Chamber and committees

We saw the findings of the Scottish Drugs Deaths Taskforce. Some of those findings on drugs can be extrapolated to alcohol harms. However, as Carol Mochan pointed out, the picture is complex. We need to continue to examine the matter to understand what is driving consumption in our communities. Some of it is to do with poverty and inequality but a lot of it is to do with other matters. The increase in over-65s is particularly perturbing to me. Is there something to do with retirement age that means that people’s habits start to change? I assure Brian Whittle that examining that matter over time is a key part of what I want to do.

I cannot, sorry. I do not have enough time. There is just too much to talk about. That speaks to why we need a further debate in the chamber.

We have just commissioned Healthcare Improvement Scotland to take forward work to enable us to deliver our mental health and substance use plan. The first part of that work is currently under way as HIS works with stakeholders to develop an exemplar operational protocol to set out how mental health and substance use services should work together. That is vital, given the number of alcohol-specific deaths that were caused by mental or behavioural disorders. We cannot allow people to be bounced between services.

Workforce—recruitment in particular—is a challenge across all services at the moment. In the autumn, we will publish a workforce action plan on alcohol and drug services to help shape recruitment, retention and service design. That should help to create service capacity to make improvements, such as establishing alcohol care teams in hospitals to identify people with underlying alcohol problems earlier. I am meeting the chair of the group on that this afternoon.

I am meeting local leaders across the country to ensure that they are committing effort and resource to ensure services are in place, accessible and effective. I also recently wrote to ADPs to reassure them that it is welcome if they use national mission resources to support services that offer treatment and support to people who are impacted by alcohol use alongside those who are impacted by drug use. Any concerns that they have should be flagged to my officials.

To help to ensure that changes are delivered, the Government has committed to developing treatment standards to offer people better access to support and a wider range of choices in treatment, in line with what is available through the medication-assisted treatment standards. The standards will be informed by the United Kingdom-wide clinical guidelines for alcohol treatment that will be launched in the coming months. The implementation of those guidelines and our proposed standards will provide the impetus for improving the identification and testing of patients who are at risk of liver disease in primary care. As we have heard from Stuart McMillan, that is welcome.

On recovery services, we are encouraging specialist services to link more closely with recovery communities and we continue to provide funding to third sector recovery groups. We are on track to increase our beds from 425 to just shy of 600 in this session of the Parliament, which is a 40 per cent increase. That represents about 1,000 publicly funded placements, which is important.

There are innovations such as the Simon Community’s managed alcohol programme, which seeks to drive harm reduction for people who are drinking at the most harmful levels.

There is so much in the issue that I cannot get through all of it. However, as the minister with responsibility for both drugs and alcohol, my role is to drive improvements in outcomes for people who are impacted by alcohol, drugs or both and do so in all the ways that help to tackle the twin public health emergencies. The Government will continue to work with statutory and third sector partners to deliver the plan to reduce alcohol harm and alcohol deaths. I will work at pace to bring all of that together to ensure that our ambition is communicated effectively, and I will seek to bring the matter back to the Parliament.

14:00 On resuming—  

Every life lost to drugs is a tragedy, and we collectively feel the loss of the talent and potential of far too many of our people. I offer my condolences to everyone who has felt that loss and my unwavering commitment to continue the work to turn the tide on this public health emergency.

Families and people with real-life experience of drug and alcohol problems tell me that there must be a commitment to change at all levels from the front line to local leaders and from public services to national leaders. That is reflected in the report, “National benchmarking report on implementation of the medication assisted treatment (MAT) standards: Scotland 2022/23”, which Public Health Scotland published this morning.

The report covers the year up to April 2023 and charts the significant progress that has been made across the country since the first benchmarking report was published in June 2022. I am heartened by the progress that the report shows. However, there is still much work to do to fully implement the standards by April 2025 and for them to be sustainable by April 2026.

From my previous work in homelessness, supporting many people dealing with substance use issues, as a Scottish Women’s Aid worker and, indeed, as a councillor campaigning for change, I am fully aware that the targets that we have set for local areas to implement the MAT standards have always been ambitious, but the standards will save lives and make a long-term difference for people in treatment.

Today’s report includes maps comparing progress with the position in April 2022. The national picture is clearly improving, and the maps allow us to chart progress area by area. Naturally, much attention will focus on the red-amber-green implementation tables, which show good progress on MAT standards 1 and 2. There has been a transformation in rapid access to opioid substitution therapy, with 18 of the 29 local areas having fully implemented MAT standard 1, compared to just one area in 2022. Likewise, MAT standard 2, on choice, is now fully implemented in 27 of the 29 alcohol and drug partnership areas.

Overall, by April 2023, 66 per cent of MAT standards 1 to 5 had been fully implemented, compared to 17 per cent in 2022, and 88 per cent of MAT standards 6 to 10 had been partially implemented. I realise that we were aiming for 100 per cent implementation of MAT standards 1 to 5 and partial implementation of standards 6 to 10 for this report. That has not been achieved, and many will see that as not good enough. Although I absolutely agree on the need for urgency and pace around reducing harm and saving lives, I also know that, from the outset, many people did not believe that services could achieve what they now have achieved. It is better to aim high than not to attempt to make any significant change at all.

All ADP areas with remote and rural settings demonstrated innovation in terms of maximising the use of technology, subsidised travel and flexible models of care so that people could benefit from equitable care and treatment. I really thank those ADPs for thinking outside the box.

The report includes some case studies that reflect that change is already happening in many places. Over the past few months, I have had the privilege of speaking with a lot of groups, service providers and people accessing services, and I have visited drop-in centres providing MAT to see for myself improvements and change on the ground. I have seen and heard of the progress that is being made and the future plans for full and sustained implementation of the standards.

The report shows a dramatic increase in capacity and capability in ADPs for evidence collection, with almost all areas now collecting experiential feedback from people who have recently used services. However, putting in place reliable and sensitive systems for collecting that feedback is a major challenge. That will take some time to fully embed, but it is undoubtedly the most important measure for whether the MAT standards are in place. Strengthening the experiential feedback is one of the four key recommendations made in the report, along with recommendations on building sustainable numerical data systems, establishing systems for more direct support and further development of guidance for implementation and assessment.

The report also reflects on next steps for local and national partners to further improve the landscape to help services make necessary improvements. I expect everyone from every service to work collaboratively to deliver on that part of the on-going national mission. For the avoidance of any doubt, the Government remains committed to the continued funding of the mission over the course of this parliamentary session.

The report highlights the need for changes in healthcare models to support implementation of MAT in prisons. We will therefore be focused on establishing a more consistent approach to access and choice in justice settings; addressing data-sharing challenges; and sharing best practice on service models that will deliver better outcomes for people. A justice network for MAT implementation is already sharing experience across areas and identifying best practice models.

For the remainder of the national mission, we are also committed to focusing more on the care and support for people who have problems with benzodiazepines, stimulants and alcohol, rather than focusing only on opioid use. That is absolutely imperative.

We have already committed to all of that on-going work through the Scottish Government’s cross-Government action plan, which we published in January 2023. It sets out how we are responding to the final recommendations made by the Scottish Drug Deaths Taskforce and how the national mission is being taken forward through a whole-Government and whole-Scotland approach. It also includes detail on what we are doing to address the workforce issues that are raised in today’s benchmarking report, and to tackle stigma.

MAT standards are about delivering faster and more responsive services, but they are also about changing hearts and minds, including tackling stigma and discrimination. Make no mistake, Presiding Officer, I am acutely aware of the damaging nature of stigma, which we must challenge wherever and whenever we see it.

ADPs and local partnerships are taking forward innovations to help address drug deaths. One that I know is of great interest to members is the potential use of safer drug consumption facilities. I confirm that the Government remains committed to the introduction of the Glasgow pilot, and I will inform Parliament immediately a view is reached by the Lord Advocate on the proposals from Glasgow city health and social care partnership and Police Scotland.

Although clear improvements have been made in response to the letter of direction that was issued to local services last year, we need to continue with formal oversight procedures and clear local accountability.

We will maintain the requirement for quarterly progress reports from local areas against their implementation plans, with monthly reports from areas of concern. The new benchmarking report will allow us to identify the areas that we now need to focus on. I will be writing to local areas in the coming weeks to update the oversight arrangements accordingly.

I will also be meeting local leaders to challenge them on progress, particularly where we believe that more commitment is needed from senior colleagues. We all want people to exercise their right to treatment, but that will all be for nothing if the services are not in place. The letter of direction requiring local leaders to implement the standards will remain in place and I will continue to provide Parliament with regular updates on progress.

The benchmarking report concludes:

“There has been a transformational change in improved access ... and choice of treatment ... for people with problematic drug use ..., and significant improvement in the other MAT standards. This is a direct result of hard work and collaboration within and between ADPs (including clinical, third sector, and lived and living experience partners) and of a shift in culture that has overcome many barriers to change.”

Of course, the continuing commitment from this chamber and all members is helping to drive improvement as well.

I thank the MAT standards implementation support team for its continuing hands-on support, working alongside local areas, and Public Health Scotland for its vital report. MAT standards are about driving change and improving outcomes. The standards are empowering people to demand the treatment that they deserve and there is no going back. We can now only go forward.

However, to quote again the report’s conclusion:

“implementation of the MAT standards is a vehicle for change and not a sufficient end in itself.”

For this year and the remainder of the national mission, the priority will be full, equitable and sustained implementation of the MAT standards in all areas.

I thank Sue Webber for her question and I recognise the passion that she has in wanting to see change being driven forward. I am absolutely committed to working with her and with members right across the chamber to ensure that we can do that.

The MAT standards have to work in justice settings and we will be pushing and supporting local areas, including healthcare teams in prisons, to achieve full implementation by 2025, as previously announced. There are specific challenges in justice settings, as highlighted in the benchmarking report. However, we have already announced our intention to improve healthcare in prisons through new models of care, improvements in data collection and setting up better links between services in prison and services in local communities to address the issues that were identified in the report. This year, MIST will be supporting health teams in prison settings to embed MAT standard 3, in particular. That is about assertive outreach, but also anticipatory care that needs to meet people when they are coming out of prison—

One key aim of the national mission is to get the people who are most at risk into treatment that provides protection and to wrap other support around them. We know that being in treatment offers people protection, but we also know that that protective factor decreases as time goes on, so the implementation of MAT standard 3 is crucial to ensuring that that support is in place.

Under MAT standard 3, all people who are at high risk must be proactively identified and offered a choice of treatment and support. That can be achieved through assertive outreach by services, especially for those who have stopped attending those services. We must ensure that there are clear pathways for those who have suffered a non-fatal overdose so that services respond to that need and assertively go out to find those individuals and get them into protective treatment services.

We must also ensure that there is support for transitions at key points, such as when someone leaves a justice setting or is discharged from hospital. MAT standard 3 focuses services on those who have left residential justice and in-patient services.

I absolutely understand the issues facing remote and rural areas. It is very difficult to deliver same-day services and meet MAT standard 1 in settings where people cannot get access to treatment. It is important to support innovation on that standard and to passport innovation, where that has happened, because we know that some remote and rural areas have been able to achieve MAT standard 1. I am happy to work across different sectors and areas to ensure that we can passport that information, and the meetings that we have with ADP chairs will help us to do that work.

As part of the national mission, the Scottish Government provides local areas with £3 million per year to ensure that those with lived and living experience, and their families, are involved in the design and delivery of local treatment and recovery services. We also provide £3.5 million per year through our whole family approach fund to enable local services to provide support to families impacted by drugs and alcohol.

We must remember that the MAT standards were developed by the Scottish Drug Deaths Taskforce, which benefited from hearing the views of those with lived and living experience, including family members. The MAT standards are not only of the Scottish Government’s making but are led by those who are at the front line. Those voices were also reflected in Public Health Scotland’s benchmarking report on MAT standards, which included forewords written by people with family experience.

I met family organisations after their empowering families on the front line conference back in March. Those families feel empowered to help to drive change on behalf of their loved ones, and for themselves, and we must listen to them.

I thank Dame Jackie for her question. I recognise that she has a keen interest in the area. I am determined that we will see sustained implementation of the standards by the dates that are set out in the benchmarking report, because there is no option but to ensure that we prevent harm and save lives.

I will ensure that the areas that are not where we want them to be continually have monthly meetings with me, because the letter of direction will remain in place. However, I also want to engage with local leaders on the matter. Local elected members need to work in partnership with us to ensure that we drive change forward.

Through the residential rehabilitation rapid capacity programme, the Scottish Government has committed funding for the development of several projects that will support women in Scotland, and their families, through recovery. More than £5.5 million has been committed during this session of Parliament to support the establishment of two houses at Aberlour that will be specifically designed to support women, and their children, through recovery.

We have also seen the opening of Harper house in Ayrshire, which will specifically support women to sustain themselves in recovery with their children. We know that women experience specific problems with trauma and with the related issues of poverty and deprivation, and we must ensure that we support women who no longer have their children with them, due to issues such as domestic abuse and complex trauma.

I recently met members of the Simon Community’s women’s group, who told me directly that they are working towards creating a safe space for women in Glasgow city centre, because they recognise the intertwined issues of homelessness and substance use. Women have their own needs, and I am committed to ensuring that we deliver on them.

—which we know is an absolute area of concern, with the potential for people to come to harm.

We will continue to learn from best practice in the implementation of the MAT standards and we will engage with experts on the ground on the most appropriate ways to deliver these vital changes in all settings. I was in Glasgow this morning to hear about the wonderful work that Sustainable Interventions Supporting Change Outside—SISCO—is doing in prisons to deliver peer-to-peer harm reduction within that setting, but also to make sure that they are doing proactive outreach work when people are coming out of prison.

I am happy to go and visit anywhere else in the country where we are seeing such work so that we can passport that learning between different areas.