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Difficult decisions have had to be made to allow us to balance the Scottish Government budget while still progressing implementation of our mental health and wellbeing and other strategies from a revised direct budget of £260.3 million.

The in-year budget changes impacted on a number of planned new programmes which could not proceed as anticipated. Planned increased funding to existing programmes were also not able to be progressed. This included programmes related to Mental Health and Primary Care; regional CAMHS developments; full implementation of Coming Home; full implementation of the new Mental Welfare Commission Patient Records System; and improving prisoner mental health.

Despite the savings made, we have continued to focus on delivery of our mental health and wellbeing strategy and recently published delivery plan, which includes commitments around mental health services and specific programmes of work around learning disability and autism, and cross-cutting trauma work.

It is not possible to report accurately on the number of additional CAMHS cases taken on since 2021 as the current aggregate data set does not allow identification of separate individuals, it only gives a snapshot of the total number of open cases at any one time.

In the NHS Recovery Plan, published in 2021, we committed to provide sufficient funding for around 320 additional staff in CAMHS over the next 5 years, with the potential to increase capacity for CAMHS cases by over 10,000. This estimate was based on the Choice and Partnership Approach (CAPA) capacity model, where each full time clinician can hold around 40 open cases at any one time, and manage around 40 new cases per year.

From March 2021 to September 2023, 295 WTE CAMHS staff have been added to the workforce, significantly increasing capacity to manage CAMHS cases. We see this reflected in numbers waiting - the total number of children and young people waiting for treatment has fallen from 10,499 in December 2021 to 5,344 in September 2023.

Our National Discharge Without Delay Steering Group has representatives from every NHS Board and Health and Social Care Partnership in Scotland. The group leads on improvement and sharing best practice across Scotland on areas related to good hospital to community transfer or discharge planning. The group meets monthly and there is a standing agenda item on support for unpaid carers which has highlighted examples of good practice.

We have funded NHS Education for Scotland to develop three training modules for the health and social care workforce, to help them to identify, include and support unpaid carers which we expect to be launched in January 2024. This will include highlighting carers’ right to involvement in hospital discharge decisions.

We have also funded Healthcare Improvement Scotland to work to improve practice on carer involvement across health, with a focus on carer involvement in hospital discharge.

As part of this, in September 2023, we brought together Health and Social Care Partnership carer lead officers and Carer Centre Managers to focus on this issue and share good practice.

We know that many carers experience mental, physical, employment and financial impacts as a result of their caring role. We must ensure adequate support for carers, particularly those most at risk of poorer health, to ensure their wellbeing and sustain them in their role.

The Mental Health and Wellbeing Strategy Delivery Plan and the Workforce Action Plan were published jointly with COSLA in November 2023. Actions in the Delivery Plan cover a wide spectrum, from maintaining good mental wellbeing, to support in communities, to ensuring specialist services are available whenever needed.

The Mental Health and Wellbeing Workforce Action Plan recognised the valuable role of carers and set out actions to improve carer awareness training for the workforce and access to wellbeing support for carers. Equality Impact Assessments have been published for both the Delivery Plan and Workforce Action Plan.

Our National Wellbeing Hub provides advice for unpaid carers, with information and resources to support carers to look after their mental health and wellbeing.

The National Specification for Psychological Therapies and Interventions was published in September 2023. It aims to improve the quality of the delivery of psychological therapies and interventions so that people accessing help, including unpaid carers, have positive experiences.

Support for carers is one of the aims of the recently published Core Mental Health Standards, which includes signposting to support and resources when needed. These standards were developed with the input of individuals with lived experience, including carers and set out clear expectations for what services will provide and to let individuals, their families and carers know what they can expect from a secondary mental health service. We want to support secondary mental health services which enable people to receive the right information, support, care, intervention, or service for their needs

Another key aim of the standards is that they are meaningful and measurable. National data sources will be used to monitor how well the standards are being met. Where areas for improvement are identified, support will be provided to local areas to ensure that safe and quality services are provided. The standards will also aim to ensure services are measuring key outcomes for patients, including carer experience.

Statistics published on 5 September 2023 covering quarter ending June 2023 show that NHS Forth Valley, NHS Highland, NHS Lanarkshire and NHS Orkney did not effectively eliminate their long waits (where 4% or fewer of all waits are over one year).

However, statistics published on 5 December 2023 covering quarter ending September 2023 show that NHS Forth Valley, NHS Lanarkshire and NHS Orkney have now effectively eliminated their long waits (where 4% or fewer of all waits are over one year).

We continually monitor CAMHS waiting times performance and backlogs and are directing tailored support to those Boards with the longest waits, including NHS Highland, providing access to professional advice, ensuring they have robust improvement plans in place and monitoring their implementation.

We have commissioned all Boards to submit performance trajectories up to March 2024, including a timeline for clearing long waits. These will be updated annually and used to inform further targeted improvement work to ensure all Boards consistently meet the CAMHS waiting times standard.

We recognise the significant contribution that Scotland’s unpaid carers make to our communities. It is very important that people who are caring for others know how to access carer support, and that professionals know how to direct people to support.

Under the Carers (Scotland) Act 2016, Local Authorities and Integration Authorities are responsible for supporting carers, according to their individual needs, and commission Third Sector organisations to provide much of that support on their behalf. This includes providing or signposting to counselling and other services that are available to them locally. Much of this vital support is delivered through local carer centres.

We are investing £88.4m per year in local carer support through local authority Carers Act funding.

The National Care Service Bill makes changes to the Carers (Scotland) Act 2016 to deliver a right to personalised short breaks support for any carer who is not currently able to access ‘sufficient breaks’ – accessed via their personalised plan under the Carers Act.

We are working with a group involving carers, local and national carer organisations and social care practitioners to develop the guidance and regulations required to deliver a right to personalised short breaks support for carers who need it under the proposed legislation. As caring roles vary in nature and intensity, carers will need different amounts and types of support to achieve ‘sufficient breaks’, depending on factors such as the type of caring role, help from other family members and wider support.

Ahead of the proposed legislation, we increased the voluntary sector Short Breaks Fund by £5m to £8m in 2022-23, to expand easy-access short breaks support, and have maintained the fund at £8m per year since then. This is in addition to £88.4m per year Carers Act funding in the local government block grant.

Table 1 shows funding allocated to each NHS Health Board in 2021-22 for clearance of any backlogs on waiting lists for CAMHS.

Table 1:

We are approaching the end of the first year of implementing the National Carers Strategy (published in December 2022). The implementation of the strategy is monitored by the Carers Rights and Support Steering Group (CRSSG), made up of representatives from national and local carer organisations, statutory sector representatives and unpaid carers - so that carers are directly involved in measuring and monitoring the impact of the strategy during its lifespan.

The CRSSG agreed 43 actions to be prioritised for Year 1. The actions cover a broad range of topics including COVID-19 and cost of living as well as outlining employment, financial and mental health support. Examples of actions that have been progressed this year include:

• We distributed £560,000 to carer centres in 2022-2023 to improve local capacity for carer support.
• We funded the Carers Parliament and the Young Carers Festival in 2023, with record numbers attending the Young Carers Festival this year. We will continue to fund events which enable carers to engage directly with decisionmakers.
• We have engaged with carers in 2023 to produce the National Dementia Strategy, the Mental Health and Wellbeing Workforce Action Plan, the Mental Health and Wellbeing Strategy and we have involved carers in the review of the National Outcomes and the National Care Service co-design. We will continue to engage with carers to ensure their voices are heard and reflected in policy across the Scottish Government.
• We are continuing to fund and promote increased uptake of the Carer Positive employer accreditation scheme, with 264 employers now signed up who are responsible for 493,000 employees (as of November 2023).
• Social Security Scotland successfully launched the initial pilot for Carer Support Payment in November 2023, with the benefit to be available nationally by autumn 2024. The benefit is a key milestone in improving support for unpaid carers and will be available to many carers in full-time education who cannot currently get Carer’s Allowance.
• Through the Communities Mental Health and Wellbeing Fund, we invested £15 million in 2022-23 in community-based initiatives to promote good health and wellbeing and tackle the mental health issues for people, including unpaid carers.

The Strategy is kept under review so that we are able to respond to changing circumstances and ensure progress towards meeting the actions contained within it.

Under the Carers (Scotland) Act, all adult and young carers have the right to a personalised plan to identify what is important to them, which may include counselling and emotional support, according to their individual circumstances. Future needs for bereavement support can be considered as part of the process and any eligible needs for support must be met.

Local authorities must also have a carer information and advice service, usually delivered via local carer centres, to help all adult and young carers access support in their area. This must include information and advice on counselling and bereavement support available to carers, not necessarily carer-specific services. In addition to information and advice services, many local carer centres provide their own counselling and support services which can include group/peer support and bereavement support.

The Scottish Government is investing £88.4m per year in local carer support through local authority Carers Act funding.