Meeting of the Parliament

Meeting date: Tuesday, December 13, 2022

Official Report 857KB pdf

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Medication Assisted Treatment and Workforce Update

The next item of business is a statement by Angela Constance on medication assisted treatment and workforce update. As the minister will take questions at the end of her statement, there should be no interventions or interruptions.

14:18  

Every life that is lost to drugs is tragic and unacceptable. I convey my condolences to those who have lost a loved one and reaffirm my commitment to saving and improving lives.

Today, I will provide Parliament with an update on progress in implementing the MAT standards and tackling the related workforce challenges. First, however, I will say a few words about the quarterly figures that were published today, which are based on data from Police Scotland. Police Scotland has reported that, during the first nine months of 2022, there were 797 suspected drug deaths—21 per cent fewer than there were during the same period of 2021. Although that figure cannot be used to make accurate predictions about the status of the annual report for 2022, which will be about confirmed cases, it enables services to identify where help might be needed and keeps Parliament abreast of developments.

In June, when I provided my previous update to Parliament on the MAT standards, the Public Health Scotland benchmarking report was published. That report confirmed that, although most areas had at least partially implemented MAT standards 1 to 5, performance fell short of the challenge that I had set to embed MAT standards by April of this year.

Although the report demonstrated that progress was being made on the ground, the pace and scale of change were neither good enough nor quick enough, especially around MAT standard 1, which is on same-day treatment. That is why I took the unprecedented step of issuing a letter of direction to delivery partners, asking them to personally sign a timed and detailed implementation plan for all 10 standards.

I can confirm that all areas have submitted their plans. We are now finalising the details and ensuring that the plans have been published on websites. Areas are already reporting regularly to the Scottish Government on progress, either monthly or quarterly, and I continue to meet chief officers and MAT leads from each area to discuss their plans and learn more about how they are meeting their local challenges.

Some areas, such as the Borders, have already achieved good things. The MAT implementation support team, which is led by Public Health Scotland, has also reported good progress on implementing same-day treatment across other parts of the country, with special mentions for the work that is being done in Inverclyde, East Dunbartonshire, Moray and West Dunbartonshire. The MIST has noted increased involvement from senior leadership in many areas, as well as improvements in pathways for people accessing treatment and better interorganisational sharing of best practice.

The MIST also notes that Reach Advocacy Scotland’s rights-based advocacy training has now been delivered across multiple alcohol and drug partnership areas, with further training planned. However, there are areas that still have challenges to overcome, and the MIST is supporting them to address recruitment, local communication issues and unnecessary structural barriers, including a persistence in some areas to continue not to involve third sector partners closely enough. Those issues are the focus of teams locally to ensure that the necessary changes and improvements are being actioned at pace.

We know that many people with a substance use problem also have a mental health concern and that, to address one, we often must also address the other. That is why, along with the Minister for Mental Wellbeing and Social Care, I commissioned a rapid review into care for people with co-occurring mental health and substance use concerns. The review’s findings, which were published on 30 November, will help inform our work to better integrate mental health and substance use services and deliver MAT standard 9.

The review includes recommendations on how to better integrate services, but it also reaffirms the challenges that exist. A survey of practitioners found that more than a third of the respondents work in substance use services that do not offer mental health support. That is troubling, as a lack of integration between mental health and substance use services is a key barrier to accessing adequate treatment and support. We are considering the recommendations now and will engage with stakeholders and local partners, and in the early part of next year, I will update Parliament on how we will accelerate the integration of services.

In relation to workforce, we know about the challenges across health and social care. That is one of the reasons why we need a longer-term workforce development plan for the delivery of MAT standards and for our wider national mission. Today, I would like to set out how we plan to expand and upskill the workforce.

I have seen at first hand and have heard directly from those delivering life-saving work in this often challenging environment. I know that there have been issues around recruitment, retention and service design. Indeed, those points were echoed throughout the research that the Scottish Government published in March.

In June, I outlined to Parliament that the majority of the additional £10 million per year MAT funding would be focused on recruiting more than 100 additional staff. I am encouraged to learn that, although that is not without its challenges, many local areas are reporting that they have made significant progress towards the targets that they have set for themselves.

In order to support and strengthen the workforce, the Scottish Government has brought together an expert group with front-line and real-life experience to develop a longer-term workforce plan, as recommended by the drug deaths task force. That plan, which we will publish in the summer of next year, will set out the medium-term and longer-term steps that are required to overcome key workforce challenges. The group has been able to successfully agree a number of short-term outcomes and has already begun to drive them forward. One example is the development of a single platform for access to training and key workforce resources. That will be launched by the summer of next year and will support the upskilling and retention of staff though improved access to continuous professional development.

People with lived and living experience need better support to pursue careers within the sector, and the expert group is developing guidance that will put in place the right support to help peers play a more active role in the design and delivery of services. Cross-Government work will also be progressed to provide through the “No one left behind” strategy employment support to people who use drugs.

It is anticipated that those measures will, to some extent, contribute to improved staff wellbeing, which is a key priority. However, I should also point out that the Scottish Government has also made £12 million available to support that and has introduced a national wellbeing hub.

We know that workforce planning needs to be grounded in a firm grasp of the diverse landscape of services, providers, locations and professionals working in the sector. In order to establish that, service mapping work is under way, alongside much-needed work to improve workforce data capture.

There has been much discussion on the timescale for full implementation of MAT standards. Clearly, the ambitious target that I set to have the standards embedded by this year was really stretching for services. However, with drug deaths at a record high, immediate change had to be driven hard and momentum had to be put into the system.

I want all 10 standards to be implemented in a sustainable way that will make a long-term difference to all those in treatment. We have not chosen an easy path in judging whether the standards are in place; we have—rightly—set the bar high by insisting that only when areas have positive experiential evidence from people using the services on the ground, will they be able to claim that better services are in place. Ultimately, that is the measure that matters the most.

The work that is being done to support local areas to fully implement the standards has thrown into sharp focus some of the challenges that we need to overcome. In light of the scale of some of those challenges, particularly in justice settings, I am accepting the timescales for full implementation in community and justice settings that were recommended by Public Health Scotland in its benchmarking report in June. The phased approach being taken between now and April 2025 with clearly identified milestones, as recommended by Public Health Scotland, means that we can continue to progress with the breadth and depth of the programme and ensure that the MAT standards work not just for the people delivering them but, most of all, for those who need them.

Public Health Scotland will continue to provide support to deliver against that timescale and will continue to publish progress reports, and I will continue to update Parliament in June and December next year. In time for my next update in June, Public Health Scotland will once again publish a full red-amber-green report to track progress.

However, we need more than just those 10 standards. I want to see an expansion of standards for other kinds of drug treatment, as well. I want to expand the scope of the standards so that they include leadership, women and children and the whole-family approach, and treatment options for benzodiazepines. Such an expansion links to actions that have been called for by the task force on a national specification for treatment and recovery services, whose recommendations the Government will be responding to in the coming weeks.

The work on MAT is interlinked with the whole of the national mission and the actions being taken forward as part of the cross-Government plan. That work is saving lives, tackling stigma and giving a voice to people who thought that they had none. It is giving a stigmatised population and workforce a platform from which to change and save lives.

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

I commend the minister on her candour. In 2021, there were 1,330 drug-related deaths in Scotland. That is not just a number; it represents 1,330 families who are suffering in anguish due to the failure of Scottish National Party drugs policy. Scotland’s drug-death rate is 3.7 times that of the United Kingdom as a whole and is higher than that of any European country. That is not just a statistic; those figures are about our communities—Scottish communities up and down the country that are suffering through a drugs epidemic.

There was a lot of high-level policy and management discussion in the statement. What we must have is delivery and improvement on the ground. I hope that the minister will be able to provide that at her next update.

Now that plans are finally in place, is the minister confident that MAT standards 1 to 5 will be met by 2023, and what action will she take if milestones are not achieved?

I am sure that Mr Gulhane will agree that MAT standards define what is needed for safe, accessible and consistent treatment the length and breadth of Scotland. They are not optional and are most certainly not a tick-box exercise. I have been, and will continue to be, clear and direct with Parliament and our partners about progress and pace. I have taken unprecedented actions that are providing unprecedented scrutiny and support, and are about maintaining momentum to ensure that we can deliver on the ground.

I accept Public Health Scotland’s findings and recommendations, which are based on a robust evidence-based plan that PHS has published. They remain challenging and are ambitious, but they are achievable, and the PHS report has set out clear milestones. I am determined that, every day, we will put our shoulder to the wheel to ensure that we build on the progress that has been made.

The importance of Public Health Scotland’s work in the area is that, come June, it will once again shine a light on what has and has not been achieved. I assure Mr Gulhane and other members that the findings will very much inform future action on support and scrutiny.

According to today’s Police Scotland publication, there were nearly 800 suspected drug deaths from January to September. On the current trajectory, it is likely that, by the end of the year, if a public health emergency is declared by the Scottish Government, the number of deaths will be in excess of 3,500. Although the Government’s focus is on reducing the number of fatalities, is it developing an understanding of which policy approach is having the most impact, to inform future practice?

The minister says that she accepts Public Health Scotland’s recommendation that standards 1 to 5 be implemented by April 2023, but is she confident, based on the reports that she is receiving to which we do not have access, that the target will be met by then? Although the target for standards 6 to 10 is more than two years away, at the current pace of progress we need work to be done on those areas right now. Is the funding in place to support implementation of standards 6 to 10?

Finally, of the 100 additional staff to whom the minister referred, how many have been recruited?

I very much appreciate Ms Baker’s unswerving and unequivocal support for implementation of the medication-assisted treatment standards. She is right to have pointed out that one death is one too many. The suspected drug deaths numbers in the most recent published quarterly figures that have been reported on today show the lowest recorded number of suspected drug deaths in a single calendar quarter since January to March 2007. However, I always add caveats on such figures, because suspected drug deaths statistics are not the same as the confirmed number of deaths.

There is an outcomes framework for our national mission plan, and we have done in-depth work in order to be clear about our response on those outcomes, and on tracking and monitoring where we are having more success and where challenges remain.

I repeat what I said to Mr Gulhane: the timelines for the work are challenging. There are various challenges, which we are all familiar with, across the health and social care sector, but resolving them is achievable. As always, I give the undertaking that where problems exist and where, by shining a light, we uncover more issues, they will have my full and undivided attention.

Standards 1 to 5 are about the standard of care that individuals receive, but standards 6 to 10 are important because they are about the systemic changes that we must make. The identification of senior leads in every area in that regard is of particular importance.

Ms Baker was correct to mention the £10 million that is based on locally agreed plans. Although recruitment challenges remain, I am encouraged that some areas have done well against their targets. I am happy to discuss that further with her. It is important to note that in MAT standard 1, on same-day treatment, we are beginning to see a shift from red to amber and, in some cases, to green. I will keep her updated.

The minister mentioned the whole-family approach in her statement. The MAT work principles state that families who are affected by substance use must be reached at local and national levels. What support is currently being provided to establish advocacy services in local areas and to empower families to have a voice in ensuring that systems and services are non-discriminatory and actively put their lived experience at the heart of services?

Families are partners in their loved ones’ recovery and in the change that we need in how services are provided across the country. MAT standard 8 is clear that the people who use services should have access to independent advocacy, whether that is for their treatment, housing, welfare or income. People should also be fully informed about the advocacy services that are available locally.

As I indicated in my statement, we will continue working closely with the MAT implementation support team. The Government has made substantial funding commitments, from Corra Foundation and alcohol and drug partnerships funding, to the whole-family approach and family-inclusive practice. We are auditing the outcomes.

It is also imperative that families receive support in their own right. I pay tribute to Reach Advocacy, which is funded by the Corra Foundation to embed a human rights-based approach to service delivery. The Reach Advocacy project provides to practitioners, families and people who use drug, training that is accredited by the Scottish Qualifications Authority.

I apologise for my late arrival in the chamber.

The minister has rightly said that the work is about saving lives, tackling stigma and giving a voice to those who thought that they had no voice. Angela Constance stated that

“we need more than just these 10 standards. I want to see an expansion of standards for other kinds of drug treatment, as well.”

Will the minister listen to FAVOR—Faces and Voices of Recovery—which has called on the Scottish Government to introduce our proposed right to recovery bill to ensure that MAT standards are properly implemented?

I will give a fair and listening ear to all stakeholders and all members from across the chamber. I will look at the proposed right to recovery bill with great interest once it is published. The member will understand that, in the meantime, the Government must pursue its own legislative programme, which includes the creation of the national care service to provide a single framework for accountability.

We will also consult on the proposed human rights bill next year. I am sure that we can all agree that that is about achieving the highest attainable standard of physical and mental health. The work that the national collaborative is doing to galvanise the voices of lived and living experience and of families in developing a charter of rights, which will inform that human rights bill, is important.

I thank the minister for her update. She knows how important I think implementation of the MAT standards is.

Will the minister provide us with an update on progress towards establishing diamorphine-assisted treatment in Dundee for the most vulnerable members of the community?

Scottish Government officials have met with the Dundee alcohol and drugs partnership on a number of occasions to discuss the potential to establish diamorphine-assisted treatment, otherwise known as DAT or HAT—heroin assisted treatment. The most recent meeting was at the end of November and the discussion focused on work that the Dundee ADP is considering undertaking on a fully costed scoping study to establish the need for such a facility. That work is being done in partnership, in particular with the third sector. The Scottish Government has confirmed that funding would be available to support that scoping work.

Cranstoun is a charity that many of us in the chamber are familiar with. It has made clear its desire to establish a DAT facility in Dundee and has been in talks with partners. At its meeting on 6 December, the Dundee ADP considered a proposal from Cranstoun and agreed to move forward with the scoping study. The independent chair of the ADP has written to Cranstoun to keep it apprised. Scottish Government officials are due to meet colleagues from Cranstoun again on 19 December.

In June, the minister advised Parliament that the remainder of the £10 million a year MAT funding had been earmarked for the recruitment of more than 100 additional staff. She has highlighted that progress has been made in some areas. However, given that Glasgow has the highest proportion of drug deaths in Scotland and not a single MAT standard had been fully implemented in the city by the target date that the minister set, will she update the Parliament on how many additional staff have been recruited in Glasgow and how much of that £10 million has been allocated to Glasgow in particular?

The funding that comes through the MAT standards work was based on locally agreed action plans. I can, of course, provide Mr Sweeney with further information on some of the specifics in and around Glasgow.

Significant amounts of Corra Foundation funding have gone to Glasgow, and there is substantial investment in Glasgow through the funding that goes via the NHS and the integration authorities. From memory, I think that that amounts to £12 million, but I will provide Mr Sweeney with some of the specifics that he is looking for.

The MAT standards emphasise a multipronged approach to treatment and residential rehabilitation as a potential course for support. Given the work to ensure that the MAT standards are met, can the minister provide an update on the efforts to increase the numbers of people who are publicly funded for the residential rehabilitation programmes?

It is really important that the work to implement the MAT standards is also fully connected with pathways into residential rehabilitation. Some of the work that we are doing with our agencies is about making sure that we have that wider connectivity.

I think that the Parliament is well aware of the Scottish Government’s commitment to ensuring that a minimum of 1,000 places are funded publicly by the end of the current session of Parliament. We are providing alcohol and drug partnerships with £5 million a year to facilitate additional placements in residential rehabilitation and detox, and placements are also supported via the prison to rehab pathway.

Public Health Scotland is providing quarterly reports, and we have seen a steady increase over the past quarters, with an increasing number of placements being made via ADPs. In the most recent quarter for which figures have been published, there were 170 referrals, which was the highest number on record. To date, the national mission has supported more than 700 referrals to residential rehabilitation.

Can I take the minister back to our previous exchange on the topic in the chamber, which was about issues surrounding rurality? Despite the progress that has been made around MAT standards, which is welcome, it is still proving very difficult for people to access same-day services in rural areas, with clinics being few and far between. A huge issue around accessing those services is transport and the difficulties that many people have in accessing them because they are some distance away.

What are the Government’s plans to increase the provision of same-day services in rural areas? What will the Government consider doing to explore ways of providing such access to transport as is needed to ensure that those who need urgent same-day care can access it at a clinic that is far away from them?

Mr Cole-Hamilton is quite correct to make the link with transport. I assure him that issues of transport will feature when I come back to Parliament to present the cross-Government action plan, as recommended by the task force. He is also quite correct to point to some of the challenges that exist in our more rural communities and particularly our island communities. Argyll and Bute contains 22 islands, for example.

Through the MAT standards implementation support team, we are seeing some real creativity and commitment to doing things differently in our rural areas. Partnership with the third sector is vital in this area. In my most recent appearance at committee, I gave Mr Cole-Hamilton a commitment to provide some case studies on that point to exemplify the good work that is being done.

I remind members that I am the vice-chair of the local addiction service Moving On Inverclyde.

What consideration has been given to assisting the third sector when it comes to prescribing?

The Scottish Government fully supports the need for prescribing services to work closely with third sector partners, which often have prescribers for the services that they provide. The work that is being undertaken by the MIST will allow local areas to deliver greater access and choice of treatment by identifying local third sector prescribing options.

In addition, the MIST has restarted a non-medical prescribing forum for non-medical prescribers who deliver MAT. I am pleased to say that that includes the third sector. As an example of what can be done, nursing staff are employed in Turning Point Scotland’s Glasgow service. It is important to remember that, under MAT standard 5, there is scope to encourage local areas to involve the third sector in the provision of more joined-up prescribing—bearing in mind that MAT 5 is about the retention of people in treatment, which is crucial to achieving our overall treatment targets.

I thank the minister for providing advance sight of her statement. She referred to the upskilling of the workforce. We know that stigma plays a large part in why some people may not present to services in the first place or may not continue in treatment; in addition, we are aware of the stigma that is attached to those who work in the sector. As part of that upskilling, what is being done to embed practice that does not further embed stigma and that assists cultural change?

In my statement, I intimated the shorter-term actions that are currently being pursued. However, in the longer-term action plan that we will bring forward next year, we will outline the core skills, knowledge, values and training that will be required.

It is true that many staff do not feel as valued as others who work in health and social care or in other emergency settings, and it is crucial that we improve public awareness of their vital work. That is one way of challenging stigma and increasing the attractiveness of the vital work in the sector.

There are some great programmes out there. We want to develop better educational pathways. The Scottish Drugs Forum’s addiction worker training project is a good example of what can be done to bring people with lived and living experience into the sector. Since 2005, more than 300 people have enrolled in that excellent training programme.

My question follows on from Gillian Mackay’s. Will the minister outline the resources that are being provided to recruit, train and retain staff within the ADP workforce?

It is important to remember that alcohol and drug partnerships bring together local delivery partners that are responsible for the commissioning and development of services. I have spoken about the £10 million per annum that is dedicated to supporting the implementation of the MAT standards. However, it is also worth remembering that, in this financial year—2022-23—£106 million is being made available to alcohol and drug partnerships to support local and national initiatives; that a skilled and resilient workforce is a cross-cutting priority that underpins all the work in the national mission; and that addressing recruitment, retention and training challenges is absolutely key to the development of our workforce.

The Government’s failure to fully embed the MAT standards is a cause of growing concern, and it comes alongside cuts to primary care, front-line policing, council budgets and justice.

The minister said that there was a clear link between drugs policy and mental health policy, yet the Scottish Government has just slashed the mental health budget by £38 million. Does the minister share my concern that, sadly, when it comes to ending the harm that is done by drugs, avoidable SNP budget cuts are setting Scotland on a path to failure?

I make it clear that the work that we are engaged in in rolling out MAT is key to removing the barriers that persist in and around people’s access to mental health. Work on that is under way. Kevin Stewart and I are involved in joint work on pathways—£2 million is being invested in expanding that pathways work into five health boards—and the Mental Welfare Commission for Scotland report and the rapid review that I commissioned point to the same, pragmatic solutions.

On resource, I point to the fact that the mental health investment for the previous financial year was around £1 billion. The key challenge for me and other colleagues in Government is to ensure that people who use drugs or are in recovery get access to the resources that exist.

That concludes the ministerial statement.