Meeting of the Parliament (Hybrid)

Meeting date: Thursday, June 30, 2022

Official Report 778KB pdf

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Dundee Drugs Commission

The final item of business is a members’ business debate on motion S6M-04364, in the name of Michael Marra, on Dundee drugs commission review report. The debate will be concluded without any question being put. As ever, I invite members who wish to participate to press their request-to-speak buttons or place an R in the chat function as soon as possible.

Motion debated,

That the Parliament welcomes the publication of the report, Time for Kindness, Compassion and Hope: The Need for Action Two Years On, by the Dundee Drugs Commission; thanks the Commission for its work in the production of both of its reports; is grateful to everyone who brought witness and testimony to this work from lived experience and frontline service provision; believes that testimony will have been incredibly difficult to deliver for many of the witnesses; understands that, despite the urgent recommendations in the first report, Dundee continues to have a very high level of drugs deaths by national and international comparisons; notes with concern what it sees as the failure to sufficiently progress the recommendations of the original report by all agencies in Dundee; further notes support for the recommendations of the Commission, which include an urgent health needs assessment for drug users, the wholesale reform of substance misuse, and recovery services that move away from a punitive medicalised model to a community facing system of care; is concerned by the report's conclusion that "the scale of the challenge to turn the situation around hasn’t been fully appreciated" by local leadership, and notes the calls for the full adoption of the recommendations with a specific delivery plan from the Dundee Partnership.

13:29  

Earlier this week, I hosted some of the Dundee drugs commissioners here in Holyrood to allow MSPs to hear their testimony directly. Their deep frustration at the lack of progress in the delivery of their recommendations in both of the reports was palpable.

“I despair. I actually despair.”

Those are the words of the chair of the commission, Dr Robert Peat.

In reviewing my files in preparation for this debate, I revisited a litany of action papers, a plethora of delivery plans and many statements of intent—thousands of warm words from political and service leadership in Dundee, yet here we are: no action—just despair. The cost of not changing is measured in lost lives, ruined families and despair that runs not just through families but through generations.

At the centre of the reports from the commission is a model of addiction service that is isolated and outdated, and that operates apart from primary care, apart from acute medical care and in purposeful isolation from mental health care.

Staff in Dundee drug and alcohol recovery services work incredibly hard in very challenging circumstances. They are frequently understaffed. They feel under attack. They want to provide care and feel proud of the care that they give. However, the reality of the service is that it is punitive and overly medicalised. Frankly, it is a broken system. The response was to rebrand it for what I believe was the fourth time. Folk in Dundee still call the service the name that it had 20 years ago. The name does not matter, when it is still doing the same thing. It is our job here to ask what is stopping real change. That is my central question to the minister today. Why no change, minister?

This Government has no real track record of public service reform. The lack of Government knowledge about how to lead reform over the past 15 years, and the lack of thirst to see reform happen, is part of the problem.

Let me give Parliament an example. One of the key findings of the Dundee drugs commission was that addiction services and mental health services could not be accessed in tandem by one suffering individual. In fact, accessing addiction services meant that someone specifically could not access mental health services. I do not believe that anybody in this chamber, anybody working in those services or any family believes that mental health and substance abuse are not linked. For so many, they are two sides of the same coin. However, it was not just this commission and these commissioners that came to that conclusion. Years ago, the Dundee poverty commission said the same thing. The Strang review into the dreadful state of our mental health services in Tayside said the same thing, and yet a very senior officer in the Dundee health and social care partnership said to me:

“We do not recognise this description.”

This has gone way past a lack of evidence or analysis. It is an obdurate refusal to listen or accept the truth, because doing that would mean that change has to happen. I believe that the minister knows it and that she shares some of the same frustrations. The minister’s own report just last week on medication-assisted treatment standards said that despite cast-iron assurances of implementation, we know, as a Parliament and as a country, that we are nowhere near it.

Dundee has had even longer, because, as the minister will know, MAT standard 1, on same-date prescribing, was required by the first report of the Dundee drugs commission three years ago.

I am afraid that ministerial direction will not cut it. If I could ask the minister one question today, it is why—why can this not change? What is stopping change, minister? Is it money? Is it people? Is it culture? Why does Scotland seem to have lost the ability to adapt and move? Let us be clear: moving all decision making to the centre would be a real disaster. The character and nature of drug abuse differs hugely from town to town and from city to city. Services must be designed and procured locally, because, even in my region, the behaviours and substances that are used in Aberdeen differ markedly from the situation in Dundee. Change has to be responsive. If there is one thing that I have learned from the commission it is the character of drug abuse in Dundee. We all know the cost, but what has been set out clearly is the character of what happens, the particular problem of benzodiazepine use, the increasing impact on women and the loss of female lives, and the huge link with poverty, which is particularly pronounced in Dundee.

The Dundee drugs commission is now closed and the commissioners wish to pass the baton. They have given four years to that work and have listened to harrowing testimony, some of them reliving trauma from their own past or present lives. They have our thanks, but they do not want that: they want progress. They are certainly due the respect that has, in my belief, been sorely lacking from those who their reports gently, but rightly, damn. The commissioners demand real leadership of reform and permanent, external, independent scrutiny because they clearly have no faith in current systems of accountability. What they ask of us as politicians is determination.

The people of Dundee demand change so that the lives of our friends, relatives and fellow Dundonians might be saved.

We move to the open debate.

13:35  

I am very grateful to the Dundee drugs commission for its review report and I recognise the considerable work undertaken by all those involved. I particularly thank Dr Robert Peat and Andy Perkins for their regular updates on the review at meetings with my colleague Shona Robison and me.

Progress to implement the commission’s recommendations has not been good enough or fast enough. The commission’s review clearly sets out the actions that must be taken across the city by a range of partners. Those recommendations must be accepted in full and implemented as quickly as possible.

This will be a relatively short debate and I will not cover the ground that Mr Marra has covered. I hope that my contribution will be seen as complementary to his and not as one that tries to set out a different picture.

The commission recognised some of?the progress that has been made since its original report. One significant development is the multi-agency rapid response to non-fatal overdoses. The Positive Steps agency and its partners across the city are playing a significant role in that. People are most at risk after experiencing a non-fatal overdose, so evidence-based interventions are crucial to saving lives.

Significant progress has also been made with the Dundee take-home naloxone project, and Hillcrest Futures is delivering a peer naloxone training and supply project.

Does the member share my frustration? I agree with him about the work on the non-fatal overdose pathway. That was initiated by Tayside Police and officers from Police Scotland. The key issue that arises from the report is that the central problem lies with core facilities such as the Dundee drug and alcohol recovery service and the substance misuse services. They key issue that arises from the report is the lack of change there.

I think that the member covered those areas pretty well in his speech. We will make progress only by working in partnership across the city and elsewhere in Scotland. Huge work is being done, but we will make a real difference only when we work in partnership. I will talk about some of those partnerships, particularly those that have been highlighted by the commission and others.

Dundee Hillcrest Futures peer naloxone training is one example that save lives every day. Police Scotland officers now carry naloxone and I thank local officers for everything that they do to support people in distress and to disrupt the supply of drugs.

I welcome the investment that is being made by the Scottish Government through the national mission. That funding is supporting a number of significant projects in Dundee, including a community wellbeing centre at the city-centre premises of Hillcrest Futures, which will deliver 24/7 crisis care and an integrated response to drug, alcohol and mental health needs, which is one of the things that Mr Marra talked about; the transformational primary care shared care programme, which will enable people to access the full range of services within their general practitioner practice, which is almost unheard of in our city; a new dedicated mother and child residential recovery house in the city, to be run by Aberlour in partnership with Hillcrest Futures; Dundee Volunteer & Voluntary Action’s five-tier recovery programme at the Lochee hub, which is soon to be expanded into Whitfield; a women’s hub, run by the Women’s Rape and Sexual Abuse Centre, to support women with substance dependency and additional complex needs; the work by Positive Steps to engage with and support victims of cuckooing and to deliver whole-family emotional and practical support for those affected by drug-related deaths; Transform’s delivery of direct support to aid access to treatment and recovery; Bethany Christian Trust’s bridge to freedom recovery programme; Barnardo’s provision on whole-family support for families who are affected by substance use; and the Corner’s delivery of support to young people who are affected by their or a family member’s substance use and are finding it difficult to manage their accommodation.

As I said earlier, partnership and connection are key, so I want to use some of my time to pay tribute to some of the city’s other essential third sector organisations and others who are supporting local people across the city and often go unrecognised: the parish nurses at the Steeple church; the navigator programme at Ninewells, which is soon to be expanded into the community; DVVA’s Lochee hub, with its five-tier recovery programme; Hillcrest Futures; We Are With You; the planet youth model, which is being rolled out by Winning Scotland at Baldragon academy and St Paul’s academy in my constituency; Street Soccer Scotland, which is doing work at the Lynch centre in Charleston; Andy’s Man Club; Wellbeing Works; and many others. They do amazing work, and they are saving lives.

I realise that we must talk about what more we can do. This week I had a constructive meeting with Peter Krykant and his colleagues from Cranstoun to discuss their calls for an overdose prevention centre in Dundee. I was pleased to back Cranstoun’s pledge, with discussions to follow on how we can bring such a service to Dundee. Having seen an OPC in operation in Paris during my time as Minister for Public Health, Sport and Wellbeing, I know that they can make an important difference, helping to engage people with support services, reduce harm and save lives.

You need to wind up, Mr FitzPatrick.

The work that Cranstoun is doing is making a huge difference to our city, so I am sorry that I have not been able to cover all the points that I wanted to make about why that service should come to Dundee, but I call on colleagues across the chamber to work with me, Peter Krykant and Cranstoun to bring that service to the city.

In closing, I again pay tribute to Dundee drugs commission for all its work. Its recommendations set out a clear path ahead and I am confident that, as a city, we can make the progress that is necessary to improve services and save lives.

13:42  

I thank the Dundee drugs commission for the power of work that it has undertaken over the past four years. The commission’s reports are thoughtful, thorough and provide a real insight into the huge challenges and barriers that are faced by individuals suffering from addiction and accessing treatment services and other key forms of support in Dundee. The commission has given a voice to a group whose cries for help have too often fallen on deaf ears. I wish to pay tribute to all those with lived experience who provided evidence to the commission. I appreciate that that will have been incredibly difficult to do, but sharing those experiences has given rise to a suite of strong recommendations that must be urgently implemented.

The chair of the commission, Dr Robert Peat, emphasised that although those recommendations might be challenging to deliver, they are all achievable; that there cannot be any further delays; that we need action now; and that lives depend on it.

The recommendations include action on the medication-assisted treatment standards, which the commission has described as “a game-changer”. It is deeply frustrating that, nearly three years after the commission highlighted the need for same-day prescribing, and nearly three years after a public health emergency was declared, only one alcohol and drug partnership is fully delivering on the recommendation on MAT standard 1. That is simply not good enough.

The abject failure to fully implement the nine other standards across the country by April 2022, as was promised, is deeply concerning. We must urgently make all 10 standards a reality for those on the ground. We need more than warm words.

Those on the front line are key to ensuring that the standards are fully implemented and sustained in future years. We must ensure that staff in the drug and alcohol sector receive greater recognition of the vital role that they play in society. That means better pay, secure employment and more opportunities for professional development and career progression. That will be essential to achieving recruitment and retention. It is clear from recent reports that many staff in the drug and alcohol sector and health and social care services more generally have been underresourced, undervalued and under pressure for far too long. I recognise that the Scottish Government will publish a workforce plan after the recess, but it should not have taken three years after the drugs death crisis was declared a public health emergency to do that.

The development of medication-assisted treatment in relation to benzodiazepine and cocaine use is another area that requires urgent action. That will be critical to help to turn the tide on the rapid increase in overdose deaths. Those drugs have been implemented alongside opioids.

We must ensure that young people who are experiencing drug harms have access to specialised treatment services. A study that the Scottish Government published late last year highlighted concerns that there were no residential services that were tailored to meet the specific needs of children and young people in Scotland. It said:

“the lack of services tailored towards younger people is concerning given the markedly different profile of drug use among this population group”.

As my colleague Michael Marra emphasised, the lessons learned in Dundee can be applied at the national level. They include the need for health needs assessments across all alcohol and drug partnerships; the integration of drug and alcohol services with mental health provision—that is crucial, and I have been disappointed by the lack of progress in Tayside on that issue—services that fit the needs of the individual rather than the individual having to fit the service; and giving the third sector a greater say in planning and delivering services. Independent external oversight will be essential.

All drugs deaths are preventable. We must act with urgency. We cannot keep talking about a public health emergency without taking emergency action, and we cannot continue to delay implementation and miss deadlines. We cannot and must not find ourselves in the same situation three years from now. We owe it to all those who are crying out for help and all those who have, tragically, lost their lives to get this right. Drive and determination from political leaders will be essential to delivering change. We cannot simply let the crisis continue. Kindness, compassion and hope for those suffering from addiction must be our guiding principle throughout.

13:46  

Like others, I thank Michael Marra for bringing this debate to the chamber and for hosting the round-table discussion. I certainly found it very useful to meet some of the members of the Dundee drugs commission. I also thank Michael Marra for his thoughtful speech.

The March 2022 report by the Dundee drugs commission is nothing short of damning, following the publication of the initial report and recommendations in 2019. It is clear—the debate has demonstrated this—that the pace of change has been too slow and progress has been limited. The Covid-19 pandemic has not helped, but the vast majority of stakeholders believe that the pandemic has not been a sufficient reason for the glacial pace of change.

Let us not forget that Scotland’s drug deaths crisis is a public health emergency and that it was so before the pandemic. As the commission’s report emphasises,

“it is ... fair to expect, pandemic or no pandemic, that significant focus and efforts should have been made in responding to this emergency.”

Last week, Angela Constance told the Scottish Parliament that alcohol and drug partnerships had fallen short of the target to embed medication-assisted treatment standards across all ADP areas by April 2022. The commission’s report says that they would be “a game-changer”. I think that we all agree on that, but the issue is ensuring that they are implemented. This debate has given us an opportunity to think about that.

In 2020, people from the most deprived areas were 18 times more likely to have a drug-related death than those in the least deprived areas. Scotland’s drug death rate is 3.5 times that of the United Kingdom, and it is higher than that of any European country.

Unfortunately, Dundee is at the very heart of this public health emergency. The statistics are bleak. Between 2016 and 2020, Dundee City averaged the highest rate of drug-related deaths of all council areas in Scotland, at 39 per 100,000 population.

Dundee drugs commission has pointed to the fact that there is plenty of work that must be done to implement the recommendations. I agree. As revealed last week and as highlighted by Claire Baker today, despite setting a target last year to ensure that the MAT standards would be fully embedded across the country, they have not been. Just 17 per cent of standards have been implemented. That is shameful. We need to see all of them delivered across all alcohol and drug partnership areas. Parliament needs to know why that has not happened. What has happened to the public emergency promise and response from the Government? The new recommendation is that only half the standards will be implemented by next April, with only partial implementation for the others. Across Scotland, there has been unwarranted variation. The minister needs to be incredibly mindful of that, and Parliament is concerned about it.

In the time that I have left, I want to highlight the limited progress that we have seen on supporting families. I welcome the work of organisations such as Scottish Families Affected by Alcohol and Drugs, which is playing an incredibly positive role in supporting anyone who is concerned about someone else’s alcohol or drug use in Scotland. I also welcome the moneys that have been made available in the national development project fund to help to support families. However, we need to see more.

What I was really taken with during the round-table discussion was how families want to play a major part in taking forward public health solutions. They need to be part of those, because they are often the 24-hour support for people who are struggling with addictions and they often feel that their views and the support that they are trying to give are not taken into account. I hope that the minister will revisit that.

I want to put on record my concern about where we are now with alcohol deaths. In 2020, the number of people who tragically died directly because of alcohol increased by 17 per cent, to 1,190 of our fellow Scots. I welcome the fact that the Government has spoken about the “twin public health emergencies” of drug deaths and alcohol harms, but we are not seeing the focus on alcohol that we should be seeing. I raised that with the public health minister and was incredibly disappointed by the response that I received, which is that the MAT standards will not be in place for alcohol treatments until 2024. I do not think that that is acceptable and I hope that, in responding, the minister will consider a rethink from the Scottish Government on that issue. It is incredibly important that that happens.

This may be the last debate before our summer recess, but the issues that we know so many people are facing will be there when we return. Parliament must—and, I hope, will—continue to press the Government to act and to deliver on its promises.

13:51  

I thank my North East Scotland colleague Michael Marra for lodging his important motion. Just two years ago, Scotland recorded its largest-ever number of drug-related deaths: 1,339. That rate of drug deaths was three and a half times greater than that of the United Kingdom as a whole, and it was also higher than the rate observed in any other European country.

I am sure that, as MSPs, we have all observed the impact of Scotland’s drug deaths crisis on the communities that we represent. In my home city of Dundee, we lost 57 of our neighbours to drug-related deaths in 2020 and, throughout much of the past decade, Dundee regularly had the highest recorded proportion of drugs deaths in Scotland. On my own street, I see the daily impact that drug misuse is having on the community and, in many ways, it is a microcosm of the city’s wider drug use issues. That is why I welcome the work of the Dundee drugs commission, which has sought to reduce drug deaths and improve access to treatment in the city.

However, two years on from its initial report on the issue, the commission’s findings in its recent review make for stark reading. Many individuals still find themselves facing few treatment options and a lack of joint working among the services encompassed by Dundee alcohol and drug partnership, so I welcome the commission’s recommendations, including those on independent scrutiny of the progress being made by the Dundee partnership, better allocation of the substance use budget, and the design of a recovery-oriented system of care.

I would urge Dundee City Council and the wider Dundee partnership to seriously reflect on those recommendations as part of the recently revised five-year drug and alcohol recovery plan.

Scotland’s drug deaths crisis has been exacerbated by the failed criminalisation model, but Scottish Government inaction has not helped either. Last week, the minister admitted that progress is neither good enough nor quick enough, with most council areas in Scotland failing to fully implement the MAT standards.

Although the Scottish Government now recognises the need for increased investment in drug and alcohol services, we cannot ignore the fact that it has imposed cumulative cuts of more than £40 million in recent years, so we need to see urgent action from the Scottish Government and a commitment to pursue approaches that are alternatives to criminalisation. That is why I support my colleague Paul Sweeney’s calls for the introduction of safe consumption rooms. I believe that we need to have a serious debate about decriminalisation and what a modern drugs policy for Scotland should look like.

I emphasise that the only way that we will ever truly tackle drug use will not be by criminalisation. We need to address the societal issues that often drive individuals to drug use in the first place. For too long, communities such as mine in Dundee have suffered the effects of poverty, homelessness and other inequalities. Change will require this Parliament to think and act more boldly in how we tackle those issues, including by looking at the provision of universal public services. If we are serious about tackling Scotland’s drug deaths crisis, we must tackle its long-standing poverty crisis, too.

13:55  

I thank my friend Michael Marra for bringing this critical and urgent matter to the attention of Parliament today. I commend the work of the Dundee drugs commission and those with lived experience for feeding their expertise, insights and views into the commission’s comprehensive initial 2019 report, as well as its 2022 review in response to the drug deaths crisis in Dundee.

The report makes reference to the staggering 1,339 drug deaths in Scotland in 2020. Although the most recent figures show that the number of drug deaths in the year leading up to March 2022 was 1,187, there is still an alarming, preventable rate of deaths in Scotland that is well above the UK and European averages.

As my friend Mercedes Villalba said, we know that there is a link between deprivation and drug dependency. Dundee, like my constituency in Glasgow, has its own unique challenges when it comes to poverty. Female and male life expectancies in Glasgow are the lowest in Scotland, at 78 and 73 years respectively, with Dundee’s male life expectancy also sitting at around 73 years. We must take cognisance of the huge trauma that that causes for communities in our respective cities, which lies at the heart of a lot of the difficulties that we have in dealing with the crisis in our midst.

What really frustrates me in reading the report is that there are simply not enough people with lived experience driving the change and the reform. That is critical in what the commission is trying to say to the Government. Indeed, the primary recommendation is that a major health needs assessment for drug users be carried out to inform public and third sector agencies about what needs to happen, but that response has not yet been implemented. Without a major health needs assessment having been undertaken, it has been difficult for the commission to be prescriptive about what Dundee needs with regard to new service creation. I advocate for that practical and specific tool, because it will be at the core of what we can do to fight the drug deaths crisis in Dundee and across Scotland more broadly.

Colleagues will be aware that I am consulting on my proposed bill to establish overdose prevention centres in Scotland. Such facilities serve the purpose that their name suggests in preventing overdoses and saving lives, and I strongly believe that they will be a critical part of Scotland’s response to the drug deaths crisis. The introduction of such facilities across the world has proved to be an effective way to reverse overdoses, prevent overdoses, engage with people who are currently at the margins of society and provide people with resources and support in relation to issues that stem from their addiction.

I have seen the benefits of that approach at first hand, and I pay tribute to Peter Krykant from Cranstoun, who is in the public gallery today, for the work that it has done to drive the pace in Scotland. It has done far more than any Government agency. I have volunteered with my friend Peter, and we saw at first hand the impact that the unofficial pilot had in Glasgow. Nine overdoses were reversed and eight lives were saved, because two overdoses related to one individual. In addition, 900 injections were supervised.

However, we found that one of the most important parts of the work was the interaction and the building of self-esteem and a sense of validation among people. The approach provides an interface for people to start to engage and get support. Even things as simple as a protein shake and a Mars bar were things that they really needed, and they found a way to validate themselves.

The recent New York pilot is another perfect example of the efficacy of OPCs, with 110 overdoses having been reversed there between November last year and February this year. The impact is striking.

It is a source of extreme frustration that the Dundee drugs commission’s recommendations have not yet been fully implemented, some two years on from the initial report. I fear that the lagging response in Dundee is indicative of the national picture, in which things are moving too slowly as the deaths mount up and up.

I will mention once more the most recent annual drug death figure: 1,187 people died a drug-related death between March last year and March this year. There is an urgent need for quick and cohesive action. In Dundee, that means the comprehensive and urgent implementation of all aspects of the commission’s recommendations. In Scotland more broadly, that means establishing a framework and licensing scheme for overdose prevention centres as soon as possible. I hope that my bill, which is out for consultation, will drive the pace of that change.

14:00  

I commend Michael Marra for securing the debate and providing the opportunity to focus on one of our cities that is most affected by drug deaths and harms.

I thank and pay tribute to the Dundee drugs commission for its work, for both reports on reducing drug deaths in the city and for its clarion call for kindness, compassion and hope to be at the absolute core of everything that we all do to turn the tide on the drug deaths emergency.

It is my view that the latest report provides a comprehensive and fair assessment of the progress that the city has made, and it clearly sets out the work that Dundee needs to do now. That includes improving services for people who are at risk and for their families, as well as providing leadership and oversight—by those who are in positions of authority in Dundee—in order to make that happen.

The report also highlights areas of good practice, which is heartening, but there is no hiding the fact that there is much still to be done in Dundee. When I met representatives from the commission on the very day that it published its latest report, their sense of frustration was not lost on me.

I have met leaders from the Dundee partnership on a number of occasions and, most recently, this week. I have stressed the need for Dundee to act with urgency to address the report’s recommendations, and I continue to offer my support in helping to deliver the change that is needed.

The report is clear in its recommendations that any plan that Dundee produces should be subject to external scrutiny, and I am supportive of that. As I said in my statements last month on the accountability of drug services, transparency and openness to challenge—particularly by people with lived experience and their families—are key to the delivery of effective change at local and national levels.

An oversight group was put in place for the delivery of the Strang review. As the minister knows, that has been years in preparation, but there has been no delivery against the review’s recommendations. The oversight group, appointed by ministers and reporting to ministers on that basis, is a model of external expert validation that could include lived experience and that would give some of those recommendations the chance to receive the kind of oversight that the commission is clearly calling for. That would address the lack of progress, at which the commission feels despair.

I can give you that time back, minister.

The point about oversight is important. Of course, we have a national oversight group for the national mission.

I will go through, in detail, the actions that we are taking now to assist Dundee. I have also been clear with the partnership that, when it comes to the work that we are doing and ministerial direction, if there is no quick improvement, we will have to look at all other options.

Will the minister take an intervention?

No, I will make some progress. The member is always welcome to pick that subject up offline as well.

We are taking action in a number of areas to support Dundee to respond to the commission’s report. Quite rightly, people have highlighted the importance of medication-assisted treatment standards. The MAT standards set out a rights-based approach so that people are able to make informed choices about the types of treatment and help that are available to them and so that there is consistency of services across the country. The MAT implementation support team continues to work closely with national health service and third sector services in Dundee to implement those standards, which includes providing additional support for that progress and the programme of change that is necessary.

However, Dundee still has work to do, particularly around MAT standard 1, which is that people receive same-day treatment. As in other parts of Scotland, I am using the powers of direction that are available to Scottish ministers under the Public Bodies (Joint Working) Act 2014 to compel chief executives and chief officers across the national health service, integration joint boards and local authorities to implement those standards and to personally sign off improvement plans. In addition, Dundee and Tayside will be subject to an enhanced level of monthly reporting. If Mr Marra would like to intervene now, I will give way.

I thank the minister for giving way. My concern is about the timetable. As I mentioned in my speech, MAT standard 1 was recommended years ago, in the first report of the Dundee drugs commission, but it seems that we are no further forward in the delivery of that recommendation. The minister is essentially saying “not yet” with regard to some form of oversight. When will the minister take action and say that it is not good enough and that a different regime will be put in place?

I am—absolutely—taking action. I appreciate that it is perhaps difficult for members who have not served in Government to understand the nature of ministerial directions, but the nature of this ministerial direction is unprecedented, because the challenge that we face is unprecedented. For example, there has never been ministerial direction for integration joint boards. This ministerial direction is for the NHS, IJBs and local authorities to implement at pace the whole system of change that is required. There is other public, practical and financial support, which we are working closely with Dundee to deliver, but I say to Mr Marra that, if I do not see quick changes—

Quick?

The first improvement plans will be available at the end of the recess, and, as I have said, Dundee and Tayside have monthly reporting; therefore, I am looking for change in months, and certainly not in years. I agree that this has gone on far too long. I am not prepared to put up with it; I know that Parliament is not prepared to put up with it; and, most important, I know that the communities that I and other members serve are not prepared to put up with it. Nothing is off the table. Make no mistake about it: the ministerial direction is unprecedented, because I am absolutely serious about this.

Mr Marra mentioned the importance of primary care, which is one area in which we are financially and practically supporting Dundee in its endeavours to establish multidisciplinary community-based teams and to move away from the single city centre delivery site at Constitution house.

We are investing more than £1.8 million over four years to support the delivery of drug treatment in primary care. That will significantly increase the capacity of the system to provide up to 800 people with protective treatment in community-based, non-stigmatised settings. It will also ensure that treatment is delivered alongside general healthcare, meaning that people with underlying conditions will be able to access the other services that they need in the same setting.

As a former mental health officer, I recognise the testimony from people with lived experience about the challenges they face when trying to access mental health support along with support for addictions. That is why the Healthcare Improvement Scotland work started in Dundee—the commission paid tribute to it—with the aim of fully integrating substance use and mental health services in the city. That is not only vital learning for Dundee; it will be vital learning across Scotland.

Mr Marra rightly asked why we are not seeing progress and what the blockages are. I have touched on some of them around leadership, and it is important to ensure that investment reaches those it is intended to reach. However, a major asset to Dundee is its fabulous third sector. I have seen that from the many visits that I have made to Dundee over the years in different portfolios. The third sector plays a vital role in delivering person-centred services. Third sector organisations are on the front line and are well positioned to establish trusting relationships with people and take an holistic approach. The third sector in Dundee, as elsewhere in Scotland, is key to transformational service redesign and a move away from centralised, overmedicalised models of care.

We are investing in a number of voluntary sector organisations. Joe FitzPatrick mentioned the Aberlour child and mother house. I, too, had the pleasure of meeting Cranstoun today to hear about its work elsewhere in the UK and about different models of care.

The Dundee drugs commission report is challenging, and so it should be. However, it also clearly speaks to the many assets that there are in Dundee. Those assets will assist the people with local and national responsibility to deliver the transformational change that is needed. They include the expertise of people with lived and living experience, the insight of front-line staff and the innovation of the third sector.

Although it has been a difficult experience for the commission, I have no doubt that its work will leave a lasting legacy, and I intend to play my part in that.

That concludes the debate. I congratulate all of you on sticking with it through to the last debate before the recess. I wish you a good recess and hope that you manage to get something of a rest over the period.

Meeting closed at 14:11.