Chamber and committees

Cabinet secretary, will implementation of the framework impact on parliamentary scrutiny and decision making in the policy area? If so, what impact will it have?

In general, the pandemic has obviously had an effect on increasing workloads and things like that, but the growing number of young people who need support has probably impacted it, too.

That would be great.

Thank you, cabinet secretary. That is all from me, convener.

In its submission, the Royal College of Psychiatrists said that there is

“a wide variation by health board in how even CAMHS set its expectation for who would likely need care in its services”

and that that is dependent on particular geographies and availability of resource. To what extent does regional variation impact rejected referrals? That question is for Joanne Smith.

I have heard from the social care sector that increasing workloads and reduced—[Inaudible.]—have undermined its ability to build relationships with the young people, families and carers who it works with and to make early interventions. How has that affected the wellbeing of care-experienced young people? I put that to Lucy Hughes.

The other issue that I want to touch on is data. The lack of data on rejected referrals has been highlighted to the committee. Do we have a sense of whether children and young people from certain backgrounds with certain conditions, or from marginalised groups, are more likely to be rejected for support? I will go to Dr Stark on that.

Enable Scotland’s report highlights that people with learning disabilities might be placed in inappropriate settings, including care homes for elderly people. What action can the Scottish Government take to ensure that provision of appropriate residential care for younger people, including those with learning disabilities, is expanded?

I am pleased that there is a downturn in cases but, as we know, the situation can change rapidly, so it is essential that caution is maintained. I am relieved that we are not following the reckless advice of the people who suggested scrapping self-isolation for those who test positive. We need to ensure public compliance with measures, which means supporting people who need to isolate. Will the First Minister confirm that the Scottish Government will continue to make support available for those who need to isolate?

I too extend my condolences to anyone who has tragically lost a loved one to a drug overdose. As the motion points out, drug-related deaths are tragic, preventable and an unacceptable loss of life. They are a symptom of people who use drugs being denied the rights and dignity to which they are entitled.

I will focus on these words in the motion:

“notes the need to continue to build on the work of the Drug Deaths Taskforce and other expert groups to implement evidence-led interventions that reduce deaths and improve lives”.

I think that we can all agree that we need to improve the lives of people who use drugs, but I must put to those who are opposed to harm reduction measures and decriminalisation the question, how can you improve someone’s life by criminalising them? How can we take a human rights approach by prosecuting people for their addictions? Prosecution and punishment have no place in this conversation, and I am reassured by the Government’s clear focus on intervention that will reduce harm and improve access to treatment and support.

I am pleased to see the recognition that safer consumption facilities are an important public health measure that could save lives. As members will know, in June last year, my amendment that called on the Scottish Government to investigate, as a matter of urgency, what options it had to establish safe consumption rooms within the existing legal framework was supported by the majority in the Parliament. I am very grateful for the minister’s update on that, and I sincerely hope that all stakeholders will engage with the proposal in a constructive manner to ensure that we can save lives.

The motion also

“recognises that no single intervention will be enough on its own”,

which is crucial. We need a package of measures and a range of treatment options. It would be a failure of the Parliament to focus on one solution and ignore others. I accept that safe consumption rooms are not a magic bullet, but neither is any other intervention or treatment.

I am concerned about the intense focus on residential rehabilitation. Of course, we need to expand the provision of residential rehab, and everyone who needs and wants to access it must be able to do so, but as I have said previously in the chamber, it will not be the right option for everyone and it should not be prioritised over other treatment options. A truly person-centred approach to the drug deaths crisis will recognise that people need to be able to access the treatment and support that work for them, and that drug use comes in many different forms.

Constituents have expressed concerns to me about the fact that opiates are often the focus in conversations about drug overdose, and that not enough attention is paid to poly drug use and benzodiazepines. I know that work on that issue is already being carried out by the Drug Deaths Taskforce, but it is vital that we continue to highlight the issue in the Parliament.

Like other members, I was concerned to hear of the resignation of the chair and vice-chair of the Drug Deaths Taskforce. I am grateful to the minister for providing an update on a new chair, and I sincerely hope that the change will not stall the progress that is being made.

The publication of the medication-assisted treatment standards was a huge step that established same-day access to treatment, which will reduce the risk of people dropping out of treatment and improve accessibility for vulnerable groups, such as people who are experiencing homelessness. There is also evidence that it reduces heroin use and HIV and hepatitis C risk, as well as overdose and criminal charges.

The living experience of people in medication-assisted treatment was recently surveyed by a team of 13 researchers at the Scottish Drugs Forum. They found that access had improved as waiting times had reduced, although waiting periods were still too long, and that while some participants had reported that there was a greater choice of medication, decisions around choice and dose were not always shared between the person and the prescriber. That suggests that we still have some way to go before treatment is fully person centred, but the picture is encouraging. I eagerly await further progress in that area as a step towards creating flexible treatment services that take account of an individual’s circumstances, needs and—crucially—wishes.

As we seek to improve the lives of people who use drugs, we must tackle infections such as hepatitis C, which are drivers of health inequalities. According to the Hepatitis C Trust, despite a dramatic increase in people completing treatment for hepatitis C in recent years, infection rates have not fallen. Around half of people who inject drugs have had the virus at some point and one in four is currently infected, which makes hepatitis C the most common blood-borne infection for people who inject drugs. As 90 per cent of new infections occur through the sharing of contaminated injecting equipment, safe consumption rooms would be an important tool in the fight to reduce the spread of hepatitis C. The trust is clear that efforts to eliminate hepatitis C will be wasted without the implementation of evidence-based harm reduction services, such as needle and syringe programmes, opioid substitution therapy and heroin-assisted treatment.

We also need to increase knowledge and awareness of blood-borne viruses, which disproportionately affect people who inject drugs, including among those who work in addiction services.

The Scottish Drugs Forum has said that the understanding and perception that front-line staff have about conditions such as HIV are often still informed by events that happened in, or practice from, the 1980s. There is often a lack of understanding of new treatments that mean that people can now live long and healthy lives with no risk of infecting their sexual partners. We need a dual approach that seeks to reduce the risk of people becoming infected and, through education, reduces the stigma.

As we progress through the national mission and look to next steps, I would be grateful if we could look in depth at how we can support families who have members with drug or alcohol issues. Reducing adverse childhood experiences will ensure that we do not continue to perpetuate the trauma associated with drug and alcohol misuse.

Above all, we must respect the humanity of people who use drugs and must restore the dignity, rights and choice that too many have been denied for too long.