Official Report 280KB pdf
The next item of business is a statement by Tom Arthur on Skye house: progress and assurance. I ask members who are leaving the chamber to do so quickly and quietly, because we are moving on to the next item of business. The minister will take questions at the end of his statement, so there should be no interventions or interruptions.
14:51
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.
The minister will now take questions on the issues raised in his statement. I invite those members who wish to ask a question to press their request-to-speak buttons. I intend to allow up to 20 minutes for questions, after which we will move to the next item of business.
I thank the minister for advance sight of his statement and, more importantly, for the way in which he has approached the issue—not only meeting me but meeting families—because it is a real and serious issue.
I first raised the issue of Skye house in the chamber almost a year ago. Although I welcome the steps that are now being taken to listen to families and improve services, systemic issues remain. When I raised the issue of the BBC documentary, I revealed that the Government was aware as far back as June 2023 of the abuse that young people were experiencing. I believe that that is yet to be investigated as part of the wider concerns.
I continue to work with affected families because their concerns have not been properly addressed. One family has exhausted every avenue in trying to hold the system accountable for the trauma that their daughter has endured.
An independent review of their case was commissioned, but, when the report was finally published, it was the parents, rather than the professionals who were involved, who were portrayed as the problem. Too often, when families speak up, they are dismissed, ignored or made to feel as though they are the obstacle to change.
My experience in supporting that family points to a culture of closed ranks in parts of our health and social care system. When systems close in on themselves, instead of protecting the most vulnerable, public trust is inevitably eroded.
We need a question, Ms Gallacher.
Does the minister support the creation of a new national whistleblowing officer for the national health service and the social care sector who will deliver in such circumstances? Does he honestly believe that the families who have come forward with such harrowing experiences have been treated fairly by the systems that were designed to protect them?
I thank Ms Gallacher for her question, for her resolute campaigning on these matters and for consistently working to represent the interests of her constituents and those who have been affected.
It is of the utmost importance to me and the Government that we provide assurance and ensure that public confidence is fully regained, given what we have been contending with at Skye house. As I said in my statement, I have sought a direct assurance from the chief executive of the health board that all appropriate mitigations and safeguards are in place and that day-to-day care is being delivered safely.
I recognise the on-going independent work of the Mental Welfare Commission and HIS in providing such assurance. We are working with HIS to put in place a programme of on-going inspections, the need for which was previously highlighted by members.
With regard to what further assurance can be provided by way of whistleblowing mechanisms, we already have such mechanisms in place, but I am happy to consider further, along with ministerial colleagues, any additional measures. I assure the member, Parliament and, most importantly, families that it is of the utmost importance to me and the Government that we provide such assurance and restore confidence.
I thank the minister for his statement, and I again express my admiration for the brave children and young adults who spoke out about their treatment at Skye house at Stobhill hospital. Their courage has helped to realise the improvements that we have heard about today. I am also relieved to hear that staffing levels are finally approaching an appropriate level for a facility as crucial as Skye house.
As adolescent in-patient mental health units are highly challenging workplaces, staffing levels will fluctuate, so it is essential that long-term workforce planning takes place so that, when such rotations happen, staffing levels do not fall back, with the result that the cycle of temporary staffing returns. Will the minister provide an assurance that the health board is undertaking long-term workforce planning for Skye house so that children and families who are affected can have confidence in the quality and safety of care in the long term?
I am confident that the health board has a full understanding of the message that is clearly implied in the reports about the link between culture and staffing, and the importance of ensuring that the positions at Skye house are permanent positions. That is reflected in the increase in staffing that we have seen. That link is highlighted in the reports, and the fact that there is a clear understanding of its importance was made clear to me in my engagement with the chief executive and her team.
Although responsibility for such operational matters sits with the health board on a day-to-day basis, I am confident from the assurances that I have received from the health board that it has a full grasp and understanding of the importance of addressing the staffing situation to ensure that there is a positive culture for patients and staff.
I would call Rona Mackay, but she seems to be busy.
Apologies, Presiding Officer.
It is crucial that anyone who enters Skye house, and their family, have confidence in their care and support. How does the minister anticipate that measures such as the introduction of a care manager role as the key point of contact will help to improve trust and relationships with families and carers?
The introduction of a dedicated care manager role at Skye house will give each family a clear, consistent point of contact throughout admission. The care manager will also be able to co-ordinate care more broadly. I am pleased to note the positive feedback from families in that regard in the inspection.
NHS Greater Glasgow and Clyde has reported that a substantial amount of work has been done to obtain feedback from parents and carers at Skye house to drive further improvements. As I mentioned earlier, I have met several young people who were in Skye house and their families, and I repeat my gratitude to them for speaking so openly about their experiences. I again reassure those young people and their families that their voices have been heard and that they will shape change.
I place on record my acknowledgement of the fight of young people and families to get us to this point. They deserve so much better. The statement says that NHS Greater Glasgow and Clyde is accountable for care and treatment at Skye House, but it seems to me that other than expecting the board to be laser focused, there are no consequences for that lack of accountability.
My question is very simple: how will the Scottish Government hold NHS Greater Glasgow and Clyde to account?
I have set out very clearly in my statement, as I have set out directly to the chief executive, my expectations of the health board. I understand that it fully appreciates my perspective on the matter and the perspective of families on what is required. It is important to note that there has been significant change in the health board recently. From what I have been told directly by the health board, I am assured of the gravity with which it treats the requirements and recommendations in the joint report and that it will work at pace to ensure that they are implemented. Notwithstanding that, my officials will continue to engage closely and monitor those matters. I have been very clear with the health board that I expect regular updates and demonstrations of progress.
A common thread throughout all the reports, as well as conversations in wider society, is the importance of a respectful culture when discussing or working in mental health services. How is the Scottish Government working to champion the rights of vulnerable children and young people?
Culture is of the utmost importance. In this specific case, it was clearly highlighted as a key concern in the reports, which is why the actions around culture are so important. I have touched on the importance of ensuring that we have more permanent staffing, which we have seen since the inspections in August last year.
Further to that, I have alluded to the work that is under way to improve the culture in Skye house. I have received assurance from the health board that that work will continue to be implemented. I again make it clear that I expect regular updates from the health board to ensure that that work is taken forward.
The minister notes the need for national improvements to better support young people in units across Scotland and for robust governance and oversight. Although health boards are working to develop a national in-patient service specification, what assurances can he give to families that their loved ones are being cared for in the way that we would expect, and is he confident in the quality of care and conditions in establishments across Scotland?
I thank Carol Mochan for her question. As I said in my statement, I have spoken directly with the chief executives and senior leadership of all three boards where the adolescent in-patient units are located. Different issues were raised across the reports, but there were also some common threads. It is my clear expectation that each board will respond to the issues that have been identified in their respective units. Further to that, a tri-regional review has been commissioned at board level to look at all regions, which will also report. External assurance specific to Skye house has also been carried by the Royal College of Psychiatrists, so further work has been undertaken in that area.
It is clear that there are lessons to be learned nationally. Carol Mochan alludes to the national specification proposal, which we support. Notwithstanding that, there will be on-going engagement between officials and the health boards to ensure that the recommendations and the wider learning from the reports are taken forward and implemented.
The comprehensive training of staff working in services such as Skye house is essential to supporting patients. I ask, as a former clinical nurse educator for the NHS, how is the Scottish Government working to ensure that full staff training is a priority and that patients’ welfare is at the core of their care?
As Emma Harper will appreciate, responsibility for ensuring that staff are fully and appropriately trained lies with individual NHS boards. Operational workforce decisions, including staff training, development and deployment, are matters for local determination. However, the Scottish Government is clear that boards should prioritise high-quality, comprehensive training across all services, including specialist facilities such as Skye house.
Progress is being made. At the time of publication of the Skye house report, 99 per cent of staff had completed training in the prevention and management of violence and aggression, ensuring that they are equipped to provide safe, person-centred care to vulnerable young people.
More broadly, the Scottish Government continues to invest in the training and development of the health workforce. In 2025-26, more than £31 million was provided to NHS Education for Scotland to support multidisciplinary training and workforce expansion.
The inspection report highlighted that the social work post at Skye house has been vacant for around three years. It is unclear whether there are plans to replace that role or, if not, how social work views and knowledge can be accessed. The report states that
“this is clearly a gap.”
Will the minister outline how social work will be engaging with the unit going forward?
Issues in the wider team were part of the discussions and conversations that were undertaken with the chief executive and her team. Although there has been a significant increase in staffing, as I touched on earlier, there is still work under way to complete that process in order to ensure the correct balance of individuals in positions across a multidisciplinary team.
I will be receiving further updates from the health board, and I will be happy to write to Gillian Mackay to provide further information.
We have an inspection regime for a reason—to pick up on deficiencies in practice and care—yet there were no inspections at Skye house between 2017 and 2024. That is an absolute scandal. During that time, teenagers in deep crisis were subject to cruelty and restraint with excessive force, and they were humiliated. Although the national specification that the minister has announced today will go some way to preventing that from happening again, I am still not clear as to why the facility was not inspected for so long.
That raises a question, which I will put to the minister. Are there any other facilities currently going so long between inspections for vulnerable people in their care, where such things might be happening again?
I recognise the importance of the independent assurance that is provided through inspection, and I agree with Alex Cole-Hamilton on that. As he will appreciate, both the Mental Welfare Commission and HIS operate independently, and it is for them to take those decisions. However, given the significance of the events that have taken place, a joint inspection report has been undertaken by the Mental Welfare Commission and HIS.
The Mental Welfare Commission will continue to undertake its duties. However, to provide assurance, we are engaging with HIS on the commencement of an on-going programme of inspections of such facilities. As I touched on earlier in my remarks, that is forecast to commence in the second half of this year.
The key learning around the importance of inspection and the role of HIS has been taken on board, and it is subsequently leading to actions that will be implemented—namely, through the inspections by HIS taking place.
In the light of the concerns that have been expressed by young people and their families that those with co-occurring neurodivergence, or those who are living with the less-understood eating disorder known as avoidant restrictive food intake disorder—ARFID—do not always get the support that they need at Skye house, how can the Scottish Government support the delivery of services in a way that is grounded in inclusive and trauma-informed practice and reflects the needs of those who are neurodivergent?
I recognise Elena Whitham’s long-standing championing of these issues, and she will be aware of the importance that I place on them, too.
It is of the utmost importance that we ensure that all our public services are delivered in a neuro-inclusive way. Indeed, that has been part of our deliberations on the proposed learning disabilities, autism and neurodivergence bill, which will be something to be considered in the next session of Parliament. Some of the provisions in that proposed legislation are, potentially, directly applicable to the issues that Ms Whitham raises.
Notwithstanding that, it is my clear expectation that all our mental health services should be providing an environment that is safe, compassionate and person centred, and that includes being responsive to individual needs, including those that pertain to neurodevelopmental conditions.
I welcome the national in-patient service specification; it was something that I tried to progress as part of the bill that became the Health and Care (Staffing) (Scotland) Act 2019, which came into force in 2024.
However, I do not understand, from what the minister has outlined, what escalation of reporting ministers will have beyond the annual report. On staffing, what will the minister actually be told, and on what basis?
An executive oversight group has been established by the board to look at the issues at Skye house. The chief executive will be kept up to date, but there is a process in place for the immediate escalation of any serious or urgent matters. The Government’s position is that officials will continue to engage regularly. I have set out directly to the chief executive clear expectations of what will be required by way of updates to the Scottish Government across all the issues that have been raised in the report, particularly about staffing, because the correlation between staffing, the type of staffing and the culture and environment is of the utmost importance. I will ensure that the Parliament and members are kept up to date on those matters.
Although the report by HIS and the MWC is specific to Skye house, does the minister agree that it is important to consider any lessons for improving access to mental health services in Scotland in a wider context?
We expect all health boards and their employees to act in line with the values and behaviours that are expected of those in NHS Scotland. NHS Greater Glasgow and Clyde has committed to delivering a significant culture change programme that is focused on listening, transparency, staff voice and psychological safety. There is also a zero-tolerance approach to behaviour that falls below high standards of care. Further action has been taken to strengthen management processes, including through increased internal audits.
Complaints were received about Skye house for a number of years, but they appear to have been ignored. Last year, I supported a constituent who raised serious concerns about their daughter’s treatment at Skye house, including a lack of supervision and a failure to listen to parents. What specific steps will the Government take to ensure that, when families raise concerns about care at Skye house, their concerns are properly investigated and are not brushed under the carpet?
I recognise the young people and families who have come forward, spoken directly to me and other members, and engaged in the process. I cannot express my gratitude more profoundly for what they have done. I hope that what I have set out in my statement—the actions that the Government has taken to commission joint inspections; the report from the inspections with its recommendations and requirements; and the Government’s direct engagement with health boards setting out our clear expectations that all those requirements and recommendations are implemented at pace—will go some way to providing reassurance and restoring confidence.
I reiterate that, although I have made my statement today, that is not the end of the matter. My officials and I will have on-going engagement with health boards to ensure that actions are taken forward and that, if any issues are identified, they are remedied rapidly. I hope that that provides reassurance to Sharon Dowey.
Air ais
Portfolio Question Time