because people in the country obviously are away from a population centre and generally away from the sort of facilities that might be beneficial to them and travelling a long distance and so on there might be some pressure for them to use digital services as opposed to travelling up to the city for a face to face how are you going to handle that because digital is not right for everybody I absolutely agree with you digital is not right for everybody and we always in every facet of where we offer digital digital has got huge benefits and many people find that they're very comfortable our satisfaction rates with the digital, the computerised behavioural therapies are very high about 83% I think so for some people works really really well and it allows them to quickly access help and support but it's never going to be it's never going to be something that everybody wants and also we have to accept that some areas of the country for some people that just are digitally excluded and some demographics are not as comfortable with using digital as others as well so absolutely I think Alistair said earlier that we need to make sure that we are always able to offer face to face but if people are comfortable with digital and if they find that helps them then again it takes that pressure off those face to face services so I think it's actually a really valuable resource for us and for people so for sure there's still going to be choice yes are there any plans in place to better understand the demand for psychiatry services and to address the significant workforce challenges around that I think we've begun to address a number of those in previous answers certainly in terms of understanding the demand then a lot of the improvements that we make the data and data collection will be helpful in doing that we in terms of the psychiatry workforce then the work that we're doing to look at the recruitment retention that I mentioned earlier but also increasing the number of trainees at the beginning of the state and then coming through the process towards consultant level will all contribute to that but I think it's important to acknowledge as well that the psychiatry is a small part of what is a very big multi-disciplinary workforce and that looking at how we best deploy the workforce that we do have and the potential workforce that we might have through things like peer support and psychology graduates etc who potentially could be brought into the mental health workforce can all contribute to that how difficult is it to recruit into this workforce so it's extremely difficult in certain areas and at certain times so there are the trainees who complete and come to consultant level are snapped up immediately into jobs so we have that and then there are a number of jobs which are vacant and are filled by locums and the support for those locums is something that we're looking at as part of that work I'm looking at the recommendations of the Auditor General and I would ask whether the Scottish Government will publish a cost delivery plan setting out the funding and workforce needed to establish and accommodate primary care mental health and wellbeing services across Scotland by 2026 this is in accordance with the Auditor General's recommendations we've published obviously part of the delivery plan against the mental health and wellbeing strategy I would accept that the work that we're doing around data is about better understanding where the money that we're spending is having the best impact and that will need to feed in to looking at how we can develop a delivery plan that looks at services and how those services interface with each other across Scotland What time skill are we looking at for this? The committee in the delivery plan is for us to produce a report on progress on that around November next year Next year? Yeah, yeah, 2024, yeah Sorry? Yeah, November 2024, yeah November 2024? Yeah Okay Thank you Okay, right, thank you Can I just pick up on a particular occupational group who we haven't spoken about so far explicitly and that's these community link workers So we had Christina Mellam from the National Association of Link Workers giving evidence to us and she basically said that they felt quite undervalued in the system citing as an instance of that that they weren't even listed in the consultation on the statutory guidance for health and care staffing Scotland Act 2019 I mean, what's your view Caroline Lam about the role of community link workers? I think that the community link worker role is enormously valuable and particularly in our more deprived communities and I think to look for evidence of that the fact that the Scottish Government has recently intervened to provide additional financial support in the context of a very challenging financial climate to support the ongoing provision of community link workers in Glasgow I think that community link workers particularly when we think about some of the underlying causes of mental distress around cost of living and all of that community link workers are really important and absolutely a valued part of the whole family of workforce across health and social care in Scotland. I don't know whether you were sitting watching our evidence session on the 16th of November with a checkbook in your hand because the community link workers funding rise was announced at the same time I think as we were taking evidence on that fact. I never have a checkbook in my hand. Can I just for the purposes of again of the record clarify that we spoke at the beginning of this £29.9 million cut which would have an effect on primary care services community link workers are part of that whole network. Are they protected of those positions of community link workers protected in the likely cuts that are coming down the track? The community link workers on the whole are funded through the primary care improvement fund rather than specific mental health money so they're part of the overall move to increase the members of multidisciplinary teams around primary care. So as I've already said convener the position for the current year is extremely challenging. You'll note in the autumn statement the consequentials coming as a result of decisions made by UK Government consequentials were in the order of £230 million of which £220 million was non-recurrent so that's £10 million that's recurrent into next year in relation to those consequentials so we are looking at a very challenging position going into next year but as I've said the community link workers funding comes on the whole through the primary care improvement fund. I'm going to finish up by asking a little bit more about the funding situation but before I get to that something else that you mentioned earlier on was the fact that many of these mental health issues are not directly the responsibility in a sense at the end of it of yourself as the director general of health and social care but they are a function of inequality in society of economic and social deprivation about lack of access to services and so on. Do you have a view about what the Government can do or can you tell us a bit more about what the Government is doing to have more of a whole system approach to this? Yeah absolutely so I think that the policies that were set out in the policy prospectors and in the mandate letters to cabinet secretary a lot of those are focused on poverty on reducing inequality and all of that work the child poverty payment would be a classic example all of that contributes towards helping to alleviate some of those sort of economic conditions that influence not just poor mental health but poor physical health as well. I think as well you know whilst these are levers that are for broader Scottish Government there's a huge contribution that the health and social care system can make so all our boards have been developing their roles as anchor institutions so looking at how they can support employment in their local communities looking at how they can use the money that they use to buy goods and services so their procurement and how they can use that to grow wealth in local communities and also looking at how they can use their estate and their contribution to the whole green agenda as well so whilst there are things that we don't have the levers for there are also things that we can ensure that we're making best use of the money we already spend in order to actually help to to drive some of that wealth building in local communities as well. So this is the community wealth building model isn't it? Absolutely. Can you give us any reassurance that this is just not just a passing fad but it's going to be part of the whole approach? No absolutely not just a passing fad I mean I think convener you'll be well aware of some of it but just take the employment aspect of that and be well aware of some of the challenges in relation to recruiting in health and social care so identifying and growing our own in local communities bringing into employment people who might not have thought of a career in health and social care or who might be economically inactive at the moment is an absolute key priority for all of our NHS boards. Okay and if I can finish up just taking us back to one of the fundamentals that we've discussed a few times this morning and that is really to ask you whether it's your belief that NHS boards are on track to meet that 10% of all front line spending being on mental health services. So as I've said earlier we are continuing to work with NHS boards to monitor that through our whole process of not only setting the priorities for annual delivery plans but also then monitoring what boards are actually delivering against those priorities through our performance meetings with them then we are continuing to monitor that. I think we face a couple of tricky certainly tricky financial years ahead and we need to make sure that we are capturing the spend not just through NHS board budgets but also across communities and primary care as well. But when I see a figure of 10% being set out as a goal of government policy I don't just see that as being about amounts. I see that being also about proportions. So in other words that might mean a shift from some areas of current expenditure to recognise that this is a growing issue which should be very much central part of the work of the National Health Service in maybe a way in which historically it hasn't been. I hope that we've reassured you that we absolutely see mental health as being a key priority for our NHS boards and we will continue to work with them and we will continue to monitor how that the proportions of those spend exactly as you've identified. I think Graeme Simpson wants to come in. Graeme. Are all the boards committed to delivering this 10% figure? All the boards are absolutely committed to making sure that they are delivering against our core mental health standards that they're providing good services and we will continue to monitor exactly how that looks in terms of the spend profile. That's not what I asked. Are they committed to the 10%? Yes and my belief is that boards understand that that is the direction of travel. It's not the direction of travel. It's the national target for spending 10% of the budget on mental health. The delivery of that, much of it will come through health boards and IJBs. And IJBs exactly. Which we haven't asked about today. Are they all signed up to it? Yes, I believe that they understand that that is absolutely... You believe they are. So if they are surely they'll report back to you and then you can monitor if they're actually on track. So as I've said, we do work through that process of continuing to monitor that and part of that is ensuring that we capture all the spend which is another one of our data challenges. Because you said earlier it was difficult for you to track that. And I think one of the reasons for that is ensuring that we capture all the spend. I think we've already identified that that area of activity we have not been as good at capturing activity and mental health as we need to be and that's what we're working on and linked to that is therefore the ability to allocate the spend against that area of activity as well. It's really been a constant theme convener of data and following the money and seeing what's happening and you know we've not been doing it well enough have we? So I absolutely accept that we have got a lot of room for improvement there and that's why we're so focused on on actually being able to, as you say, be really clear about what we're spending and what we're getting for that. Yeah. Okay, can I finish just with a fairly straightforward question? So the causal of Scottish Government mental health strategy I think was published after the Accounts Commission audit Scotland report came out I mean the committee is really interested in understanding when you're going to publish or report a progress report on where you are with the commitments that are contained in the delivery plan and in particular when you will report back on the workforce action plan because again for the avoidance of doubt you know we've been told by a number of witnesses that there is to quote the expression a workforce crisis so progress report when is that likely to be? So the delivery plans are we've talked about them being renewed in about 18 months so we'll between now and then I think as we've talked about there's a number of different areas who will continue to report the progress on these areas around the regular publication of workforce statistics the stuff we already published but then also the new information about outcomes that we want to get into the public domain as well that will give that sense of how progress has been made across all of these areas Yeah and I think to go back to a point Graham Simpson made earlier on from our point of view we recognise that some of this data is required for management purposes but actually the maximum amount of that data that can be in the public domain so that people can understand what's going on and be able to follow the implementation of the policy and the delivery on the outcomes I think it's something that we would be strongly supportive of as a committee but look we've come to the end of our session can I thank you Alistair Cook Gavin Gray and Caroline Lamb for being with us this morning in particular can I thank you for coming into the committee room quite a few of these sessions have been with people remote and that's not always the easiest sometimes you may be surprised to learn the technology fails but on the whole we've had some really good sessions and can I thank you very much indeed for the time you've given us this morning and for being so willing to answer the questions that we've put to you I'm now going to draw the public part of this morning's session to a close and move the committee into private session Thank you