National Mission on Drugs

– in the Scottish Parliament at on 8 September 2022.

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Photo of Annabelle Ewing Annabelle Ewing Scottish National Party

The next item of business is a statement by Angela Constance, who will give an update on the national mission on drugs. The minister will take questions at the end of her statement, so there should be no interventions or interruptions.

Photo of Angela Constance Angela Constance Scottish National Party

First and foremost, I want to convey my deepest condolences to those who have lost a loved one, and to reaffirm my commitment, and that of the Government, to saving and improving lives. Every loss of a life to a drug death is as tragic as it is unacceptable. During the recess, National Records of Scotland published its annual drug-related deaths report, which confirms that we lost 1,330 fellow citizens to drugs in Scotland in 2021. This remains a public health emergency.

Although there has been a slight decrease from the previous year, deaths continue to rise for some groups of people and in some geographical areas. Deaths among women, for example, increased again in 2021. That is particularly concerning, and it emphasises the need for us to do more for women and families. I am pleased to inform the Parliament that the Phoenix Futures family service and the first Aberlour mother and child recovery house will come on stream soon, and I have seen for myself the progress that is being made at River Garden Auchincruive in developing new accommodation for women.

There has been a reduction in the number of deaths among under-25s—although the figure remains too high, as every death is one too many. A survey of young people on their drug and alcohol use is currently being analysed, and we will use the information from it to co-produce service standards in order to meet their needs.

As in previous years, the majority of drug deaths involved more than one drug. While opiates remain the most prevalent, benzodiazepines—particularly street benzodiazepines—were implicated in nearly two thirds of deaths.

Some key outcomes from our recently published “National Mission on Drug Deaths: Plan 2022-2026” are fewer people developing problem drug use, the tackling of multiple disadvantage, and support for families and communities—alongside the need to reduce harms and promote treatment and recovery. That plan, alongside Public Health Scotland’s recent “National Drug-Related Deaths Database (Scotland) Report”, will help us to understand where and when to better target our response.

In July, the Scottish Drug Deaths Taskforce published its vital final report, “Changing Lives”, and again I thank all its members, past and present, for their contribution. The final report contains 20 recommendations and 139 actions. It is comprehensive, critical and challenging; I asked for a bold blueprint for action and I welcome it.

The task force asked that we publish an action plan within six months, setting out how we will deliver its recommendations. I commit to doing that and, ahead of my appearance next week at the joint meeting of the Criminal Justice Committee, the Health, Social Care and Sport Committee and the Social Justice and Social Security Committee, I will publish our first response to those recommendations in more detail.

Taking forward the task force report, we have also given alcohol and drug partnerships £3 million to invest in their response. Officials will be working with ADPs on the priorities for that funding in line with the task force recommendations.

The task force report is a challenge to all of us across Government, the Parliament and wider society. Culture change is at the heart of the report’s call for a system to be based on care, compassion and human rights. The Government will lead by example, through developing a cross-Government programme of work to support that change. That work focuses on three challenges: ensuring more holistic support; prioritising prevention and early intervention; and tackling stigma. Those cannot be delivered by one department, nor indeed by Government alone, but will require co-ordinated action and commitment from a range of sectors in public life. That co-ordinated programme of work will be published in a cross-Government action plan and will set out how other portfolios—for example, housing, justice, education, mental health and primary care—will support the work of our national mission.

That work will have to be delivered against the backdrop of the rising cost of living and the additional pressures that that will undoubtedly bring to bear on individuals and the services that support them.

The task force report is clear that a cultural shift is required in how we treat, think about and speak about people who use drugs. “Stigma,” it says, “kills people”. Stigma cuts deeper, though, and can blight many aspects of people’s lives, not just those relating to drug and alcohol services. Stereotypes and prejudices put up unnecessary barriers that prevent people from flourishing. There are practical steps that all of us in Scotland should take to address that stigma, remove those barriers and improve access to services. As outlined in the programme for government, we will publish a stigma action plan. I will provide a further update on that work in the autumn.

We know that complex challenges exist around recruitment, retention and service design. We have recently established an expert group on workforce to identify immediate actions that can be taken to tackle those challenges. As recommended by the task force, the group will develop a workforce action plan, which will set out the longer-term actions required to deliver a sustainable skilled workforce that is valued for its work. I intend to return to the Parliament in November to provide a further update on that work.

It is also important to acknowledge that, throughout its lifespan, the task force regularly made recommendations and engaged with Government and others, which means that a wide range of the activity that it has proposed is already under way. The medication-assisted treatment standards, which were initially developed by the task force, form a key part of our national mission.

As members will know, in June, I wrote a letter of direction to health boards, integration authorities and local authorities to make sure that local partners are in no doubt about the Government’s commitment to the standards and their responsibility for their delivery. By the end of September, chief officers must publish improvement plans for implementing the standards. In line with the task force’s recommendation, those plans must involve and include the voices of people with lived and living experience.

The continued roll-out of naloxone is another area of action that the task force has spearheaded. Many of our emergency services now routinely carry naloxone as a result. That includes Police Scotland, which began the national roll-out of its naloxone carriage programme in August.

However, we need to progress in other areas that are highlighted in the report, including improving accountability. To better do that, I established the national mission oversight group to provide scrutiny, challenge and expert advice to the Scottish Government and the wider sector as services are adapted and improved to save lives. I have invited David Strang, the former chair of the Drug Deaths Taskforce, to be the independent chair of that group, bringing his skills, knowledge and leadership to the oversight of the national mission.

The task force also calls for the Scottish Government to continue its work with partners to implement a safer drug consumption facility. I confirm that the Crown Office is considering the proposal that was shared with it at the end of June, before briefing the Lord Advocate on the matter. I will update Parliament further once a response has been received from the Lord Advocate.

The UK Government has also published a white paper, “Swift, Certain, Tough”, which outlines new consequences for drug possession, including measures such as passport confiscation. Increasing or expanding criminal sanctions have not in the past proven successful in preventing drug deaths. Given that some of the proposals might apply in Scotland, I have written to the UK Government setting out some of my concerns. Much of what is included in that paper runs contrary to our public health approach, but I would welcome views from across the chamber on the matter.

In addition to consulting parliamentary colleagues, I will return to Parliament to provide updates on our work on stigma, workforce, MAT standards and the cross-Government plan in the coming months. The Government will redouble its commitment to the national mission on drugs, the principles of which will guide us through the emergency. They are: follow the evidence, invest to transform services and trust our lived and living experience.

The independent national collaborative, chaired by Professor Alan Miller, will produce its vision for integrating human rights into national policy and local service design and delivery. The collaborative is recruiting to its change team and reference groups. It will ask tough questions and demand clear answers, and I have no doubt that it will hold us all to account, ensuring that people with experience can participate in decisions that affect them.

September is international recovery month and, so far, I have had the pleasure of attending community events in Kilmarnock and Penicuik. I also look forward to the forthcoming recovery walk in Paisley. The visibility of the recovery community reminds us all that people can and do recover. As well as saving lives, it is our job—indeed, our mission—to ensure that our families, friends and neighbours not only survive but thrive.

The Deputy Presiding Officer:

The minister will now take questions on the issues that were raised in her statement. I intend to allow about 20 minutes for questions.

Photo of Sue Webber Sue Webber Conservative

I thank the minister for advance sight of her statement.

We can all agree that, when someone is brave enough to come forward for support, they should not have to wait months for help, but, sadly, that is exactly what is happening on the ground. One of my constituents, James, first sought help in February this year, having been directed to the local recovery hub in south-west Edinburgh. James did not get his place in residential rehabilitation until the end of August. That was six months—half a year—of waiting, of jumping through hoops and of barriers. That is the case of someone who knew the system.

There is nothing new in the statement that would have expedited help for James. There are just more working groups and oversight groups. That is far removed from what is needed: actual action on the ground.

Access to residential rehabilitation should be immediate upon request. I do not need to remind the minister that saving a life is all about grasping that window of opportunity—a window that is often both narrow and closing. I could hear the frustration and pain in James’s voice as he relayed to me the process that he was forced to go through. To really cap it off, when he finally got his residential rehab placement, James was then means tested for it.

Does the minister think that it is acceptable that people are having to wait six months for a placement and that local councils are, in some cases, using means testing for access to out-of-area residential rehabilitation placements?

Photo of Angela Constance Angela Constance Scottish National Party

Let me say directly to Ms Webber that people should not be waiting months for the treatment that they are assessed as requiring. She will, of course, be aware, as I am, that decisions on access and assessments are taken at local level.

Nonetheless, the Government has taken action through the residential rehabilitation working group, which has provided all areas with a good practice guide that I expect to be implemented. All areas now have—or so they inform us—operational pathways into residential rehabilitation. I would obviously appreciate receiving any more detail about Ms Webber’s constituent’s experience of that pathway.

It is my job to ensure that there is funding, because I want to ensure that people who are assessed as requiring residential rehabilitation can access it when that is clinically appropriate. We are monitoring and evaluating how each ADP area is using the funding that has been allocated by the Scottish Government. I appreciate that it might be of little comfort to Ms Webber’s constituent, but I know for a fact that, over the past financial year, more than 500 placements were publicly funded via ADPs. That is a substantial increase. The financial investment that we have made to date will increase capacity by 20 per cent.

The point that Ms Webber makes about using existing capacity in the system is well made, and that is why, despite housing benefit being reserved to the UK Government, I developed the dual housing support fund. I do not want people having to choose between funding their residential care placement or their tenancy.

There is always more work to do, and we will do that. I accept that there is certainly more work that needs to be done at local level.

Photo of Claire Baker Claire Baker Labour

I thank the minister for advance sight of the statement, and I welcome the appointment of David Strang as the chair of the national mission oversight group.

More strategies and structures have been announced today, but it is three years since the public health emergency was declared, with at least 2,500 people having died from drug overdoses. Those were preventable deaths, and those people leave behind devastated loved ones. I will hold the Government to account for that, for the lamentable lack of delivery on MAT standards and for the cuts to ADP budgets, which are only now being reinstated. However, we all want the same outcomes—the deaths to stop and people to be supported, accepted and able to live a life.

In order to ensure a more rapid response—one that does not wait for the action plan or for a decision on priorities—will the Government ensure that people who have had a near-fatal overdose, including those who have already experienced one, are always contacted and offered support, regardless of which health board area they live in? I know that MAT standard 3 says that, but the task force’s report says that not all health boards are delivering that due to capacity and resourcing issues.

The minister also mentioned the impact of street benzos. When will we see the final clinical guidance and a strategy to address their widespread usage?

Photo of Angela Constance Angela Constance Scottish National Party

Ms Baker is quite right: I have no doubt that members across the chamber all want to see the same outcomes, and the deaths are, indeed, preventable.

With respect, I remind Ms Baker that, since I came into this post, a long list of actions have taken place over the past 18 months or so. Those include more timely reporting of suspected deaths, the establishment of a treatment target, the 191 projects that are being funded over five years to the tune of £35 million, the continuity of funding that I have provided to both front-line and third sector organisations, the 511 residential placements that have been funded, and the work that is going on right now to continue the widening of things such as distribution and support to families. It is a little disingenuous to decide that it is all about plans and that there has been no action.

On the point that Claire Baker makes about MAT standards, I think that we are on the same page. MAT standard 3, which involves outreach and quick action following a non-fatal overdose, is crucial, as there is a window of opportunity. Claire Baker will be aware of the improvement plans that have to be published in all areas as a result of ministerial direction. Some areas will be under quarterly oversight and reporting arrangements and some areas will be under monthly ones. We are currently documenting the capacity of ADPs to improve and measure standards. I want MAT standards, including MAT standard 3, to be implemented ASAP. MAT standards are not optional; they are necessary and they save lives.

On benzodiazepines, the progress that has been made with MAT standards has brought about positive improvements in some areas, with people being able to access a better and more holistic treatment option. Claire Baker will be aware of the work that we are funding, again through MAT standards, in relation to the benzodiazepine treatment clinic in Fife. Two sets of clinical guidance are currently available in relation to the prescription of benzodiazepines, but I accept that we need to do much more work to increase the confidence of medical practitioners in the use of that guidance.

The Deputy Presiding Officer:

Before I call the next MSP who wishes to ask a question, I make two points. First, I remind all members who wish to ask a question to ensure that they have pressed their request-to-speak button. Secondly, in order to get through as many questions as possible, we will need more succinct questions and answers.

Photo of Joe FitzPatrick Joe FitzPatrick Scottish National Party

I take this opportunity to offer my condolences, along with those of the minister, to all those who have lost a loved one.

I know that the minister is familiar with the important work of the Dundee drugs commission, which made a number of recommendations earlier this year. What support has been provided to assist in taking forward the commission’s recommendations? What monitoring is in place to ensure that sufficient and rapid progress is being made on those and on the implementation of the MAT standards in Dundee? It is worth noting that Dundee is excelling in relation to MAT standard 3, but, as the minister said, it is all of the MAT standards that count.

Photo of Angela Constance Angela Constance Scottish National Party

Although the recommendations in the report were for the Dundee partnership, I assure the member that I have engaged with the commission and the partnership. The MAT standards implementation support team regularly meets Dundee City Council, and it is providing clinical expertise as well as practical support to make the necessary changes to embed the standards. A monitoring system is in place, and ADPs have been supported in setting up the reporting schedule for the progress towards implementing each of the MAT standards. I can advise the chamber that NHS Tayside will be doing that on a monthly basis.

Photo of Craig Hoy Craig Hoy Conservative

Does the minister realise that we have spent the last 15 minutes listening to cans being kicked down the road? Does she share my concern about the steep rise in the number of drug misuse deaths in which cocaine is a contributing factor—up from 6 per cent in 2008 to nearly one in three last year? What more can the minister do to combat cocaine use, particularly among younger and middle-aged men, a disproportionate number of whom are falling into the trap of a downward and dangerous spiral of regular cocaine use, which is damaging their health, leading to financial hardship and, ultimately, costing lives?

The minister and I talked about that last year, so how about having no more action plans and no more working groups and, instead, having action on the ground—

The Deputy Presiding Officer:

And, as we get to the final question, how about having succinct questions, which I have just asked for? Minister, could I have a succinct answer?

Photo of Angela Constance Angela Constance Scottish National Party

I dispute the allegation that we are kicking anything down the road. Action is taking place and progress is being made right now in every community in Scotland, supported by Scottish Government funding. We are not only investing in services; we are also reforming services.

It is imperative that those in this chamber who, at times, accuse this Government of being overcontrolling and centralising, and who champion local accountability, remember that, as this Government takes on our responsibilities—we will not shy away from our commitments—we also want to have a transparent system in which there is accountability at every tier of government.

I will do everything that I can to monitor, support and scrutinise work that is going on on the ground and to facilitate it.

On the question about cocaine, we have to remember that cocaine use is often in the context of poly-drug misuse, and that that makes treatment options more complex. However, we should not forget that this is not just about medication-assisted treatment; in respect of cocaine in particular, it is about psychosocial interventions, and we need to have parity. I assure members that there is parity between medication-assisted treatment and the more psychosocial interventions.

Photo of Audrey Nicoll Audrey Nicoll Scottish National Party

The national mission outlines the Scottish Government’s commitment to increasing distribution and availability of naloxone. I recently worked in partnership with Alcohol and Drugs Action in Aberdeen to train my staff to administer naloxone. Further to the update that was provided in her statement, will the minister outline how the Scottish Government will ensure that those who work in our emergency services and our prison population and staff have access to and training to administer naloxone, given its efficacy in saving lives?

Photo of Angela Constance Angela Constance Scottish National Party

I commend the action that has been taken by Ms Nicoll and her staff. The Scottish Drugs Forum provides free training to members of the public and professionals on how to administer naloxone.

We fund the award-winning and innovative click and deliver service that is provided by Scottish Families Affected by Alcohol and Drugs to improve access and make that more simple for individuals or, indeed, their families.

We have invested to widen access within the Scottish Ambulance Service, the police and the Scottish Fire and Rescue Service in a pilot. The very important peer naloxone programme that is taking place in communities and prison settings is in recognition of the heightened risk of overdose on release from prison.

However, there is, of course, more that we could do—in particular, to improve the supply of naloxone in prisons.

Photo of Paul Sweeney Paul Sweeney Labour

I thank the minister for advance sight of her statement.

The minister will be aware that the consultation on my proposed drugs death prevention (Scotland) bill closed at midnight last night, and that more than 85 per cent of respondents to that consultation believe that an oversight body must be entirely independent of Government in order to be effective. Sadly, that is not the case with the new national mission oversight group, which appears to be a continuation of the task force, rather than anything else. Will the minister commit to establishing an independent body, such as my proposed drug death council, or are we just going to continue to keep doing the same thing over and over again, as we have for the past 15 years, while expecting different results?

Photo of Angela Constance Angela Constance Scottish National Party

On the one hand, colleagues say that there are too many groups, working groups and organisations. On the other hand, Mr Sweeney is asking me to establish another group. The national oversight group is not a replacement for the drug deaths task force. The drug deaths task force’s work is done—that work is complete and it is now for the Government to take it forward and deliver.

On national oversight, other members—I think that Mr Alex Cole-Hamilton did so—have recommended that we tap into international expertise. There is, in fact, international as well as home-grown expertise on the national oversight group. I am very pleased to say that Mr Strang has agreed to take on being the independent chair of that group.

As well as the national oversight group, accountability is within Parliament, first and foremost. As a minister, I welcome the fact that the biggest and best body to hold the Government to account and to scrutinise it is our Parliament. I would always advocate that.

Photo of Collette Stevenson Collette Stevenson Scottish National Party

I welcome the commitments in the programme for government to publish a cross-Government action plan and an anti-stigma plan as part of the national mission. Taking a whole-person approach and doing everything that we can to eliminate stigma are essential, alongside the Scottish Government’s work to improve access to treatment. Can the minister provide more details on those plans and the benefits that they could bring?

The Deputy Presiding Officer:

Minister, could you please try to do that reasonably briefly? Thank you.

Photo of Angela Constance Angela Constance Scottish National Party

Yes, Presiding Officer.

I know that Ms Stevenson is a great advocate for and champion of people who are affected by drugs, and that she is always fearless in tackling stigma.

The stigma plan will propose concrete actions. We need to do that in a meaningful way. We will roll out the stigma charter that was developed by the task force, but there is also a key strand of our anti-stigma work that connects very closely with our work on the workforce, the national collaborative and the work that we are doing to roll out MAT standards. The national media campaign and the Stop the Deaths campaign were also important in that regard.

Photo of Alex Cole-Hamilton Alex Cole-Hamilton Liberal Democrat

I am grateful to the minister for having acted on our calls to bring in international expertise in that way. It is vital.

The report highlights that the impact of substance use is not limited to the user; it also exerts an impact on the families around them, especially children. On any given day in Scotland, as many as 25,000 children are affected by parental substance use. I therefore welcome the announcement of Phoenix Futures’ family service in Aberlour’s mother and child house. I worked with Aberlour when it had a previous iteration of that service; however, the service had to close, due to a myopic decision by Glasgow City Council at the time, which decided that the service was just not being used enough. What guarantees can the minister give to members about the longevity of such services? I ask because we are going to need them, even when we might think that we do not.

Photo of Angela Constance Angela Constance Scottish National Party

I very much agree with Mr Cole-Hamilton that we need to be in this for the long term, and that our services, particularly around supporting children and families and early intervention and prevention, are not just available when things are challenging. We need to be committed to such services in good times and bad.

On the action that this Government has taken, support for Aberlour alone will be to the tune of £5 million. I spoke in my statement about the other services that we are expanding for women and children.

Mr Cole-Hamilton will also be aware of the programme for Government commitment in relation to the whole family wellbeing fund, which is a substantial commitment of Government resource. However, it is not just about the quantum of resource, of course; it is also about how it is used. We have a very keen eye not just on the quantum of investment but on the impact of that investment and on ensuring that it reaches where it is needed. I am determined to keep a keen eye on that.

Photo of Stuart McMillan Stuart McMillan Scottish National Party

I remind members that I am a board member of Moving On Inverclyde, which is a local addiction service.

The minister will be aware of the increasing and improving approach that is taking place in Inverclyde among all agencies and the third sector organisations, which I believe has led to a reduction in drug deaths from 33 to 16. However, clearly there is still a lot more to do, because those are still 16 people who have died.

One of the key challenges is mental healthcare provision in helping people to deal with addiction. That point has been raised with me consistently over a number of months, including last week, when I attended quite a number of events in my constituency on international overdose awareness day—

The Deputy Presiding Officer:

Mr McMillan, can we please have a question? I have already indicated that I want to get through all members’ questions and I need co-operation for that. I need succinct questions and succinct answers.

Photo of Stuart McMillan Stuart McMillan Scottish National Party

Will the minister consider using Inverclyde as a pilot area for an enhanced mental health programme to help to deal with the addictions issues that we face? Would she agree to meet local organisations to discuss the situation?

Photo of Angela Constance Angela Constance Scottish National Party

I will, of course, meet the member and local organisations. The task force made a number of really important recommendations in that regard, which I fully support.

People should not be turned away; they should not be left to navigate their way around fragmented services; and treatment for one health condition should not be dependent upon the other.

MAT standards are important in that regard, and mental health and addiction services need to be joined at the hip. I think that I am on record as saying that we need to be doing much more in that regard; members will be aware of the work that I and Mr Stewart are involved in, both in relation to the rapid review of mental health and addiction services and in relation to investment on the ground to help better connect services and provide better holistic and person-centred support to people and communities.

Photo of Maggie Chapman Maggie Chapman Green

I thank the minister for her statement and reiterate that the Scottish Greens believe that one drug death is one death too many.

This is a public health issue and should be treated as such, and not by applying punitive or criminal sanctions that we know do not work. Can the minister provide more detail about the timescales for the cross-Government action plan and say, specifically, what interaction those who are involved in developing and implementing it will have with the Lord Advocate, Police Scotland and the Scottish Courts and Tribunals Service?

Photo of Angela Constance Angela Constance Scottish National Party

Of course, I cannot comment on the actions and decisions of the Crown Office or the Lord Advocate. However, Ms Chapman and I come from the same place, as does Mr Sweeney, when it comes to the comfort that is sought of being able to implement the harm reduction measures that have been proved to work in other countries across the world.

Between now and the end of the year, I will be regularly coming back to report to Parliament on the anti-stigma action plan and our workforce. I have made a commitment to Ms Baker to provide updates on MAT standards, and we will consult Parliament on the cross-Government action plan.

I am also keen to discuss members’ views on the recent UK Government white paper, because aspects of it might apply to Scotland. The consultation for that closes on 10 October, so I urge members to look at the letter that I have written to the UK Government and to communicate any views on that matter.

Photo of Brian Whittle Brian Whittle Conservative

Quite rightly, the Scottish Government’s approach is to treat people who are caught in addiction. However, it is my belief that in order to prevent adding to the appalling numbers, and to effectively tackle the issue, we must understand why Scotland’s figures are so bad compared with the rest of the UK and Europe. Therefore, I ask the minister: what work is being done to understand why Scotland is such an outlier in drug abuse?

Photo of Angela Constance Angela Constance Scottish National Party

We have debated and discussed “Why Scotland?” fairly extensively in the chamber, I believe. The member will be aware of my view that it is about prevalence, poly-substance misuse and benzodiazepines.

I have always been direct and blunt that we have not succeeded in getting enough of our people into the treatment and support that they need. I also say to the member that, as a matter of fact, although the situation in Scotland is worse than it is anywhere else in Europe, there has been a rise in drug deaths across the UK and a rise in the prevalence of drug use.

As well as looking at some of the initiatives in England that I agree with and that fit with the public health approach, we also need to be setting our eyes further afield, so that we can learn from the very best of international practice. We know what works. It is my view that all of us now need to get on and do it.

The Deputy Presiding Officer:

As I had anticipated, we have run out of time. I was not able to call two members; I would have liked to call them. I am sure that if they wish to pursue the matters that they had planned to raise, they will write to the minister. There will be a short pause before we move on to the next item of business.