“Drug and alcohol services in Scotland”
The next item of business is a statement by Fergus Ewing on the Scottish Government's response to Audit Scotland's report on drug and alcohol services. The minister will take questions at the end of the statement and there should therefore be no interventions.
I welcome the opportunity to outline the Scottish Government's plans for tackling alcohol and drug misuse, in light of the report on alcohol and drug services that was published last week by Audit Scotland. These are matters of such concern to the Parliament and to the people of Scotland that we were happy to agree to Annabel Goldie's request for this statement.
The Auditor General for Scotland's report lays bare the immense challenge that Scotland faces in tackling drug and alcohol misuse. While not new, the statistics make grim reading: a social and economic cost to Scotland of more than £5 billion a year; death rates from alcohol and drugs among the highest in Europe; and more than 40,000 hospital admissions due to alcohol-related illness. It was for those reasons that, when we came into government, we were determined to get to grips not only with a drugs problem that was already well-entrenched in Scotland, but with a growing challenge around alcohol issues.
Working closely with the Convention of Scottish Local Authorities, we developed and delivered a new drugs strategy, "The Road to Recovery", which was published last year. Last month, we published our alcohol framework for action. Both strategies provide the new approaches for which those problems have been crying out. For both, we have sought to develop a consensus and agree a way forward in Parliament and in the country at large.
However, we realised that, as well as setting the strategic direction, we needed to take a hard look at delivery, to ensure that we were getting the maximum impact from the significant investment in services. We took careful note of the problems identified in the "Report of the Stocktake of Alcohol and Drug Action Teams" in 2007 and the Scottish Advisory Committee on Drug Misuse report, "Reducing harm and promoting recovery". We also set in train a wide range of action to address those issues.
Early last year, I asked the Auditor General to look into expenditure on alcohol and drug services. I am grateful for the incisive analysis that he has now published. We will reflect the findings of the report throughout the range of action that we are taking forward.
At the same time, we asked an expert group, drawn from our key advisory committees on substance misuse, to design a new accountability and governance framework for action on alcohol and drugs. We have now received the group's proposals—copies are available in the Scottish Parliament information centre—and we are considering them in light of the Auditor General's report.
Following our consideration of those proposals, later this month we will announce, with COSLA, a new framework for local action on alcohol and drugs, replacing the current model of alcohol and drug action teams. The new framework will directly address a range of the problems identified by the stocktake and the Auditor General's report.
The roles and responsibilities of the key public bodies and, indeed, of the Scottish Government will be clarified and confirmed. Local partners and partnerships will have clear lines of accountability to the Scottish Government and to one another. They will be required to work more effectively within community planning partnerships.
New local partnerships will be remitted to develop local strategies for tackling drug and alcohol misuse based on a robust assessment of needs in their area; a transparent, evidence-based process for agreeing how funds for tackling alcohol and drug misuse should be deployed; and a clear focus on the outcomes that that investment is achieving for their communities.
Those local strategies will also need to cover approaches to cross-cutting issues, such as that of children who are affected by parental substance misuse, where integrated working and effective communication are essential. The drugs strategy set out a range of actions that need to be taken to improve the identification of children at risk, build capacity and strengthen the management of immediate risk. The delivery reforms will provide a further impetus to that work. Local strategies will also outline action to help families and better inform parents.
The effective operation of local partnerships is critical to addressing the concerns that were raised by the Auditor General's report about variability in the range and accessibility of alcohol and drug services throughout the country. However, the Scottish Government, too, has a critical role to play, in ensuring that appropriate and effective services are delivered in every part of Scotland to those who need them, when they need them.
I acknowledge that waiting times for many services are too long—as revealed again in figures this week. To address that, the Scottish Government is, for the first time, working with the national health service and other partners to develop a target for access to drug services within the NHS performance management arrangements known as HEAT—which stands for health improvement, efficiency, access and treatment. The new target will take effect from April 2010. We are examining the scope for extending the target to cover alcohol services too, providing the same minimum standards for access across the country. Furthermore, as our alcohol framework for action makes clear, we will be updating the national framework for alcohol treatment services, enabling us to outline clearly to local partners the full range of essential services that users should be able to expect wherever they live in Scotland. The corresponding task on drug services will be carried out as part of the programme of work to develop the new HEAT target.
Alongside that work, we will strengthen our efforts to promote the national quality standards for substance misuse services, which were published in 2006 by the previous Administration and which set out the prerequisites in terms of quality for all services. We have also sought to ensure that the services are properly funded, while seeking to correct the long-standing funding imbalance between alcohol and drugs. We are increasing direct Government funding to health boards for drugs services by 14 per cent over the spending review period, and we are increasing spending on alcohol misuse by a massive 229 per cent during the same period.
Finally, and importantly, we are in the process of recruiting a group of national co-ordinators to help local partners and partnerships meet the challenges presented by the new framework and the Auditor General's recommendations. I am confident that the new team will make an important contribution to improving the quality, range and standards of service planning and commissioning right across Scotland.
Those projects form part of our much wider range of action to implement our strategies on alcohol and drugs—strategies on which, as I have said, we are keen to maximise consensus in Parliament and across Scotland. We are, therefore, taking forward Annabel Goldie's proposal for a national event on alcohol and drugs, and, in particular, on the action that we are taking to ensure that delivery is effective. I am therefore pleased to announce today that the event will take place in Edinburgh on Monday 20 April—the same day on which we will launch the new framework for action.
I know that Cathy Jamieson has proposed specific cross-party discussions on alcohol misuse, and the Cabinet Secretary for Health and Wellbeing will discuss those proposals with her.
As a nation, the challenges that we face are indeed daunting. I hope that, as a Parliament, we can work together to achieve the results that we want and which Scotland needs. As a Government, we undertake to do all that we can to ensure that that happens.
I refer to the entry in the register of members' interests relating to my work as a consultant psychiatrist on addictions and to my membership of the Royal College of Psychiatrists and the Royal College of General Practitioners.
I thank the minister for the advance copy of his statement, but I am not convinced that it takes us an awful lot further. A considerable amount of material is still to come out. However, I welcome the report of the delivery reform group, and I look forward to the Government's response to it. I also welcome the report from Audit Scotland, although it is regrettable that the information on funding is still so complex and difficult to identify. However, that is not the fault of the drug action teams. I therefore ask the minister whether, with the abolition of the DATs, which has been suggested, it will be possible to protect the good work done by many DATs and ensure that all stakeholders will continue to be engaged? Will he assure us that such things will not be lost because of an administrative change?
The minister referred to waiting times, which he rightly described as unacceptable. There are 872 people who have been waiting more than six months to be assessed, of whom 28 per cent are in Grampian and 20 per cent are in Lothian. Why has the Scottish National Party broken its manifesto promise to increase funding by 20 per cent? Funding for drugs is going up by only 14 per cent, and workers are being made redundant.
When will the HEAT target be published for consultation? The target is clearly important, although it seems to apply to health but not to local authorities, so how it will relate to community planning partnerships, which deliver, is unclear. Perhaps the minister can clarify that.
Finally, when will the minister place the details of the event on 20 April in the Scottish Parliament information centre?
I thank Richard Simpson for his broad welcome for the announcement. I recognise his experience and the work that he has done in the field over many years, as well as his deep care for those who are involved in it. I will answer the questions that he raised in turn.
We will announce the new delivery arrangements, which have been agreed with COSLA. We want to build on the best of the work that is done by the DATs. However, members of all parties would acknowledge that some DATs have been more successful than others and that there has been a gap in their accountability to the public for the work that they do. We are seeking to fill that gap in two ways—first, by making DATs directly accountable to their local government parent through the single outcome agreements; and, secondly, by making them accountable to their health boards for the funding that the health boards will provide through the new HEAT target.
Accountability means explaining to the public what one does and how one uses the money that one is entrusted with. It means showing the public what one does and, after one has done it, having an analysis done to see how effective that has been. That is what accountability means, and it has been lacking in the arrangements up until now. The Auditor General has recognised that in his report. It is fair to say, however, that we recognised that—and it was recognised in the chamber—long before the publication of the Auditor General's report. Indeed, it was manifest in the publication in January of the delivery reform group's main recommendations. We will fill that gap, but a great deal of work remains to be done.
Richard Simpson touched on the situation in Grampian in particular. I have visited Grampian on at least three separate occasions to deal with the matter, and I have worked closely with Aberdeen City Council and Richard Carey at the health board—both have injected substantial extra resources in recognition of the deep problem that exists. I am pleased to say that, although waiting times in Aberdeen are still far too long, they have been reduced substantially as a result of additional funding and the good work that has been done at the local level by drugs workers, whom I pay tribute to and applaud for their efforts. They are the ones who are doing the work, not politicians such as me.
Richard Simpson asks when the new HEAT target will apply. Our intention is that the new HEAT target on drugs will apply from April 2010. Of course, we want fully to consult everybody who is involved to ensure that the new arrangements are accountable.
I apologise to members and to the minister for my late arrival in the chamber.
I express to the minister my personal appreciation of his statement to Parliament and thank him for the advance copy of it. It is a timely and constructive response to the Audit Scotland report, which was published last week. I also thank him for acceding to my request for a summit event. I am delighted that that event is imminent and I look forward to attending it. I begin to feel that, at last, the fresh winds of hope are blowing through this bleak area.
When the minister proposes a replacement model for the current alcohol and drug action teams, does that represent the demise of those bodies and the creation of a simpler, more direct structure between Government and delivery, with less bureaucracy? Can the minister confirm that the Scottish Government will ensure that the £173 million that is spent every year to deal with drug and alcohol abuse will be much more transparently expended against visible measurements and outcomes that, in the case of drugs, will reflect a focus on recovery?
I very much welcome Annabel Goldie's constructive response and I look forward to continuing to work with her and other members to ensure that the delivery arrangements are successful.
The new arrangements will introduce accountability, as I have said. One problem with the previous arrangements that must be addressed is that not all ADATs have been headed by people of sufficient seniority and stature to be able to pull rank within their localities. I am confident that the new arrangements will address the concerns that Annabel Goldie raises, but I will be candid: the Auditor General's report is a chilling document. It sets out at length an analysis of a drugs policy that since 1982, as the report records, has had at best a chequered history and has demonstrated neither the effective use of public money nor the delivery of outcomes. Under the new arrangements, outcomes will be paramount and local organisations will be required to deliver them. That is what we need, and what all members in the chamber want.
I was happy to agree to the high-level national event that is taking place on 20 April. To call it a summit might be a slight misnomer, since I am not exactly a head of Government, but I hope that it will produce more palpable, successful and manifest results than will another summit—which some members may have read about—that is taking place elsewhere.
I thank the minister for the advance copy of his statement and for not name checking me in it, which leaves me a degree of independence in scrutinising it.
As the minister will be aware, among the chilling statistics in paragraphs 77 to 82 of the Audit Scotland report, it is stated that the amount that is spent across Scotland on drug and alcohol services
"does not reflect the scale of the respective problems".
Paragraph 82 states that the amount that is spent on those services varies greatly throughout the country, and that that variation
"is not explained by differences in the levels of drug and alcohol misuse"
in different areas.
In his statement, the minister drew attention to the fact that, in the future, the delivery of drug and alcohol services should be based on a "robust assessment" and a "transparent, evidence-based process". He went on to suggest that a new HEAT target on drugs will be introduced. However, the disparities that I have mentioned surely arise from the fact that there has unfortunately been a mismatch in the equation that we use to set the standards. It seems a bit odd that the minister wishes to introduce only a HEAT target on drugs, for example. He mentioned that he will develop a new framework, but the document that he invited us to read before we came to the chamber—
Can the member get to the point?
The report from the delivery reform group says that, in order to oversee that reform, there should be HEAT targets on alcohol and drugs. Would it be sensible to advance that progress and introduce HEAT targets on alcohol and drugs simultaneously?
Ross Finnie—to name check him—is correct that there are varying levels of funding throughout the country for tackling drugs and alcohol. However, that is partly because the problem varies throughout Scotland. Some areas receive very low funding, particularly in relation to drugs, because they have, I am happy to say, a relatively small problem. It would not be helpful for me to name those areas, for many reasons, but plainly there is a bigger problem in Glasgow than there is in some rural or island communities in Scotland.
With regard to the funding issue, I hope that Ross Finnie welcomes, as I think the Lib Dems have done, the additional money that the Government has invested in tackling both drugs and alcohol. I am particularly proud that, in the 2009-10 drugs budget, for which I have responsibility, we managed to increase the amount of money at the centre going to treatment by 13.5 per cent. We did that by tightening our belts at the centre, so that as much money as possible was pushed towards the delivery of treatment.
Similarly, the Government will spend £120 million to tackle alcohol misuse during the three years from 2008-09. That is a massive increase of almost 230 per cent, which reflects the huge scale of the problem.
Finally, Ross Finnie asked about the HEAT targets. I think that my statement made it clear what we are going to do about those. We will be open and transparent in what we do, and I hope that all parties will play a part in developing the new HEAT target on drugs. At one level, the big targets are simple. We have 52,000 people who are problematic drug misusers and we want that figure to come down. We have 40,000 to 60,000 children who have one or more parents who are affected by drug misuse, and we want that figure to come down. Last year, 455 people died from drugs. That is a scandalously high figure. We are carrying out a huge amount of detailed work—at least, my officials are doing so—to make that figure too come down.
As I said, a HEAT target on alcohol is also a priority for us. I look forward to working with Ross Finnie and his colleagues on that issue as well, as does my colleague Shona Robison, who is responsible for that policy area.
I will try to call everyone who wishes to ask a question. If we have brief questions and answers, I will be able to do so.
I, too, apologise for being a few seconds behind the parliamentary timetable. The minister mentioned a national event on Monday 28 April. Could he provide us with a few more details on that?
I thank Nigel Don for that question. I know that he takes a close interest in the topics in relation to Grampian. I am pleased to say that I will be speaking at the conference together with Shona Robison and Councillor Ronnie McColl of COSLA. I pay tribute to the work that COSLA has done jointly with the Government, in an extremely close partnership, to develop the strategies. However, the strategies are in place and it is now about delivery. That is the priority, and that will be the focus of the event.
We will invite to the event those who will be responsible for delivery. I also wish to see at the event the health and justice spokespersons and committees, and I will shortly be writing to them to invite them to attend an event on 20 April that Annabel Goldie has described as a summit. [Interruption.] I say to Mr McLetchie that the invitations will be in the post. On that day, we will launch our new framework for local partnerships on alcohol and drugs. The event is plainly an important and serious one. The focus will be not on high, abstract thinking—something for which many members might believe that I am not ideally suited in any event—but on nuts-and-bolts delivery.
As the report emphasises the link between alcohol misuse and crime, will the minister support our proposals for alcohol treatment and testing orders—as alternatives to custody—and post-custodial programmes? The minister mentioned accountability and single outcome agreements, but the report highlights gaps in those agreements in relation to drug and alcohol misuse services. How will alcohol support services such as Albyn house in Aberdeen be maintained in the face of council cuts?
I think that Richard Baker is implying that drug treatment and testing orders are successful. If that is what he is saying, I agree. Despite having extensive criminal histories, 48 per cent of those who have completed drug treatment and testing orders have no further convictions within two years of the start of the order.
Richard Baker is also correct to argue that the misuse of drink fuels a great deal of the crime that occurs. However, I think that even he will concede that no one in Scotland has given a clearer or stronger lead on the topic than the Cabinet Secretary for Justice. The provision of unprecedented resources to tackle the problem is hugely welcomed throughout the country. Of course, if anyone has any specific and detailed proposals on how any new measures could be made to work, we will always be ready to consider them.
I ask the minister whether treatment also means recovery. As he will know from the area that we represent, many people who are addicted to drugs and alcohol participate in a revolving door of services and treatment but do not get long-term support for recovery. That results in relapses. Given that 75 per cent of people who use drugs have mental health problems, I also ask the minister to ensure that underlying mental health issues are identified and treated at the same time as addiction.
I am very happy to agree with the member. On the ministerial tour that I had the pleasure of making, during which I made 10 presentations of the drugs strategy, the very point that Mary Scanlon has raised was made forcibly and repeatedly during the presentation that I gave in Inverness.
It is very difficult for people outwith Inverness to access post-treatment services; I am sad to say that, in some parts of the north, they cannot even access a place where they can have talking therapy and meet others who have been through the same addiction experience. It would not cost a lot of money to tackle that problem.
I share Mary Scanlon's analysis of the situation; indeed, our drugs strategy, which I advertise to members, makes it clear that we need to tackle the needs of each person as a person. Mental health is, sadly, often a key element that requires to be treated alongside the addiction.
I refer to the top of page 4 of the minister's statement. In March, the police picked up a 13-year-old female who was lying unconscious beside the River Thurso and who, when tested, was found to have in her bloodstream nearly five times the legal limit of alcohol for driving a car. It was probably a near-death experience. Will the minister ensure that such young people receive the interventions that they require to prevent further alcohol misuse and harm?
I am not familiar with the case that Jamie Stone has mentioned but, as we all recognise, all young people who have alcohol problems should receive the help that they need. Indeed, the health service, those who tackle addiction and those involved in the type of antisocial behaviour projects that might well be considered in tomorrow afternoon's debate are carrying out a lot of work on providing young people with alternatives that will occupy their time and lead them away from consuming alcohol.
I certainly agree that the issue must be tackled, not least at school. In fact, a great deal of work is being carried out to ensure that proper messages about alcohol, drugs—including tobacco—and healthy eating are sent out at school.
I congratulate the Scottish Government on its attempts to address a problem that many over the years have bewailed but on which few have taken any action. Is there any indication of how much might be saved for the public purse by properly addressing the twin concerns of drug and alcohol misuse and of the likely scale of resources that will be freed up for alternative investment? [Interruption.]
There are too many conversations going on in the chamber. This is a serious matter.
One of the most chilling statistics that I have ever heard is that the abuse of alcohol and drugs costs the nation £5 billion a year. We cannot repeat that often enough; after all, if we do not remind ourselves of the scale of the problem, it might not receive the prominence or the attention that it deserves.
However, I will make two positive comments. First, treatment for drug and alcohol addiction works. As is made clear in the United Kingdom guidelines for clinicians on the clinical management of drug misuse and dependence—or what is called the orange book—between a quarter and a third of all those who receive treatment for drug addiction recover and become abstinent. That is the holy grail of our drugs strategy "The Road to Recovery: A New Approach to Tackling Scotland's Drugs Problem".
Secondly, the other very good news is the somewhat counterintuitive evidence that for every pound spent in treatment to tackle drug addiction, £9.50 is saved to the public purse in lesser costs to the health service, our justice system and so on. Of course, the human cost saved—the cost of people recovering their lives from the grip and fog of addiction—is incalculable and, indeed, beyond price.
As the Audit Scotland report confirms, there are limited data on the number of children who are affected by parental substance misuse, and I take it from his statement that the minister recognises the need to do better in that area. When can we expect work to begin on confirming the number of children who live with a parent with an addiction in order to establish a risk?
In evidence to the Health and Sport Committee last week, Ruth Stark, a senior social worker, said that there was a real problem in accessing children who live in this situation. Graeme Rizza put things more strongly. He said:
"We need to be more robust about our access to children with non-engaging parents".—[Official Report, Health and Sport Committee, 25 March 2009; c 1714.]
What can the minister do now to ensure that we identify those children and that, when we do so, we gain access to them and put in place the services that they urgently require?
As Duncan McNeil knows, the current best estimates indicate that between 40,000 and 60,000 children may be affected by parental drug misuse that involves at least one parent with a drug misuse problem, and 65,000-plus children are affected by parental alcohol misuse. Members of all the parties that are represented in the chamber recognise that those children need our particular help and support.
The drugs strategy recognises the huge amount of good work that is being done, of which I know Duncan McNeil is aware. For example, the Lloyds TSB Foundation for Scotland partnership drugs initiative alone supports 270 innovative projects. It is right to give credit to bodies that fund such good work. My colleague Adam Ingram is taking forward considerable work to help those young people.
I agree with Duncan McNeil. The problem is one of the most serious problems that we all face, and I look forward to working with him and every other member in the chamber to address it. I undertake to do so with my colleagues.