Drugs Services

– in the Scottish Parliament on 14th December 2021.

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Photo of Liam McArthur Liam McArthur Liberal Democrat

The next item of business is a statement by Angela Constance on actions to increase access, choice and support through drugs services in Scotland. The minister will take questions at the end of her statement, so there should be no interventions or interruptions. You have around 10 minutes, minister. [Interruption.] Sorry, minister, but do you have your card in?

Photo of Angela Constance Angela Constance Scottish National Party

You are not going to make me shout, are you?

The Deputy Presiding Officer:

You have 10 minutes from now.

Photo of Angela Constance Angela Constance Scottish National Party

Thank you, Presiding Officer.

The loss of life in Scotland from drug-related deaths is still as heartbreaking as it is unacceptable. I offer my condolences to all those who have lost a loved one. My focus continues to be on doing everything possible to turn the tide on drug deaths. Two weeks ago, I updated Parliament on the progress that we are making on building capacity and improving access to residential rehabilitation. Today, I will focus on the other main pillar of the national mission: medication-assisted treatment—MAT— standards.

I had hoped to visit services this morning in Kirkcaldy to hear specifically about the experience of setting up same-day treatment and the other MAT standards there. Sadly, that visit could not go ahead because of omicron. On my visits to other areas where same-day treatment is already in place, I have seen and heard about the difference that it has made for people. Introducing the MAT standards quickly has improved lives.

First, I will say a few words about the quarterly figures on suspected drug deaths that were published today. Although those indicate that there might have been slightly fewer suspected deaths over the first three quarters of 2021 than there were during the same period in 2020, as I said in the chamber in September when the first quarterly report was published, the figures remain high and there is still a long way to go.

The report is on estimated drug deaths from Police Scotland information and is the second report to be published this year. It covers July to September. Although the report is on suspected drug deaths, so it cannot be used to make accurate predictions about the status of the annual report for 2021, which will be about confirmed cases, it helps services to respond more quickly to what is needed and it will help Parliament to monitor progress.

In that vein, I can also announce that I have approved investment of more than £1.1 million over three years for a range of measures to further help to monitor progress. Surveillance projects will be developed on a new problem drug use prevalence estimate, a hospital-based toxicology study and improvements to the national drug-related deaths database. All those projects will improve our real-time understanding of harms to enable faster and better responses.

We know that treatment is protective, and my priorities start with getting more people into protective treatment on the back of our commitment to an additional investment of £250 million over the five years of the mission. One of the most significant things that we are doing to achieve that is implementation of the medication-assisted treatment standards, which the Scottish Drug Deaths Taskforce produced in May 2021. I am grateful to it for that work. Embedding the standards across Scotland by April 2022 is a key priority to give people access, choice and support through drugs services. The MAT standards set out what people should expect and can demand of services.

In June, Parliament agreed that I should provide regular updates on progress. The first thing that I will report on is the launch of our stigma strategy last week. Stigma is, for many people, a barrier to the services that people have a right to, whether that is to residential recovery or MAT. The need to tackle stigma is laced through the MAT standards, so that important campaign aims to get everyone to think and talk about problem drug use in a much less judgmental way as a first step towards ending stigma.

I can also report that I have now met chairs, chief executives and chief officers of authorities across the country to get their assurances and commitments to embed the standards in a way that will make a real difference to the services that people can access from day 1. With the support of our national implementation team, which is based in Public Health Scotland, we have helped all authorities to assess their readiness, identify where they need extra support and produce project specification documents, which are now being signed off by integration authority chief officers.

I can also report that good progress is being made in turning services around to improve access, choice and support. To help with that, we will provide around £6 million this year to ensure that all standards are fully embedded by April 2022. I have committed to providing more than £10 million a year for the next four years to ensure that the standards are continuously improving.

I will highlight some of the key things that this year’s funding will help to achieve. In Fife, we will be providing £300,000 a year to help to set up a benzodiazepine-specific treatment service. That new service will directly address the growing risk of benzos contributing to drug deaths, and other areas will be able to learn from it. In Dundee, we are providing £600,000 a year to get more people into treatment through primary care. That is one of a suite of new approaches that are being taken in Dundee, signalling a change in its service model, as recommended by the Dundee drugs commission. Those new approaches have been made possible by the additional funding that has come with the national mission.

As I said to the Health, Social Care and Sport Committee in September, everyone is focused on getting MAT standards properly embedded by April 2022, but the work does not stop there. Over the life of the national mission, we want services to improve continuously and we want that improvement to be sustained for people who need help and support.

As members would expect, there will be tough challenges ahead. The implementation team and local services have identified some issues that have to be resolved. There were workforce challenges across health and care even before Covid; there are still some areas that rely on very medicalised models of care, even where there is support available from other disciplines and third sector partners; and we know that services in rural areas will face particular challenges, such as the distance to travel to services for same-day treatment.

To overcome those challenges, we are supporting local areas to share best practice on solutions. We are asking local services to adapt their care models to be less reliant on traditional, medical models of care, and we want to empower local third sector groups to do what they do best, which is providing flexible, local alternatives at pace. We are encouraging local areas to adapt their primary care models to get more general practitioner practices and community pharmacies involved in the care of people with problem drug use. Such flexibility will be required to make the MAT standards sustainable.

That will mean that people will not have to wait for days or even weeks to access MAT and same-day treatment will become the norm. A wider choice of MAT will be available, with people having more choice of dosage and long-acting buprenorphine being made more widely available than it has been before. Better assertive outreach and anticipatory care will be in place to help people at high risk to start or continue on MAT. Everyone in treatment will be given support to remain in treatment for as long as they need, which is particularly important through transitions from rehabilitation, from hospital or from prison.

Services will be psychologically informed and will help people to grow social networks. Primary care and mental health care will be available alongside MAT, and all care will be trauma informed. Advocacy and support for housing, welfare and income needs will also be available from MAT services.

In my next six-month report to the Parliament on MAT, in June 2022, I will be able to report on how authorities have moved beyond embedding the standards to improving on them.

The implementation team will be working with services in March and April next year to gather evidence that the standards are all embedded. That evidence will be made available and it will be more than just proof that all the necessary processes and structures that are set out in the MAT standards are in place. We have already begun training locally to gather evidence of progress from people who are using the services. Authorities will be relying on experiential evidence to help to show what has improved and to make further, sustainable improvements across the life of the national mission.

No one should underestimate the scale of the challenge that I have set for integration authorities and alcohol and drug partnerships to embed the MAT standards by April 2022—I certainly do not. However, the standards will help to make people’s rights real, and I can report that we have already made good progress towards that. With that progress, we can improve and save lives as part of the national mission by increasing access, choice and support for people through drugs services.

The Deputy Presiding Officer:

The minister will now take questions on the issues that were raised in her statement. I intend to allow around 20 minutes for questions. If members wish to ask a question, I ask that they press their request-to-speak button or place an R in the chat function.

Photo of Sue Webber Sue Webber Conservative

I draw members’ attention to my entry in the register of members’ interests: I am a member of Edinburgh Alcohol and Drug Partnership.

Six months ago, when Scotland’s shocking drug death statistics for 2020 were first released, Nicola Sturgeon promised to get a grip on the crisis and pledged an additional £250 million to tackle the drug deaths emergency over the next five years. Last week’s budget announced that there would be £147.6 million to address the twin public health emergencies of drug deaths and the harms from alcohol. That included £61 million specifically to address the national tragedy of drug deaths, as part of a commitment to invest £250 million over the lifetime of this Parliament. The figure for the same thing in the budget for 2021-22 was £145.3 million. If we adjust the budget for inflation, that means that services are facing a real-terms cut of about £2.5 million. The First Minister pledged to get it right and to provide funding. Where is the additional £250 million that was promised?

Photo of Angela Constance Angela Constance Scottish National Party

To start on a positive note, it is useful to know that Ms Webber is a member of the Edinburgh Alcohol and Drugs Partnership. I hope that that will be a useful source of information for us both.

I suggest that the member may have been a little mischievous with respect to the budget. The First Minister made a very clear commitment at the start of this year of £250 million in addition to core alcohol and drug budgets, and that is reflected in the budget. It was a key manifesto commitment, which the Government is following through. I assure Ms Webber that I am ensuring that every penny of that additional £250 million will be put to the maximum use to save and improve lives.

The Conservatives are more than welcome to pitch up to Parliament and argue for an extra £1 million or £2 million. I have pitched up to Parliament with the full support of the First Minister and the Cabinet Secretary for Finance and the Economy and have brought £255 million, which is made up of £5 million in emergency funding at the start of this calendar year and that crucial £250 million over the lifetime of the national mission. We are delivering on our promises to invest in and reform services, and I assure Ms Webber that every penny of that money will be put to good use.

Photo of Claire Baker Claire Baker Labour

Today’s recorded suspected drug death figures are a sobering reminder of why the statement has been made today. I hope that the reported decrease marks the start of real improvements, but the fact remains that the long-term trend is still upward and progress has been too slow.

Today’s update is welcome and the minister claims that good progress is being made. Will she be publishing any data or documents to support that description? For example, it would be instructive to know how many ADPs are achieving MAT standard 1 on same-day prescribing.

What progress is being made in addressing the high fatality rate that is linked to street benzos? The benzodiazepine working group issued interim clinical guidance in August. Today’s report from the Scottish Drug Deaths Taskforce talks about a consensus meeting and then a conference. Although I welcome the specific treatment announcement that has been made about Fife, 70 per cent of fatalities in 2019 were linked to street benzos. If we are serious about addressing fatalities, work on that must be a priority.

The Government must press ahead with safe consumption rooms as part of a package. I know that there are barriers, but I do not accept that those are insurmountable. When will the Government bring forward a proposal on that issue?

Photo of Angela Constance Angela Constance Scottish National Party

Ms Baker is correct to reflect on the sobering reminder of the statistics about suspected drug related deaths that were published today. Although those figures show a small decrease in the first three quarters of this year compared to the same period last year, we report the facts and must take care not to draw too many conclusions from the statistics. She is correct in saying that the statistics must be treated with care. The bottom line is that drug deaths in this country remain far too high.

I am regularly briefed by my officials about the data that we publish. The position is ever-changing, with progress being made every week. However, as I outlined in my statement, we will gather the evidence and interrogate it, and we will publish more information before or at the time of my next six-monthly statement and progress report to Parliament so that members can see the situation area by area and standard by standard. I am also happy to extend to Ms Baker and other MSPs an open invitation to come and engage on progress in any area if they want to do that. We are delving into the detail and scrutinising the delivery of MAT standards in all 30 alcohol and drug partnership areas.

The point about benzos is very important. There are plans for a round-table discussion on the subject at the start of next year. The area is hotly debated among clinicians, and I am keen that we build a consensus on it. We are also in discussions with the UK Government on some legislative opportunities in and around prohibiting the sale and use of pill presses.

On safer drug consumption facilities, we are pursuing two options. We continue to engage with the UK Government, but our detailed and delicate work on what we can do within our powers also continues. Like Ms Baker, I am absolutely determined.

The Deputy Presiding Officer:

I am conscious from earlier statements on the issue that there is a lot of interest in it and that the minister can provide a lot of detail but, given the number of colleagues who want to ask a question, I would be grateful for succinct questions and answers from now on.

Photo of Gillian Martin Gillian Martin Scottish National Party

Problem alcohol and drug use affects not just the person who is seeking treatment but their family too, and in particular dependent children. How is the minister ensuring that those who are parents get appropriate treatment choices that take into consideration their caring responsibilities? She mentioned stigma, and I note that fear of repercussions and stigma among parents who have alcohol and drug problems may prevent them from coming forward for treatment. I would be interested to hear a little more detail on how that is being addressed.

Photo of Angela Constance Angela Constance Scottish National Party

I will attempt to be brief. The issue of stigma, which Ms Martin highlighted, is particularly important in the work to overcome the barriers to supporting women to achieve access to the services that they need. Ms Martin will be familiar with the work that we have undertaken with respect to residential rehabilitation and filling the gaps in services there with respect to women and children. On Wednesday last week, at the Beacons in Blantyre, I launched the framework to improve holistic family support, which is about the importance of family-friendly services. The framework is backed up with funds totalling £6.5 million.

In addition, the Drug Deaths Taskforce recently published a report on women and drug-related deaths, which makes a range of recommendations on the development of services, collaboration, the sharing of information and workforce training. They will be taken forward as part of the implementation of MAT standards.

Photo of Craig Hoy Craig Hoy Conservative

Between 2006-07 and 2015-16, cocaine was the main drug of between 5 and 8 per cent of drug users, but the figure rose to 21 per cent in the most recent data, which was released in March. As part of the national conversation on drugs, what is the minister’s message to those regular cocaine users, very many of whom believe that their use is simply recreational and who would, therefore, never think of seeking out help, support or treatment?

Photo of Angela Constance Angela Constance Scottish National Party

Mr Hoy is correct to point to the growing implication of cocaine use in drug-related deaths. I am paying particularly close attention to the matter and I have been discussing it with a range of services including the alcohol and drug partnership in my local area of West Lothian, where there are particular concerns about young men using cocaine on a regular basis and the particular harms that are associated with that in terms of debt, financial pressures and mental health.

There are treatment options for cocaine use and it is imperative that people come forward to seek help in that regard. With cocaine use, there is a need to have person-centred approaches, and often to employ more motivational approaches in order to help people to identify the problems that cocaine is causing them in their lives, and to work out person-specific plans to help to overcome that.

The Deputy Presiding Officer:

The next three colleagues join us remotely.

Photo of Alasdair Allan Alasdair Allan Scottish National Party

What action is the Scottish Government taking to improve drug services in rural areas, in which there is often less choice in services? In particular, how are third sector organisations, such as the Shed Project in my constituency, being enabled to continue and expand the vital work that they do to support people, including those who are struggling with addiction?

Photo of Angela Constance Angela Constance Scottish National Party

Local initiatives such as the Shed Project in Alasdair Allan’s constituency, which provides drop-in services that are tailored for people with alcohol or drug-related problems, are vital to the delivery of services in rural areas.

There are specific challenges for rural areas, just because of their geography and the distances that are travelled. Nonetheless, I am clear that MAT standards have to be delivered in all parts of Scotland—albeit that the solutions for rural areas may need to be more innovative and more flexible. That is why the MAT implementation support team is working with a range of rural services to share best practice, and is working hard to find solutions to those unique challenges. That work is being supported through an additional financial resource, which this year was initially identified as £4 million but which has now increased to £6 million.

Photo of Baroness Katy Clark Baroness Katy Clark Labour

I have no doubt that the minister agrees that it is important to have the community on side, with maximum consultation on all aspects of drugs policy. I know that that was raised with her previously, when North Ayrshire Council, community councils and the local community found out from the media about the national drugs facility that is intended for Saltcoats. Will she outline what she can do to ensure maximum consultation, and will she provide an update on what is happening about the Saltcoats facility, so that that can be shared with the community?

Photo of Angela Constance Angela Constance Scottish National Party

I imagine that Katy Clark is aware that that question was covered rather comprehensively in my last statement to the Parliament. I reiterate that I have a responsibility to lead a national mission. Gaps were identified in services that are available to women and families. We sought to address that. I have engaged with some of the councillors in the area and with the local constituency member, Kenneth Gibson. I assure members that Phoenix Futures has a great track record in working with communities and in saving and improving lives, as can be seen from the very similar project that it has run in Sheffield for the past 25 years.

Photo of Stephanie Callaghan Stephanie Callaghan Scottish National Party

Will health boards be encouraged to carry out their own local consultations? The increase in our services must be progressed in a way that best meets the needs and circumstances of our local service users.

Photo of Angela Constance Angela Constance Scottish National Party

I have two points to raise. We have provided ADPs with an additional £0.5 million this year and for the life of the national mission to increase and improve their engagement with people who have lived and living experience of drug use. In addition, as part of our specific work on implementation of the MAT standards, as I referred to in my statement, we are recruiting local people so that we can bear down on the detail of good qualitative evidence from those who matter most. That is about people who are trying to access—or who are accessing—services. There is investment in peer-to-peer research; that is particularly important.

Photo of Willie Rennie Willie Rennie Liberal Democrat

I thank the minister for her detailed work. The big question is whether it is enough to meet the enormous challenge that has built up, with Scotland having the highest drug death rate in Europe.

As I am sure that the minister knows, there has been a significant increase in the number of deaths of homeless people in which drug misuse was a major factor. What has she learned from those deaths? What plan does she have for improving stabilisation services?

Photo of Angela Constance Angela Constance Scottish National Party

I very much appreciate Mr Rennie’s questions, because the point about stabilisation services is very important. It relates to our concerns around not only alcohol, but benzodiazepines. Whether we are talking about detoxification or stabilising people who are in chaos or crisis, that often needs to be done in supervised environments with the correct medical and clinical support. We have received a report from the Drug Deaths Taskforce that makes recommendations around stabilisation services—I have been to visit a few such services—and we are taking that forward.

On the points that Mr Rennie raises regarding the correlation between homelessness and drug deaths, the bottom line is that we do not have enough people in treatment. That is on us, and that is why getting more people into treatment is at the core of our national mission to save and improve lives. That means that we have to work harder to prevent people from becoming homeless in the first place and to reach people who are further away from services. Mr Rennie is correct to point to the scale of the challenge, but we can make a difference. Such deaths are avoidable and preventable, and there is evidence from around the world on what we need to do.

The Deputy Presiding Officer:

We have three and a half minutes and four members with questions, so I ask members to be as brief as possible.

Photo of Stuart McMillan Stuart McMillan Scottish National Party

Can the minister provide an assurance that abstinence-based rehabilitation centres that are operated via religious organisations will also qualify for funding, in order to provide increased choice for people who are seeking assistance?

Photo of Angela Constance Angela Constance Scottish National Party

Faith-based residential services are included in the scope of residential rehab funding. Obviously, there needs to be transparency and accountability, and clarity around how faith informs the model of care, and we would expect all providers to be equal opportunities providers. I value the role of the faith communities in service provision, and there is also a role for them to play in winning hearts and minds.

Photo of Gillian Mackay Gillian Mackay Green

The minister mentioned in her statement the interaction between stigma and medication-assisted treatment. I appreciate that the detail of the stigma strategy is probably too great to go into here. Nonetheless, what practical work is under way to engage directly with those who would benefit from medication-assisted treatment, in particular those who may suffer from multiple stigma?

Photo of Angela Constance Angela Constance Scottish National Party

I point to the fact that the media campaign that is aimed at tackling stigma was carefully developed, over a not inconsiderable period of time, with people who had lived and living experience. However, as we go forward with the national mission, there is more to do to address the stigma that people in the workforce feel, and which families and communities are adversely affected by, too.

Photo of Brian Whittle Brian Whittle Conservative

The minister is initially focusing, quite rightly, on preventing death in the most acute drug addiction cases, but there is also a need to prevent people from falling into that position in the first place. Does she agree that we need to co-ordinate our resources and use the data to deploy them in the most effective manner, with greater integration between statutory and third sector services? She will be aware of my view on funding the third sector effectively.

Photo of Angela Constance Angela Constance Scottish National Party

I hope that Mr Whittle is well aware of my view that we absolutely need to have an acute focus on prevention and education, as we do. I hope that he is also aware of my views on the value, role and potential of the third sector in this country, which is why funds of £11 million were announced this year.

Photo of Audrey Nicoll Audrey Nicoll Scottish National Party

I welcome the minister’s announcement this afternoon. She will know that the Criminal Justice Committee has been taking evidence on the challenges that are faced by people who were previously accessing drug services and are now in prison.

In our recent pre-budget scrutiny work, committee members recommended, among other things, investment in recovery cafes in prisons. To what extent will the actions that the minister has outlined today support the Scottish Prison Service’s on-going work to respond more effectively to prisoners who have a drug dependency? Will there be an injection of funds in recovery cafes, as the committee asked for?

Photo of Angela Constance Angela Constance Scottish National Party

I again point to the funds that are available to the third sector. I have visited recovery cafes—most recently, the one in Perth prison. I recently met the Addiewell recovery cafe team at the annual recovery walk. The MAT implementation support team is very focused on working with the national prison care network to ensure that access to MAT is not compromised and that people in prison have the same access to MAT standards.

I very much support recovery cafes. We fund organisations such as the Scottish Recovery Consortium and Sustainable Interventions Supporting Change Outside—SISCO—to carry out recovery work in prisons. They bring that lived experience from local recovery communities into prisons to provide support such as peer mentoring. They are very valuable indeed.

The Deputy Presiding Officer:

Thank you, minister. I apologise to Monica Lennon for not being able to call her to speak.

Photo of Stuart McMillan Stuart McMillan Scottish National Party

On a point of order, Presiding Officer. I apologise to members for omitting to declare my interest as a board member of Moving On Inverclyde, which is not a faith-based organisation.

The Deputy Presiding Officer:

Thank you, Mr McMillan. That is now on the record.