Health chiefs say a controversial shake-up of psychiatric services across Tayside is being hampered by “significant workforce challenges” – exactly as opponents predicted more than a year ago.
NHS Tayside pressed ahead with its planned review in January, despite concerns that many staff would be unwilling or unable to make the move to new cities.
Under the scheme, leading disability inpatient services will be provided at Murray Royal Hospital, Perth, while services are being transferred out of the Mulberry unit at Stracathro Hospital near Brechin and general adult psychiatry acute admissions centralised in Dundee
However, members of the Perth and Kinross Integration Joint Board have now been told that the majority of staff – around 55% – are unable to move for a variety of reasons.
At a meeting on Tuesday, Gordon Paterson, chief officer of the Perth and Kinross Health and Social Care Partnership, said: “The progress of implementing the redesign programme has been slow and that is partly because of some of the significant workforce challenges, in relation to the proposed transfer of patients and wards from one site to another.
“We need to ensure that we have adequate staffing in place. We need to engage with nursing staff and clinical staff to ensure that that they can transfer from Perth to Dundee, or Dundee to Perth. If they can’t we have to make sure we can suitably redeploy them and there are some alternative options.”
He said: “We recognise that this is an upheaval for staff and we recognise that some staff can’t travel.”
Mr Paterson said it was crucial to get to the next phase of the plan, which involves shifting a ward from Carseview to Murray Royal.
“We are anticipating we will be in a position to progress this early in the new year, notwithstanding the fact we are sensitive to the impact and implications for staffing,” he said.
Independent councillor Xander McDade described the situation as “quite disturbing”.
He said: “At the meeting in January 2018, the main rationale for the redesign – which we were given repeatedly – was that the only way we could safely staff the service was to go ahead with this model.
“That was the clinching argument.”
NHS Tayside’s Alan Drummond said: “This was raised as a red risk prior to that meeting.
“It wasn’t a case that staff didn’t want to carry on their care for patients, they were just unable to make the move.
“We raised this as part of the consultation and we were told that the risk would be managed. This is not the unknown we are dealing with, this was raised three years ago.”
Mr Paterson said he was also aware that an independent inquiry into mental health services, led by Dr David Strang, was due to be published in February and could make further recommendations.
Dr Strang said earlier this year that the redesign should be halted to allow for a wider review of health services.
It said the key themes were patient access to mental health services, patient sense of safety, quality of care, organisational learning, leadership and governance.
Referring to risk management, the report said: “Patients report telling staff they were suicidal but the risk was not taken seriously until they made a serious attempt to take their own life.”
‘Violated and traumatised’
In relation to patient safety, the report noted: “Some patients report being frightened of certain staff on the wards who have a poor attitude to the patients in their care.
“Others mentioned that another patient had assaulted them whilst they were on the ward.”
The report said the use of restraint within inpatient facilities was of “great concern” to patients, who had experienced it or witnessed it taking place.
It said: “Patients feel violated and traumatised, particularly if they have personally suffered violent abuse in the past.”
It added that staff seemed unable to control the availability and use of illegal drugs on the wards in the inpatient facilities.
“Both patients and families report seeing drugs delivered, sold and taken within the Carseview Centre site,” the report said.
“Staff confirm this is a serious issue which is not being adequately addressed.
“There is a lack of support from management for frontline staff attempting to address this issue and it is having a detrimental effect on patient care and treatment regimes”.
‘Unexpected and concerning’
In a section on the Crisis Service, the report said that the Crisis team “struggles to respond to sudden surges in demand on the service.”
It said: “There are occasions when the length of time to wait to be seen is long and families supporting someone in crisis are advised to phone the police or NHS24, if they are worried.
“This advice is unexpected and concerning to carers coping with a crisis in a domestic situation.”
The report said the centralisation of the out-of-hours Crisis team to Carseview Centre has had a “detrimental effect on those patients in Angus and Perth & Kinross who are experiencing mental health crisis”.
It said: “There is a perception that whilst the Crisis service has expanded in recent months, the situation has worsened in terms of patients being assessed then not being offered any crisis intervention, or referred back to the GP.”
Inquiry chairman David Strang said: “The themes which have been identified will shape the next stage of the inquiry.
“Our final report will include conclusions and recommendations which will lead to the improvement of mental health services in Tayside.”
NHS Tayside chief executive Grant Archibald said: “We are taking on board all comments in the interim report, alongside the feedback we received from the Health and Social Care Alliance (the Alliance) published in their report in December 2018.
“The key themes which have been identified in both the Alliance report and in today’s interim report are recognised by the board and the mental health leadership team – and we are taking action on these.
“I also recognise and want to thank the many staff who are already working really hard to improve services and look forward to their continued support.
“It is clear that we have further work to do but since I came to Tayside, I have made mental health a top priority and I am confident we can learn lessons, strengthen our engagement with patients, service users, families and the public and make the right kinds of changes, at the right time, to transform our mental health services.”
He added: “We would like to thank everyone who has shared their experiences so far and we look forward to the independent inquiry’s final report and recommendations which will be a major influence on the future shape of mental health services in Tayside.”
Children have been forced to wait more than year for treatment after being referred to mental health services in Tayside.
One mental health campaigner described the figure as “frightening”.
Figures released by NHS Tayside in response to a Freedom of Information request revealed the longest wait for treatment to begin at the health board’s Child and Adolescent Mental Health service was 425 days – around 14 months.
A small number of children were also required to wait more than a year for their treatment to begin.
However, the health board said no child – defined as someone under the age of 16 or 18 if in full-time education – on the current waiting list for treatment has been on it for longer than 305 days.
Mental health campaigner Gillian Murray said there is “no excuse” for such lengthy delays between referral and treatment starting.
She said: “That’s frightening that a child has had to wait over a year for treatment, there’s no excuse for any wait that long.
“Isn’t there meant to be a set time limit when you’re legally meant to be seen?
“It definitely shows how poorly patients are being treated by NHS Tayside but I think those figures would likely be the same throughout Scotland, to be honest.”
Ms Murray’s uncle David Ramsay killed himself after being turned away from the Carsewive Centre at Ninewells Hospital and has campaigned for an independent review into mental health services in Tayside.
An NHS Tayside spokeswoman said patients are prioritised according to need.
She said: “There has been a lot of work undertaken by staff in our Child and Adolescent Mental Health Services (CAMHS) to improve access to services for young people in Tayside over the past 12 months.
“We have been working closely with Healthcare Improvement Scotland Mental Health Access Improvement Support (HIS) Team to deliver an improvement plan which will reduce waiting times. This includes a full CAMHS service workforce review and recruitment drive to key posts, to ensure that the team are fully equipped to manage the service demand and enhance the experience for children and their families.
“We are determined to continue making improvements to ensure all our children and young people receive the best quality care without delays and we hope to reach the national standard in the near future.
“When a child or young person is referred into CAMHS their referral will be scrutinised by our Clinical Specialist Referral Management Team and prioritised by clinical need into urgent, soon or routine. It is important that a child or young person who requires an intervention is seen by the right person at the right time.”
The NHS in Scotland is not financially sustainable and its performance has continued to decline, the public spending watchdog has warned.
Audit Scotland said health boards were “struggling to break even” and none had met all of the key national targets – with NHS Lothian not meeting any.
It highlighted increasing demand on NHS services, and rising waiting lists.
Health Secretary Jeane Freeman said the government was already taking forward Audit Scotland’s recommendations.
But the watchdog’s report prompted widespread criticism of the Scottish government, with the Conservatives claiming it should “make shameful reading for the SNP”.
The report said pressure is building in several areas – including the recruitment and retention of staff, rising drug costs, Brexit and a significant maintenance backlog.
It said “decisive action” was needed to protect the “vital and valued service”.‘
What does the report say?
The report warned that the NHS in Scotland is “not in a financially sustainable position”, with NHS boards “struggling to break even, relying increasingly on Scottish government loans and one-off savings”.
And it said the “declining performance against national standards indicates the stress NHS boards are under”.
The only target met nationally in 2017/18 was for drugs and patients to be seen within three weeks.
Only three of Scotland’s regional health boards met the target for patients beginning cancer treatment within 62 days of being referred
The proportion of youngsters seen by CAMHS within 18 weeks fell from 83.6% in 2016/17 to 71.2% in 2017/18.
The Scottish government invested £13.1bn in NHS services last year, but Audit Scotland said when inflation was taken into account there was a 0.2% real terms drop in cash.
Health boards made “unprecedented” savings of £449.1m, but many relied heavily on one-off savings for this, while three boards – NHS Ayrshire and Arran, NHS Highland and NHS Tayside – needed £50.7 million of loan funding from the government to break even.
This was “significantly more” than in previous years, with Audit Scotland saying four boards have predicted they will need a combined total of £70.9m in this current financial year.
The report said the “NHS is managing to maintain the overall quality of care, but it is coming under increasing pressure”, adding Brexit would create “additional challenges” for the health service.
However the scale of these challenges was “difficult to assess” because of “significant uncertainty” over the terms of the UK’s withdrawal deal from the European Union, and because data on workforce nationality is not routinely collected.
Auditor General Caroline Gardner said: “The performance of the NHS continues to decline, while demands on the service from Scotland’s ageing population are growing.
“The solutions lie in changing how healthcare is accessed and delivered, but progress is too slow.”
What has the Scottish government said in response?
Health Secretary Jeane Freeman said the government was already taking forward Audit Scotland’s recommendations.
She said NHS funding had reached “record levels of more than £13bn this year, supporting substantial increases in frontline NHS staffing, as well as increases in patient satisfaction, reductions in mortality rates, falls in healthcare associated infections, and Scotland’s A&E performance has been the best across the UK for more than three years.”
She added: “While our NHS faces challenges, common with health systems across the world, we are implementing a new waiting times improvement plan to direct £850m of investment over the next three years to deliver substantial and sustainable improvements to performance, and significantly improve the experience of patients waiting to be seen or treated.
“Ultimately we want to ensure people can continue to look forward to a healthier future with access to a health and social care system that continues to deliver the world-class compassionate care Scotland is known for.”
What other reaction has there been?
Conservative health spokesman Miles Briggs claimed the NHS was “facing an unprecedented challenge” with boards across the country “staring into a black hole of more than £130m.
He said: “For a government which has been in charge for more than 11 years, this should make shameful reading for the SNP.”
Labour’s Monica Lennon added: “After more than a decade of SNP complacency our NHS is in crisis.”
Dr Lewis Morrison, chairman of the British Medical Association (BMA) in Scotland, said the “stark warning” from Audit Scotland “could not be any blunter”.
But he added this would “come as no surprise to frontline doctors who have faced the consequences of inadequate funding year after year”.
And RCN Scotland director Theresa Fyffe said the report “underlines what those in the nursing profession have been warning about for a number of years – an unsustainable pressure on staff to deliver more care.
“This leads to staff burnout and, in some cases, a choice between staying in the profession and their own health.”