Petition update

Still awaiting a consultation although cuts to services continue to be on the agenda.

Jenny Laird
FORFAR, SCT, United Kingdom

Apr 24, 2016 — Sorry I'm not keeping you all regularly updated; many challenges sorely getting in the way, alongside the ongoing issue of there being a minimal and vague response from NHS Tayside who are giving little information about how they plan to continue with their proposals, or what changes shall actually be made. Service provision for mental health related care is in a crisis and going by the many recent accounts I've heard, it is evident that the of years of under-investment, administration issues of 'care in the community', as well as the lack of transparency and collaboration, so many are being routinely failed and the effect is devastating. However...

We have had further meetings with the SNP Councillors, the Labour Candidate and Integrated Joint Board representative for Angus who have been actively supportive and all behind the campaign to not let the Mulberry close. David May standing for Liberal Democrats has also expressed his support and concern... as does common sense and anyone that understands or empathises with such difficult and traumatic realities. Graeme Dey who is the MSP representative for Angus has been unwilling to deal with the concern until after the elections in May, since early in March, which is disappointing indeed. We thoroughly appreciate the ongoing support from so many, and so value the community spirit; helping where you can and letting us know what matters to you. I will certainly keep trying to encourage changes to how services are planned and delivered which reflect the wishes of those directly affected and thoroughly hope that the Mulberry remains open. The Mental Welfare Commission recently gave the ward a glowing and well merited report, working alongside the Scottish Recovery Network, rated as being 95% recovery focused which is exemplary. They are also involved in a national program to improve patient safety, chosen out of six inpatient facilities in the whole of the UK due to being highly regarded as a centre of excellence and a safe haven to many. In Tayside it clearly provides the best 'model of care' out of the three inpatient wards for all those affected by mental health issues, for service users as well as those who work there. Considering all of this, and much more, it would be tragic and senseless if it was decided to carry on regardless and close it.

There was a parliamentary hustings regarding mental health matters at the Caird Hall in Dundee, organised by SAMH on the 14th; the Scottish association for mental health. All five parties were represented, including Shona Robison; the Cabinet Secretary for Health, Wellbeing and Sport. Two questions were asked relating to the closure of the Mulberry ward which referenced the cuts to the provision of community based support, the ill-effects of the centralisation of 'healthcare', also the lack of crisis support, consultation and transparency. There were many other critical issues addressed, a little more about which can be found by searching for #AskOnce on Twitter Shona gave her assurance that all due process would be followed by NHS Tayside though it was highlighted that, in reality, this is not happening. Jenny Marra, the Labour representative, called for an independent scrutiny of such major changes to public services and care of the vulnerable though NHS Tayside has stated that they would not consider such changes as major which I shall certainly be questioning further. Shona later expressed her ambivalence though; not believing there be a need despite being aware of the serious issues at Carseview which are clearly ongoing, already found to be due to fundamental issues with management, approach to care and essentially about how mental health provision is provided and treated. Moral among NHS Staff, as well as those affected by cuts in mental health and social care seems to be at an awful low. There was a 33% increase in NHS staff absences last year, and a considerable amount was due to stress or mental health issues. Much needs to systematically change.

We gratefully managed to speak with Shona after the hustings though which highlighted that she was not fully aware of the matter despite the many concerns which have been raised. Although we understand it is a busy time with the elections looming some basic acknowledgment of the grave affects such decisions are having and the how critical the situation is for so many... would be nice. The impression she has of the issue, which I assume is due to the correspondence that she's clearly had with NHS Tayside, as well as the detachment of realising the effects that such mismanagement has on people's lives, raises much concern considering her responsibilities and position of authority. However, she gave a guarantee that she would look into the matter, that everything would be fairly handled and that no decision would be made without her knowledge and endorsement. She also stated that she would ensure that NHS Tayside would follow regulations and due process, including a full consultation with people concerned (which we've had no indication of happening from NHS Tayside yet) although said there would need to be cuts or changes in how provision is provided. We said that money could be better allocated if they actually allowed collaboration to happen and listened to those at the front line and receiving end of said care, to create service provision which most effectively helped. Despite her not agreeing that there should be an independent review even though there have long been many issues over NHS Tayside's 'overspending' and how the provision and planning of health and community care is delivered, we will still be requesting this if called for by you all.

We've managed to arrange a meeting with two directors from NHS Tayside; Karen Ozden, the Director of Mental Health and Lynne Hamilton, the Mental Health Programme Director and Finance Manager/Interim Contract Manager on the 27th, this Wednesday, which is great to hear. It was stated in correspondence that "We note the concerns and points you have raised in the email and would welcome an opportunity to meet with you to discuss these and agree a way forward with your support." I have been gathering together questions, facts and accounts of what actually helps so i can make the most of this opportunity. There will be six of us at the meeting, four of whom are determined to save the Mulberry and are directly involved with mental health services or have an understanding of how cuts are affecting people. In arranging the meeting Lynne clarified that a meeting, which was referred to in a staff bulletin "is for the Programme Team to discuss and plan how to progress the further work the NHS Board have asked for in relation to Engagement with wider stakeholders and further options appraisal. The purpose of going back to the Board in April is for them to confirm they are satisfied with the approach we are going to take for engagement and further work." I will hopefully find out more about how satisfied the Board are tomorrow. I sincerely hope the conversation is valuable and productive, and a public, more open consultation takes place soon. If you would like any questions asked please do comment on this update or on my Twitter or Facebook page, and i will compile them onto the list to ask. I will also be requesting a written response to the complaints and concerns so far as this has been avoided, i presume due to them knowing that without this there is little grounding to request an independent review.

Details of the NHS Tayside board meeting which was held last Thursday, the 21st, can be read about here:

At 293 pages long it's rather overwhelming to read through but the most up to date information i can see is detailed in pages 33 to 36. Notably, a summary of the recommendations that have been made are:
• Agreed with the clinical advice that a three-site model was not sustainable for Tayside • Approved the proposal that GAP inpatient services should be provided from two or one locations • Agreed that an Option Appraisal should be carried out looking at two site and one site service to ascertain the most viable option • A report be produced on the process to be used for consultation with the Integrated Joint Boards • A full Business Case was to be drawn together including staffing implications, financial Implication, consultation and engagement across NHS Tayside • Noted the concerns that the clinical and professional leads have identified in terms of sustaining safe and effective General Adult Psychiatry inpatient services on three sites across Tayside • Agreed that these full reports should be presented to the June 2016 Board meeting with an update on the engagement process to come to the meeting in April 2016 • Agreed that the service should continue to develop and where necessary implement an operational contingency plan to prevent and manage risks as they arise on a day to day basis

Glennis Middleton attended as far as i'm aware, and i look forward to meeting with her tomorrow along with Jim Houston and Mairi Evans to discuss what the best way to move forward is, and help prepare for future conversations and commitments. They all thoroughly, gratefully, support the provision of inpatient care in Angus as well as for Tayside. Glennis has described the proposals and process so far as “flawed and incomplete" and in regards to future consultation and service provision, wants the process to be done openly, transparently and equitably as it has not been so far which is reassuringly rational and wise indeed.

In correspondence from Lesley McLay; the Chief Executive for NHS Tayside she says:
"I must first stress that there has been no decision made to close Mulberry Unit. The Board has agreed in principle that the current model of acute adult inpatient services being delivered from three sites across Tayside is not sustainable. To maintain good quality, safe and effective inpatient services for the people of Tayside in the future it will be necessary to redesign the service to be delivered from either two sites or one single site. The experience and knowledge of people who have first-hand experience of the local mental health and learning disability services is invaluable to the planning of services and I am extremely sorry if the approach that has been taken to date has not openly demonstrated just how much we do value working in a collaborative and co-productive way. "
I struggle to understand why the word 'maintain' was chosen as appropriate considering how dire access to crisis or therapeutic care is at present though I am most interested in what solutions and design for services they come up with and sincerely hope that they begin to allow collaboration and consult more extensively and as required soon.

Other notable concerns are raised through referring to the Angus Adult Mental Health Care Group Strategy report 2014-2019. In this it is stated that:
"The most appropriate treatments, interventions, support and services will be provided at the right time to everyone who will benefit, and wasteful or harmful variation will be eradicated."
Sadly, the feasibility of this being achievable has been becoming much more difficult to reach and many are suffering, including those that are trying their best to work together to help provide such essential support ... and it has a knock on effect to so many. From listening to recent accounts of people trying to access support for mental healthcare in Angus, as well as in Tayside and beyond, even for those that are most critically in need, their attempts to ask for help have so often been futile. Provision seems to be deteriorating; more difficult to access, short sighted and all too often detrimental in the long term. In my experience as a service user I sorely know how devastating such oversight can have though I understand that there are many barriers and complexities which prove challenging. We are, all only human. The reality is that many people are suffering awfully though, when it doesn't need to be that way. All while there is much rhetoric of so much more being done, a reduction in stigma and discrimination... I'm rather dubious about how funding for provision is being spent. Mental ill health, suffering, isolation and distress continues to be treated as secondary to physical health yet it is the single largest cause of disability in the UK, contributing up to 22.8% of the total 'burden' compared to 15.9% for cancer and 16.2% for cardiovascular disease. Even though all health and social care is interwoven, the proportion of NHS funding allocated to providing basic mental health support is minimal and has been in decline despite the impression being given that it is a priority. NHS Tayside has actually cut community psychiatric provision by 10.5% since 2007 despite all the talk about increased support for 'care in the community'. Along with the cuts in crisis care and third sector provision, which has coincided with an escalation of increased need for support, this is resulting in many critical issues. There is an ongoing systematic discrimination.

I think it would also be valuable to reconsider The Healthcare Quality Strategy for NHS Scotland which highlights the need to address the system by which care is provided. It states that:
"In order to support staff, patients and carers to implement the inventions that will support the actions required to deliver the vision for health and healthcare services in Scotland, we need to identify and remove any hurdles and barriers presented by the current approaches to policy development and delivery. Responsibility for taking this action lies primarily with NHS senior management and with Scottish Government Ministers and officials. However, feedback from staff, patients and carers will inform the continuous cycle of improvement required to ensure that the wider system continues to support and facilitate the delivery of high quality health and healthcare services in Scotland. ... We argue that the most effective way of achieving the culture change outlined above is to develop a new relationship between individuals and the services in place to support them. In other words, there will need to be a real shift in control over support and intervention away from professionals and services and towards individuals, their families and communities."
This sounds excellent and i'm sure would result in a huge improvement in the quality and safety of care if implemented, as well as savings of all sorts. If this is an aim however for how services are to be planned, NHS Tayside and the Scottish government are not keeping to their word, which is "Meaningful service user involvement at all levels of planning and operations." I will be asking that this is seriously considered in plans going forward.

There is to be a peaceful protest on the 12th May for anyone that may want to attend. This will take place at the entrance of Stracathro from 8.30am to 4pm, more details about which can be found at the Facebook page: We hope to see lots of people there supporting the cause for appeal.

I would also encourage anyone to take a wee while if you can to write about your experience of mental health care from NHS Tayside in the last 3 years, either as a patient, a carer or friend at Patient Opinion: These will hopefully be published on their site and emailed to the people in the health services who need to see your story. You may even get a reply! If you do choose to write about your experience of inpatient care or trying to access crisis care please tag with mental health, community and Mulberry or whatever you feel is relevant. I believe it is a valuable way for people to let NHS Tayside know about what services help and hinder recovery and much easier to navigate than the complaints procedure. Patient Opinion is an independent non-profit feedback platform for health services which regularly features in the national and local press as well as being made public on their blog, Twitter and Facebook pages so is a great way to openly share what helps and does not.

I eventually received a written response on behalf of Shona Robison, Paul Gray, Director-General, Health and Social Care and Chief Executive, NHS Scotland. It states that "over the last two years, NHS Tayside has been reviewing its existing clinical models of care across the whole of Tayside. This incorporates a recognition of the importance of investing in community-based services to ensure that as many people as possible are able to receive the care they need whilst remaining at home. It is important to recognise that, in relation to mental health, this process is ongoing and that no decision has yet been made about the future shape of the service. NHS Tayside has been clear that its priorities in carrying out the review of mental health provision, to date, are patient safety and improving quality of care." It also says that they "encourage you to engage with NHS Tayside and to contribute to the next stage of the process." while assuring that the Scottish Government is "fully committed to ensuring that NHS Boards and their partners continue to provide mental health services that reflect local need as well as clinical best practice." I appreciate receiving a response but I feel much has not been acknowledged... "continue to provide"... there is no crisis support in Angus. Begs belief but i will return to that soon.

My apologies again for not updating more often and for this colossal read for a Sunday evening or whenever really. I will try to update again next weekend after the meetings which I've mentioned. We must try to keep fighting to save the Mulberry and for services which provide a safe haven for people when in need. Many of the most vulnerable are being left without any support at all... cuts like this are having a grave impact so I genuinely hope this campaign can change things for the better.

Best wishes. x

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