Letter from Public Audit Committee relating to the Committee's Inquiry into the Health and Wellbeing of Children and Young People, 2 December 2021
Dear Gillian,
Thank you for your letter of 3 November outlining your Committee's plans to undertake an inquiry into the Health and Wellbeing of Children and Young People.
The Public Audit Committee welcomes this important and very timely piece of work. So far in this session of Parliament, our Committee has taken evidence on a range of reports and online outputs published by the Auditor General for Scotland (AGS) relevant to the scope of your inquiry work. I outline some of the key messages from our work below.
Improving outcomes for young people through school education.
The improving outcomes for young people through school education report, published by the Auditor General for Scotland and the Accounts Commission in March 2021, recognises the important role of the school education system, together with other sectors, "to tackle issues which affect young people's life chances and outcomes, such as child poverty and health and wellbeing".
The report highlights that many young people have reported that their mental health has been affected by the impact of the Covid-19 pandemic. Audit Scotland welcomes
the increased focus on supporting and monitoring wellbeing during the pandemic but cautions that this needs to continue. It also raises concerns that there is insufficient national data on some of the wider outcomes of school education, such as health and wellbeing.
The report also highlights that school education in Scotland is about more than just exam results. While there has been an increase in the types of opportunities, awards and qualifications available to children and young people, Audit Scotland reports that better data is needed to understand whether other outcomes, like wellbeing and confidence are improving.
The issue of insufficient data to measure outcomes is a consistent theme heard by our Committee. We would therefore encourage your Committee to consider what work is ongoing to develop better data on the health, wellbeing and confidence of children and young people as part of your inquiry.
As you will be all too aware, the Covid-19 pandemic has disrupted the life of every child and young person in Scotland. The report recognises that the impact of Covid-19 on outcomes for children and young people is influenced by their circumstances including their experience of poverty and deprivation. The report goes on to state that—
"Pupils living in very challenging circumstances have been most affected by the impact of school closures. These pupils were particularly affected by access to digital resources. The Scottish Government and its partners have taken action to address the digital gap, but it has taken time to implement these measures".
Scotland's Colleges 2020
This “digital gap” was an issue drawn to the Committee’s attention during its scrutiny of the AGS’s blog on Scotland’s Colleges 2020. During a roundtable evidence session in September 2021, the Committee heard directly from the President of the National Union of Students (NUS) Scotland, who stated—
“A striking moment this year was the realisation of just how many students were in digital poverty, particularly early in the pandemic, and struggled to access the laptops, equipment and internet connection that they needed to take part in their studies. The Government made some investment in the sector last year, which helped incredibly. It was not necessarily enough money, in that colleges were often topping up that investment from the Government. However, we still see digital poverty as an issue that is facing students this year”.
NUS Scotland also highlighted that students “are a demographic and a population that tend to struggle more with their mental health at that stage in life”. They also highlighted the wider benefits of students attending college, including gaining confidence and building their social skills, which was significantly impeded by the pandemic.
We would therefore encourage your Committee to consider how students within the college system are being supported with their mental health, as well as the issue of digital poverty in schools and other education settings, and the funding available to narrow the digital gap.
In October 2021, our Committee took evidence from a range of stakeholders on the provision of child and adolescent mental health services (CAMHS) in Scotland. This session was prompted by the publication of a blog on this issue by Audit Scotland.
The evidence session provided the Committee with an up-to-date position on how CAMHS are operating in Scotland. The Committee heard compelling evidence that limited progress had been made to address the significant concerns raised in Audit Scotland’s report on Children and young people’s mental health, published in 2018. Indeed, rejected referral rates, waiting times for CAMHS treatment and the availability of robust data on mental health services for children and young people appear to be as much of an issue today as they were three years ago. It is clear that the Covid-19 pandemic has clearly exacerbated a system that was already under significant pressure.
Following the evidence session, the Committee agreed to write to the Director-General for Health & Social Care and Chief Executive of NHS Scotland to—
seek further information about the significant variation in CAMHS waiting times across Scotland;
• establish how good practice is being shared to improve CAMHS across Scotland;
• provide a breakdown of the actions that have been taken against each of the 29 recommendations made by the Scottish Association for Mental Health and NHS NSS Information Services Division in its “Rejected referrals to child and adolescent mental health services audit”, published in 2018.
• provide further information on work the Scottish Government is progressing with Public Health Scotland to improve the quality and scope of data on the provision of mental health services for children and young people.
The Committee also agreed to write to the AGS to stress its view that urgent action is required to address the systemic issues, as abovementioned, and to encourage him to consider how Audit Scotland may seek to review its work programme in light of the evidence heard.
Responses have been received from the Director-General for Health & Social Care and Chief Executive of NHS Scotland and the AGS.
As regards the correspondence from the Director-General, the Committee was concerned by the limited level of detail provided on the action taken by the Scottish Government against the 29 recommendations of the “Rejected referrals to child and adolescent mental health services audit”. The Committee therefore invites your committee to consider this area in more detail as part of your inquiry work, if time permits.
The Committee also noted concerns recently expressed by the Scottish Association for Mental Health in the media about plans to replace the term “rejected referrals” by the Scottish Government. The Committee is of the view that the current term should be maintained until there is clear evidence that children and young people are able to access the support that they need for their mental health. The Committee wishes to draw this to your attention, should you wish to follow it up as part of your inquiry work.
As you will note, the AGS has no immediate plans to do any further audit work on CAMHS. Instead, he plans to undertake audit work on adult mental health services, while closely monitoring the progress on the actions being taken by the Scottish Government on CAMHS, to inform future audit work in this area.
While the Committee is disappointed that further audit work on CAMHS is not in the scope of the AGS’s work programme in the short term, it is encouraged that your inquiry on the health and wellbeing of children and young people will continue to shine a light on this important policy area.
We hope that this information is helpful to inform your inquiry work.
Your sincerely,
Richard Leonard MSP
Convener