Chamber and committees

I thank Gillian Mackay for that question, which is a very important one that has several facets to it.

As per MAT standard 8, the Scottish Government is working with Public Health Scotland and experts across the sector to ensure that people who use drugs have access to independent advocacy and support for their housing, welfare and income needs. The Scottish Government is committed to ensuring that those who use alcohol or drugs are supported to access services and that staff are trained to understand the wider complex needs of people who use drugs.

In order to ensure that those important and complex interlinked issues are recognised, Reach Advocacy has been awarded funding to deliver training on the implementation of MAT standards as part of a wider human rights-based approach. The training allows front-line staff and managers across statutory and third sector services to develop their knowledge of MAT standards and human rights legislation in order to provide holistic and rights-respecting care.

There is also a fundamental part about really taking on the learning when we recognise where things have gone wrong. That learning can then be cascaded to other front-line services. After hearing directly from front-line services yesterday, I am cognisant of the impact that repeated overdose reversals are having on members of staff. We are looking to support members of staff’s wellbeing.

I thank Audrey Nicoll for asking that important question. Buvidal and naloxone are medicines that need to be available everywhere to help to save the lives of some of the most vulnerable people in our communities. It is simply unacceptable for health boards and integration joint boards to single out those medicines and treat them differently from all other medicines. Stigma is pervasive in all areas of our culture when it comes to issues relating to drug use. My officials have met chief finance officers and ADPs to ensure that the costs of those medicines are being provided for appropriately. For boards where there may still be some confusion, we will be writing out shortly to give clear instructions on the need to properly fund the availability of Buvidal and naloxone.

The definitions that are used for drug deaths statistics are consistent across the UK, but there are important differences in data collection methods and in the death registration systems that affect the comparability of the statistics, due to there being different levels of missing data across the UK nations. The same comparability problem that is found with identifying drug misuse deaths applies to the figures for all individual substances and drug categories. The drug misuse death definition is the main headline figure that is used in Scotland, but the drug poisoning death definition is the more accurate comparator with the rest of the UK.

The Scottish Government remains committed to improving our data and surveillance on drug deaths and harms through, for example, our rapid action drug alerts and response—RADAR—surveillance system. That system, which has come into its own recently, assesses emerging threats, shares information to reduce the risk of drug-related harm and recommends rapid and targeted interventions.

There have also been great advances in toxicology reporting in Scotland. Ministers in the rest of the UK have looked towards us for leading on that. The more we can identify the substances, the more we can introduce harm-reduction measures.

I thank Clare Haughey for the question, because it is on the fundamental aspect of ensuring that people who have co-occurring issues with substance use and mental health are not bounced around services, which happens far too often.

We have commissioned Healthcare Improvement Scotland to produce an exemplar protocol, which will build on best practice from across the country and internationally. It will ensure that every area has access to a high-quality document on which they can base their own protocol. Once the exemplar protocol has been made available to the local areas early next year, HIS will offer strategic change management support, which will help local areas to adapt the exemplar protocol to their own circumstances, pilot elements of it and then implement it fully. In addition, we will work with HIS and stakeholders, including NHS Education for Scotland, to ensure that we have the appropriate training and data reporting to support and monitor improvements.

By implementing the exemplar protocol, local areas will also be implementing MAT standard 9, with co-occurring support being provided where it is needed. However, the protocol is not limited to opiates or medication-assisted treatments; it will support many more people in relation to their substance use.

That is a really good point, because we need challenge and scrutiny of, and independent eyes on, some of these things. I will probably pass over to Susanne Millar to help us with understanding the evaluation process from a Glasgow perspective. Obviously, things will look slightly different from a Government perspective, as my scrutiny will be of the evaluation that Glasgow will take forward.

I am happy to hand over to Susanne at this point.

On your first point, the resourcing of any other safer consumption project would be an on-going process between my officials and officials at Edinburgh council. That is not something that I can foresee, but I take your point about how pressed the budgets are.

We need to have a robust evaluation process, which needs to be flexible and agile. At the same time, I do not believe that that should stop us exploring the possibility of other pilots that could be proposed while the initial Glasgow pilot is being undertaken. As is set out in information that I submitted to the committee, we have had conversations with the Crown Office and Procurator Fiscal Service about what it would be willing to consider.

It is clear that the Lord Advocate would consider a robust application from an area, provided that it followed the parameters of the initial Glasgow pilot. An application would need to be precise, detailed and specific, underpinned by evidence from that area and supported by those, such as Police Scotland, that would be responsible for policing such a facility. Any area that sought to make an application for a pilot would need to ensure that it satisfied the Lord Advocate in relation to everything that Glasgow did.

Conversations have already been undertaken in the city of Edinburgh about whether the council there would seek to have such a pilot in the offing. Officials in the Scottish Government are supporting that area to explore what that pilot could look like.

We do not need to wait for the full evaluation of the first Glasgow pilot before applications are put forward by other areas.

Absolutely. I anticipate that, by the time we go into the spring, we will have a lot more information about what the stigma action plan is going to be. We are co-designing a voluntary accreditation scheme that people who are working in services can sign up to. That means that they, as practitioners, and their service will adhere to looking at how they can reduce stigma and drive it down. That is really important.

We are also supporting organisations to launch campaigns such as “See Beyond—See the Lives—Scotland”, which is run by a few partner organisations, to get the stories behind the people. We have heard powerfully from MSP colleagues about the stigma that they and their families have faced. There is a lot going on in the background, but I will keep the committee and the chamber up to date on that.

Yes, and I absolutely take that point.

As for the case that was brought to our attention on social media, I asked officials to start looking into it straight away, because the story of the individual’s journey that it told did not reflect what an individual’s journey should be in that setting. Let us zoom out from that one person and think about the journey as it should happen. When someone transitions from any setting, whether it be a hospital setting, a prison setting or whatever, a cohesive plan should be in place to ensure that their medication or anything else does not fall between the cracks, that they do not present as homeless and so on. The individual in question should have had a seamless transition from the prison facility into the community setting.

I am still waiting to find out what some of the difficulties in that situation could have been. We know that Edinburgh has a named person standard operating procedure in place, which means that a specific patient is able to have the medication follow them, because you need to have a Home Office licence to store Buvidal. At the point of transfer, the person should have been able to have long-acting injectable buprenorphine set up for the next time that they were due to have that, so there must have been a breakdown in communication somewhere.

There has to be learning from that case, because it cannot be something that happens regularly across the country. That also harks back to the sustainable housing on release for everyone—SHORE—standards. When somebody makes that transition from a prison setting back into a community setting, their healthcare should follow, as well as support for their needs in relation to housing, access to welfare benefits and so on. I am happy to keep the member informed.

I will answer part of that and then see whether Susanne Millar wants to come in.

If we consider the running costs of such a facility, we can see that staffing it within that timeframe is reflective of the tariff that we know it will cost us. However, I recognise that people will use drugs at all times of the day, so there is need to look at how we can assess, as the pilot develops, what the real-time information is telling us about individuals’ habits and how individuals are engaging with the service. It is something that I have certainly thought about and I am sure that Glasgow has thought about it as well.