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The next item of business is a statement by Maree Todd on the Scottish Government’s response to concerns raised regarding care of children at Skye house. The minister will take questions at the end of her statement, so there should be no interventions or interruptions.
14:44
My statement today follows a previous parliamentary question regarding the harrowing BBC “Disclosure” documentary “Kids on the Psychiatric Ward”. I am grateful to have the opportunity to expand on the answer that I gave last week. As the Parliament would expect, I must outline up front that I am unable to comment on the detail of individual cases of care and treatment.
However, I want to say two things very clearly at the outset. First, I was shocked at what I saw on the programme. The accounts given by the young people about practices that they experienced were appalling and upsetting to hear. My heart goes out to them and their families. Secondly, I want to put on record my sincere thanks to those young people for having the courage to come forward and tell their stories. They did so articulately and movingly, but they should not have had to do so.
As I said in the chamber last week, when our most vulnerable and unwell young people ask for help for their mental health, we owe them the highest standard of care and compassion. It is all too clear that what was described is completely and wholly unacceptable. It should not have happened, and we will do all in our power to prevent it happening again.
Today, I will outline what must and will improve in our child and adolescent mental health units, both in regard to standards of care and system oversight. All young people who need in-patient admission for their mental health must be able to access safe, high-quality care, which must always respect their human rights and support their recovery.
I want to speak directly to the young people featured in the documentary. My message to them is that their testimonies will result in change for the better.
Staff in our in-patient facilities take critical decisions every day. Their obligation is to take such decisions consistently, informed by clinical evidence and with the patient’s rights and best interests central every time. Healthcare staff across Scotland demonstrate extraordinary skill and compassion, and every day, they can and do save lives. Their role supports a fundamental principle: recovery is possible.
It is possible across the full range of need, from those with milder mental health conditions to those with severe and enduring mental illnesses, which includes those who are in in-patient facilities. There were moving and inspiring accounts in the “Disclosure” film of how some of the young people are now studying to become nurses, doctors and psychologists. That is what recovery means, and we maximise the chance of recovery if care and treatment is timely, compassionate, evidence-based and respectful of the patient’s rights.
What I found so disturbing about the documentary was the culture that was depicted. By any standards, the behaviour of some staff during the time covered fell far below basic standards of decency and compassion or what we all expect of healthcare professionals. As we saw, patients in CAMHS facilities are often acutely unwell and frequently require to be admitted for their own safety. Many are detained under the Mental Health Act 1983 and not there voluntarily.
A well-functioning mental health in-patient facility will ensure that our most vulnerable people always receive the treatment and care that is necessary to keep them safe. Even in that context, some treatment options are a last resort. Issues that relate to nasogastric feeding, sedation and restraint require staff to make delicate judgments. Sometimes, such treatments can be the difference between life and death. By definition, they are difficult decisions for staff to make, which was acknowledged in the programme.
However, what also came across very clearly was a disregard for patients’ rights by some staff who were working in the in-patient unit at the time. Inappropriate, cruel and stigmatising language was used. The young people described how they had often shown nothing other than their illnesses’ symptoms. Treatment decisions are difficult, but that can never be an excuse for the kind of operational culture that was described.
I turn to my expectations for change. National health service boards are responsible for the quality of care that they provide. However, since I was made aware of the allegations in the programme, my officials have been in on-going contact with NHS Greater Glasgow and Clyde. The board has given clear assurance that the issues that were raised in the programme have been dealt with in accordance with its complaints procedures and legitimate expectations of care.
As soon as the board was made aware of the allegations in the programme, it undertook a rapid information-gathering exercise. Its view is that standards have significantly improved since the events that were described. An internal quality of care review is now in progress and will be completed by 14 March. The board is considering a range of indicators to assess current practice and drive improvement. Furthermore, an external review is being commissioned to review the care, treatment and patient experience at Skye house. The board is in the process of sourcing appropriate external expertise to undertake the review, which I expect to happen as a matter of urgency. I will carefully scrutinise the outcomes of both reviews as soon as they have taken place, and I expect NHS Greater Glasgow and Clyde to act immediately on any recommendations for improvement. As it would expect, I will hold the board closely to account for that.
Tomorrow, the Cabinet Secretary for Health and Social Care and I will meet the chief executive of NHS Greater Glasgow and Clyde, along with the chief executives of NHS Lothian and NHS Tayside, which also host adolescent in-patient units. I will seek further direct assurance that the issues that were raised in the programme have been addressed and that care and treatment have improved. I will also ask about the governance arrangements in place to ensure that what happened can never happen again.
As the minister for mental wellbeing, I want to go even further to ensure that the units operate in the way that I expect. To that end, I have asked NHS Healthcare Improvement Scotland, as the inspection body, and the Mental Welfare Commission for Scotland, as the independent organisation that is responsible for providing assurance on compliance with the Mental Health (Care and Treatment) (Scotland) Act 2003, to carry out a series of visits to all three adolescent in-patient units in Scotland, plus the national child in-patient unit, as soon as possible. My view is that an independent perspective is required to provide wider assurance on care quality, patient safety and patient experience. The voices of children and young people, and their families, will be central to those visits.
I will take very seriously all resultant recommendations about how we can improve the scrutiny of our child and adolescent mental health service facilities, whether they come from the board’s on-going reviews or from the enhanced programme of visits.
What we saw in the “Disclosure” film would have been deeply worrying for members across the chamber. My door is open to members who want to discuss the issue further, and I will continue to engage collaboratively with members from all parties on the matter.
Before I close, I will address an issue that has been raised in relation to the role of the Mental Welfare Commission. Some reports have questioned the effectiveness of the commission’s scrutiny and have suggested that it did not pick up on issues that were raised in the programme. The commission is an independent body and can rightly speak for itself, but, since 2016, commission representatives have visited Skye house seven times, using a mix of pre-announced and unannounced inspections. The commission’s reports highlighted concerns and elements of positive practice. However, it is important to point out that the commission bases its findings and recommendations on observations during the limited timeframe of each visit.
What is crucial is that boards act on the recommendations that are made. There must always be appropriate governance and assurance processes to ensure effective care, as well as a working culture that responds to feedback, so that care is delivered with kindness and compassion on an on-going basis.
As I have outlined, I am determined to use the expertise of relevant bodies to ensure that care and treatment in our CAMHS in-patient facilities are of the highest quality and that patients’ rights are always respected. I repeat my offer to members—if there are suggestions for how we can go further, I will seriously consider them.
I have no doubt that all members will stand together in condemning instances of appalling treatment of some of our most vulnerable young people. I again commend the young people and their families for coming forward and speaking out; I do not underestimate how difficult that must have been. I am only sorry that it was necessary to do so.
I treat the issues that were raised in the documentary with the utmost seriousness. It must and will result in improvements.
The minister will now take questions on the issues raised in her statement. I intend to allow around 20 minutes for questions, after which we will move on to the next item of business.
I would be grateful if members who wish to put a question would press their request-to-speak buttons.
I thank the minister for advance sight of her statement.
The minister states that she is unable to comment on the details of individual cases of care and treatment. However, in this instance, individual cases are critical to shining a light on the lack of action taken by those at Skye house and those in the NHS and the Scottish Government.
The Scottish Government did not find out about the problem through the BBC documentary—it has known for years. I have emails from my constituent that outline when she contacted ministers for help. On 23 June 2023, my constituent contacted Scottish Government officials on behalf of her daughter, Harmony. On 12 August 2024, she contacted the First Minister; the Cabinet Secretary for Health and Social Care, Neil Gray; and the Minister for Children, Young People and The Promise, Natalie Don-Innes. The email subject line read:
“Urgent concerns regarding the care and treatment of our child”.
On 25 November 2024, she again contacted the minister, Natalie Don-Innes, after being ignored by the minister who has delivered the statement today.
I have no idea how the minister can stand here today and pretend to be shocked, because she has known about this for years. The minister says that she finally feels the need to make a statement on the abuse that young women endured while they were detained at Skye house—two years late. Is she now acting only because the issue has been made public?
Why did none of the Scottish Government ministers treat my constituent’s letter with the utmost seriousness? Why did multiple ministers ignore a parent who was trying to raise institutional failures at Skye house?
If the minister is going to take suggestions from members today, will she conduct an urgent investigation into the matter to find out why nobody contacted my constituent to give them the help and support that they deserved?
I thank the member for that question. As she will understand, Scottish ministers receive a huge amount of correspondence daily. When issues are raised about a medical setting such as Skye house, the Scottish Government would normally direct correspondence to the health board, because patient care and delivery are the statutory responsibility of local healthcare providers.
Although, as I have made clear, I cannot intervene or comment on individual cases, I acknowledge the concerns that have been raised by the family that Ms Gallacher has spoken about. I am extremely sorry for the distress that the situation is causing, and I look forward to meeting them to hear their concerns.
Because patient care and delivery are the statutory responsibility of local healthcare providers, it is for relevant NHS health boards to respond to complaints about services. I am happy to look into why the family had no response whatsoever and I will certainly investigate that and get back to Ms Gallacher. Generally, people do receive a response, although it might have been that the response directed the family to NHS Greater Glasgow and Clyde.
I thank the minister for her statement. I am sure that all members will share the minister’s shock and disgust at the allegations about the behaviour of staff at the Skye house child and adolescent psychiatric ward at Stobhill hospital in my region of Glasgow.
NHS Greater Glasgow and Clyde has previously claimed that the staff lacked experience in in-patient units and the complexities of the young people being cared for in Skye house. The health board has also previously indicated that there are staffing issues at Skye house. That is clearly an unacceptable consequence of chronic understaffing and an overreliance on a casualised agency nursing workforce. It will be difficult to improve the culture of mental health nursing at Skye house and similar facilities until that fundamental cause is addressed.
Does the minister agree that there must be an urgent review of permanent staffing levels and training at Skye house and other child and adolescent mental health facilities, so that patients and their families can be reassured that such abuses will never happen again?
First, I agree with the member that the care and treatment of young people that was described in the programme is completely and wholly unacceptable. As I said in my statement, when our most vulnerable and unwell young people come forward and ask for help with their mental health, we owe them the highest standard of care and compassion.
I can assure the member that, since we heard about the programme, officials have been in regular engagement with NHS Greater Glasgow and Clyde on the issues. They have received assurance that the situation has already improved and that staff numbers are higher and staff experience and training are of a higher quality than they were in the period that the programme covers.
I will, of course, seek further assurance that that is the case. The purpose of the internal review, the external review and the commissioning of the visits by the two organisations concerned, Healthcare Improvement Scotland and the Mental Welfare Commission for Scotland, is to give me, everyone in the chamber and the public confidence that changes have occurred.
It is crucial that we all remember that many young people are still under the care of Skye house. Can the minister expand on the assurances about the standards of care that are currently being provided at Skye house, and can she advise how the Scottish Government is supporting the young people who are currently using those services and their families?
Since I was made aware of the allegations in the programme, my officials have been in regular contact with NHS Greater Glasgow and Clyde, asking a series of questions about how complaints and incidents during the period were handled, how Mental Welfare Commission recommendations were addressed and how staff were trained and supervised. There were also important questions about leadership and governance.
From NHS Greater Glasgow and Clyde’s response, I am satisfied that the appropriate review and assurance processes are in place and that improvements have been made since the events described. I will be carefully monitoring the outcome of the internal and external reviews that have been commissioned and, as the board would expect, I will hold it to account.
On support, I would always encourage young people and their families to raise concerns with staff or via the advocacy services that are available in in-patient units, if they feel able to do so, so that any issues can be resolved as quickly as possible. Young patients and families can also contact the Mental Welfare Commission advice line.
I make a declaration of interests as a practising NHS general practitioner.
The minister spoke of accountability, but not a single manager has been sacked for scandal after scandal in our NHS. Today, we heard clear evidence that the Scottish Government knew of the abuse suffered by those children years before the release of the documentary, yet nothing was done.
Minister, who in the Government is responsible for failing our most vulnerable children, and which manager was responsible and held to account?
The member is well aware that the responsibility for delivery of care is down to NHS Greater Glasgow and Clyde. I absolutely am concerned about what I heard in the programme. What I heard in the programme shocked me, and that has put in place a sequence of events that will give me and others in the chamber assurance that the situation has changed since the period of the programme.
I assure the member that I take the issues very seriously, and I will be working very closely with the board. The Cabinet Secretary for Health and Social Care and I will meet the chief executive of NHS Greater Glasgow and Clyde tomorrow, along with the chief executives of NHS Lothian and NHS Tayside, because there are in-patient adolescent units in all those areas. We take our role in scrutiny and in assuring the quality of services to our most vulnerable young people very seriously.
I remind all members of the requirement to speak through the chair.
I remind members that I hold a bank nurse contract with NHS Greater Glasgow and Clyde.
The culture in respect of and the attitude to the rights of service users that are reported to have been shown by some staff in Skye house are hugely concerning. Can the minister advise how the Scottish Government will champion the rights of vulnerable children and young people who use services such as Skye house and ensure that all staff are fully trained on the welfare of patients and are cognisant of the rights of all children and young people?
As I have set out, I am dedicated to strengthening the current system of scrutiny and assurance to drive improvement and protect Scotland’s vulnerable children and young people in in-patient settings. The vast majority of our dedicated healthcare professionals are fully committed to the welfare of the patients who are in their care, and they go above and beyond to support them in a way that is in their best interests. Where that does not happen, boards have a duty to address that and ensure that appropriate support and training are provided.
The Mental Welfare Commission has a duty to visit people who are receiving care under mental health and incapacity legislation. Its visits allow us to hear directly from the person who is receiving care and treatment whether they feel that their rights are being respected. Where the Mental Welfare Commission identifies issues, NHS boards should prioritise them and report feedback and recommendations through their existing escalation and clinical governance structures.
Given that the Mental Welfare Commission has visited Skye house on six occasions since 2017, and given that the main issues that were raised in the BBC’s investigation include allegations of physical abuse—including nurses quickly resorting to force such as physical restraint and dragging patients down corridors, leaving them bruised and traumatised—can we have any faith that the enhanced programme of visits will provide the necessary oversight?
Given the magnitude of the allegations, surely it is time to consider regular unannounced visits to such facilities, because Skye house is not the only institution that has had allegations made against it involving abuse of children. Otherwise, we cannot be sure that children are getting the standard of care that they need.
I assure Pauline McNeill that unannounced visits by the Mental Welfare Commission already occur. The commissioning of visits by the Mental Welfare Commission in combination with HIS is a new development as a result of the programme and of the concerns that have been raised. I am clear that I expect that approach to give greater assurance, both to members and the general public, that standards are as high as we expect and want them to be, right across Scotland.
On restraint, the Scottish Government is absolutely clear that alternatives to physical restraint should always be considered first, and that use of physical restraint should only ever be a last resort for the shortest period of time in order to ensure safety. Health boards must ensure that they have policies in place covering all forms of restrictive practice and that staff receive appropriate training. We expect other interventions to be considered before any restrictive practice is considered.
Healthcare staff have a professional responsibility to accurately record all elements of a patient’s care and treatment, including use of restraint and the reasons for it. The expectation is that episodes of restraint would be recorded in clinical case records.
As the minister is aware, many of the young people in Skye house were diagnosed with eating disorders. We know that compassionate care and treatment are essential parts of optimal recovery.
This week marks eating disorders awareness week. Can the minister advise how the Scottish Government is working to support improvement of in-patient eating disorder services and wider services in Scotland, including for people who require further care and treatment?
As Emma Harper said, this week is eating disorders awareness week. Later this afternoon, I will be pleased to speak in Emma Harper’s members’ business debate on the issue, and to talk about our work to improve the support and services that are available. We have recently published new national guidance for eating disorder services to ensure that everyone has access to a high standard of care across all stages of care and treatment. We have also made good progress in responding to the short-term recommendations that were made by our national review of eating disorder services.
The testimony from people at Skye house is horrific. I hope that the Government is supporting those who went through that, and that it is ensuring that they get the mental health support that they deserve.
Although NHS Lothian and NHS Tayside were not covered in the “Disclosure” programme, will the minister ask those boards to look into practices at their in-patient units to ensure that any issues in relation to care standards are properly investigated and resolved, and to ensure that the issue is not more widespread?
Let me reiterate that the care and treatment of young people that were described in the programme are completely and wholly unacceptable. I absolutely agree with Gillian Mackay on that.
The Cabinet Secretary for Health and Social Care and I are planning to meet NHS Lothian and NHS Tayside—which also have adolescent in-patient units—tomorrow. All three adolescent in-patient units will be visited by HIS and the Mental Welfare Commission, in combination.
We absolutely agree that broader scrutiny and assurance of the system of in-patient care in Scotland are required, and we are determined to deliver them.
The barbaric conditions and behaviours at Skye house that were described do not take place in our care homes because of the rigour and reach of the Care Inspectorate, and they do not take place in our prisons because of the rigour and reach of His Majesty’s Inspectorate of Prisons for Scotland.
The “Disclosure” documentary revealed deficiency in the rigour and reach of the Mental Welfare Commission. It is true that the commission visited Skye house on seven occasions, but six of those visits were announced. What more is the minister’s Government doing to examine the powers and reach of the Mental Welfare Commission to make sure that it has the teeth that are necessary to stop such behaviours happening again?
The Mental Welfare Commission gives us assurance on application of the Mental Health (Care and Treatment) (Scotland) Act 2003. Its understanding of the situation in in-patient units is limited by a visit’s being a snapshot—a single visit.
As Alex Cole-Hamilton said, the commission has powers to visit unannounced. I am clear that we are asking the Mental Welfare Commission and HIS to make joint inspections of all our adolescent in-patient units to provide exactly the scrutiny, assurance and confirmation of the quality of care that we would all expect and are seeking at this moment in time. That is why we have instructed that we will meet them before they plan those visits, and why we are keen to give input on how the visits are supported.
No young person should have to endure what the brave young people who featured in the Skye house documentary underwent. I commend them for coming forward.
Will the minister outline how those young people are currently being supported in the aftermath of the incidents, and how NHS Greater Glasgow and Clyde will be fully equipped to ensure that such incidents never occur again?
I absolutely agree with my colleague that young people should be able to expect a high standard of care and treatment in our mental health services.
I understand that NHS Greater Glasgow and Clyde is actively engaging with the families of those who were highlighted in the programme to discuss their experiences and to provide answers to any additional questions that they might have.
As I have set out, I consider it to be of paramount importance that we ensure that those kinds of experiences are not repeated. That is why I have asked HIS and the Mental Welfare Commission to carry out a series of visits and to recommend what is required to ensure the quality and safety of our CAMHS in-patient units, now and into the future.
In the statement, the minister committed to taking very seriously all resultant recommendations on how we can improve scrutiny of our CAMHS facilities.
It is shocking that young people have been treated in such a manner, as is the delay—which has already been mentioned by my colleague Meghan Gallacher—before anything is done by the Scottish Government.
The minister rightly states that the Mental Welfare Commission is an independent body that has limited time frames for its visits. However, we need to ensure that communication between the commission and NHS boards is not only robust but is able to flag up relevant concerns as a matter of urgency. Will the minister outline what the current communication process is between the Mental Welfare Commission and NHS boards, and how the Scottish Government intends to review the process to ensure that nothing falls through the gaps?
Roz McCall is absolutely correct to shine a light on the question of how boards respond to Mental Welfare Commission concerns. The commission will write after either an announced or an unannounced inspection, and in doing so will make recommendations. It is the expectation of ministers that those recommendations will be acted on. They will go into the usual clinical governance processes in the health board, so they should be acted on.
The reason why the Cabinet Secretary for Health and Social Care and I are meeting the three chief executives and commissioning both the internal and external reviews and the Mental Welfare Commission’s visits is that we are absolutely determined to scrutinise whether that process has occurred, and whether boards are taking on board the concerns that are being raised and acting on them.
I am sure that all members will welcome the news that HIS and the MWC will undertake a range of visits to all three adolescent in-patient units in Scotland. Will the minister advise whether they are to become regular occurrences? What role does she expect HIS and the MWC to play in holding service providers to account in the future?
I welcome the commitment from HIS and the MWC to visit all three adolescent in-patient units. As part of that, I have asked them to consider future arrangements for scrutiny and assurance, and I will consider very carefully their recommendations and advice. The MWC already undertakes regular visits, including unannounced visits, to mental health in-patient settings, and those will, of course, continue.
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