Public Audit Committee

Meeting date: Thursday, March 31, 2022

Official Report 640KB pdf

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“Drug and alcohol services: An update”

The next item on our agenda is consideration of Audit Scotland’s recent briefing on drug and alcohol services, which is an update report on some work that Audit Scotland has looked at over a decade or more.

We are joined in the committee room by Stephen Boyle, the Auditor General for Scotland, and, from Audit Scotland, Antony Clark, interim director of performance audit and best value, and Jillian Matthew, senior manager, performance audit and best value.

I invite the Auditor General to make an opening statement.

Today I bring to the committee a briefing on drug and alcohol services. As you note, convener, our paper updates our earlier work from 2009 and 2019.

Three years ago, we highlighted that drug and alcohol deaths and associated ill health remained high in Scotland. Problem drug and alcohol use is closely linked to deprivation, and ministers have described Scotland’s drug deaths as an emergency, with the country having the highest drug-related death rate in Europe. The number of people dying from alcohol has also been increasing, and excess alcohol consumption similarly causes wider societal and health harms.

My joint briefing with the Accounts Commission provides a further update on the key challenges and areas for improvement, which we plan to follow up in more detail next year.

Progress on addressing the challenges has been slow since our 2009 report, but we have seen the Scottish Government and its partners increase their efforts and tighten their focus in recent years. We highlight a number of new developments, such as the Scottish Drug Deaths Taskforce, new medication assisted treatment standards and efforts to improve access to residential rehabilitation. Those developments have been accompanied by a significant increase in funding in the past two years, after a period of reduced funding and no real-terms increase. However, it is not yet clear what impact those new approaches and increased investment are having.

Our paper also highlights that the delivery of drug and alcohol services is complex, with clearer accountability needed. There are many organisations working across different sectors, and governance is complicated and difficult to navigate. More focus is, therefore, needed on prevention and tackling inequalities. Spending could be more effectively targeted at interventions that tackle the root cause of drug addiction in communities, but the Scottish Government has not yet identified what level of investment is required to achieve the greatest benefits.

We are calling on the Scottish Government to join up the various strands of work and funding streams to show how it is collectively targeting improved outcomes. The Government now needs an overarching plan that clearly links spending to reducing the tragic loss of life. In the longer term, more focus is needed on policies that tackle inequalities and the root of drug and alcohol misuse.

As ever, we look forward to answering the committee’s questions.

Thank you for that opening statement.

The first lines of the update paper are a stark reminder of the situation that we find ourselves in. They say:

“In Scotland, 1,339 people died from drug-related causes in 2020—the highest ever reported and the highest rate in Europe.”

However, as you have just said, you view progress as having been slow. In the report, you say that there is

“a lack of drive and leadership by the Scottish Government.”

To what extent did the Scottish Government respond to the clear recommendations that you made more than a decade ago, in 2009?

I will bring in my colleagues to provide more detail on the 2009 report. Today’s briefing paper provides an update on the 2009 and 2019 reports and signals our intention to undertake further work.

In an area of real significance, ministers have been clear in their assessment that this is a national emergency. The statistics and the stark numbers before us represent the real-life circumstances of individuals, families and communities.

With regard to tracking the progress over the years, we note in the report that the arrangements that Scotland has to deliver drug and alcohol services remain complex and fragmented, and some of the governance arrangements are also difficult to navigate. It is not clear what the most targeted and successful funding delivers in terms of improved outcomes. Many initiatives have been brought in, going back to alcohol and drug partnerships that date from around the time of the publication of our first report, in order to try to deliver more local and targeted strategies. However, the overall benefit that such structures are delivering across Scotland is not clear and, 13 years later, we still face some dreadful statistics in terms of the delivery of outcomes for problem drug and alcohol usage.

That is why, in spite of recognising the progress that has been made in recent years, with additional significant funding commitments planned over this parliamentary session, we have arrived at the call for an overarching plan that is clear, transparent and measurable and which sets out what the most successful interventions are and what evidence supports the interventions that lead to better outcomes, and for the governance and arrangements across the country to support the delivery of improved services.

I will pause for a moment and invite Jillian Matthew and perhaps Antony Clark to say a bit more about the trajectory over the past 12 years, if they wish to do so.

As the Auditor General said in his opening statement, progress has been slow, but I think that we have seen a lot more developments and progression over the past couple of years. As we say in the briefing, it is still a bit early to tell what impact some of the new initiatives have had. As we have said in other reports, there are still gaps in some of the data and information systems, and we have seen quite significant delays in the drug and alcohol information system—or DAISy—which was designed to help alcohol and drug partnerships in local areas to see how they are managing people with drug and alcohol use issues, to measure progress and to look at activity. There are still quite a few gaps in the information that is needed to do that well.

We know that people are currently working on trying to improve information relating to rehabilitation services, as well. Obviously, that is a priority area for the Scottish Government.

Around 2016-17, investment in drug and alcohol services reduced, and we did not see a real-terms increase, rather than a cash increase, until 2020-21. There has been much more significant investment relatively recently, but we still do not fully know how that money has been directed. As we have said, we need more details about the spending, which we have not been able to track fully. How much of that is directed towards prevention? How are the different strands of funding helping to improve outcomes and deliver some of the priorities that the Government has set? We still do not have a clear picture of how all that links together.

There are further questions to come about the transparency of spending, the governance arrangements and the strategy. However, I have one other question that I want to put to you.

Exhibit 1 in the briefing shows that alcohol-related deaths reduced and levelled off over a period of 15 years and that they have started to rise again. In your opinion and assessment, what measures drove down alcohol-related deaths and what may be the cause of their recent increase?

I am not sure that we are necessarily able to attribute with any great confidence the factors behind the movements in alcohol-related deaths that you identified in exhibit 1. As ever, there are many complex factors behind the use of alcohol. We know that there have been policy interventions—in particular, we touched on the introduction of minimum unit pricing for alcohol in the briefing—but we have not given a direct explanation of why alcohol-related deaths dropped. Our intention is to track the Government’s analysis, review Public Health Scotland’s role in doing so, and undertake further work.

In the briefing, we speculated on the impact that the pandemic has had and the potential implications of increased alcohol use in the past two years. As ever, that is simply speculation. We know that many and various factors are involved. Our intention is to follow up with further work, but our ability to be definitive about what we think are the root causes behind the numbers is probably restricted.

10:30  

We understand that, and it would be helpful to return to it. One of the overarching questions that came out of the briefing—which many people looking at this whole area of public policy ask—is why, despite the fact that there are now new initiatives, it has taken so long, given that you were evaluating it all those years ago in 2009. During that time, things have not got better—they have got worse.

Yes. That is certainly one of our conclusions in the briefing paper: progress has been slow. Should the committee wish to do this, exploring the reasons behind the lack of anticipated progress with the Government and its partners would be valid. We have looked to identify some of those reasons. I have touched on the fact that we are still identifying some of the governance arrangements, which seem complex. There has been a lack of transparency in the funding environment for the delivery of drug and alcohol services. We also note the reduction in funding from 2016-17 onwards. As Jillian Matthew mentioned, funding has returned to the anticipated growth levels in cash terms. The Government has significant plans over the life of this parliamentary session for some of the emergency intervention and longer-term planned recovery arrangements—some of the rehabilitation services—that it is supporting.

It is too early to say how significant and beneficial those interventions will be, but it is vital that the Government has an evidence base on which to make informed policy decisions in the future. We are keen that we do not prepare another report, as we have done in recent years, that details slow progress. I am keen to see some of the interventions demonstrating value for money and that some of these critical steps are taken.

Thank you. I invite Craig Hoy to ask a series of questions.

Good morning. One of the Scottish Government’s key measures and policies has been the introduction of new standards for medication-assisted treatment, which has become a bit of a buzz word. Your briefing rightly notes that the standards aim to give people access, choice and support through drug services. They are due to be embedded across the country by April 2022, which, as we know, is this week. Can you provide an update on where you believe that to be and how realistic the deadline is?

I will ask Jillian Matthew to update the committee on that point.

As far as we know, that is on track. When we liaised with the Government on our report and some of its key findings, that process was confirmed to be on track.

One of the other key innovations and developments was the creation of the Scottish Drugs Death Taskforce. The original chair and deputy chair resigned citing serious concerns that the pace at which the task force was being asked to operate risked the implementation of sustainable change. In effect, they said that speed did not equate to effectiveness. Do you share concerns that, after a period of inactivity, we might mistake activity for progress?

We note in the briefing paper the circumstances of the resignation of the chair and deputy chair and the subsequent appointment of a new chair and deputy chair. There are a number of related points in our paper. We talk about the slow progress and the need for an overarching clear and transparent plan that is measurable and which sets out the impact of different levels of investment. As you have touched on already this morning, there is a planned significant increase in Government funding. In this paper, as in many of our reports unfortunately, we talk about the lack of high-quality data with which to measure progress. All those things need to be in place so that, over the life of this parliamentary session—as we move towards a step change in planning and focus around drugs and alcohol—that is delivered to best effect.

I recognise the conflict between pace and the need to have a clear, measurable and deliverable plan. In relation to our recommendation, we look forward to a new overarching plan capturing not only the work of the task force but the earlier strategy around rights, respect and recovery, and the national mission. That should all be gathered up in a clear, measurable and deliverable plan.

Ms Matthew slightly pre-empted me in relation to the considerable delays in the implementation of the drug and alcohol information system—DAISy—and that database. There are still considerable data gaps in the system. Will you elaborate on the work that is under way to address those gaps? What timescale are we operating to in order to ensure that we get the important information into the system?

We spoke to members of the team at Public Health Scotland who are working on that. It is clear that there is still a lot of work to do. Some of that relates to the quality and availability of data from alcohol and drug partnerships. Local work needs to be done in that regard, but there are also national developments relating to the data that is required. Some of those are still being worked through and reflect the more recent initiatives that have been announced, such as the national mission.

The original plan for DAISy has evolved over time, as it had to take into account some of the new strategies, and work needs to be done to ensure that data is available to answer some of the questions and to measure performance and progression.

There is a focus on residential rehabilitation services, on which there have been some recent reports. There is a lot of work to do around activity, pathways, the number of places and so on to build up a full picture of what is available. The Government is also looking at increasing capacity. There is quite a bit of work to be done on that, which was the main area that members of the team talked about, but there are also other pieces of work. They recognised that there are still quite a few gaps in other areas. We talked about homeless people being very vulnerable and about wider services not being joined up yet. There will be an incremental approach to building all that into the system. Given that there have already been so many delays, the issue is still about getting all of that in place, including the quality of data from local alcohol and drug partnerships.

Audit Scotland’s 2019 update questioned the appropriateness of a 21-day waiting time target for drug and alcohol treatment. In relation to drug deaths, you also raised serious concerns about people who do not attend treatment—those who, in effect, fall out of the system and have no contact whatever with treatment services. Are you aware of any work being undertaken by the Scottish Government to address those two critical issues?

I will turn to Jillian Matthew to see whether she has an update on the Government’s plans on those issues.

For completeness, Mr Hoy is absolutely right to say that, in our 2019 report, we noted the extent to which the 21-day target was appropriate, given the urgency of the circumstances that problem drug users might face. We also talked about their ability to engage with services at key emergency points in their lives. All those matters were at the root of our recommendation to take stock and consider whether those measures were productive and were helping in what were felt to be acute circumstances.

I will check whether the team has any more information. If we do not, we can come back to the committee in writing.

I will quickly comment on a broader point. The issue with the 21-day waiting time target speaks to a broader issue about capacity in the system. To me, the issue seemed to be that people were waiting too long to access services that they needed at a time of crisis. The investments and commitments that have been made around building capacity are seeking to address that.

One would assume that, as part of those developments, thought would be given to the appropriateness of the length of time that people have to wait to access services. I am not sure whether that discussion is taking place in Government—Jillian Matthew might be able to answer that.

On the point about DNAs, it is clear from what we hear from ADPs that there is still a challenge around people falling out of contact with the system. That seems to speak to the cultural issue about the need to engage and commit, and to work with people when they are going through difficult circumstances in their lives. That is why the whole issue of fairness and respect has been an important part of the conversation on changing the culture around drug and alcohol support for individuals.

DNAs are another area where there is no regular data collection or reporting. When we examined the issue previously, there had been a one-off exercise to try to assess what the situation looked like. The Government has announced a new target, which is due to come into place in April—as you say, Mr Hoy, that is some time from tomorrow—on the number of people who are in treatment. As others have said, there is an issue about urgency, and three weeks can be far too long for someone who is in crisis and who needs treatment. Obviously, the MAT standards are focused on trying to address that. The new treatment target is on the number of people who are in treatment and how long they stay in it. That is because there is an issue about retention and people remaining in treatment rather than dropping out of the service if they are not getting the right support.

Is there a fear that, much in the same way as happens with rejected referrals in child and adolescent mental health services, the data that we have, even if it is accurate and was properly captured, does not necessarily represent the true scale of the problem, because people are falling out of the system and we no longer have any further data for them? Is that a legitimate concern?

Yes—that data is just not there at the moment.

Thank you. I have to say that we are quite concerned about data gaps.

Colin Beattie has a number of questions.

Obviously, everybody is very concerned about the issue, which is a big issue for Scotland and something that we have to tackle. Can we take any comfort from the fact that fewer young Scots are using drugs and alcohol? I realise that, among older people, there has been an increase, but can we take some comfort from the fact that, among younger people who would be getting into drugs and alcohol for the first time, drug and alcohol use is reducing? Also, in the first nine months of 2021 versus 2020, there was a 4 per cent drop in the number of deaths. Is it too soon to think that that is a trend that is resulting from some of the initiatives that have been taken?

It is probably too early to be definitive in identifying a trend in the recent data. In exhibit 1, we tried to draw on some of the longer-term averages in order to smooth out some of the impact of initiatives. As was touched on in the previous question, data gaps can take a bit of time to show. As we say further on in the report, there is a difference between some of the National Records of Scotland data and Police Scotland’s estimates. There is an overall issue about robustness of data that makes me hesitant to identify definitive patterns, at this stage.

I guess that your overall question is whether there is cause for optimism about some of the choices that different groups in society, including younger people, will make. Again, I am reluctant to be definitive about that. That probably speaks to the overall point that we make in the report—that Government and its partners will want to be absolutely clear about which interventions are making a difference.

Whether it is education and training for Scotland’s young people; emergency interventions such as providing naloxone to police officers, staff in other emergency services and others so that they can prevent death from overdose at the point of crisis; or rehabilitation services, which feature prominently in the Government’s thinking, given the £100 million investment in them, all those interventions will have to be tested and evaluated. The work of the Scottish Drug Deaths Taskforce, the national mission and the strategy will have to be gathered together in a transparent way so that the Government can be satisfied and clear about what is and is not making a difference.

As ever, I am hesitant about definitively saying that there is cause for optimism. As we note in the report, we are clear that in recent years there has been much more focus from Government and its partners than there was in the previous three or four years.

10:45  

I will move on to a slightly different topic. I am sorry—Jillian, do you want to come in?

On your specific question on younger people, the figures that I have to hand are on drug-related deaths, rather than overall drug use, but they show an increase in drug-related deaths across all age groups, including younger people. However, the largest increases are among 35 to 44-year-olds and 45 to 54-year-olds. National Records of Scotland’s annual reports on drug-related deaths show that, over the past few years, there have been upward trends in drug-related deaths among all age groups. We can send the committee links to the reports.

The figures on suspected drug deaths that we included in the briefing come from police figures. We point out that there is an issue with a time lag in the data. They are new figures that have been introduced to try to get more timely data. Further data for the period October to December 2021 has been published since our briefing, which shows 116 fewer suspected deaths in the calendar year 2021 than there were in 2020. The figures’ source is slightly different from the source of the figures in the NRS reports, but they mirror them quite closely. They are new figures; the NRS is still looking at how good an indication they give. However, they are being used to give an indication of what things are currently looking like.

The quarterly trend throughout 2021 is that suspected drug deaths are reducing. When the NRS report comes out in June or July, with annual figures taken from death certificates, it will be interesting to see whether the figures have come down for the first time and whether they mirror the police figures for suspected deaths. However, we will not know that until the summer.

We certainly hope that the situation will look a bit better.

I just want to draw out the point in the briefing paper on the importance of prevention: prevention is better than cure. The point hints at the question whether we can turn the tap off and stop people getting involved in risky and unhealthy drug-related and alcohol-related behaviours. The paper is very clear that there is still a long way to go in getting services collectively to work together in the national drive towards that shift to prevention.

To go back to funding arrangements, your 2009 report says that such arrangements are “complex and fragmented”; the situation seems to be unchanged, according to your latest briefing. What is the impact on delivery of services because of those funding arrangements? How can the Scottish Government make improvements in that area?

It is as much a question of partnership and delivery arrangements as it is of funding arrangements. I will bring in Antony Clark to say a bit more about how the overall structures work.

You mentioned that we said that the arrangements were “complex and fragmented” and our judgment in the briefing paper is no different from the conclusions that we reached in earlier reports. There are many partners involved in delivery of services across the 31 alcohol and drug partnerships in Scotland—councils, health boards, police, third sector organisations—all of which are responsible for preparation of local commissioning and strategies.

As you will know, Mr Beattie, there are plans for change as a result of what might happen with the national care service. There are indications that alcohol and drug services will be included in its remit. Therefore, Government and Parliament has opportunities to scrutinise and decide on whether there will be fundamental structural change.

This is similar to the discussion that we had on social care. Although there is an opportunity for change through the national care service, given the structures and arrangements that we have at the moment and the numbers of deaths that we capture in today’s briefing paper, the change needs to happen with some urgency; we would not want to wait five years to see the level of change that is required.

I am keen to bring in Antony Clark to say a bit more, if you are content for me to do so.

Before Antony comes in, I want to put another question to you. Given the complexity and diversity of the stakeholders that are involved, is it inevitable that funding will be fragmented? How could that situation be improved? It is not good that funding arrangements are “complex and fragmented” when you are trying to put together a strategy. Does the system have to change?

I ask Antony to answer that.

If I may, I will turn to that question after I have provided a brief overview of the complexity of the arrangements.

I think that we all know that people experience difficulties with drugs and alcohol, which can lead to many problems in their lives, including with housing, employment and family circumstances. It is quite proper that we have a range of partners focusing on the needs of, and trying to support, individuals.

As the Auditor General said earlier, the partnership arrangements have been around for quite some time—they have existed in various forms since the late 1980s. I do not think that anybody is arguing that partnership is not the way forward. However, the reality of ADPs having to engage with integration joint boards, councils, health boards, police authorities, the third sector and housing agencies is that that can make it very difficult for them to influence and shape a range of services. That is one of the reasons why we have seen, in our previous reports, progress towards addressing specific issues to do with drug and alcohol support, but much more limited progress in making the bigger shift towards prevention.

As the Auditor General said, there is an opportunity, in the thinking around the national care service, to consider how we can get a greater focus on wider system changes, while providing better, higher-quality and impactful services specifically for people with complex and severe drug and alcohol problems.

As to the question of funding, that really is quite complicated; I am not sure that there is an easy answer. However, it is clear from our discussions with ADPs that the plethora of funding streams and how they are allocated makes it difficult for them to plan for the long term. There might be opportunities in thinking through how longer-term funding could be allocated, or whether there are ways to provide funding that gives ADPs a bit more flexibility and choice in how the funding is used.

I think that there will always be a need to have core funding through health, police and fire services—I do not think that anyone would want to take that way. However, the challenge is how ADPs engage with the police, housing and other partners to get the services shifted and changed in ways that will work.

That story is not unique to ADPs. It echoes some of the conversations that we have had with the committee before about community justice authorities, and it echoes some of the conversations that your predecessor committee had around community planning partnerships. For us in Audit Scotland, there is an interesting question about how to make partnership working more effective and impactful, which is something that I think we will want to consider as part of our longer-term work programme.

I hope that that is helpful.

It is.

I will carry on the theme of funding. My next question is about transparency, which you raise in paragraph 17 of your report. Is it inevitable that transparency is difficult to exhibit when funding is so fragmented and there are so many stakeholders? Is the solution to the complexity of the funding also the solution to the transparency?

Jillian Matthew will want to come in to add a bit to what I say. However, I see that the Auditor General’s microphone is on, so maybe I should defer to him first.

There is really no need to do that, but I will not decline the invitation to speak.

I will touch on a couple of things, and colleagues will, undoubtedly, elaborate. I will focus on ADPs for a minute. They prepare annual reports, which are submitted to the Scottish Government. I think that I am right in saying that there is no follow-through production of an overall report on how ADPs have functioned in Scotland. We think that that is a missing link.

We are not advocating structural change to bring further transparency; smaller things could happen to achieve that. This perhaps speaks to a point that the committee has heard from us with regard to other topics in recent weeks, which is that there are many pots of funding in delivery of public services. Some services are delivered by Government and some funding goes outside Government to partners—other public bodies, the third sector and beyond. What we do not have is a clear picture of overall spending, which is hard to pull together, or—more importantly—of the outcomes and impacts of that spending. It is a question of transparency and of what is delivering the biggest benefit.

The scale of the emergency that we face brings us back to the urgency with which Government and its partners need to know, with clarity, what is delivering the biggest benefit and impact from a particular level of public spending. Overall, transparency will help to accelerate some of the thinking into what we hope will be a plan with deliverable and measurable outputs.

I will pause, as I am sure that colleagues will want to say more.

I do not have much to add to what the Auditor General has said.

I want to emphasise a point about funding. Part of the question was about how fragmented funding is. Yes—it is. There are various pots of money, and we have found it really difficult to follow them to see what the overall funding has been. We should be able to see that, even if there are lots of pots of money. However, as I said, we struggled to get a clear picture, despite liaising with the Scottish Government. There are various announcements; some of the funding is published and some of it is not. It is difficult to pull it all together and follow it through, which is why we are saying that there must be a lot more transparency.

I turn to Willie Coffey, who is joining us through a videolink. It is not solely an audio link, Willie; we can see you, too.

Thank you, convener. I hope that the videolink will survive the next five minutes or so.

Auditor General, I have a couple of questions on early intervention and prevention, and I will perhaps ask one on governance arrangements.

Over the years, I have worked with a number of drug and alcohol projects in my constituency. If the people there had one key ask, it was to have a flexible and quickly accessible service that they could call on to get help when they needed it. There has been good progress in reporting on this matter, certainly in my constituency. Do you recognise that as an issue that has popped up in your discussions and analysis? How does it fit in with the work that the Scottish Government is trying to do on early intervention? It seems to me to be a huge issue for the people in Kilmarnock and Irvine Valley. It is leading to more suicides than we would like to have, obviously. It is a serious issue. It has been raised with me several times that direct and fast access to help and support services is crucial.

Good morning, Mr Coffey. Thank you for that question. The themes that you touched on are consistent with our reporting—not just in this briefing paper but across many aspects of our work—that early targeted intervention leads to better outcomes from the delivery of public services in terms of the experience that users get. It is no surprise that, through your constituency work, you are hearing that that is exactly what people who use and rely on acute public services are saying.

It will not be the only approach, however. I absolutely understand why there are a range of measures in the Government’s plans. Some are emergency interventions; the roll-out of Naloxone was mentioned as one of the acute interventions that can be made, and it is a necessary component. However, early preventative work will be essential to deliver the level of change that Scotland needs.

It is fair to say that, through this briefing paper and some of our other work, we have drawn on and referred back to the Christie commission report of 10-plus years ago, which focused on early intervention and prevention as a way of delivering longer-term, sustained improvement in public services. There is regret that those ambitions in the Christie report have not been realised; we are still talking about the implementation gap when it comes to well-intentioned policies.

11:00  

Really, that is what ultimately matters in terms of what comes next, not only in drug and alcohol services—as vital as that area is—but in the wider delivery of public services and early interventions across many fronts. We want to see that level of change in relation to the quality of public services that we are all looking for. I absolutely agree with the premise of your question, Mr Coffey, that those early interventions and arrangements will make that longer-term difference not only to drug and alcohol services but to services in the round.

As important as drug and alcohol services are, many of the challenges are deep seated across communities in Scotland and will require policy intervention across a number of fronts to deliver the level of change that we are looking for.

You also note that the Government has not been particularly clear on the level of spending that is being targeted at early intervention and prevention. Can you say a few words about that? What should the Government be doing to clarify or improve that aspect?

You are quite right. In paragraph 18, we note that the percentage of spending targeted on early interventions has not been clearly set out by the Government.

To reiterate the point that Jillian Matthew made a few minutes ago, there needs to be absolute clarity in the planned spending. There is what feels like a fairly fragmented structure at the moment, with spending being delivered across many different organisations and a complex governance and accountability set-up. In our view, that hampers us in having clarity about what is actually making the difference, both in terms of early intervention and some of the more reactive spend. It really speaks to the overall conclusion that we make in the briefing paper about the need for an overarching plan, with milestones and an annual report on progress across the national mission, the rights, recovery, and respect strategy, and the work of the drug deaths task force. We are keen to see the Government reflect that in its updated plans, which we anticipate will be produced over the summer.

You also note that there are a number of competing projects locally. I am sure that there are projects in all members’ constituencies that are competing for support and funding to tackle these issues. To what extent is that a problem that is preventing us from getting to where we need to be? I encounter it quite a lot in my area; groups are almost arguing with one another that they should be receiving financial support to deliver these services. There does not seem to be any clear way through this in relation to who delivers the best solution on the ground.

I will ask Antony Clark to say a bit about partnership working. In fairness, it is working successfully in many places, but if the commissioning model turns into competition among the various providers, we need to think about the extent to which that is a barrier to delivering effective services.

There is evidence, from our audit work and from other reports, that it feels as though there is sometimes an imbalance of power in terms of the third sector’s ability to access resources and contribute to developing and implementing new services, many of which would be focused on preventing people relapsing into problem drug and alcohol behaviour.

That issue needs to be thought about in relation to the commissioning arrangements, the local planning arrangements and how ADPs work with partners across different sectors, so that is a very fair point, Mr Coffey, and we recognise your wider observations there.

To refer back to the starting point of your question about the shift towards prevention, in our briefing paper we highlight other evidence that supports your overall position. In particular, the “Hard Edges Scotland” report, which we reference in paragraph 20 of our paper, highlights the need for significant shifts in arrangements and planning for delivering services not just in this area but for services for other people with complex needs. It is clear that public bodies can do much more, working with others, to become more flexible and more focused on the needs of people, families and communities in delivering different types of services or in delivering the better outcomes that Stephen Boyle identified.

Later in our briefing paper, we highlight the lack of access to some community-based services as a problem for people passing through the criminal justice system. That can lead people back into the criminal justice system whereas, if other services had been available, they might have had better outcomes, if I can put it that way.

That is a really important point. I know from local experience that, during Covid in particular, when people were coming out of the criminal justice system, they were finding it difficult to access support services. If we can do anything to reinstate and recover that aspect of the service, that would contribute, at least in part, to turning things around.

My last question is about the governance aspect. Your report reminds us that

“The Scottish Government and COSLA agreed eight recommendations to improve the governance and accountability”

of various services, leading to the development of the partnership delivery framework for alcohol and drug partnerships. Could you say a wee bit more about how that has been progressing, please?

If we are able to, we will. Like you, Mr Coffey, we note the work that the Government and the Convention of Scottish Local Authorities are doing together, and the eight recommendations. We touch on that at paragraph 24 of our report. I am not sure that we have an update on that, although I think that the minister noted the progress in a written response, and there is planned publication of progress against the recommendations—that is pending.

I will pause for a moment to check with colleagues whether we have any further information on how that is progressing.

I do not think that we do. If we are able to, we will come back to you in writing, but that may be something that the committee will wish to pick up with the Government and COSLA directly.

Yes—we will probably follow that up. Thanks very much to both of you.

We have a final couple of questions from Sharon Dowey, who is also joining us via a video link.

Good morning. This is another question on governance. I refer to paragraphs 28 and 29 of your report. The Scottish Government’s consultation on a new national care service shows that a majority of respondents agree that ADPs should be integrated into community health and social care boards. What is your assessment of the cost of doing that, and would that improve lines of accountability?

It will be interesting to see how the structure of the national care service evolves, following the Government’s response to the consultation. If alcohol and drugs services are included under the national care service, in whatever shape and structure, we see that as an opportunity to bring clarity to some of the challenges that we note in our report about

“complicated and difficult to navigate”

governance structures, and to capture that in a clear plan. Antony Clark made a point about bringing out the real benefits of partnership working, but with clearer accountability, setting out the intended, measurable and transparent outcomes of that.

In direct answer to your question, we have not undertaken any assessment of the cost or full benefits of that. As we mention in today’s briefing paper, we plan to undertake further work on drug and alcohol services and, very likely, on the progress that will be made towards a national care service. There are opportunities for us to report further to the committee on how the Government’s plans for the national care service and drug and alcohol services are developing.

One of the most concerning lines that stuck out in your report is:

“Most drug-related deaths are in people aged 35-54, but this is increasing across all age groups, particularly in people aged 25-34.”

Jillian Matthew referred to that earlier. It is a focus of all parties that increased funding gives vastly improved outcomes. We noted that you recommend a number of actions that the Scottish Government needs to take, as you set out in paragraph 31,

“To increase transparency and demonstrate value for money”

in the

“funding for drug and alcohol services”.

Has the Scottish Government accepted that that work needs to be progressed? If so, has it set any interim targets for undertaking it?

You are right: the impact of funding represents the core purpose of today’s paper. We are keen for the Government to set out the spending on drug and alcohol services transparently—as we have mentioned once or twice this morning—so that it is clear to the Government, its partners and users of the services what is making the most difference.

We have cleared our report with the Government in terms of accuracy, and we note the ministerial responses welcoming it. As for how that translates into the Government’s plans, we will continue to engage with it, and we will see what comes next regarding our recommendation that there should be an overarching plan that draws together the national mission, the strategy and the work of the drug deaths task force. We hope that, ultimately, that delivers clear, transparent, improved outcomes. That is effectively part of our on-going work.

Thank you very much. On that note, we will draw this evidence session to an end. Thanks, as always, to the Auditor General, and to Antony Clark and Jillian Matthew, for joining us this morning. We have looked with a great deal of interest at the briefing paper and the evidence that you have provided, and we will clearly need to consider our next steps. Thank you very much for your time this morning.

11:11 Meeting continued in private until 11:43.