 The final item of business this evening is a member's business debate on motion 7514, in the name of Michael Marra, on the final report of the independent oversight and assurance group on Tayside's mental health services. The debate will be concluded without any questions being put, as ever. I invite members wishing to participate to press the request-to-speak buttons now or as soon as possible. I invite Mr Marra to open the debate for around seven minutes, please. Thank you, Presiding Officer, and thank you to members for the opportunity to bring this important issue to the chamber. My thanks also to the independent oversight and assurance group appointed by Scottish ministers for the report that we are here to discuss. Thanks also to the stakeholder participation group for their work over the past few years and for finding the time to meet me in advance of the debate. In the last five years, 345 people in Tayside have lost their lives to suicide, 158 of those in my home city of Dundee. 345 lives lost, 345 families thrown into turmoil and grief, families who needed better of their services, their government and all of us. These deaths speak to a mental health service in crisis, and for every soul lost, dozens more were hanging on by their fingernails. It is in the context of that crisis that an independent inquiry into mental health services in Tayside led by Dr David Strang was launched. It reported in early 2020, Presiding Officer, with 49 separate recommendations for Tayside and 2 for the Scottish Government. Dr Strang went on to publish a progress report in 2021 that, damningly, found that there remained a long way to go to deliver the improvements that are required, and very significantly noted concerns about the level of confidence in the accuracy of the reported progress. I will return to this later. Now we have yet another report in front of us from another group of experts. They have again noted some improvements and again identified the urgent work still needing done. The pace of change is far too slow. All urgency is missing. I raised the delayed discharge of my constituent Ryan Caswell with the First Minister eight months ago here in the Chamber of Parliament. The First Minister called his situation unacceptable. There has been no change. Ryan has been living in Carstew hospital for three years. Ryan has complex care needs, autism spectrum disorder and learning disabilities. In three years, his desperate parents have been unable to find suitable accommodation or care packages. For three years, he has been forced to stay in a hospital that is completely inappropriate for his needs, and for three years, his parents have worried day and night about his care, his safety and his future. There are dozens of people in Tayside waiting for the board, this Government and this minister to get their acts together and deliver the care that they need, the care that we all promise. I would like to hear from the minister on his remarks a commitment and a plan for ending the scandal of delayed discharge in our mental hospitals that is identified in this report. Of course, services cannot just be wished into existence. They have to be planned, managed and resourced appropriately. Analysis provided to me by the Royal College of Psychiatrists shows that Tayside has the highest rate of consultant psychiatrist vacancies in Scotland. Less than half of posts are filled. In one service, only one in five of those posts are filled. 80 per cent unfilled. Some of this huge weight is picked up by hugely expensive locum staff. Those staff do not fill out of our shifts, they do not provide staff development and they play no part in the planning for any future robust services in our communities. For years, we heard from service users that people with the dual diagnosis of mental health and substance use struggled to access services. The Dundee Poverty Commission's interviews with hundreds of citizens in Dundee, the Dundee Drugs Commission, the authorities denied them all until the evidence became overwhelming and this was a feature of Dr Strang's reports. At that point, they promised to do better. So where are we now? The oversight group reports that dual diagnosis will be addressed at a later date. The Strang report was not delivered three weeks ago, it was delivered two years ago. After all those previous years of denial, we will get to it when we get to it is nowhere near good enough. Delayed discharge, workforce planning, dual diagnosis, just a few of the urgent challenges the service faces identified in this report to ministers and to which we require a full response. I want to close, Presiding Officer, with what I know must be a central question for this minister. NHS Tayside has had to be dragged kicking and screaming to the reform process. Of huge concern, this report shows that serious doubts remain about their commitment to it. After Dr Strang's progress second report was called into question, the accuracy of the reported progress from local leadership, the oversight group reported in January last year. Tayside had 28 recommendations rated as green and 21 as amber. Our independent assessment had nine recommendations rated as green, 38 as amber and 2 as amber red. Worlds apart, quite literally incredible. Can this Tayside board really be trusted to mark its own homework? The evidence says no. Can this Tayside board be left alone to deliver the change that we need? The city of Dundee says no. I hope that the minister will set out tonight his plans for the future of governance. The minister clearly believed that additional oversight was required, and he would not have appointed this external group. The oversight group does not believe that it should become permanent, but previous measures have proven to be entirely insufficient. To whom will NHS Tayside be accountable? Who will hear their reports? Who will ensure that echoes of the lost are heard, the silence of the helpless known and the cries of the bereaved answered? If we are back here in three years with another report and another set of recommendations, that will have been an abject failure that shames us all, and it will be measured out in many more lost lives. I want to begin with a few thank yous. First, I thank Michael Marra for bringing this incredibly important topic forward for debate. Secondly, I thank the minister for setting up the independent oversight and assurance group. Without that intervention, I seriously question whether we would have seen any meaningful progress made in addressing the state of mental health services provided by NHS Tayside, but with due respect to Mr Marra and Mr Stewart, however, the biggest thank you must go to the independent oversight and assurance group for the job that they have done. I had a privilege of meeting with Fiona Leeson and her team during their work, and I do not mind admitting that I was hugely impressed not only by their commitment and their approach but, more importantly, by their candour. The answer to every question that I put to them in a way that, with me, reassured that those were people who intended to leave Tayside's mental health services in far better shape than they found them, and they were not going to be fobbed off or kidded by cosmetic improvements. That is why, like others, I have every confidence in what their final report says, good and bad, is credible. I must admit that I was a little conflicted about how I viewed the picture of the report page. I wanted to take heart from the progress highlighted, but the more I reflected on it, the more I came back to it. As Michael Marra has alluded to, the oversight group operated for a year. Prior to that, NHS Tayside had ample opportunity to drive the progress that was demanded by Professor Strang, first of all in his initial report, and then the follow-up report, the progress report in June 2021. When I look at areas that still require attention, I cannot help but feel deeply disquieted that we are not far further forward. You wonder what it will take for NHS Tayside to get its house in order. The report notes, for example, that some important areas relating to workforce still have a long way to go. There is also an urgent need to improve some aspects of governance and public performance reporting as a means of developing a more open and transparent culture and building trust among the communities of Tayside. Why on earth are the group still having to highlight a need for those at the top to properly support and lead a highly skilled and committed staff to ensure that they can do their jobs properly, not to mention involving major decisions on service delivery, and why has not transparency and rebuilding trust and confidence within that wider community already been placed at the heart of everything the board does around mental health? Is it any wonder that NHS Tayside has the worst record for recruiting general adult psychiatry consultants in Scotland? When those skilled individuals are in such demand, why would they choose to work for a board whose reputation in the field is as NHS Tayside's it is? Yes, progress has been made, but there remains much more to do to improve the mental health offering and rebuild trust, and in so doing hopefully make recruitment earlier. For me, Presiding Officer, there are two very obvious questions as we look to the future. First, how confident can we be that the momentum for change will be maintained? Secondly, how will progress or lack of progress be monitored from here on in? How will NHS Tayside's feet be held to the fire? As the MSP for Angus South, I have confidence about the intent and the direction of travel around community mental health service provision in that part of Tayside. I have engaged directly with the Angus health and social care partnership on that and have been able to make some suggestions to ensure that all cohorts are captured. I believe they are on the right track. I would not expect anything else, to be honest, under the leadership of Gail Smith, but the Angus situation is inextricably linked to that of wider Tayside. We need, for example, a decision about single site provision. I understand that the least on-cast view is up in around 18 months' time, and the physical environment of Strath Martin has been raised as a source of concern for patients and staff. Having praised the minister for the action that he took in setting up the group in October 2021, I also looked to him in closing to hopefully provide assurance that there will be no backsliding in Tayside. Now, the oversight group has produced its final report, and that we will emerge from the mess that he, following on from the initial work set and trained by G. Freeman, has set about sorting, with mental health services provided by NHS Tayside that properly and fully meet the needs of those who require them. Thank you very much, Mr Bey, and I call Paul Stwine to be followed by Tess White up to four minutes, Mr Swinney. Thank you, Deputy Presiding Officer. I want to thank my friend Mr Marra, the member for North East Scotland, for tabling this motion for debate, this vital motion for debate in the chamber, and I was happy to support it. Three years ago, Dr David Strang set out a list of 49 recommendations for NHS Tayside and two for the Scottish Government as a whole, a clear list of remedies to solve Scotland's mental health crisis. Yet, as we debate this important motion this evening, three years down the line, well over half of those 49 recommendations for the health board are marked by failure, a worrying sign of the lack of urgency and complacency that defines Scotland's mental health crisis. In the two years following Strang's report, there were 144 probable suicides in the Tayside area. When reading this report and listening to the contributions of colleagues this evening, harrowing has there been in some cases, it is all too easy to find oneself lost in the numbers and statistics, but it is crucial to remember that behind those figures were 144 lives lost to suicide in Tayside. I must question, had more urgency been shown in enacting the recommendations, how many of those vulnerable lives would still be here with us today, still with their families and friends, and still a part of their communities. The Tayside mental health report paints a disturbing image of how we are willing to treat our most vulnerable. However, the problems facing NHS Tayside do not exist in a vacuum. I ask colleagues here today, can you confidently say that mental health patients in your constituencies receive the treatment that they deserve? The mental health crisis that threatens Dundee in its hinterland is prevalent in many post-industrial Scottish cities. Start comparisons can be made between the experiences of Glaswegians and Dundonians over the years. Both Dundee and Glasgow City have stubbornly high suicide mortality rates, which stand well above the Scottish average. These higher than average suicide rates in our cities can be put into context by some of the cruel ways that inequality impacts health and social outcomes in Scotland. Indeed, the national records of Scotland highlighted that the rate of suicide in the most deprived areas of Scotland was almost three times higher than in the least deprived. That relationship between poverty and poor mental health is the ultimate reminder of how hard life can be for those who find themselves at the bottom of our social hierarchy. It is the ultimate reminder of how unfair our system can be. Against this backdrop, it is deeply disappointing that funding for mental health services in the next financial year will be frozen despite the health budget increasing overall by 6.2 per cent, failing the Scottish Government's own aspiration to have mental health expenditure as a 10 per cent share of the entire national health service budget. Whilst that is a difficult topic to discuss, the general trend in Scotland can in some cases allow for optimism. In 2021, the number of people dying from suicide fell to its lowest level since 2017, partly driven by an improvement in outcomes for female mental health patients. A noticeable decrease in suicide rates for any group in our country should be acknowledged. However, it is imperative that we can remain cognisant of the disproportionate impact of suicide among young men. Just last week, I spoke in this chamber about the effects that the cost of living crisis is having on young men's mental health. The Samaritans report that they have seen their call lines skyrocket with more and more people mentioning finance and unemployment concerns as a stressor shows clearly that the Tayside mental health report shows that we cannot become complacent. Despite a recent decrease in suicide numbers overall, the mental health crisis is far from solved in Scotland. We know the effects that poverty has on mental health and suicide rates, with the cost of living crisis driving more Scots into poverty and making life more and more difficult each day. As I stand here, Scotland faces a growing crisis, a mental health crisis that is currently being compounded by our failing economy. We must act now. We must ensure that those recommendations are seen as essential, not optional. We must ensure that advocate resource is dedicated to implementing them. It is only by putting words into action that we can protect our most vulnerable in Tayside and across Scotland. Thank you very much, Mr Swinney. I call Tess White to be followed by Richard Leonard. Deputy Presiding Officer, I too thank Michael Marra for securing the time for this evening's debate and so quickly after it was postponed a couple of weeks ago. After the findings of David Strang's 2020 trust and respect report into mental health services in Tayside, it is vital that parliamentarians continue to shine a light on the provision of these services after grave concerns were raised in the Scottish Parliament in 2018. I am encouraged today to hear Graham Day's passion for change. I was not an MSP in 2018, but I knew of the public campaign for an inquiry into Tayside's mental health services. I read about the tragic story of David Ramsey, who hung himself after a second emergency assessment at Carsview. I was horrified by the increase in suicides in Dundee by 61%. My own family has experienced the devastating impact of suicide. My heart goes out to all the families across Tayside who have lost loved ones this way. As a north-east MSP, I've seen Carsview through the eyes of constituents, and I've felt their fear as they've tried to navigate a frightening system that was so stacked against them. I looked at the final report of the independent oversight group on Tayside's mental health services, not just with interest but with personal and professional investment. Reading between the lines, there's a tremendous amount of work still to be done, and I particularly struggle to understand why Tayside executive partners and the IOAG continue to be a part in their assessment of progress. As Michael Marrow rightly pointed out, the report states that Tayside executive partners have reported 33 green recommendations in 16 amber. The IOAG have rated 20 green, 29 amber and 2 red. Deputy Presiding Officer, that's a gulf in assessment, not a gully, and how can that be? There are two areas in the latest report I find extremely concerning. The first is on workforce and the second is on culture. On workforce, as the report emphasises, there's still a long way to go. That seems an understatement when it was reported just a couple of weeks ago that Tayside is at the epicentre of a national scandal in adult psychiatric care with serious issues recruiting consultant psychiatrists, and I hope the minister will address this in closing. On culture, the report identifies an urgent need to improve governance and public performance reporting as a means of developing more open and transparent culture. It's something we've heard so many times and something that's been raised with me by my constituents time and time again. These are fundamental points that still require significant improvement. The essence of David Strang's report was trust and respect. He said that the successful delivery of healthcare services depends on good levels of trust between healthcare providers and patients, their families and carers. That's the gold standard, but Tayside falls well short, well short. Deputy Presiding Officer, there's still a huge way to go for mental health services in Tayside. This may have been the IOAG's final report, but it's definitely not the end of the line. The process still needs oversight and accountability from Grant Archibald, and I'd like to say that from Grant Archibald and his team to the highest levels of the Scottish Government, it can't be brushed under the carpet any longer. Thank you. Thank you very much indeed, Ms White. I call the final speaker in the open debate, Richard Leonard, up to four minutes, please. Thank you, Deputy Presiding Officer, and I thank Michael Marra for bringing this debate to Parliament. In so doing, he has performed a democratic service not just for his own constituents, but for all of our constituents. The way that families in Tayside have been let down by failed mental health services is not just a local scandal, it's a national scandal. That's the reason why I pressed the First Minister to set up the Strang review back in 2018, and that is why I pressed her as well to implement all of the recommendations in full when his report, Trust and Respect, was published two years later. But what has been a recurring failure here, and we see it once again with the report of this independent oversight and assurance group last month, is what David Strang described in 2021 as, I quote, an over-reporting of progress. Of his 51 recommendations, there are 33 where the oversight group agrees with the assessment of the Scottish Government and Tayside executive partners, but of the 18 recommendations where the independent review group disagrees with the Government's assessment, in all by one of them, they have found that the situation is much worse than the health board and the Government claim, that there is at best optimism bias, at worst a culture of denial and an indifference to the truth. Listen to some of the language the authors of this report choose. Of the new mental health strategy in Tayside, Living Life Well, they call work streams unrealistic, that they are spread too thinly. They also say, and I quote, the governance structures for mental health also continue to be overly complex and unclear in terms of responsibility for what, on the treatment of patients. The report is highly critical of the three strikes and your out approach regarding appointments, which results in closed case outcomes. Psychological therapy services still exist, as they say, in a somewhat confused landscape. There is a plethora of activity on stakeholder engagement, but much of this is fragmented, with no real sense of people working together on shared priorities. Advocacy organisations are still under resourced, under staff and under finance. NHS staff feel, to quote the report, its groundhog day with reviews upon reviews, and one of the most damning findings is that a report with the title, Listen. Yes, Listen, a survey of the views of people who use mental health services in Tayside, we learn, has not been listened to at all, with no formal consideration of the report by the health board, and no formal response from Tayside executive partners. I will conclude with this. Two days ago, I met up again with Mandy McLaren, whose 28-year-old son Dale tragically completed suicide eight years ago. Mandy is one of the most courageous women I have ever met. When we spoke, the first thing she said was, where is the action? We have had enough bad reports on bad reports. She told me that, as recently as last week, someone in crisis had to phone Wedderburn House 67 times to get through. She knows of others who have had a three-year wait for a psychologist and are still waiting. Mandy McLaren's message is simple. Enough is enough. It is time that this Government was part of the solution instead of being part of the problem, because I tell the minister that the Government is on the wrong side of this argument with the people. The Government is on the wrong side of this argument over a health service, including a mental health service, which is supposed to be freely available at the point of need. The Government is on the wrong side. This is not just about governmental duty, it is a moral and a social duty. It is time to end the shameful betrayal of a community in need, to act, to plan, to show respect and to finally bring hope in place of despair. I now invite the minister to respond to the debate for around seven minutes. I thank members for their contributions tonight and for Mr Marra for bringing the debate to the chamber. I will do my best to respond to as many of the points raised as I possibly can in the short time that we have. First of all, I would like to put on record again my appreciation of the oversight group's work and the inclusive approach that they have taken throughout their tenure. My thanks to Fiona Lees, Fraser McKinlay and David Williams for all that they have done. The reason why I appointed this oversight group was to use the words of Michael Marra that I did not want folkmark in their own homework. That is why they went in. They have had a huge amount of engagement with front-line staff. That has been commendable. I am conscious that those conversations often painted a difficult picture, but they are views that must be heard. They are also views that I have heard when I have been out and about in Tayside, of which I have been probably in Tayside's mental health services more than any other mental health services in the country, because I want to ensure that we get right for the families that have been spoken about here today. Importantly, the oversight group has also listened to the voices of lived experiences of mental health and learning disability services in Tayside. We must also listen to what their experiences tell us. One of the most frustrating things for me is that people that I have talked to feel that they have not been listened to at the right time. That is wrong. I know from this job that those services that are performing best in the country at this moment are the services where people are being listened to and people are helping to shape the services. That should be the same in Tayside. In implementing the recommendations from the oversight group, we must ensure that individuals and their families are empowered to make meaningful contributions that shape the future of services in Tayside. I also want to recognise that there is a wealth of organisations across Tayside who are doing fantastic work to promote mental health and wellbeing across the region. I am pleased that the oversight group was able to meet many of them. I accompanied Fiona to a mental health festival in Perth, which was extremely well attended. I have to say again that many of the stories that I heard from folks who attended that were extremely frustrating. Those people must be listened to without doubt. I welcome all of the contributions to the oversight group's final report. The report is comprehensive and it clearly articulates how we move forward and where we must now focus all of our efforts. I am encouraged to see the progress that has been made so far in some respects, in terms of strategic planning, clarity on roles and responsibilities and accountability in delivering services and in patient safety, including the approach to significant adverse event reviews, distress brief intervention and the introduction of a new observation protocol. However, as has been highlighted during the debate, there is clearly much work to be done across many of the original trust and respect recommendations and the six key areas for priority action that were highlighted by the oversight group in their final report. I have therefore been seeking assurance that the necessary outstanding actions will be taken. I have met with the Tayside executive partners and chief officers to set out my clear expectations on the importance of their role in delivering the improvements that are required. They have committed to producing an improvement plan by the end of March, which will set out clear actions and milestones that deliver on those key priority areas. I can assure the chamber that that improvement plan will be gone through with a fine tooth comb to make sure that what needs to be done will be done. I will continue to meet with Tayside executive partners to review progress, and my officials will provide an on-going package of support to colleagues across Tayside as they develop and then implement that improvement plan. In tandem, we will work together to agree the criteria to de-escalate the health board from its current level 3 escalation in respect of mental health services on the board performance escalation framework. However, that will not happen until there is a real improvement. I will give way to Mr Marra, of course. Michael Marra, I greatly appreciate it, minister. An improvement plan is right that we have to whom will it be held accountable? Will the plan be published? Who will have the opportunity to question those lead partners beyond yourself, minister, in terms of a public forum so that people can be held accountable for the delivery of the points that will be set out in it? They will be accountable to me, because I will be looking at this very closely indeed. I will not be putting in another oversight group or anything like that. Now is the time for action. We stopped them from marking their own homework. We have seen that, as some have said, they have over-promised on what they have delivered. In some cases, it could be said that some things have been a tick-box exercise. That is not good enough. That cannot be, so they will report to me. I will say to every member in this chamber and members who represent Tayside have already written to me that I am more than happy to keep folk absolutely appraised of what is going on there, and I am more than happy to share all of the information that I receive and all of that as we move forward, because there has to be openness and transparency here. We owe that to the people that you, Mr Marra, Mr Leonard and others have talked about today. We owe that to them. Additional scrutiny in that respect and on the improvement plan will be provided via the Scottish Government's national planning and performance oversight group. In the coming weeks, I will also meet with a chair of the board at NHS Tayside, the chairs and vice-chairs of the three integration joint boards and members of the lived experience stakeholder participation group. Those meetings will serve to further reflect on the conclusions that the oversight group have reached in that final report. I will also set out my very clear expectation that the chairs' role in scrutinising and supporting the improvement plan will be vital to ensuring that we make improvements for the people of Tayside who rely on mental health and learning disability services. Before I conclude, I would particularly like to thank members of the stakeholder participation group for their tireless work in recent years in extremely difficult circumstances. I know that none of that has been easy for them, and we owe it to them to get this right, because members of the group have shown bravery and openness in sharing their experiences. I therefore want to take this opportunity to say that we are listening and will continue to work with you to ensure that the improvements that are required in Tayside are delivered. There is a clear and collective interest here, so I welcome having the chance today to debate these important issues. I am very clear in my commitment to make sure that the findings of this report are implemented, and I want to continue those conversations and work right across the chamber over the coming weeks and months to support the delivery of the high-quality mental health and learning disability services that the communities and people of Tayside deserve. Thank you very much, Presiding Officer. Thank you very much, minister. That concludes the debate, and I close this meeting of Parliament.