Chamber and committees

Thank you.

I think that I have learned my lesson about not volunteering to go last. I will be as brief as I can be.

Cabinet secretary, you mentioned a just transition for our farmers and crofters, which is really important, especially when we are looking for them to redevelop their skills and practices, as we have just been speaking about. A big part of that will be continuing professional development. The committee has heard in evidence that there needs to be a massive culture shift in how our farmers and crofters take up such opportunities. We have to be cognisant of certain groups, such as female farmers, new entrants or younger farmers.

Although stakeholders and respondents are broadly supportive of CPD, they have raised a number of questions about how it would be implemented and what the Scottish Government’s intentions are for those powers. I am thinking about measures to compel versus measures to incentivise. When can we expect to see any regulations in that area?

I thank Carol Mochan for that question, which gives me the opportunity to inform the Parliament that, in the coming weeks, we will have a debate in the chamber on alcohol harms and how the Scottish Government is seeking to address the matter. I look forward to having Carol Mochan and others participate in that debate with me.

The 2024-25 alcohol and drugs budget has remained the same as that for 2023-24. The minor change seen in the published 2024-25 budget is not a proposed budget spend increase; rather, it shows funding being formally baselined into the alcohol and drugs budget line. The £13.6 million budget increase from 2022-23 to 2023-24 includes an additional £12 million to deliver the cross-Government plan, which was published in January 2023. The remaining £1.6 million increase covers portfolio operating costs for drug and alcohol staff, the funding for which was previously held centrally. Funding for drugs policy has increased by 67 per cent in real terms from 2014-15 to 2023-24, according to Audit Scotland figures published in 2022.

Today, I want to assure members that I am determined to continue to work across these benches, across all sectors and across each and every community throughout Scotland to embed the critical aims of the national mission to save and improve lives. My thoughts are with everyone impacted by the loss of a loved one.

I acknowledge the suspected drug deaths figures that were published last week by Police Scotland. That management information report provided an indication of current trends in suspected drug deaths. It covered the period from January to September 2023, and it reported that there were 900 suspected deaths, which is 13 per cent more than there were in the same period in 2022.

I am absolutely steadfast and determined to turn the tide on drug deaths. A real concern for me right now is the increasing appearance of synthetic opioids in the drugs supply. That increase is being seen across the United Kingdom; I will cover that later. Those new drugs, especially nitazenes, are being found in a range of substances, and they bring with them an increased risk of overdose, hospitalisation and death.

That is why the MAT standards are so important. The second annual benchmarking report, which was published in June, illustrated that clear progress was being made in a number of areas of Scotland. I take the opportunity to again thank everyone involved in working to change services for the better. Change is happening. In my meetings with individuals and various stakeholders over the past few months, I have heard about and witnessed for myself the will and drive to improve access to treatment and support. For example, on MAT standard 3, the MATS implementation support team—MIST—is working in collaboration with colleagues from across Scotland to develop guidance to ensure that all people who are at risk of drug harms are identified and provided with support, and to ensure that pathways extend beyond the Scottish Ambulance Service and the emergency department and into housing, family members and justice and third sector organisations, and include people who use any substances problematically.

It is important to acknowledge the hard work and determination in relation to implementing the MAT standards. However, I do not shy away from the work that there is still to do to ensure that successful implementation is achieved and sustained across Scotland.

That is why, following the ministerial letter of direction that was issued in June last year, I have maintained the requirement for the majority of areas to report quarterly to the Scottish Government. In seven areas, there has not been significant progress, and those areas will provide monthly updates on their progress. However, I do not wish to demotivate or demoralise any member of staff or individuals in those areas, who are working above and beyond to implement the standards, because there have been local challenges to overcome.

MIST is working closely with each of those areas, and I can report that, for most, good progress is being made with a view to the full implementation of standards 1 to 5. It is my intention to meet staff in those areas in the coming months to hear for myself how barriers are being overcome. I have heard from individuals, families and supporting services that our aims are not always translating into positive experiences on the ground, and I will discuss those cases when I meet local leaders.

We know from this year’s benchmarking report that standards 6 to 10 require new approaches. I acknowledge that some of those are taking time to embed, but I remain committed to implementation in 2025. What I see, however, is services working together more closely than before. For example, MAT standard 9 criteria and the mental health strategy set clear expectations that people with co-occurring mental health and substance conditions should have access to high-quality and integrated care. Work is on-going to improve care by getting the local foundations right, empowering the workforce and embedding clear lines of accountability. As part of MAT standard 8, we are working alongside Public Health Scotland and experts across the field to ensure that advocacy and support are in place at local level. For MAT standard 7 and primary care—although this can be seen as challenging—areas are exploring different service models such as shared care, non-medical prescribers and better joint working.

Community pharmacy also has a role in improving outcomes for people. For example, there is a programme of work that has been successful in improving education for pharmacy teams on substance use. That includes the roll-out of training on naloxone use for all community pharmacies and supporting the pharmacy network in Scotland to deliver undergraduate and postgraduate pharmacy training on substance use.

In justice settings, in partnership with others, MIST has led the development of a resource kit to support police and prison staff to implement the MAT standards. There is innovative work going on in HMP Perth to promote recovery and to ensure that those at the highest risk of drug harm are followed up by community services. There is improvement work being undertaken in NHS Highland to support those who are most vulnerable in police custody, offering nursing support at first point of contact. In Kilmarnock, the organisation We Are With You attends people who are in police custody to help them with regards to MATS.

MATS implementation needs to be based on hearing and listening to the voices of people who use services. However, areas need to go further than listening. We need to drive improvement based on the feedback that is gathered from those with lived and living experience. That will often mean making changes to how we do things.

Last week, I had the pleasure of attending the launch of the national collaborative’s draft charter of rights. The charter helps people to understand their rights and sets out the kind of actions that public bodies, including the Scottish Government, will be expected to take in the context of the forthcoming Scottish human rights bill. That strengthens efforts that are already under way as part of implementing the MAT standards, and, crucially, it ensures that people are involved in decisions that affect them.

The successful implementation of MATS and our national mission requires a skilled and resilient workforce. It is therefore crucial that services are able to attract, retain and support staff. We are engaging extensively with partners to get a clear understanding of the specific steps that are required to drive improvement. Those steps are set out in the drugs and alcohol workforce action plan, which was published earlier this month. The action plan details the key workforce priorities that we will deliver over the next three years, and I want to offer reassurance that significant progress has already been made towards delivering a number of those.

Although I am committed to ensuring that MAT standards are fully implemented, I fully recognise other emerging threats that we need to be aware of and tackle, including the threat from synthetics such as nitazenes. We have improved our surveillance to monitor drug trends and what is in the drug supply through our rapid action drug alerts and response, or RADAR, system. That has allowed Public Health Scotland to issue two public health alerts this year on specific substances, one of which was for synthetic opioids. Alerts aim to raise awareness of risks for individuals and families and to alert service providers to deliver vital harm reduction, including the provision of naloxone.

Through surveillance, we have already seen synthetic opioids appear in the supply. Those substances, which are significantly stronger than regular opiates, are a massive concern for everyone, not just in Scotland but across the UK.

In the summer, the UK Government issued its own alert about nitazenes, and, last week, the National Crime Agency published information estimating that, in the past six months, there had been 54 nitazene-related deaths in the UK, nine of which were in Scotland.

I discussed the issue with the UK Government and other devolved Administrations at the UK drug ministerial meeting that was held last month, and I am committed to continuing to work with UK colleagues on the issue. I also recently met international experts to discuss their experience, and I will hold a round-table event with stakeholders to discuss operational issues early in the new year.

We know that naloxone works on synthetic opioids. Therefore, our aim is to continue to increase the number of kits in general circulation, with the public to provide initial medical treatment.

In addition, we are working with our cities to establish drug-checking facilities and the aim is to submit licence applications to the Home Office to allow those to be established in the coming months.

In Glasgow, we are supporting the setting up of a safer drug consumption facility in which emergency care can be offered if someone overdoses. That will be even more important if there is an increase in consumption of synthetic opioids as overdose is more likely due to their increased strength.

In Glasgow, the enhanced drug treatment service treats people with prolonged heroin use who have had little or no response to traditional opioid treatment methods. The service has been evaluated to work safely and effectively, and it has ensured a safe supply of diamorphine as a harm-reduction method for that population.

We have also seen an increase in the use of cocaine and its associated harms. No medicine is available that can act as a substitute, but other types of treatment such as psychosocial interventions and supervised detoxification are available. Third sector organisations are leading the way in helping people with cocaine problems. Indeed, a blog was recently published on the Healthcare Improvement Scotland MAT learning system website detailing how Harbour Ayrshire, which is a charity, is helping people into recovery from cocaine.

Moving forward, continued implementation of the MAT standards will drive further change. I remain committed to the timelines that have been set out. We must also be alive to emerging threats and services must adapt—as they have been doing admirably thus far—to meet the new challenges.

MAT implementation should remain at the forefront of what areas are doing. The work is saving lives, stigma is being tackled, the workforce is being valued, and areas are sharing learning and best practice. Everything is coming together to save and improve lives.

I must pay due respect to the continuing commitment from parties in this chamber. Members’ challenge and desire for change are welcome as we look to full, equitable and sustained implementation of MAT standards in all areas across Scotland.

Small teams and those in remote and rural settings have particular challenges. However, ADP areas with remote and rural settings have demonstrated innovation in maximising the use of technology and flexible models of care so that people can benefit from equitable care and treatment. Those in our remote and rural communities have always had the adage that, as my grandpa would say, “‘Huv tae’ is a guid maister”, and they are very innovative in their approaches.

Emma Harper mentioned Borders In Recovery, which is an organisation that I would like to visit in the new year to discuss how it delivers its support services in that rural setting. I am keen to ensure that our rural services develop.

We know that stigma prevents people from accessing the treatment and support that they need and are entitled to, and that there can be specific impacts in rural areas. Work is taking place locally to reduce stigma, with all ADPs reporting that they consider stigma reduction in written strategies or policies, including the MAT standards implementation plans, alongside a range of other actions.

Nationally, we published our stigma action plan last year, which outlines our plans to develop a voluntary accreditation scheme to tackle structural stigma and to implement a national programme of activity to challenge social stigma. I will keep the Parliament updated on the progress of that plan.

Annie Wells asks an important question. Cocaine use is rising across the country in different age groups and cohorts of individuals. Although there is no medication substitute for such a stimulant, detoxification can work well. We have committed £5 million per year to look at our stabilisation and detoxification provision across the country. Of that, £3 million is to increase the provision, and £2 million is for a rapid capacity-building fund.

I ask that local areas work together collectively on services so that we can increase the provision of placements for stabilisation and detox, because they are a key part of our mission. They are also the key link between community recovery settings. People might go into the detoxification and stabilisation setting and then on to residential rehabilitation, if that is right for the individual.

I am happy to keep Annie Wells informed as we go along.

I absolutely recognise the issue that Paul Sweeney raises. The model that is on offer in Glasgow started during Covid, so there was an interruption to the number of people who were brought on board. We know that the number is increasing as time passes after Covid, but I am also aware that there are other models that we can implement across the country. Funding has been made available for projects to carry out scoping exercises in local areas and to look at taking on that approach. I have had discussions with Cranstoun and other organisations about how that can perhaps be delivered in different parts of the country with different models, and I am willing to work with any local area that wants to do that. The Government is ready to stand side by side with local partners.

I have been pondering how we ensure that we collate the information that we get from the RADAR reports and collect from the Queen Elizabeth university hospital’s programme, which monitors people in real time as they come into accident and emergency, and examine that information in totality. I am concerned about what might be coming down the line to us. I visited local organisations this week and heard that four doses of naloxone have had to be deployed in a service to reverse an overdose. That is concerning.

I am also concerned about the fact that nitazenes have been found in substances that are not linked to heroin, which means that somebody will not anticipate that they are taking a nitazene. They might be buying an illicit benzodiazepine or using what is supposed to be a cannabinoid-type vape, and nitazenes are contained therein.

I commit to keeping Parliament abreast of the emerging threats, but I will also try to figure out how we respond in an even shorter timeframe.

I recognise Sue Webber’s commitment to and passion for this subject.

Access to specialist treatment is slightly different from access to same-day treatment in the MAT standards. Perhaps I need to do a bit of work to communicate that more effectively. We are making progress in achieving MAT standard 1 across the board, which is very welcome.

Harm reduction is a form of recovery; I do not think that we can separate the two. I am committed to extending access to residential rehabilitation. We have committed more than £37 million to seven capacity projects, and people are accessing those services in numbers that we have never seen before. Last year, 812 people accessed a publicly funded placement in residential rehab, which represented a 50 per cent increase.

I am committed to working with members across the chamber and to considering the proposed right to recovery bill when it is published. I will be interested to see how some of the concerns about unintended consequences that were raised during the consultation have been addressed. I give a commitment to looking at the bill once we see the details of it.