Chamber and committees

I was reflecting on the questions that we had asked Kit Malthouse. One of the questions that we put to him was whether the UK Government would back drug-checking facilities in Scotland; the answer was no. If it is something that we were able to introduce, I would be more than happy to chat to the member about all the measures that he has just mentioned.

Safe consumption rooms are another life-saving intervention, and they must be allowed to operate in Scotland. Mr Malthouse said that he needed more evidence on safe consumption rooms. Considering that they have been operating in Europe for around three decades and have proved effective in a range of countries from around the world, including Australia, Canada, Spain, Switzerland and the Netherlands, I am not sure what further evidence he requires. Those facilities could be saving lives now.

I found the minister’s focus on enforcement particularly disturbing. In Scotland, there is a general consensus that a public health approach is needed to solve the crisis. It is clear that the UK Government does not share that view but instead sees it as a criminal justice matter, despite all the harm and stigmatisation that the war on drugs has caused.

I was also disappointed by the minister’s use of stigmatising language, which I will not repeat. We do people a disservice when we label them. It robs them of their dignity and humanity and it others them. If we want treatment services built around human rights, we must dispense with such language and speak about people as if they are human beings deserving of our respect and compassion.

We need a person-centred system that views people as whole beings, rather than various conditions that need to be categorised and dealt with separately. Above all, we must seek to reduce and prevent harm wherever possible. We must maximise every opportunity to connect people with services. The more we embed stigma-free treatment and life-saving interventions in the community, the greater the chances of connecting with those who need the help the most. For example, I was pleased to see the roll-out of naloxone to some taxi drivers in Edinburgh, which will surely result in more lives being saved. I applaud all those in the scheme, which has also been implemented in Glasgow. I hope to see it being implemented in more of our cities and towns.

The Scottish Greens also support the roll-out of heroin-assisted treatment across Scotland. According to NHS Greater Glasgow and Clyde, there is high-quality evidence to suggest that HAT can improve individual and societal outcomes when provided as a second-line treatment for people with chronic opioid dependency. It is yet another area where meaningful progress is being blocked. Stakeholders have reported to the Drug Deaths Taskforce that the process for submitting an application for a licence for HAT is overly complicated and resource intensive. The ability to offer HAT alongside other medication-assisted treatment should be more widespread, and any remaining barriers to the provision should be removed.

Despite the fact that HAT is a well-evidenced intervention, with clear health and social benefits, roll-out has been hindered by an overly bureaucratic process. I have heard the Minister for Drug Policy say on more than one occasion that we need to turn expressions of interest from health boards into commitments. At the moment, health boards must apply to the Home Office and the Scottish Government and could be approved by one and rejected by the other. That may discourage some boards from applying.

It is vital that HAT licensing is devolved to Scotland in order to reduce the administrative burden and to facilitate its roll-out across Scotland.

As I begin this speech, my thoughts are with everyone who has lost a loved one to a drug overdose. I pay tribute to Collette Stevenson for her powerful speech.

When we have these debates, we often focus on policy and reform, but it is important that we also take time to reflect on the lives lost and the terrible pain felt by those who have been bereaved. For too long, our criminal justice system and drug treatment services have robbed people of the dignity that they deserve. Our focus must be on restoring that dignity while preventing further deaths. The Misuse of Drugs Act 1971 is outdated and obsolete, and it further erodes the dignity and safety of people who use drugs. In its 2021 report on drug law reform, the Scottish Drug Deaths Taskforce stated that it was

“unequivocal that the Act in its current form creates barriers to the implementation of a public health approach.”

When the case for reform was put to the Minister of State for Crime and Policing at the joint committee meeting, however, it was clear that he did not have a good grasp of either the situation in Scotland or the root causes of drug use. When asked whether he recognised that poverty was an underlying cause of drug use that needed to be tackled, he answered no and said that he believed that drugs and violence drive poverty.

I have spoken before in the chamber about the fact that Scotland’s drug deaths crisis can be traced back to 1980s deindustrialisation and the subsequent economic and social impact. According to the Royal College of Physicians of Edinburgh, some of those experiencing the highest levels of drug deaths and drug-related harms grew up in the post-industrial 1980s, when unemployment levels were high and the heroin market expanded into deprived communities. That group suffers multiple, complex disadvantages, including poor physical and mental health, unemployment, unstable housing arrangements, involvement with the criminal justice system and family breakdown.

The UK Government is so far behind in this conversation, it should worry us all. How can we hope to tackle the crisis effectively when UK ministers are espousing such ill-informed views, which further stigmatise people who use drugs? Kit Malthouse refused to entertain the prospect of drug-checking facilities here in Scotland. As we heard in the chamber last week, there are now plans, and a licence issued by the Home Office, to operate a facility in Bristol. Such services can save lives. I wish the Loop, which will operate the facility, the very best. I hope that it will have incredible success and, hopefully, once and for all, provide evidence that the UK Government will listen to. It is nonsensical and hypocritical to rule out drug-checking services in Scotland and allow them in England. We need those powers to save lives.

The varying purity and strength of illicit drugs makes it impossible—

A number of constituents have contacted me in despair at the news that Historic Environment Scotland is currently considering whether Cumbernauld town centre should be a listed building. Just when it looked as though plans to redevelop the site were progressing and there was an opportunity to replace the current town centre with something fit for a town the size of Cumbernauld, the HES proposal threatens those plans.

Can the minister assure me and my constituents that Historic Environment Scotland will not approve a proposal to list such an awful building if that will put at risk plans to develop a modern and accessible town centre?

I thank the minister for advance sight of her statement, and I welcome her commitment to improving consistency in drug death reviews. As she said, that will improve data collection and will allow national trends to be established. Most importantly, it will give families answers and will ensure that they have certainty in the process. Will the minister commit to taking any necessary action to ensure that there is consistency across Scotland in how drug death reviews are carried out and that they are carried out in as many cases as possible?

To ask the Scottish Government how Historic Environment Scotland ensures that communities are adequately consulted when considering whether a building should be listed. (S6O-01135)

On the whole-systems approach that we have been talking about, should we be embedding work to tackle health inequalities across all statutory services, and not just in health? To what extent is that happening?

We have been talking a lot about income. To what extent would panel members support a universal basic income, a minimum income guarantee or something like that as a way of tackling income inequality, and therefore the health inequalities that result from it?

I echo the comments of those who have spoken before me about the dedication of our health and social care staff.

The NHS is currently set up as a national sick service. Too much care is still provided in hospitals, and treatment services are prioritised over prevention. Meanwhile, demographic changes, as we have heard from Sarah Boyack and Christine Grahame, have placed increasing pressure on services, which have struggled to keep pace with demand and have faced significant challenges due to the pandemic. The Christie commission made the case for shifting care into the community 11 years ago, but we have not seen the progress that we might have wanted since then.

I therefore welcome the clear acknowledgment from the Government that we need to increase our focus on prevention and early intervention to support people to live healthier lives, and that begins in the community. Supporting and building community services and the community workforce will not only improve health outcomes, but will also enable hospitals to focus on acute and specialised healthcare.

To effectively shift care into the community, we need to take a holistic whole-system approach that acknowledges the need to build community provision while reducing pressure on hospitals. Building capacity in social care will help to reduce delayed discharges, which will alleviate pressure on hospitals and ensure that no one is stuck in a hospital bed when they do not need to be.

Not everyone needs to be in hospital, and not everyone needs acute care. There is ample evidence that health outcomes can worsen if people are in hospital when they do not need to be there. I have heard from stakeholders about the impact that a stay in hospital can have on people with certain health conditions. Disruption in routine and removal from familiar surroundings can contribute to a deterioration in conditions.

Gillian Martin raised many important points of good practice from her constituency, which centred on an important point that has been a running theme at the Health, Social Care and Sport Committee, which is how we ensure the sharing of best practice without adding a burden to clinical staff. I do not think that we have the correct answer to that yet, but it would help many services, not just in terms of how we deliver good care locally.

We need to expand services such as hospital at home, which provides treatment and support while allowing people to be cared for in their own home. That is particularly important for older people with frailty, who are at particular risk of being affected by institutionalisation and delirium. According to Healthcare Improvement Scotland, 30 to 56 per cent of older people experience a reduction in their functional ability between admission to hospital and discharge. Reducing hospital admissions, where appropriate, can lower the risk of deterioration and support people to live more independently at home.

For many people, being discharged from hospital is just the beginning of a difficult journey, and people living with long-term conditions are at higher risk of readmission if they are not supported to self-manage their conditions.

The third sector plays a vital role in supporting people in the community, and great work is being done to assist people after discharge. Chest Heart & Stroke Scotland’s hospital to home service supports people who are returning home after a stroke or have been discharged from hospital with a chest or heart condition. It works with the NHS to build a personalised flexible package of support, which can include setting recovery goals, emotional support and help in maintaining physical activity and exercise. That is a great example of how third sector services can work alongside the NHS to make sure that people can get the care that they need in the community, without having to go into hospital.

Primary care will also continue to play an essential role in supporting people to live healthy lives in the community. Ninety per cent of patient contacts are through primary care, and GP practices are often the first point of contact for patients. We need to expand the multidisciplinary team and increase the range of services that people can access at their local practice. During the Health, Social Care and Sport Committee’s inquiry into alternative pathways to primary care, we heard much about the important role that community link workers play in general practice and connecting patients with resources in their community.

GPs often have only 10-minute appointments with patients, which can limit the issues that they can cover, but link workers can spend more time speaking about complex social issues such as housing, benefits and employment and engage patients with social prescribing, which was described by one witness as

“the bridge between the community and the NHS.”—[Official Report, Health, Social Care and Sport Committee, 22 March 2022; c 6.]

The Royal College of General Practitioners Scotland has been calling for the roll-out of community link workers to all practices in Scotland. I am therefore pleased that as part of the Bute house agreement, the Greens and the Scottish Government have committed to expanding community provision of mental health services linked to GP practices. Enabling people to access mental health support in the community without having to go on a waiting list will mean that more people can get the help that they need when they need it, while also reducing pressure on acute and specialist services.

The Scottish Greens also support the embedding of welfare rights advisers in GP practices, so that people can be connected to services that can support them with money advice and benefits, and I welcome the Government’s commitment to place money advisers in up to 150 GP practices in deprived areas. We know the impact that stress and pressure on income can have on those with long-term health conditions, and it is essential to ensure that people can afford to keep themselves well.

Alongside providing services in GP practices, it is important that we empower people to access community support themselves. During health committee sessions, we heard about the role of a local information system for Scotland—ALISS—which aims to allow people living with long-term conditions, disabled people and unpaid carers to access the information that they need to help them live well.

Having one point of contact for people who are looking for resources on support within the community is valuable, as it allows people to find out for themselves what is available, without having to search through multiple sources. However, although ALISS was felt by some committee witnesses to be a useful resource, others described it as difficult to use, as it was not updated regularly. I would be grateful to hear from the minister what plans are under way to improve ALISS, as it seems to be an invaluable resource that we should be making the most of.

In conclusion, Presiding Officer—

Despite the relatively self-limiting and mild nature of monkeypox, some people might be more susceptible and might require hospital care, if they catch it. How is the Government ensuring that all health and social care workers are protected from the virus and have information about how to keep themselves and their patients safe from on-going transmission?

Sorry.

I am pleased that, in this session of Parliament, there is a renewed focus on prevention, early intervention and community care, but that must be followed up by real action. We must act now to keep care close to home. I look forward to working with members across the chamber to realise that ambition.