Meeting of the Parliament (Hybrid)

Meeting date: Tuesday, November 30, 2021

Official Report 1028KB pdf

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Residential Rehabilitation

The next item of business is a statement by Angela Constance entitled “Pathways to Recovery: Update on progress and milestones for expanding access to Residential Rehabilitation in Scotland”. The minister will take questions at the end of her statement, so there should be no interventions or interruptions.

16:31  

We carry a national shame of thousands of heartbreaking drug-related deaths. It is my job as the Minister for Drugs Policy to lead the national mission to turn the tide on that crisis.

When I speak to people in recovery, I am often reminded that preventing somebody from dying is only the beginning of the recovery journey. Recovery is not something that happens to people; it happens when the system of services and resources facilitates individuals to build recovery capital and social connections, and to pursue their recovery goals safely. The system of services needs to be based on hope and trust to meet people where they are and not leave them there.

I come before Parliament today with the word “hope” in mind to provide an update on our progress on residential rehabilitation and to set out our milestones for the road ahead. Our national mission to tackle the drug deaths emergency is focused on a public health response to save but also to improve lives, whether that is through harm reduction services, medicated assisted treatment, abstinence programmes, or support for mental health, housing and welfare. It is about supporting people to access the treatment and recovery that is right for them. We are therefore working to ensure that all the component parts of a recovery oriented system of care operate effectively with good links and pathways between them to reduce harm and promote recovery.

Residential rehabilitation must be part of the range of evidence-based prevention, treatment and recovery services. That will ensure that there are options and choices for those who seek an abstinence-based recovery. There are three parts to our national approach to achieving that: improving pathways into and from residential rehabilitation, in particular for those with multiple and complex needs; investing in a significant increase in the capacity of residential rehabilitation; and developing a standardised approach to commissioning residential services.

Today, we have published a suite of reports that detail the current state of pathways into, through and from rehab. The research that the Government has undertaken has highlighted areas that do not have clear pathways. That has enabled us to tailor and target our interventions to the areas where it is hardest to access rehab. Pathways into and between all types of services are important, but they are even more vital for residential rehab, because it is all too often not part of the range of options available.

We know that the transition from rehab back into the community is a higher-risk phase, so it is important to get it right, with reintegration into other services, such as housing and employability services. Pathways to residential rehab and aftercare should be clear, consistent and easy to navigate, no matter what area of Scotland a person lives in. We want to ensure that people feel supported and have more choice in their treatment journey, and that a no-wrong-door approach means that they can ask for help through a variety of services, including housing, criminal justice and community outreach. The tragic statistics that were published today on homelessness deaths, more than half of which are linked to drugs, make that an ever-greater priority.

We will be ensuring a rights-based approach by applying the PANEL—participation, accountability, non-discrimination, empowerment and legality—principles in the development of pathways in all alcohol and drug partnership areas. By summer next year, we will ensure that each ADP has a published pathway document to share with clinicians, social workers and outreach workers, as well as individuals and their families.

We have responded to calls for more transparency and accountability by working with Public Health Scotland to track the number of residential rehab placements that ADPs have funded. That will provide the Government with a clear line of sight on how the residential rehab money is being spent. So far, in the first six months of this financial year, ADPs have funded 212 placements with an investment of around £1.4 million from the £5 million that was allocated to be spent on residential rehab and aftercare this year. That is almost the same as the number of placements funded annually in 2019-20.

Let me be crystal clear: it will be unacceptable for any area not to be investing in residential rehab. We aim to increase the number of publicly funded placements by more than 300 per cent over the five years of the programme so that, by 2026, at least 1,000 people every year are publicly funded for their rehab placement. We will work with ADPs to support the delivery of that ambition and to facilitate regional approaches, especially in those areas where the rates of drug deaths are highest and access to residential rehab is most challenging. Regional hubs overseen by Healthcare Improvement Scotland will ensure that the local system of treatment and recovery services, including residential rehab, is operating to the highest of standards.

In order to facilitate the increase in publicly funded placements, we are working to increase capacity. That builds on the recommendations from the residential rehabilitation working group—to which I am very grateful—to ensure equal access across Scotland.

The total estimated number of rehab beds that are available in Scotland just now is 425. Our aim is that, by 2026, there will be 50 per cent more rehab beds in Scotland, giving a total of 650. We have established a rapid capacity programme as part of the recovery fund, which will expand existing services and establish new services. Our surveys highlighted a gap in provision that meets the needs of women and those who require childcare facilities, so we have made that a focus for the programme.

We have already committed to just over £8 million of funding over the next five years to support a new national family service, to be delivered by Phoenix Futures. The service, which will be up and running by summer 2022, will support up to 20 families at any one time.

I am pleased to announce to Parliament today that we are providing funding to expand the capacity of the Lothian and Edinburgh abstinence programme—LEAP—by 40 per cent. That funding will enable the detox capacity in the Ritson clinic to increase by 50 per cent. That will enable more people to safely detox before going into the LEAP service. The project will be delivered in partnership with the Lothian ADPs and will act as a blueprint for a regional model of delivery to address inequities of access across Scotland.

I can also announce to Parliament today that, in recognition of the fact that one size does not fit all, and given the need for a diversity of residential rehabilitation options, we are funding River Garden so that it can scale up its innovative residential therapeutic community and social enterprise. Based on the experience of international models in Italy, Sweden and the USA, River Garden offers a three-year residential programme for people in the early stages of recovery. The service currently supports seven residents, and the funding will enable it to realise its vision of supporting 56 men and women in recovery.

That brings us to a total of £18 million of investment so far from the recovery fund, which will increase capacity and ensure choice.

In order to transform more fundamentally the way in which residential rehab beds and placements are funded, we are developing standardised approaches to commissioning rehab services. Subject to the outcome of the national care service consultation, the Government may take a national approach to commissioning specialist addiction services. However, although the national care service has the potential to reform how services such as rehab, detox and stabilisation are commissioned and procured, we do not need to wait until the more systematic changes are made. That is why we have asked Scotland Excel, as the centre of procurement expertise in local authorities, to undertake market analysis and further engagement with ADPs now to consider the different routes that are available to the Government.

When the First Minister and I recently visited Bluevale Community Club, we emphasised that no ideas are off the table, as problems and solutions belong to us all. We want to build a political consensus around what works—for example, we welcome the recognition across the Parliament that safer drug consumption facilities have a role to play in saving and improving lives.

I have outlined today the work that we are undertaking over the next five years to ensure that everyone who wants residential rehabilitation, and for whom it is considered clinically appropriate, can access it. My priorities are about making people’s rights real by funding and shaping new services, supporting the development of clear pathways and reforming the commissioning model. The national mission is not about prioritising residential rehabilitation over medication assisted treatment standards or abstinence over harm reduction—it is about supporting people, and getting more people into the treatment and recovery that is right for them. By doing so, we can help people to flourish and feel hopeful about their futures, and we as a country can see through this crisis to a better time.

The minister will now take questions on the issues that were raised in her statement. I intend to allow around 20 minutes for questions, after which time we will move on to the next item of business. It would be helpful if any member who wishes to ask a question were to press their request-to-speak button now.

I thank the minister for advance sight of her statement and the many attachments that came with it.

In October, the Scottish Government held a debate on a person-centred approach to mental health and substance abuse. Today, we have heard again about the importance of getting more people into the treatment and recovery that is right for them. However, the problem with the idea, and the ideology, of person-centred care is that, in reality, the care that people receive is system centred or organisation centred. Patients generally get what the system or organisation is willing and able to deliver, not the care that they want or need. What guarantees can the minister give us that person-centred care will be centred on the person and not on the ability of providers to deliver a service?

I very much appreciate Sue Webber’s contribution. I understand that there is a wide variety of attachments and publications underpinning today’s statement. We have published a wealth of information, and I am happy to engage further on the detail in and around that with Ms Webber or any other MSP. Boring into the detail is crucial if we are to redesign systems of care, whether those are community services or residential rehabilitation services, to meet the needs of individuals rather than those of providers, local authorities or Government. We have to put the person at the centre.

Although I appreciate that much of what I have published today might be less than sexy politically, if I can put it that way, it is important to bore into the detail of where the money is being spent in order to understand where the gaps in provision are and to sort out pathways so that they are clear, consistent and easy to navigate across the country, as well as to invest in services to use and build on existing capacity.

Much of our work around national commissioning and taking a regional approach will help us to change the system so that, instead of meeting the needs of a self-perpetuating system, we meet the needs of our people, who need treatment that is right for them, not right for us.

I welcome today’s reports and the advance sight of the statement. It shows that some progress has been made, which is to be welcomed. However, I want to introduce a note of caution to how we frame the discussion. I welcome the fact that the minister mentioned harm reduction, but we must not stigmatise people who use opiate substitutes to address their addiction. It is a legitimate treatment option, and, if we are serious about bringing to an end Scotland’s fatalities, it is part of the response.

I have a few questions on the statement. Although the increase in placements is positive, the recent residential rehab funded places monitoring report shows significant differences by ADP. When will the postcode lottery come to an end?

We have seen an increase in the number of fatalities among those aged under 25, and there is recognition that there is a lack of access to specialist treatment, including rehab, for young people. What facilities are planned for young people?

Is the minister confident that the resources that are in place are sufficient, and is she monitoring whether there are any increases in the cost of residential rehab?

I will try to cover all those questions as quickly as possible.

I am grateful to Ms Baker for her recognition of the progress that we are making. I absolutely endorse what she says about not stigmatising opiate substitute therapy or harm reduction. That is one of the reasons why we are taking a whole-systems approach, and it is why we talk about a wider system of care in which all parts complement one another and fit together. She will also note that we are significantly increasing the number of placements, which I hope is welcomed across the chamber.

In terms of phase 1 of the rapid residential rehab recovery programme, we are investing £18 million, which equates to at least 77 beds and will increase capacity by around 18 per cent. That is a significant step forward.

Ms Baker is right to ask what is next. Although we have had a focus on women and families—and our work there is far from done—we need to think much more about where services need to be, particularly for young people. Over the past few years, we have seen a growing number of young people either being admitted to hospital or, tragically, losing their lives.

Today’s homelessness statistics and those tragic deaths, which were also preventable, mean that we need to think with even more haste about how we support those with multiple and complex needs. The £18 million investment is a great boost to services across the central belt of Scotland, and our investment in the Lothians, in particular, will give us a blueprint for expansion elsewhere. However, we also need to take a close look at the acute needs that exist in our rural communities.

The expansion of residential rehabilitation is welcome; however, the minister outlined in her statement the importance of having a range of different treatments available. What role will community services play as access to rehab is expanded? I am aware that the period after residential rehab is particularly crucial.

That is an important point. Over the piece, it is important that we do not consider residential rehabilitation in isolation. We need to remember that community services are key to the success of residential rehabilitation. It is about providing continuity of care, preparing people prior to their entering rehab and the aftercare that they receive. We need to think about the aftercare on a much more long-term basis. It is not about people coming out of residential rehab and receiving a little bit of support for a wee time; we need to think about the longevity of that on-going support. The active outreach and referral to the lived experience recovery organisations are also important in improving aftercare. The £5 million improvement fund, of which £3 million was allocated to improve the quality of existing rehab services, also includes improvements in preparation, outreach and aftercare.

Before I call the next speaker—not looking at anybody in particular—I remind members who wish to ask a question to please press their request-to-speak button. They are not looking at me, so we will see what happens.

The minister conceded that one size does not fit all. As the Government considers yet another structural overhaul of drug and alcohol support, through the creation of a national care service, what assurance can she give that a further review will not simply result in more cuts and bad outcomes for those who require access to residential rehab and aftercare services?

Improving access to, and the capacity of, residential rehabilitation is a key part of our national mission to tackle the drug deaths crisis, but it is not the only part. As we have heard from other members, harm reduction and community services are important, too.

In this post, with the support of the First Minister, I have made long-term funding commitments not only to ADPs but to the voluntary sector, which is often at the front line in this area. There are four new funds for people to apply to: the recovery fund, the local support fund, the improvement fund and the families and children fund.

I absolutely concur with the point that it can never be a one-size-fits-all approach, but we have a national emergency that requires national leadership. However, our approach also requires good partnership working on the ground and bespoke arrangements. I think that Mr Hoy could equally criticise us if we were to devolve or outsource Government decisions. We need to set an example, lead, fund and show direction as well as raise the bar in what is expected in every part of Scotland.

The proposal to increase capacity for residential rehabilitation recovery is welcome and timely. What provision will be made to include access so that the highest-risk individuals do not face barriers to access arising from preconditions such as being alcohol or drug free prior to their admission?

As is set out clearly in the good practice guidelines that we have published today, we can do much more to remove the unnecessary barriers that exist in relation to admission and referral criteria. Those barriers are most acutely felt by people who have the most complex needs, whether that is because of a history of homelessness, mental health problems or addiction issues.

Although it will always be the case that services need to make judgments about entry criteria that are based on safety and efficiency, and taking cognisance of the needs of other residents, it is also important that, as well as our expansion of residential rehabilitation, which is for those who seek an abstinence-based recovery, we look at other models of care, whether in relation to residential care or supported accommodation. Members will have heard my announcement today of extra funding for NHS Lothian for placements to LEAP. That funding increase will improve access to detox. However, there is much more that we can do in relation to that range of services to accommodate people safely who are not pursuing an abstinence-based recovery.

In the wake of the developing situation surrounding the omicron variant, how many individuals in residential rehabilitation have been double vaccinated? How many residents in rehabilitation centres have adequate testing and vaccination services available to them? What is being put in place to ensure that residents get the booster in good time?

We published a status report perhaps six to eight weeks ago—I will send that information to Ms Mochan. As a result of that information, which demonstrated that vaccination levels of people accessing residential rehabilitation were not as high as those in the general population, or in accordance with various clinical priorities, including those for different age groups, we undertook a range of actions.

New guidance has been issued to health boards. We have proactively arranged for guidance and testing kits to be sent to residential rehabilitation centres. We have also provided training and support for people to access via webinars and suchlike.

I assure Carol Mochan that the area is one that we are taking a very active interest in, because it is about access to healthcare. As part of their bigger vaccination programme, all national health service boards have plans for how they will reach people whom it is harder for services to reach. We are taking a very close interest in the issue, because it is about people’s right to access the same healthcare that Carol Mochan and I have the right to access.

As the minister knows, Phoenix Futures—backed by the Scottish Government—plans to open a national drug rehabilitation centre on the site of the former Seabank care home in Saltcoats in my constituency. However, the organisation will not consult the local community; instead, it will contact neighbours and elected representatives to help them to understand what it does. I, for one, am still waiting.

Does the minister agree that a new development of such a nature and scale must be consulted on, not least to ensure that any local concerns are taken on board and addressed, to scotch any misunderstandings and to ensure that the project becomes part of the Saltcoats community and not just located in it?

I appreciate Mr Gibson’s points. As I said to Mr Hoy, we face a national crisis that requires a national mission, and that requires national leadership and the taking of decisions at national level.

Having said that, I would always be the first to recognise that we can all work harder to improve our partnership working. In that vein, I recently met councillors from North Ayrshire Council and Phoenix Futures, which will deliver the project, to discuss the plans for consultation and community engagement. It is important to recognise that having a national service in an area offers local opportunities and local benefits, and that was a huge focus of our discussions with local councillors.

I am confident that Phoenix Futures has a well-established approach to carrying out exercises such as community impact assessments and consultations on projects such as the one in question. It has run a very similar family service in Sheffield for 25 years, and I expect the new national centre in Scotland to follow that example.

If I can provide any further assistance to Mr Gibson in reassuring his constituents, I will most certainly do that, but I was very proud that the new national service was the first project that we announced as part of our rapid residential rehabilitation increased capacity programme. We all have obligations to keep the promise. There was a gap in services for families. We know that fear of what will happen to one’s children is a big barrier to women in particular in coming forward and seeking the assistance that they need. The new service offers us a good opportunity to start breaking the cycle and to keep the promise.

While I am well aware of the importance of the subject and the comprehensive nature of the detail that the minister wishes to provide to the chamber in responding to questions, I remind her that we have very limited time, and quite a few members still wish to ask a question.

I thank the minister for providing advance sight of her statement. She knows that she carries the good wishes of the entire chamber towards the end that she has described.

We still face a problem of global proportions—we are still the worst in the world in this area—and our response must be equal to that. I am grateful to the Government for committing to increasing the number of rehabilitation places to 1,000, but I am very concerned that it will take us till 2026—five years—to get to that number. People are dying today.

What is keeping us? Why will it take us so long to deliver the increased number of places?

For the sake of brevity, I emphasise to Mr Cole-Hamilton that we have taken significant steps forward, but that does not detract from the need always to do more and to go further and faster.

As part of the first stage of our residential rehab programme, we have committed £18 million, which will add an additional 77 beds, increase capacity by 18 per cent and provide 450 more placements over time. That is an important first step.

I do not demur from the fact that there are other steps that we must take quickly, part of which is about the whole-system approach. Within the next fortnight, I will come back to the Parliament to make a statement on progress on, for example, medication assisted treatment standards.

I commend all parties in the chamber for taking a united approach to tackling drug-related deaths. We must use every opportunity at our disposal to identify people who are at risk and to signpost them to support services. Will the minister provide an update on engagement with her UK Government counterparts on proposals to introduce safe consumption facilities in Scotland?

I continue to take two approaches. On one hand, I continue to engage with the UK Government on the evidence, not the politics. I recently attended the UK drugs summit and, at that time, I published an evidence paper in support of safer drug consumption facilities. Recently, on the back of comments from Douglas Ross and the Conservatives’ shift in position, I took the opportunity to write back to the minister, Kit Malthouse, to see whether that would encourage a similar change in heart from the UK Government.

On the other hand, as members know, I am determined to do as much as we can within our own powers. The Lord Advocate’s statement on safer drug consumption facilities is helpful and is to be welcomed. We are working through the detail of a proposition for us to pursue within our powers.

Public Health Scotland today published statistics that state that 12 alcohol and drug partnerships, including those of North Lanarkshire and South Lanarkshire in my region, did not provide data on the numbers of people entering residential rehab. One of the reasons for that was patients not meeting abstinence requirements. What other treatment options are provided to individuals in those circumstances so that they are not turned away with no follow-up support?

Let me repeat again that it will not be acceptable for any part of the country not to invest in residential rehab. Saying that, I recognise that residential rehab is not for everyone, which is why we are taking a whole-system approach. We need treatment and recovery services with different models of care—those of a residential nature and those in community settings.

As the minister suggested, Scotland has a shockingly high number of drug deaths, so it can come as no surprise that drugs account for a high proportion of deaths in the homeless community, with more than 50 per cent of homeless deaths being drug related. What is the Scottish Government doing to tackle drug deaths in the homeless community, reach out to the community and ensure that homeless people have access to rehabilitation services?

Mr Whittle is absolutely correct when he says that it is about how services reach out to people who have more complex needs. Work that started in Dundee and is overseen by Healthcare Improvement Scotland is very much focused on the integration of addiction and mental health services. We know about the connection between problems with addiction, mental health and homelessness, so we need a full spectrum of services, which must be far better connected. As a result of the work that started in Dundee, an additional four health boards have taken the same approach. There is a £2.2 million project that has expanded that work, which is about the better integration of services so that they can reach the people who are most in need and remove barriers where they exist.

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

The minister will be aware of issues that I have raised with her in the past. When it comes to residential rehab, there will be many individuals with an addiction to prescription drugs such as benzos, and there will be many others with an addiction to street drugs. With an increase in the number of residential rehabilitation spaces, will the Government ensure that there are sufficient spaces for people with an addiction to prescription drugs?

The guidance on good practice pathways emphasises the need to facilitate access to residential rehab for all individuals, no matter what type of substance they are addicted to.

Our research has shown that there are particular barriers around the use of benzodiazepines, which have specific detox risks, and around polydrug use, which is a germane issue in considering drug deaths in Scotland. However, people’s use of substances should not be a barrier to accessing rehab.