Chamber and committees

The 10 MAT standards came from the Scottish Drug Deaths Taskforce itself, and were created after a concerted effort and work with people with lived and living experience and other partners. If we think back to when the standards were first discussed, we were talking about an entire system and culture change to create services that would deliver at pace on the ground. That was made difficult from the beginning by the fact that ADPs and health and social care partnerships are all set up in different ways, so we started from a really difficult and complex position.

I will keep pushing for local areas to deliver on the MAT standards, because we need them to do that and we know that that will save lives, but the fact that two thirds of areas delivered standards 1 to 5 last year was a big step change. I am really conscious of the fact that standards 6 to 10 will be where we really start thinking about advocacy work, trauma-informed work, psychological and mental health support and how we start to embed the MAT standards within primary care, which will all be really tricky.

I will have to have robust conversations with local areas. Some areas have moved to monthly reporting, which is really important, but other areas where we have seen progress have gone back to quarterly reporting. Some specific situations will be tricky. There are some areas where drug deaths have not started to decline or where there are perennial issues, which means that I must have sit-down conversations with them. That will be very supportive, as opposed to me telling people what I think they should do, because that is not how we should work. We must ensure that we take areas with us. Despite progress not being as fast as I, or any of us, wanted it to be, we must recognise that people across the country have pulled out all the stops.

Also, because of the way that healthcare operates, we will find it tricky in our justice settings. Just last night, I met other ministers who are responsible for what healthcare should look like in a prison setting. We know that 76 per cent of those admitted to prison test positive for illicit substances and have significant substance use problems, so the MAT standards must work in justice settings.

I will continue pushing so that all 10 MAT standards are fully implemented by the end of 2025 and, by the time that we get to the end of this session of Parliament, the standards will be sustained and they will operate as business as usual.

All 10 should absolutely be implemented and operational by 2025 and they must be sustained by the end of this session of Parliament. We must find a way forward so that, beyond this session of Parliament and this Government, the MAT standards are treated as business as usual and will be what people can expect.

I have spoken with officials about the decision to split the standards into two groups after the first year, which predated my time as minister. The decision might have been about what was easier to measure: the first five standards were measures that officials within Government, and locally, thought could more easily be benchmarked.

We must not underestimate the work that the MAT standards implementation support team, which is based within public health, is doing at the moment. Members of the team have created entire data capture systems that did not exist beforehand. There is a massive amount of work to do in capturing experiential data, which is more difficult to quantify. That is why, if you look at the MAT standards, you will see that some are only provisionally marked as green because the experiential data, which will be led by people with lived experience, is being captured. Services say what they are doing, but the data will show how people are experiencing that service. It was quite tricky to set up the collection of that data, so we must recognise the sheer amount of work that has been undertaken.

Might I add to that?

Like you, I am very passionate about being trauma informed and ensuring that services are trauma responsive.

We need a full systems and cultural change if we are truly going to tackle stigma. Part of the Government’s response to the Scottish Drug Deaths Taskforce’s report was to launch a tackling stigma action plan. However, while we are in the process of rolling that out, we need to co-design what it looks like. Therefore, we are making sure that we work with our partners in the third sector, local government and the health and social care partnerships but also with the people who are experiencing the services. It is important for those people to be supported, by and large, by the third sector.

It will take a little time for us to co-design what the stigma action plan will look like, because co-design is not simple or easy. To do it effectively, we need to take a bit of time to ensure that we really hear from the voices of lived and living experience. With regard to our processes just now, I think that, sometimes—as you probably heard from witnesses last week—we can design stigma into our services by accident. We need to make sure that we hear what people who are living through substance use are telling us.

We also need to ensure that we think about some of the groups that are often not thought of when it comes to the designing of services. I am thinking about people from black and minority ethnic groups, who face substance use issues in the same way as everybody else, and I am thinking about services that we need to ensure are there for women and their specific needs. All too often, stigma can drive people away from services, so I am keen that we hear from all those voices. A lot of the time, the voices that we talk about as unheard are actually talking very loudly and we are just not listening to them. Therefore, for me, the co-design process is vital in getting that right, and it is going to take a wee bit of time.

I will also keep the committee informed about what can be learned from that case once I get a fuller picture back.

I do not know. I do not have any insight into that at the moment. Michael Crook might.

We know that Police Scotland has created an operational procedure that will dictate how any such facility is policed, and it is for Police Scotland to communicate that.

You are absolutely 100 per cent right, Ms Clark, to ask about how the staff of such a facility would be protected. It is for Susanne Millar to reassure us about the advice that Glasgow has taken on that. As the minister, I believe that the individuals who will be supporting some of our most vulnerable citizens should themselves be protected. I will hand over to Susanne to answer that.

It was just to say that the Lord Advocate will not proceed with her prosecution statement unless she has satisfied herself about the process.

I will just briefly say in response to that that I would ask members of the joint committee to reach out to Police Scotland, put questions to it, and perhaps take its evidence, because I think that that will help you to form the bigger picture. Police Scotland has been supportive in understanding the need for such a facility. Assistant Chief Constable Ritchie was behind the proposal from the beginning. Police Scotland has come on a journey as regards playing a role on the issue. It was probably an oversight that none of its representatives was available at the community council meetings. I do not think that either of us can speak for Police Scotland, except to say that, since 2016, it has certainly supported our endeavours.

Thank you, convener. I thank all three committees for coming together to focus on this issue, which cuts across all your portfolios.

We are now at the midpoint of the national mission and we have seen significant progress in many areas. There has been a huge increase in naloxone distribution, improvement in our surveillance and early warning systems, progress on the implementation of medication assisted treatment standards and an increase in residential rehabilitation referrals and capacity.

As a Government, we have taken a truly whole-systems approach to tackling drug deaths and the underlying drivers. Our response to the Scottish Drug Deaths Taskforce set out bold actions, including in mental health and oral health, community pharmacies and developing a concessionary travel pilot. We recently published our second annual report, which I hope members have had a chance to read to see the depth and range of work that is being delivered.

That progress is not just due to our increased investment. It is very much due to a huge, concerted effort by people and organisations right across the country, and my respect and thanks go out to them. This truly is a national mission.

In 2022, we saw the first annual reduction in drug deaths since 2017. Although I welcome that record fall, I reaffirm my commitment to continuing the national mission and recognise that we still have a lot of work to do. I will never underestimate the scale of the challenge that we continue to face, which includes responding to new threats such as synthetic opioids and the ever-increasing use of stimulants. We will continue to implement evidence-based policies to reduce deaths and to improve the lives of people affected by substance use, and we are continuing with our commitment to put people with lived and living experience at the heart of everything that we do.

We recently had a debate in the chamber that was focused on drug law reform. That debate highlighted the limitations and the barriers that we still face. A key facet of drug law reform is the ability for Scotland to implement actions that we know will save lives. One example is safer drug consumption facilities, and I again welcome the position from the Lord Advocate and the confirmation from the United Kingdom Government that it will not seek to block or prevent the proposals in Glasgow.

Safer drug consumption facilities are important, but they are only one small part of a much wider picture when it comes to supporting people wherever they are. I look forward to the opportunity to provide wider updates through this evidence session.