Hansard

My statement follows the joint Healthcare Improvement Scotland and Mental Welfare Commission for Scotland report on Skye house, NHS Greater Glasgow and Clyde’s regional adolescent in-patient mental health unit.

Following the BBC “Disclosure” documentary on Skye house, which aired in February 2025, my predecessor, Maree Todd, made a statement to the Parliament on 25 February 2025, setting out the Government’s plan for stronger external assurance. That commitment reflected the seriousness of the issues that were identified in the documentary. It included commissioning a programme of joint visits by Healthcare Improvement Scotland and the Mental Welfare Commission for Scotland to every adolescent mental health in-patient unit in Scotland, including Skye house, in order to ensure that concerns were examined thoroughly and independently. I express my thanks to both organisations for the thoroughness with which they have carried out that work, and to all those who contributed to the reviews.

As the Parliament would expect, I will not comment on the detail of individual cases. However, I will specifically address the findings of the joint visit to Skye house, as I know that it is a matter of deep concern to members across the chamber.

I also want to acknowledge, at the outset, the young people and families whose courage in raising concerns, including through the BBC “Disclosure” documentary last year, has helped to bring the issues to light. They should not have had to fight to be heard. They deserved better.

Since the BBC documentary aired, both Maree Todd and I have met several families and young people who were in Skye house. I am grateful to them for speaking so openly about their experiences. I have been deeply moved by what they shared and impressed by their commitment to driving change in the future. Today, I want to reassure those families and young people that their voices have been heard and that they will shape change.

It is also important to remember that the “Disclosure” documentary had a significant impact on staff. The reviews show that a lot of high-quality critical care is being delivered within in-patient units in child and adult mental health services. I am incredibly grateful to those staff, who are working hard to provide compassionate care to young people in challenging circumstances. However, I am also very clear that the serious issues that were identified in the report are where we need to see improvement.

The issues highlighted range from cultural concerns and staffing pressures to weaknesses in governance, such as inconsistent recording of restraint—I remain particularly concerned about the lack of clarity around the lawful use of restraint during nasogastric feeding. I have met the Children and Young People’s Commissioner Scotland to discuss those concerns.

I have also met the health board leadership and been assured that improvements have been made since the inspection took place seven months ago. The chief executive has confirmed to me that the board feels that the risks in Skye house are being actively and appropriately managed each day and that the service is operating safely, while recognising that caring for this patient group involves inherently high levels of clinical risk.

The board has also strengthened its governance through a dedicated executive oversight group, which is chaired at executive level. The group meets regularly to provide direct oversight of Skye house, monitor progress against actions and escalate any concerns immediately to the chief executive.

I understand that a number of new staff are now in post, including eleven new nurses, and that recruitment is nearly complete to strengthen the wider multidisciplinary team. Increasing permanent recruitment should mean less reliance on temporary staffing, which was a key factor in the cultural issues that were identified. I have also been told that the civility saves lives champions who are working in Skye house are helping drive the cultural improvements that are clearly required. That brings with it a zero-tolerance approach to any and all inappropriate behaviour.

The board’s action plan demonstrates there has been a drive to improve and reduce the use of restraint. It reports that 99 per cent of Skye house staff have now completed prevention and management of violence and aggression training, with bank staff trained in safe restraint practice. In addition, improvements have been made to the recording and oversight of the use of restraint, with clearer governance and reporting.

Although I acknowledge that improvements have been made, I have been clear that more still needs to be done to ensure that the care at Skye house reaches the high standards that every young person in Scotland has the right to expect. NHS Greater Glasgow and Clyde is accountable for care and treatment at Skye house and I now expect the board to be laser focused on driving up those standards of care.

The board has accepted all of the requirements and areas for improvement that are set out in the joint inspection report and now has an action plan in place to address them. I expect that plan to be implemented at pace, so as to improve the experience of young people needing care in our adolescent in-patient facilities.

In respect of the serious issues that were identified around the authority to treat under the Mental Health (Care and Treatment) (Scotland) Act 2003, I understand that weekly checks and audits of all treatment forms are now in place. A multidisciplinary review of legal processes is under way, and the board is working closely with the commission to ensure full compliance going forward.

Members may also be aware that I am taking urgent action to improve the use of restraint and seclusion in in-patient mental health settings by updating the code of practice under the 2003 act. I have also asked the commission to begin monitoring and reporting on the use of restraint and seclusion at a national level to enhance oversight. Following the publication of these reports, I have met with the chief executives of all of the boards accountable for delivery, to ensure that robust improvement plans are in place, and my expectation is that all formal requirements and areas for improvement will be implemented swiftly. I have made it clear that I expect regular updates on progress.

As well as the individual reports on each of the in-patient units, I welcome the national overview report that was recently published by Health Improvement Scotland and the commission. It brings together the themes arising from visits in order to inform future improvements to the quality and safety of our CAMHS in-patient units. In response to those themes, I have considered what national improvements will be required to better support young people and I have highlighted my support for the recommendation that all health boards that are currently responsible for adolescent psychiatric in-patient units should develop a national in-patient service specification and, following the review of care that they have already undertaken, put in place more robust governance and oversight.

A national specification will help to ensure that all settings operate to the same high standards and will clearly set out the role of in-patient care as part of a broader child and adolescent mental health service.

I have written to those same chief executives to ask them to report back to the Scottish ministers after the election with detailed proposals on how, collectively, they will further strengthen CAMHS community services and pathways in and out of in-patient care, improve care at home and ensure that vulnerable young people receive the right support at the right time, in the right place.

For further assurance, the commission will also undertake follow-up visits to monitor progress against the action plans for all regional units. Officials will follow up with the boards on any resulting recommendations through routine engagement and performance monitoring. We are working closely with the commission to explore how to improve routes of escalation between the commission and the Scottish Government. I intend to provide additional funding to the commission for more rigorous visits in future, including for visits over multiple days.

Healthcare Improvement Scotland will monitor progress on the action plan, and has the ability to escalate any issues to ministers and the Scottish Government, if it would be appropriate. Officials will work closely with HIS in the first half of 2026-27 to develop proposals for an on-going programme of CAMHS inspections, with that activity expected to start in the latter half of this year.

The reports set out a number of challenges for the services. They also highlight many positive aspects and, critically, they give us a clear path forward. The young people and families who spoke up did so with extraordinary courage. We owe it to them to ensure that care at Skye house and across all our CAMHS in-patient services is safe, compassionate and rooted in the rights and dignity of every child.

I am absolutely determined that the changes that are now in train are delivered at pace during the remainder of my term in office. I am committed to doing everything in my power to deliver that change and restore public confidence.

To quote the recent inspection reports,

“When a child or young person is admitted to one of Scotland’s national or regional mental health units, it is because they require assessment and treatment for complex mental health needs. They are at their most vulnerable and they, and their families, have a right to the highest quality, compassionate care in a safe, clean, welcoming environment. We found that this was the experience of some but not all of those we met with. This is not good enough, all have the same right, irrespective of where the care is provided and by whom.”

I invite members to work collaboratively with me on the matter. I know that improving mental health services for children and young people is an important issue to many of us across the chamber. I hope that, together, we can work towards mental health services of the highest standards for all young people in Scotland.