Official Report 723KB pdf
The last public item on our agenda is continuation of the committee’s stage 1 scrutiny of the Right to Addiction Recovery (Scotland) Bill. We will take evidence on the bill from Neil Gray, Cabinet Secretary for Health and Social Care, and his Scottish Government officials, Laura Zeballos, deputy director, drugs policy, and Morven Davidson, who is a lawyer in the legal directorate. We will move straight to questions, starting with Brian Whittle.
Good morning. I have an initial framing question about your understanding of the bill. It is incredibly difficult for somebody who is caught in a loop of addiction to decide to ask for help. The whole point of the bill is that, if that help is asked for, it is forthcoming timeously. Is that your understanding of what the bill is trying to achieve?
Yes, it is. It is important to set out at the outset that, although the Government is neutral on the bill at this stage, while we await your good work and the further evidence being collated and compiled, it is fair to say that we support the intention of the bill, which is to ensure that there is timeous access to support when people request it. There are measures in place to support that in a broad sense, through the medication assisted treatment standards and various other elements that are already in train, but the general principle of the bill that Mr Whittle sets out is also my understanding of it.
Given that, are there any barriers in relation to the Scottish Government’s ability to secure delivery of the rights as set out in the bill?
Could you frame that question again, please?
Does the Scottish Government’s perspective anticipate any barriers in relation to its ability to secure delivery of those rights?
Through the bill?
Yes.
Yes, and those issues have come through in the evidence that has been provided by the likes of Public Health Scotland and the Royal College of General Practitioners. Some of those who have contributed evidence have suggested that an unintended consequence could be those rights becoming exclusionary for only those who are able to follow a particular path.
We are very clear, as Mr Whittle set out in his opening question, about the challenge for somebody who is in a situation where they have a substance dependency. They will probably have had varying degrees of interaction with statutory, community or voluntary services, and their decision to come forward to seek help is in itself a momentous one that we should support and embrace. However, we must make sure that a GIRFE—getting it right for everyone—approach is taken at that point. It should be person centred, and there should be a recognition that an abstinence-based approach at that initial stage of seeking help is not for everybody. There are other ways of getting people to a point of finding their own recovery, which could include going through residential rehab or various recovery treatment options. The MAT standards already provide for the timeliness of how that should be delivered, which is within hours of the first presentation.
The most recent quarterly data shows that the 90 per cent target is being exceeded at the moment. That is not to say that there is not more work to be done there—there is, because there are gaps in certain parts of the country—but the work that has been done through the national mission over recent years has certainly improved the picture on people accessing support and help when they ask for it, which is the point that Mr Whittle raises.
Thank you for that. Given that the bill is at stage 1, would any amendments be required to enable its successful implementation, from a Scottish Government perspective?
I cannot comment on that at this stage, because we have taken a neutral position on the bill and we are reserving our judgment until the conclusion of the committee’s work. We will obviously rest on the work of the committee and the expert opinion that comes through in evidence in order to arrive at the Government’s position thereafter.
I will leave it there just now, convener.
Good morning. I am interested in exploring some issues relating to the “National Collaborative Charter of Rights for People Affected by Substance Use” that was developed by the national collaborative and everyone who played a part in it. More generally, I am also interested in the enforcement of individuals’ rights and how all that interplays with the bill. The cabinet secretary will be very aware of the launch of the charter of rights, which states:
“Once the proposed Scottish Human Rights Bill becomes law these internationally recognised rights”
as set out in the charter of rights
“will also become enforceable in our tribunals and courts”.
Evidence from the Scottish Human Rights Commission noted that some of the rights that the charter of rights sets out are not yet enforceable in domestic law, because they have not been incorporated, while Audit Scotland noted that people are still facing significant barriers to getting support. We know that that is due to stigma and limited access to services in rural areas, for example. How would the bill as set out complement the charter of rights for people who are affected by substance use, or could it come into conflict with it?
I will bring in Ms Davidson to provide more detail on that in a second. Ms Whitham is correct in her assessment of the intended direction of travel of the charter and legislation. Along with the First Minister, I was at the launch of the charter, which is an internationally recognised piece of work that further embeds service users’ understanding of their rights to access treatment and services and the greater support that those things should provide. I cannot take a position on the potential impact of the bill, but the committee has heard evidence that suggests that it has the potential to conflate some the elements of rights and the treatment that is available. Should the bill be enacted, I believe that it would be the first time that a right to a treatment would be provided in legislation. That is not incorporated in any other aspect of health and social care. In and of itself, that is a potential challenge.
On how the bill would interact with the charter of rights, the charter does not create new rights as such. It draws together existing rights that are already available internationally and domestically. The purpose of the charter is to make those rights more accessible and to enable service providers to adopt a human rights approach. There is no conflict between the charter and the bill in a legal sense, as the charter is not a legislative instrument and it and the bill would sit side-by-side. The charter draws on existing rights that are already available in the drug and alcohol treatment sphere.
If the bill were enacted, how might it align with any future human rights bill in Scotland? The proposed human rights bill has been delayed and will not be enacted during this parliamentary session. The current Scottish Government has promised that it will tick over into the next parliamentary session and that it will be lodged then. I am interested in understanding how this bill might align with a Scottish human rights bill.
As there is legal interaction on the matter, I will defer to Ms Davidson.
The Scottish Human Rights Commission’s evidence to the committee touched on that. The basic legal position is that legislation is capable of incorporating international human rights. States are given a wide margin of appreciation for how they can incorporate human rights into domestic law. The question of whether the bill is an appropriate vehicle to do that or whether it would achieve effective incorporation is a question for the member in charge of it.
The last area that I will look at is the enforcement of rights. Thinking about the current situation rather than a hypothetical one, although we do not have a crystal ball, let us assume that a Scottish human rights bill will be lodged in the next session of the Parliament. I would be interested to hear what steps the Scottish Government is taking to ensure that people who experience substance use are able to realise their existing rights in the absence of this bill, as it is proposed, and in the absence of a Scottish human rights bill that would underpin and make those rights enforceable. We hear that people are not always able to realise the treatment that they seek in their local areas. Right now, there is an enforcement gap in the system, as people are not able to challenge decisions effectively or do not know the routes that are open to them.
12:15
We strongly believe that we are compliant on a human rights basis with the services that are being provided. There is more work to be done, which I set out in my initial response to Mr Whittle. The charter provides us with a greater basis from which we are making sure that those who are seeking to access those services understand what their rights are and where they can turn in order to access the services on a human rights basis. Making sure that the charter is grounded in that position was a central focus—as Ms Whitham will know from her previous experience—of the work of the national collaborative, and it has garnered international recognition as a result. However, I will turn to Ms Davidson on where we are with enforcement at the present time.
Do you mean the enforcement of current rights that are available in law?
Yes.
It might be helpful if I talk a bit about what those rights are and how they are accessed. There are a number of international and domestic human rights that are potentially relevant to the treatment of drug and alcohol abuse. Some examples are article 2 of the European Convention on Human Rights, which protects the “right to life”, and article 3, which protects individuals from torture and inhuman treatment. Those are rights that are currently enshrined in our domestic law and they are enforceable through our domestic courts.
You touched on international obligations. The one that is most relevant here is article 12 of the International Covenant on Economic, Social and Cultural Rights, which protects the right to
“the highest attainable standard of physical and mental health.”
That right has not yet been incorporated into our domestic law. Although states have an obligation to comply with that right, there is currently no route to enforcing it in the domestic courts.
I have a final question on this. At the moment, how are individuals able to challenge the treatment that they receive or that they are not receiving but would like to receive? What redress do they have just now? How do they realise their existing rights in domestic law?
There are various avenues open to them. The most obvious ones are the statutory providers’ complaints processes. As MSPs with constituents, we would all have interaction with those processes, in relation to ensuring that the principles and the law that Ms Davidson has set out are being applied.
As I said, the MAT standards that we have set our local delivery partners the challenge of meeting in the last quarter demonstrated that we are beyond the 90 per cent target. That shows that there is still work to be done to make sure that we are delivering a system that meets the expectations of the MAT standards and that we are seeing timeous support and treatment being provided. However, it also demonstrates my expectation regarding the broad and supportive culture for people who are in the situation that Mr Whittle outlined in the first instance in relation to being able to access treatment and support at the earliest point of interaction with services.
Should that not be the case, there are various mechanisms through which people can seek redress, the most obvious of which is a health board or an alcohol and drugs partnership’s complaints process.
Thank you.
I declare an interest as a practising NHS GP.
Cabinet secretary, the Scottish Government has legislated for cancer treatment times. Why can we not do something similar for drugs and alcohol?
What we did not do with the cancer waiting times was legislate as to what the treatment would be. My understanding is that the bill sets out what the treatment should be, which, as I said earlier, is a significant departure from the rights that people have in other aspects of health and social care. As I said in response to Mr Whittle and Ms Whitham, we have already set out the MAT standards, which set clear expectations around treatment times, on which we are seeing good performance, although there is always room for improvement.
I do not take a position on what the bill is legislating for. I have already set out that we are neutral on that, but I am in agreement, in principle, on the intention of supporting more people towards treatment. It is for the member in charge of the bill to address Mr Gulhane’s point about legislation for waiting times or treatment elsewhere in health and social care. I believe that this would be the first time that we would be specifically legislating for a right to a particular treatment—a right that is not available elsewhere.
I am interested in the national service specification for substance use support services that the Government has committed to publishing. Is there any idea when that might happen? How will the impact of the service specification be monitored? What contribution will implementation of the service specification make to meeting the intended outcome of the bill?
We do not have a timescale for that at this stage. Work is under way to review not only the national mission on drugs and drug-related harm but where we are with alcohol services. We have had a number of sessions with a wide variety of stakeholders, including those with lived and living experience of substance dependency—alcohol and drugs—to look at the areas that Ms Mochan is interested in. Our intention is to set out our plan at the conclusion of the national mission, which will be at the end of this parliamentary session. We are cognisant that the work is demonstrably not complete and that we still have much work to do. Although the national mission is coming to a conclusion, there is still work to be done. We are embarking on a review of the efficacy and performance of various aspects of the national mission, as well as our alcohol interventions. We will set out our plans for both before the end of this year.
How would the use of such support services link with the bill, if it is passed?
I do not think that there is a lot that I can add to that, given the Government’s position on the bill at this stage. I cannot comment on the specifics of the bill. All that I can set out is the wider work that we are doing at the minute, which I described to Ms Mochan in answer to her first question.
We need to ensure that we have coherent support in place for those with a drug or alcohol dependency. We must take further action, because the drug and alcohol-related harms in Scotland are far too high. Progress has been made, but my interest is in ensuring that we go further with the social infrastructure that is available and the destigmatising of access to support services. That needs to be done in a co-ordinated way that works for individuals and how they wish to access services. Demonstrably, certain interventions will not work for everybody, so we need to ensure that we have breadth of intervention as well as depth of availability. That is what the work that is currently under way is seeking to address.
The bill would place significant decision-making responsibility on a single health professional, but current practice emphasises that a multidisciplinary approach, involving social work, care staff, ADPs and a load of other professionals, should be taken. Given the importance of multi-agency and multidisciplinary input in recovery care, how does the Scottish Government assess the risk that the bill’s current framing could undermine existing collaborative practice and care planning?
Again, I will not comment on the bill in and of itself, but the committee has heard evidence on the importance of the multidisciplinary team. As I said in my responses to Mr Whittle and Ms Whitham, we want to ensure that we get it right for everybody and that we provide services in a way that destigmatises the process and makes it as easy to go through as possible. Providing various opportunities for interaction is critical to that. The multidisciplinary team is fundamental to ensuring that we have that breadth and depth, as I referred to in response to Ms Mochan’s question about where we go next. I am clear that we need to meet people where they are, as opposed to where it is easier for us to deliver services, and that is what we are seeking to do.
On the point about meeting people where they are, the bill would require diagnoses and treatment plans to be made in person with a clinician. Given the work that the committee has done on remote and rural healthcare, is the cabinet secretary concerned about people having to travel for those in-person appointments rather than accessing services in the way that they are currently delivered?
It is for the member in charge of the bill to discuss some of those elements rather than for the Government to take a position on them at this stage.
I have read with interest some of the evidence that has been taken. Concerns have also been expressed about the need for a diagnosis to access services, as opposed to those services being available for anyone seeking help. I stress the importance of making sure that we get this right for everybody. We want to meet people where they are—I return to that phrase—and make services accessible, rather than exclusionary, at all points. Those points have already been made in evidence to the committee.
Thank you.
Gillian Mackay made a good point about the rural situation. I am always interested in rural issues and challenges in healthcare. We have some really good third sector organisations as part of the multidisciplinary team, such as WithYou in Stranraer, Dumfries and the Borders.
Does the bill omit anything that needs to be included to support or enhance care for people in rural areas? For example, I know that there are challenges with implementing the MAT standards in rural areas and that there are confidentiality issues with rural services. I am picking up on Gillian Mackay’s point by asking whether anything needs to be added.
I cannot comment on what should be in the bill, but, as somebody who grew up in an island community, I recognise the challenges of rural service delivery.
Ms Mackay talked about recognising the importance of the multidisciplinary team, and that importance extends to the community and voluntary sector groups that Ms Harper referenced. A number of organisations in rural and island communities can be the first point of interaction and can provide the first opportunity for engagement on a recovery pathway, so it is important that we continue to ensure that that breadth of opportunity for engagement exists through support for community and voluntary organisations. That point has certainly come through in the round-table discussions and stakeholder interaction that I talked about in response to Ms Mochan’s question. That work will continue over the coming months.
I will bring in Ms Zeballos at this point.
12:30
We understand the importance of there being a range of opportunities for interaction with regard to local service delivery. We know that local services offer digital engagement, home visits and routes of engagement that recognise particular constraints. An assertive set of activities go on to ensure that we provide the support and treatment that people need in a way that does not create artificial barriers.
Good morning. Cabinet secretary, you touched on the bill’s requirement for a medical diagnosis. We have heard in previous evidence sessions some concern about that formalisation. The Government’s written evidence addresses the issue, but can you say a bit more about the Government’s concerns in that regard and address the concern that one of the unintended consequences of that requirement could be a challenge to existing services that do not require a formal diagnosis?
I have seen that point being raised in other evidence sessions. For the reasons that Ms Zeballos set out in response to Ms Harper and were set out in my written statement to the committee, we have a concern about that issue. Some people who have given evidence have said that the approach could be exclusionary. I know for a fact that the last thing that the member in charge of the bill would want is for there to be any unintended consequences that would result in people feeling excluded or being practically excluded. It is important that we have due regard to that.
Ultimately, it is for the member in charge to discuss that matter more substantively, and the Government will take a more formal position once the committee has completed its work.
I declare an interest in that I am employed as a bank nurse by NHS Greater Glasgow and Clyde.
I want to ask about the reporting requirements. In your written evidence, you noted that section 5 of the bill would require ministers to report to the Parliament with a range of information, and you invited the committee to consider whether there were any issues in relation to the general data protection regulation and the Information Commissioner’s Office that would impact on the aims of those reporting requirements. Can you say a bit more about the potential issues or unintended consequences that could arise for the Government as a result of that section, if the bill were enacted?
In response to Ms Harper, Ms Zeballos and I stated that we recognise that services that are provided in rural and island communities are often provided to a very small number of people. The confidentiality issues that arise from that, which those who represent or have come from rural and island communities will recognise, are a concern for us.
A significant amount of regular reporting on harms as well as deaths, particularly on the drug side but also on the alcohol side, is done by the Government, Public Health Scotland and others. We are considering whether that can be strengthened and increased as part of the review of the national mission.
Other than expressing the concern that we expressed in the submission that we provided, there is nothing more that I can say about the bill itself.
Are you able to say whether the reporting requirements that are set out in the bill would be sufficient to enable the extent to which the bill met its intended outcomes to be monitored?
That issue should be explored with the member in charge of the bill. I do not think that I can go beyond what I set out in my written evidence. I have provided a bit more clarity on where the concerns arise—one such area relates to rural and island communities. If the bill is agreed to at stage 1, we will, in responding to the committee’s report, take a stronger position on those aspects, as we will on the wider bill.
It is worth noting that, even in more urban areas, there are still small communities, where confidentiality and familiarity with friends and neighbours could have an impact.
That is correct.
Through the bill process, it has become clear that some changes need to be made to the bill. Would the bill benefit from more time, which would involve its being agreed to at stage 1 and coming back to the committee at stage 2 to be amended, so that it can have the impact on people that those on the front line have said is necessary?
I hope that Mr Gulhane and the rest of the committee will forgive me for restating that we have taken a neutral position on the bill. We will return to our position on whether it could or should be amended—and, if it were, whether it would meet our expectations—after the committee has done its work and we have seen the totality of the evidence that has been provided.
I have already pointed to issues that have come through in evidence that, as I have set out in my written submission, cause me concern, but we will base our final judgment on the work that the committee does.
If changes were to be made to the reservations, I assume that the Scottish Government would be happy with the bill.
Again, Mr Gulhane will need to forgive me. He has tempted me to take a position, which I cannot do at this stage. The Government is neutral on the bill. I have set out the various areas that we have concerns about, which are areas that the Government has policy on and in which a significant amount of work is being done.
Our response to the bill will be informed by the good work of the committee and by the evidence that the committee has gathered. We will take a position on that basis, once the committee has reported and before stage 1.
I would like to return to my previous question. The bill does not specify what treatment someone who is asking for help should receive. There are myriad options, as well as others that are not listed. Any treatment could be provided, but the fact is that the person has asked for help and would be guaranteed treatment within a certain period of time, in a similar way that people would be guaranteed treatment in other areas.
Why is there such a difference between the legislation on drugs and alcohol, which the bill would be part of, and the legislation in areas such as cancer care?
I have set out my position in that regard. The bill specifies a particular treatment pathway. I will rest there.
My final question is about the number of people in Scotland who use substances. Does the Scottish Government have reliable and up-to-date information on the number of people who use substances, beyond opioids and alcohol? Is the Scottish Government looking to ensure that that unmet need is met?
By its nature, it is difficult to establish that data set with certainty. Based on Mr Gulhane’s professional engagements, he will be familiar with why that is the case. People have various engagements with health professionals and others, which helps to provide a level of data, but other people do not, so such data is more difficult for us to substantiate.
In Glasgow, part of the Thistle’s success is that people are, for the first time, interacting with that service and the wider services that are offered in the centre, such as those relating to housing support, social work and education. We are capturing information that shows that many people who engage with the Thistle have never engaged with any statutory service before, and that intervention is giving them the opportunity to have a recovery pathway for the first time.
That illustrates how challenging it is to get the fuller and more accurate picture that Mr Gulhane is looking for. It is challenging to get accurate data, because of the complexity of human society and the fact that people will be at varying stages of recovery, with many, understandably, hiding their situation not only from statutory services but from their family members, loved ones and wider social groups.
Public Health Scotland reports on various elements that Mr Gulhane referenced, but getting the data is a challenge, as I am sure he will understand.
For a number of years, you and I have been around this particular crisis, which has been much talked about. In fact, one slogan that came from those watching our discussions was, “You keep talking, we keep dying.” Despite the whole Parliament’s strong desire to make significant improvement, it has not been made. Although we accept that it must be amended, could the bill be a mechanism for the significant step change that we need but have failed to realise over the past decade?
I recognise that the bill’s intention is to do that, and it is a shared objective. However, given what I said about the Government’s neutral position on the bill, I have to reserve my position on whether it could be such a mechanism. Through the committee’s work, a significant amount of evidence has been gathered, which I look forward to seeing a compilation of. We will, in part, take our position based on that, as well as other considerations.
We clearly and demonstrably have more work to do in relation to alcohol and drugs. Too many people are losing their lives or being harmed by their substance dependency, and we need to do more to support them.
Progress has been made, and I point to one area, above all else, that has changed during the national mission, which is the level of stigmatisation of people who seek to access services, particularly drug-related services. I say that on the basis of my interaction with families who have, sadly, lost a loved one to drug dependency and those who are currently seeing their family members battling that issue. I recognise that some of the evidence is anecdotal and not necessarily empirical, but it is clear to me from my conversations with those loved ones, particularly those who have lost family members, that had the services that are available now been available then, and had the stigma been reduced as it has been now, their loved ones would have been able to access services in a different way.
12:45I recognise Mr Whittle’s point that there is clearly more work for us to do, and it is right that we consider the potential way forward that the bill gives us. A significant amount of work is on-going that is supporting and changing lives. I point to stigma as one particular area of improvement, because I am told consistently by family members that there has been a demonstrable shift due to the national mission.
We need to do more. As I referenced to Ms Mochan, we are demonstrably not at the end of the journey. We still have more work to do, which is what the Government is currently reviewing. We are not waiting until the end of the national mission; we are doing that work now. We are keeping the bill’s potential under consideration and are reserving our judgment on it while the committee does its work.
I appreciate what you have said about the Scottish Government’s position—you have a neutral view and cannot make specific comments on the bill—but could the bill’s intended outcomes be realised, or are they being realised, without the need for primary legislation?
Yes. I set out the work on the MAT standards, which is well established. We are making progress in other areas when it comes to broadening the availability of treatment support, such as the work to expand publicly funded residential rehab capacity. The Government is now meeting its commitment, and we need to sustain that support and potentially expand it.
As I said at the outset, my firm view is that no one particular area will resolve the issue for everybody. We need a multitude of options to be available to people via various organisations—statutory, community and voluntary ones—to ensure that we respond to people in a way that meets their needs. The national mission’s breadth and depth help to provide that, although we clearly have more work to do.
That does not take away from the fact that far too many people are tragically dying from alcohol or drug dependency, and we are committed to continuing to support people to find a route to recovery, which has to be multifaceted and multidisciplinary. We have to reach people in all communities, and we are committed to delivering that aim.
I thank the cabinet secretary and his officials for their attendance and for helping the committee to scrutinise the bill at stage 1.
At next week’s meeting, we will conclude our oral evidence as part of the committee’s stage 1 scrutiny of the Right to Addiction Recovery (Scotland) Bill by hearing from Douglas Ross, the member in charge of the bill. We will also continue our scrutiny of the supplementary LCM for the Employment Rights Bill by taking evidence from the Minister for Social Care, Mental Wellbeing and Sport.
That concludes the public part of our meeting.
12:48 Meeting continued in private until 12:49.Previous
Subordinate Legislation