Meeting of the Parliament

Meeting date: Tuesday, October 4, 2022

Official Report 1147KB pdf

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Topical Question Time

The next item of business is topical question time. In order to get in as many members as possible, short and succinct questions and responses would be appreciated.

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Mental Health and Substance Use (Report)

To ask the Scottish Government what its response is to the Mental Welfare Commission for Scotland’s report “Ending the exclusion: Care, treatment and support for people with mental ill health and problem substance use in Scotland”. (S6T-00904)

I begin by reaffirming the commitment from me, as well as from the Minister for Drugs Policy, Ms Constance, and from the rest of the Scottish Government to saving and improving the lives of people who are living with poor mental health and addiction. I fully support the position that Ms Constance recently set out in the chamber, that every drug death is one too many and that this remains a public health emergency.

I thank the Mental Welfare Commission for producing its timely report. We will, of course, carefully consider its findings in detail in the coming weeks. The commission has made it clear that our focus must be on delivery. Members will be aware that, through the national drugs mission and our work across mental health, a significant amount of activity is under way to deliver more effective and joined-up care for people with co-occurring mental health and substance use issues.

That includes work that is being led by Healthcare Improvement Scotland to create better working links between substance use and mental health services; the on-going rapid review of mental health and substance use services; and the implementation of the medication-assisted treatment standards, alongside the development and implementation of standards for adult secondary mental health services.

The Mental Welfare Commission’s report is damning. It talks about there being little or no out-of-hours support for people and a lack of trauma-informed care; people being refused access to mental health service due to their addiction; and services being understaffed and underfunded. One service user said that people feel

“abandoned by a broken system”.

Another said:

“I just want to see change ... all I see is people dying or being forgotten about.”

However, the time until the delivery of MAT standards 6 to 10, which are central to addressing mental health and addiction issues, has been extended, with an implementation date of 2025, which is three years later than it was originally promised. Following the statement in June from the Minister for Drugs Policy, have senior leaders been appointed across Scotland? How will the Minister for Mental Wellbeing and Social Care work with the Minister for Drugs Policy to drive forward the delivery of MAT standards 6 to 10, which are central to mental health, and ensure that they are not neglected, as the focus will be on standards 1 to 5, which have to be delivered by next year?

I make it clear to the Parliament that the Minister for Drugs Policy and I believe that mental health and substance use services must be joined at the hip. We have been clear that we want all the MAT standards to be fully embedded as soon as possible. As far as we are concerned, the progress that has been made to date has not been good enough or quick enough.

At the end of the previous parliamentary session, the Minister for Drugs Policy wrote a letter of direction to all territorial health boards, integration authorities and local authorities. That letter directed that, by the end of September, chief officers and chief executives must personally sign specific and timed improvement plans for implementing those MAT standards. The Minister for Drugs Policy will update Parliament further on the progress of those standards in December.

All of that activity, which I recognise is taking place, requires investment. Although the Drug Deaths Taskforce acknowledged recent funding commitments, it said that they did not go far enough “to deliver transformational change” and described the funding as “woefully inadequate”. Although the Minister for Drugs Policy leads on policy in the area, it is, as the Minister for Mental Wellbeing and Social Care has recognised, partly his responsibility because many of the MAT standards focus on the relationship between drug services and mental health. Is he confident that the £10 million a year for the implementation of the MAT standards is enough, given concerns that have been raised around the risk of staff burnout?

I welcome the opportunity to answer that question. We are supporting the delivery of the standards with that £10 million a year for the next four years, as Ms Baker rightly highlights, but there is more than that going on. I and the Minister for Drugs Policy are jointly providing Health Improvement Scotland with funding of more than £2 million to improve pathways between mental health and substance use services. HIS will work directly with local partners to ensure that people are receiving person-centred care.

However, let me go beyond that, because it is my and Ms Constance’s expectation that we will use existing expenditure at health board, integration joint board and local authority levels to get this absolutely right. This is a joint project between all spheres of Government, in order to get it right for people. We will ensure that the investment is made properly, and, beyond that, we all need to work together to change cultures. That is why the HIS work is so important—in that regard, too.

I know from conversations with police officers in the north-east that they are often the stand-in for other services when someone is in crisis out of hours. That is starkly reflected in the Mental Welfare Commission’s report, which quotes officers as saying that the police and ambulance services are the

“constant fall back for other services, when neither are the appropriate services to offer meaningful assistance beyond an assessment at A&E.”

What immediate steps is the Scottish Government taking to ensure that people in crisis can be swiftly and reliably referred to the right help and interventions out of hours?

Crisis intervention is one of the areas that are being looked at by the Drug Deaths Taskforce, and, beyond that, we have support on the ground at this moment. Let us take, for example, distress brief interventions. Ms White mentions the north-east of Scotland. In my city of Aberdeen, the distress brief intervention project is dealing with people in crisis daily, and, from talking to police officers in my patch, I know that that is making a real difference in taking pressure off them.

Beyond that, the member may well be aware of the pilots that we have going on with the Scottish Ambulance Service in the north-east of Scotland, including in Dundee, where there are quick interventions for people who have mental health crisis. Those things are already happening in many parts of the country. I am happy for Ms White to write to me or Ms Constance so that we can update her on all the actions that are being taken in the north-east corner of our country.

We are all aware that getting people into treatment and recovery that is right for them, at the right time, is at the core of the national mission to save and improve lives. Residential rehabilitation is one of a wide range of options. Can the minister provide an update on plans to expand access to residential rehabilitation placements? I remind members that I am co-convener of the cross-party group on mental health.

I welcome Emma Harper’s question. Over the course of this parliamentary session, we are working to increase the overall residential rehabilitation capacity from 425 to 650 beds and to enable 1,000 people to receive statutory funding for their stay in residential rehabilitation. The Government has committed more than £23 million in funding for the development of projects by Phoenix Futures, River Garden, NHS Lothian and Aberlour. Investment in the four projects combined will provide a total increase of 85 beds by 2025-26, boosting the current rehab capacity in Scotland from 425 to 510 beds.

In addition, we have been working with alcohol and drug partnerships to aid the development of clear pathways into residential rehabilitation. The results of that can be seen in Public Health Scotland’s most recent interim report—published on 27 September—which found that 218 statutorily funded residential rehab placements had been approved across Scotland between April and June 2022. That is an increase of 85 on the previous quarter.

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Air Quality

To ask the Scottish Government when it expects to meet air quality limit values, in light of the recent report from Environmental Standards Scotland. (S6T-00897)

Current data indicate that European Union limit and target values have been achieved across Scotland for all air quality pollutants, with the exception of six locations for nitrogen dioxide—three in North Lanarkshire, two in Glasgow and one in Edinburgh. The most recent assessment projections estimate that all those locations, bar one in North Lanarkshire, will be compliant during 2022 and that the remaining North Lanarkshire location will follow suit in 2023.

The report highlighted that monitoring guidance might not provide a comprehensive picture of air quality in our cities, especially around areas with vulnerable people, such as schools and hospitals. Does the minister agree that we should install air quality monitors at every Scottish school?

Before moving on to the specifics of my answer, I note that I very much welcome Environmental Standards Scotland’s report. Indeed, I welcome the fact that we were able, with a great deal of work, including by my predecessor, Roseanna Cunningham, and Scottish Government officials, to ensure that Environmental Standards Scotland was set up and that there was no governance gap as a result of EU exit.

I am statutorily obliged to respond to the report within six months, which I will do. I will not pre-empt the response today, including on Maurice Golden’s specific point, although it is a good one. I will bring the response back to the Parliament, but I make it clear that I absolutely welcome the recommendations and am committed to working with ESS to progress them.

The report concludes that current attempts to improve air quality are not enough, that the system contains significant weaknesses and that areas of non-compliance are likely to remain. I understand from the minister’s answer that the Government will make a formal response to the report, but will she at least give us an assurance that those failures will be recognised, so that progress can be made?

Our ambition is for Scotland to have the best air quality in Europe. We are working very hard with Scottish Government officials and our stakeholders across civic society to drive forward progress, but we are always alive to improvements that need to be made, including those that have been highlighted by Environmental Standards Scotland.

It is important to note that, over recent decades, there has been a significant reduction in pollution because of improved fuel quality, cleaner vehicles and an increased focus on sustainable transport. Between 2005 and 2019, which is the year for which we have the most recent statistics, nitrogen oxide emissions decreased by 53 per cent, fine particulate matter by 30 per cent and sulphur dioxide by 85 per cent. However, we are not complacent, and we will continue to work through the cleaner air for Scotland 2 strategy and on the recommendations of ESS in continuing to improve that.

Will the minister give an indication of how the level of air quality in Scotland compares with that in the rest of the United Kingdom and with those in other parts of Europe? How will the Scottish Government deliver on its commitment to further improve air quality in Scotland?

Compared with the rest of the UK—and, indeed with other parts of Europe—Scotland enjoys a very high level of air quality. Targets are being met across most of Scotland, and levels of the main air pollutants, including those that I mentioned in my previous answer, have declined significantly in the past three decades.

The introduction of low-emission zones in our four largest cities as of May this year is a key initiative in further improving urban air quality, and we have committed to investing at least £320 million, or 10 per cent of the total active travel budget, in air quality improvement by 2024-25. That figure is almost triple what it is today.

Although electric vehicles contribute to air pollution by producing brake and tyre dust, which means that we need fewer cars and not only cleaner ones, EVs do not emit nitrogen dioxide and so are part of the solution in improving air quality.

The Climate Change Committee estimates that we will need at least 30,000 public EV charging points in Scotland by 2030, but the Government’s target is for just over 4,000 in the next few years. Given that only 395 public charging points were installed last year, when does the minister think that Scotland will reach the figure of 30,000 public EV charging points, which are desperately needed?

I should allow my colleague the Minister for Transport to respond directly to questions about transport and about charging infrastructure as it relates to that.

Having said that, part of the cleaner air for Scotland 2 strategy is about recognising that air quality is a multifaceted issue that requires work to be done across Government. I am therefore working closely with the transport minister, as well as with planning and health colleagues. I will come back to the member with an estimate of when the roll-out of EV infrastructure will be where he thinks that it ought to be.

I draw members’ attention to two key provisions for the link between transport and air quality. We have made commitments to reducing the number of car kilometres driven by 20 per cent by 2030 and to phasing out new petrol and diesel vehicles by the same date. Both actions will have significant impacts on air quality in Scotland.

Lung conditions are the third leading cause of death in the UK, with more than 2,500 premature deaths per year in Scotland being attributed to air pollution. In that context, what action is the Scottish Government taking to ensure that local authorities are required to deliver robust and up-to-date air quality action plans with specified target dates?

The Scottish Government and I are in no doubt that air pollution and physical health are closely connected, with the very young, older adults and those who have underlying health conditions being most impacted. However, the relationship is complex. It is widely accepted that pollution has a negative impact on health, but we also know that the types of illnesses that air pollution exacerbates are also impacted by other factors, such as smoking.

On the member’s direct point, as part of our cleaner air for Scotland strategy, we have committed to developing a more systematic approach to action plan production and implementation. That includes having standardised formats and methodologies for agreeing and setting the defined timescales for completing individual measures, for revoking air quality management areas and for reporting progress. We will also commission a review of air quality data collection and reporting in Scotland to identify any notable gaps in data provision, which will make recommendations on how to fill those. That is all part of our cleaner air for Scotland 2 strategy, which we are currently progressing.

That concludes topical questions.