Meeting of the Parliament (Hybrid)

Meeting date: Thursday, May 26, 2022

Official Report 1073KB pdf

---

Drug Deaths

The next item of business is a statement by Angela Constance on accountability for delivering the national mission to reduce drug deaths and improve lives. The minister will take questions at the end of her statement, so there should be no interventions or interruptions.

14:24  

The loss of life in Scotland from drug-related deaths is as heartbreaking as it is unacceptable. Every drug death is a tragedy that leaves families, friends and loved ones looking for answers and support. I offer my condolences to everyone who has been affected by a drug death, and I reaffirm my commitment to work across Government and Parliament, and beyond, to deliver the national mission to save and improve lives.

The impact of problematic drug use is far reaching and can cause harm in every aspect of life, which is why our national mission needs to be far reaching through an all-Government, all-Scotland approach, with shared accountability at all levels.

People who have drug problems often experience complex needs and require support from more than one service. Consequently, the lines of accountability can be complex. Over the lifetime of this session of Parliament, we will ensure that effective accountability is in place through the establishment of the national care service, which will have responsibility for alcohol and drug services. It will provide a single structure for accountability and better oversight of delivery, and the further integration of community health and social care will provide better joined-up and person-centred services. However, we cannot wait until the national care service is fully established, and we are taking action now to improve accountability at all levels.

The national mission is backed by an additional investment of £50 million a year, which is a 67 per cent increase in funding since 2014-15, and we are now investing more than £140 million in drug and alcohol services. Of that additional £50 million, more than £20 million is invested through integration authorities for health and social care, with an additional £10 million to support the implementation of medication-assisted treatment—MAT—standards. Transparency and reporting remain key to the success of the national mission, and I am asking integration authorities to account for those funds more thoroughly by increasing the frequency of their reporting from annually to quarterly.

In May 2021, we opened four new funds to invest in recovery, local support, families and children, and other service improvement. We have committed up to £18 million a year on a multiyear basis, which provides security for third sector, grass-roots and advocacy organisations, which are often at the forefront of saving lives. That approach enables me to account for that investment and ensure that it is made in ways that will deliver the national mission.

Although accountability to Government and Parliament is essential, I have also been working with the Convention of Scottish Local Authorities to support local areas to improve the accountability within alcohol and drug partnerships. We have agreed eight recommendations with COSLA to improve strategic planning and are testing new tools to enable local areas to review and improve accountability with appropriate external validation. Let me be clear: local lived experience panels are also core and central to the planning and development of local services.

We are working with Public Health Scotland to improve the use of local evidence through datasets such as the drug and alcohol information system, or DAISy. We are also developing a local performance framework, which will set out clear expectations across the national mission, provide transparency and enable us to measure progress at a local level.

Earlier this year, I announced phase 1 of the new treatment target to ensure that more people with problematic opiate use are accessing life-saving community treatment, and Public Health Scotland will publish quarterly data on progress. To ensure that people receive the protection of treatment or recovery that is right for them, we have set integration authorities the ambitious target of embedding the medication-assisted treatment targets by April.

Local progress from each health and social care partnership is being evaluated by the MAT support team, and a report will be published in June to coincide with my update to Parliament. The report will be a collation of operational procedures, data and, crucially, lived experience evaluation that will be undertaken by peer researchers.

Last November, I set out my expectation that we would increase the number of people who access residential rehab. I have responded to calls for more transparency and accountability by working with Public Health Scotland to track the number of placements. That gives me a clear line of sight on how the residential rehab money is being spent. I am committed to increasing the number of publicly funded placements by more than 300 per cent so that, by 2026, at least 1,000 people every year are publicly funded for their rehab placement.

Alongside that, we have published good practice on the pathways that are needed to ensure that people are prepared for rehab and receive the support that they need after their treatment in rehab is complete. As a result, my expectations could not be clearer.

In the first nine months of the most recent financial year, alcohol and drug partnerships funded 326 placements with an investment of around £2.2 million from the £5 million allocated to them to fund placements and aftercare. I am heartened by that progress, and I expect those numbers to continue to improve as we work with areas where the data shows—to us in Government and to local populations—that access is most challenging.

Our priority must always be preventing the tragedy of drug deaths, and each and every death is one too many. Each one devastates families and communities. I am determined that we will learn every lesson from every death, so that services are improved to better meet the needs of our citizens who are at risk of dying.

When a child or vulnerable adult dies, chief officers for public protection play a key role in ensuring that we learn vital lessons from those tragic events. I intend to do what is necessary to ensure that those same chief officers take on new accountability to ensure that lessons are learned and changes made as a result of reviews of all drug-related deaths. Therefore, I will be setting out clear expectations to ensure consistency in how those reviews are carried out, as well as issuing guidance and training for all those involved. The Scottish Drug Deaths Taskforce has a strong interest in that area of work and may make further recommendations in its forthcoming report this summer.

We already publish quarterly suspected drug death management information from Police Scotland, in addition to the annual national statistics report from the National Records of Scotland, and we are investing a further £592,000 to improve the national drug-related death database. The leadership that is provided by directors of public health will enable us to use that unparalleled amount of information to best effect and to deliver meaningful change.

I have taken action to improve the accountability of the national mission at a Scotland level. I have provided a renewed focus for the national drugs mission implementation group to provide scrutiny, challenge and advice to the Scottish Government and the wider sector. That includes advice from international experts. The second year of the national mission is focused on delivery on the ground—where it matters most—and I need the group to provide robust scrutiny and advice to ensure that we are delivering for those who need it most.

I will also publish a national mission plan in summer, setting out plans for implementing the mission during its remaining four years. The plan will include an outcomes framework that will enable us to better monitor our impact on prevention and early intervention; the reorientation of a system of care that is treatment, recovery and trauma informed; and support for families and communities.

Professor Alan Miller, as chair of the national collaborative for people with lived and living experience, will bring forward the vision for integrating human rights into national policy making and local service design and delivery. The collaborative will contribute to developing monitoring and accountability mechanisms based on the internationally recognised human rights that will be included in the forthcoming human rights bill.

The human rights approach and the national collaborative provide a way of holding the national Government and local government to account, of making sure that people who use drugs can participate in decision making that affects them, of exposing stigma and discrimination and of asking tough questions and demanding clear answers.

More than ever before, we are reforming services, providing practical as well as financial support, and gathering and publishing more information so that we can challenge ourselves and each other, at all levels, to foster responsibility for and accountability to people with drug and alcohol difficulties, who—like you and me—are entitled to services that meet their needs. That is a key part of getting it right for everyone.

The minister will now take questions on the issues that were raised in her statement. I intend to allow 20 minutes for questions, after which we will move on to the next item of business.

We welcome the statement, which has provided some clarity on the Scottish Government’s approach to tackling this national shame. With 1,339 drug-related deaths in Scotland in 2020, it is clear that the national mission that has been set by the Government desperately needs to succeed.

I am glad that there is more detail on spending and accountability, and I thank the minister for looking at how accountability can be improved at all levels. Accountability is key to making real progress on the ground, but more clarification is needed on who is ultimately responsible for ensuring consistent implementation of the MAT standards. There are the First Minister, the Minister for Drugs Policy, the drug deaths task force, alcohol and drug partnerships and now the national mission implementation group. I have a straightforward question: who is ultimately accountable for delivering the national mission, and how are all those groups working together to tackle our national shame?

More specifically, time and again, I speak to people who have been on methadone for over two decades. They are desperate to come off it and on to a more modern and safe opiate replacement. MAT standard 2 states:

“All people”

should be

“supported to make an informed choice on what medication to use for MAT, and the appropriate dose.”

I know that I have asked this before, but what can the Scottish Government do to accelerate and facilitate movement of those people to safer replacement therapies, such as Buvidal?

I appreciate Ms Webber’s comments. Improving clarity and providing more detail about accountability and the investments that we are implementing to provide change on the ground are of crucial importance.

Of course the whole raison d’être of today’s statement was to demonstrate how, across the piece, we are improving accountability at national and local levels. The purpose of the national mission implementation group is to give oversight and advice, as opposed to taking responsibility. Responsibility will, of course, always rest with the Government, including me. It is important to stress that the integration authorities have a legal responsibility to plan and deliver treatment and recovery services, but we all have to recognise that they cannot do that alone and that they must work with others. They must provide adequate support to alcohol and drug partnerships, and alcohol and drug partnerships must, of course, engage and work with lived and living experience in the community and voluntary organisations.

Ultimately, I would never for a minute demur from my or the Government’s responsibilities, but accountability is shared. We are accountable to ourselves and to one another, and we all have a responsibility to hold ourselves and one another to account.

On Ms Webber’s final point, it is important to recognise that methadone is an internationally recognised treatment and should not be stigmatised. It should also never be our only offer. By and large, people need a holistic range of care and treatments. Buvidal has been shown to have much success, of course. It was first implemented in our prisons in Scotland during the pandemic, after trailblazing work in Wales was looked at. Buvidal does not suit everyone, but it offers huge opportunities to release people from making a daily trip to the chemist and to allow them to get on with their daily lives.

I thank the minister for advance sight of her statement.

We agree that accountability is crucial and that the Government must face scrutiny of its progress in tackling Scotland’s appalling record on drug fatalities. The minister is on record stating that the MAT standards would be implemented—not just embedded, but implemented—in a year. It gives me no satisfaction to say that that commitment is heading for failure. Rather than provide generalised statements, will the minister commit to publishing progress standard by standard and ADP by ADP, in order to allow proper scrutiny and accountability?

The minister stressed in her statement the importance of transparency. Will she ensure that a full and detailed breakdown of spending on drug and alcohol services will be published in one place and made easily accessible, as was recommended by Audit Scotland, which described the current information as “incomplete, disparate” and inconsistent?

Audit Scotland has recommended that the national drug and alcohol waiting time target of 28 days is too long. Will the minister commit to action to amend that?

The medication assisted treatment standards are a significant undertaking; they are not a tick-box exercise. That is why I did, indeed, commit to embedding or implementing them by April this year, but that will have to be followed up not only by sustaining but by improving the standards.

This is not a tick-box exercise; I want far more evidence to be collected, beyond people showing me their operational procedures. That is why we are evaluating local progress from each health and social care partnership. That evaluation involves, of course, looking at their operational standards and their policies and procedures. Crucially, it also involves looking at data.

The third strand of our accountability and evaluation of progress at local level is the work that is being done with the peer researchers, because the work must always involve testing how services are delivered and received by those who need them and by those whom the services are meant to serve.

I am conscious of the time, Presiding Officer. I have already answered written parliamentary questions in detail, outlining that I will, as per my commitment to six-monthly reporting, be back on my feet in the chamber in June with a report that will not only look at the national picture but will cover progress area by area. We will be able to report on progress on each standard. That will be followed by a more in-depth report in the summer, which will look not just at whether a standard has been met area by area, but at the criteria for meeting each of the standards, area by area.

I reassure Ms Baker that a substantial amount of work is going on right now to gather up-to-date evidence on the progress that is being made and on the further work that we will have to pursue over the lifetime of the national mission.

I agree with the point about Audit Scotland and publishing information on spending in one place. The whole reason for moving to MAT standards is recognition that waiting time treatment targets are not the best measurement.

I very much welcome the content of today’s statement and thank the minister for advance sight of it.

Can the minister outline how the Scottish Government is working with stakeholders including local authorities, ADPs and the third sector, to improve local governance of services? Can she also confirm how best practice from across the country will be used to drive improvements in the service?

As I intimated in my statement, we have agreed on eight recommendations with COSLA. Essentially, that is about improving the work of alcohol and drug partnerships, but it is also about including health boards, local authorities, police and third sector partners. There is a need for all those partners to work together and to ensure that health boards are taking on their responsibilities to give appropriate support to integration authorities—and, subsequently, to ADPs.

As I also mentioned, we are currently testing some self-assessment tools. Again, that is all about governance, strategic planning, quality improvement and financial planning as well as accountability. That should be rolled out next month.

It is important to say that, as well as peer review and the new liaison structures between my officials and ADPs, there is scope for external validation to ensure that the right actions are being taken to improve local governance. Public Health Scotland is doing a range of work in that area. We are mapping the contributions, including investments, of partners to that work.

On Monday, I will publish a right to addiction recovery bill, which I will take through Parliament. The minister will be aware that 77 per cent of respondents to the consultation on the proposed bill were in support of it. Will the Scottish Government give its support to the proposed bill, which has been drafted by front-line experts and people with lived experience, who know what is needed to tackle Scotland’s drug deaths?

I have said to Mr Ross on a number of occasions that his bill, when he introduces it and we see the detail of it, will absolutely be given a fair and sympathetic hearing. I know that a range of views have been expressed on the bill. I am not going to jump in and either give a blank cheque and a rosy endorsement or unfairly criticise something that I have not seen, but I look forward to seeing the detail. I have met Mr Ross to discuss his bill and to candidly discuss some of the issues that I hoped to see reflected in it when he introduces it. It will be given a fair and sympathetic hearing by this Government.

The minister mentioned health and social care partnerships. I anticipate that Glasgow’s partnership will have a key role, should NHS Greater Glasgow and Clyde finally be able to proceed with the safe consumption facility that it planned in 2016. I pay tribute to Paul Sweeney for his consultation on a proposed bill on an associated matter.

Was the minister able to raise resolution of the legal uncertainty over safe consumption facilities when she attended the United Kingdom Government’s national drugs summit last week? What other matters were discussed?

I did, indeed, attend the UK Government drugs summit last week. I was invited; I think that I was the only representative there from a devolved nation. I am of the view that it is important to engage and discuss matters even with people with whom we have quite fundamental disagreements. The issues that I raised directly with the UK Government were issues that I have raised in the past in relation to the Misuse of Drugs Act 1971. I would like that act to be reformed, but if the UK Government will not reform it, I want the powers to be devolved.

We discussed once again matters including safe drug consumption. Members will be aware that, as a Government, we are also pursuing our own activities and actions within what we can do under our legal powers. We also discussed issues around pill-press regulation. I met the National Crime Agency recently and am pushing the UK Government to make progress on that matter. I think that it is willing; I am just keen for it to go a wee bit faster.

I thank the minister for her statement, but it has left me rather underwhelmed. She has said repeatedly that establishing overdose prevention centres in Scotland is a priority and that they are an essential tool for tackling the drug deaths crisis in our midst; yet, in today’s set-piece statement on drug deaths, there was not a single mention of the Government’s work so far on delivering overdose prevention centres in Scotland. The minister will know that, yesterday, I launched my consultation on my proposed member’s bill to establish OPCs in Scotland, but I must ask why it has been left to Opposition members to drive the pace of reform when we agree on the need for them. When are we likely to see genuine, tangible updates and progress from the Government on the delivery of overdose prevention sites within its competence?

I made a commitment to the Parliament about improving accountability and governance. Although issues in and around governance might not excite everyone, they are crucially important. This is a shared agenda. We all have our individual responsibilities and our part to play, and I consider it a crucial part of the national mission that we hold ourselves and each other to account both locally and nationally.

Mr Sweeney is right: there is strong support right across Parliament for safer consumption rooms. In my view, as in his, the evidence is clear and compelling. The only debate now is about how they will actually be delivered. I am sure that Mr Sweeney is aware that the Scottish Government is leaving no stone unturned to deliver clinically and legally safe consumption facilities within our powers, and I will continue to pursue that activity.

At the end of the day, I do not want to be asking the UK Government for permission, because it is quite clear to me that it will not reform the Misuse of Drugs Act 1971 and that, certainly in the short to medium term, we are not going to come to an agreement with the UK Government on safer consumption facilities. That is a matter of regret when even Mr Ross is of the view that the Conservatives should not stand in the way of a pilot.

The consensus in Scotland is strong. We are engaged with our partners, and we will leave no stone that is within our powers unturned. That is the route that I am following. I appreciate that Mr Sweeney has an alternative proposal, and, as with other legislative proposals, it will be given a fair and sympathetic hearing.

I point out that there are six more members whom I hope to call. The position with time is not as it was 10 minutes ago, so I make a plea for succinct questions and answers. I appreciate that there is a lot of ground to cover, but let us see whether we can fit everybody in.

I will ask the minister about drug-testing schemes whereby drugs can be tested for rogue ingredients that could lead to extreme harm or even death. It is my understanding that licences to facilitate such schemes can be given by the UK Government—indeed, one was given to the Loop scheme in Bristol in conjunction with Bristol City Council. What is the minister’s position on the matter?

As I have stated to Parliament before, I am fully supportive of the work that is being done to implement drug-checking facilities in Scotland. The task force funded some initial research projects by the University of Stirling on the development of a drug-checking programme, and I am pleased that the first application for the three prospective sites will be submitted to the Home Office in the next month. It is encouraging that the project in Bristol has received a licence, and I very much hope that the Home Office will see the benefits of the introduction of such facilities in Scotland. I made that point to Mr Malthouse when I met him last week.

The minister knows that the Liberal Democrats want her to succeed on this issue and, to that end, she has our good wishes.

In the statement, it is encouraging to see a direction of travel towards rehab, but the services need to be sustainable even when occupancy drifts below 50 per cent. Before people can access rehab, they need to be stabilised first. The minister and I have discussed many times the need to address the gap in stabilisation services. That issue did not feature in today’s statement, so will she update members on where we are on stabilisation?

Mr Cole-Hamilton will appreciate that the statement was about governance and accountability and some of the nuts and bolts around them. Like him, I am a supporter of stabilisation services, although they are not necessarily easy to run, and they are expensive. They are separate from residential rehabilitation and the abstinence-based programmes, but there must be links between relevant services.

Some of our work on regional and national commissioning in the residential rehabilitation sector is quite germane in that the work that we are doing through Scotland Excel will help to establish the level of need in different geographical areas across the country. We are very focused on that issue.

Stuart McMillan joins us remotely.

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

Will the minister provide an update on how she is going to ensure that the views of recovering users, their families and associated charities continue to be taken on board?

Yes, absolutely. Governance and accountability are not only about data, policies and procedures, important as they are. All those activities need to be informed centrally and consistently by the views of people with lived and living experience. Much of the work that we have done around accountability has been in response to what we have heard from people with drug and alcohol problems, their families and the organisations and advocates that represent them.

We continue to report quarterly on our investments in residential rehab, we have committed to six-monthly reporting on MAT standards, and we are increasing financial security. There is also the treatment target and our work to improve governance and accountability at both national and local levels.

Drug deaths are our national shame. I welcome what the minister said about data and accountability, with each drug death now being investigated. However, I am upset that that information is not already available, because it is so vital. Once the investigation into a drug death has been concluded, what is the mechanism that will allow the lessons learned to be translated into action to save lives in the future?

There is part of this that I feel very strongly about and always struggle with. When we talk about learning the lessons, that trips off the tongue very easily, but it can sound really trite. I know from my background as a professional social worker and from holding other Government portfolios that there is guidance that sets clear parameters for when the death of a child or, indeed, a vulnerable adult should be investigated. There is guidance on how that should be done and on how information should be shared. As a minimum, we should have the same for the reporting of reviews into drug-related deaths. We will be doing some further work and consultation on that, and I am keen that we get it absolutely right. I am also very conscious that the reviews can be really important for families who are seeking answers.

I feel very strongly about this issue. Although we, as politicians, can sound a bit trite when speaking about it, I want to ensure that we make a difference on it.

I thank the minister for advance sight of her statement, and I welcome her commitment to improving consistency in drug death reviews. As she said, that will improve data collection and will allow national trends to be established. Most importantly, it will give families answers and will ensure that they have certainty in the process. Will the minister commit to taking any necessary action to ensure that there is consistency across Scotland in how drug death reviews are carried out and that they are carried out in as many cases as possible?

Yes. Following on from my answer to Sandesh Gulhane, Ms Mackay makes an important point about consistency. Although reviews of drug deaths are carried out in most areas, they are all done in a different fashion and there is not always visibility in the review process or of the outcomes at either a local or a national level.

I have an open mind. As a minimum, the new procedures that we put in place should at least reflect what is in place for child deaths or under procedures for vulnerable adults. If Ms Mackay has further suggestions about how we can strengthen our resolve and approach in this area, she is very welcome to share them.

I welcome the minister’s statement and the clarity on accountability. As part of that important accountability, how can we ensure that services are flexible enough to meet people where they are and to enable them to participate fully in the decision making that affects them?

As I intimated earlier, the integration authorities have clear legal responsibilities to plan and provide services. It is clear, however, that they cannot do that alone. We also need greater clarity and support around the role and function of alcohol and drug partnerships, and a range of partners need to be involved, including voluntary organisations. We need more meaningful partnership with voluntary organisations at a local level.

The MAT standards provide another vehicle by which improved partnership working will be driven. Another aspect of MAT standards that I know Ms Maguire will be interested in is how they help us to make systemic changes to prevent people from being bounced around between addiction, homelessness and mental health services. We are embarking on that work right now, as we are investing in and reforming drug and alcohol services like never before.

Our longer-term vision is to introduce a national care service, which will provide a single structure for accountability. With the further integration of community health and social care, we will be able to provide better joined-up and person-centred services.