After a quiet spell, BBC Scotland has returned to its proxy war strategy against the SNP using exaggerated and distorted tales of problems within NHS Scotland. They tend to be insensitive stories but the latest is particularly so, using anecdotal evidence from only 24 patients who approached them directly out of the ‘hundreds’ treated annually in Tayside’s Carseview unit.
Here’s the essence of the scare story, developed into a ‘documentary’ and repeated regularly:
‘An MSP has called for a Dundee mental health unit to be put into crisis measures following revelations in a BBC Scotland documentary. Former patients at Carseview told the Breaking Point programme they were pinned to the floor and bullied on wards where illegal drugs were rife. Dundee-based Labour MSP Jenny Marra said the allegations were “horrifically worrying.”’
The documentary lacks the qualities of any good documentary relying entirely, as it does, on recollections from a very small self-selecting sample of often-traumatised patients, who have come forward, and the partisan comments of an opposition politician. Given the often-traumatic life-threatening nature of mental health conditions and the difficulty in treating sometimes terrified patients, mistakes will be made by staff with the best of intentions. As for the intentions of the BBC Scotland reporters, we’ve learned to suspect them.
There is, of course, reliable evidence to suggest that the reported incidents which, of course, must be investigated, are not representative of the unit or of the majority of its staff. The Review of Adult Mental Health Services in Tayside on 7–9 December 2017 by Healthcare Improvement Scotland found no major concerns of this kind at all. The full report can be read at:
Health Improvement Scotland is independent and has previously demonstrated its rigorous and critical approach resulting in fearless condemnation where it is required. See, for example, this on Aberdeen Royal Infirmary:
Healthcare Improvement Scotland (HIS) warned of “widespread disengagement” of medical staff and “unprofessional conduct” by senior doctors. It also criticised a “dysfunctional surgical unit” and failures in performance management and in addressing earlier concerns highlighted by the General Medical Council (GMC).
‘Inspectors have ordered a health board to tighten procedures after badly stained mattresses were found on wards at Hairmyres Hospital in East Kilbride.’
During the Review of Adult Mental Health Services in Tayside, HIS spoke with:
- ward staff
- community-based staff
- health and social care staff
- senior managers
- operational managers, and
- community managers.
Why is there nothing in the report comparable to that in BBC Scotland’s coverage?
HIS noted areas where adult mental health services in Tayside are performing well:
- Staff we spoke with were well motivated with a recovery-focused and person-centred approach to care.
- The senior management team appeared to be cohesive, with a view to provide high quality care to patients whilst reviewing challenges in relation to finance and resourcing. Staff told us that leadership was clearly visible in the ward areas.
- Many of the community mental health nurses were following independent practice and critical thinking and were involved in high levels of decision making. This was reflected in the number of charge nurses (Band 6) and senior charge nurses (Band 7) in post. These community mental health nurses also had the opportunity to develop their skills further.
- The ‘mental illness partnership project’ between NHS Tayside and Police Scotland was a good example of inter-agency working. We were told that over 75 police officers have received training from mental health professionals to help them provide support to people in times of need.
- The crisis resolution and home treatment team was organised and well resourced. There were clear and established processes for collecting meaningful data to enable the team to make informed decisions to improve the quality of care they provided.
HIS noted areas where adult mental health services in Tayside could make improvements:
- With regards to ensuring that clinical staff maintain the necessary knowledge and skills to deliver high quality care, we were told NHS Tayside is developing a training strategy that reflects both current need and considers future demands aligned to the Transformational Nursing Agenda. This is a national approach reflecting how nursing, as a profession, will need to evolve including consideration to the development and professional positioning in an integration Health and Social Partnership context. We acknowledge that the partnerships have significant challenges in recruiting and retaining psychiatrists, however we were told that efforts are being made to establish posts that offer clinical and academic combined opportunities.
- There was inconsistency with regards to psychiatric consultants. High numbers of locum psychiatrists are employed in the inpatient facilities and community areas. We were told that this has been challenging for staff and those who use the services. Patients told us that they were frustrated by the number of different psychiatrists they were in contact with. This can cause problems in building therapeutic relationships and trust.
- The consistent use of locum psychiatrists has reduced the opportunity for medical learning and minimised the opportunities for medical leadership to evolve.
- Although the general environment in the Carsview Centre was good, improvements and adjustments could be made. Making adjustments will ensure patients are cared for in a less restrictive environment, whilst ensuring appropriate levels of safety and encouraging recovery.
- There was an inequity of service for patients who live in Angus. For example, patients in this area do not receive 7-day intensive home treatment support. In some instances, patients have had to be admitted to hospital as no support was available at the weekend. This could also have an impact on the support needed by patients when they are discharged from hospital.
- The Angus health and social care partnership should review their current provision and consider a 7-day service for patients in Angus.
- Psychiatrists and junior doctors did not document risk assessment details or contribute to patients’ care plans. This could weaken the consistency of care approach or interventions.
Plenty there for a real documentary? Since the BBC ‘documentary’ was aired, we read in the Daily Record:
‘NHS staff have been offered counselling to cope with the trauma of watching a BBC documentary criticising an under-fire mental health unit. Experts have been put on standby to support doctors and nurses at the Carseview Centre, in Dundee , who may be adversely affected by the hard-hitting programme.’