Chamber and committees

Ms Mackay has made a really important point. Person-centred care lies at the core of this. We can get into areas of real complexity; I know that there are medication-assisted treatments, including methadone and Buvidal, that are geared towards opioid dependency and opioid substitution therapy, but we have to watch that we do not silo services. The number of deaths in which cocaine was the only implicated drug is comparatively small—I think about 16. We are therefore looking at cocaine in the context of poly-drug misuse. Because that picture is much more complex, we have to take action at the level of the individual, with services engaging with individuals as individuals first and foremost, and working out what support and help they need.

The point about cocaine is important, given the 23 per cent to 25 per cent increase in its implication in drug-related deaths. We have heard a lot about its purity increasing as well as its price being lowered, and in thinking about our approach to services, we also have to bear it in mind that cocaine use is more a feature among younger people. I realise that I am generalising, but it tends to be people over 25 who use opioids, whereas there has been a rise in cocaine use among younger people. As a result, some services will have to be age appropriate, given the different pattern of drug use among young people.

There are no easy answers. We need to think about whole packages of care and support and to get underneath the skin of the reasons why people use drugs and particular substances.

We know that stigma is a huge barrier to people accessing treatment, and that it has a huge impact on people’s wellbeing and on how people are treated in services and the community. Parliamentarians, as well as people in the media, care services and the wider public sector workforce, have a role to play in that situation.

Some of the work around a trauma-informed workforce is really important in this regard, too. Ms Harper raised an issue about the anti-stigma charter that has been developed by lived-experience representatives, in engagement with other lived-experience groups. The purpose of that charter is for it to be used by different organisations and services, and it can be adapted. I would describe the charter as having a core purpose, but it can be adapted to other services.

Part of the national naloxone campaign is about stigma. We are talking about lives that we can and must save, and here is how to do it. It is about engaging the wider population in what they can do, as part of the national mission, to help save lives. Later this year, we will report back to Parliament about a national campaign on stigma.

In relation to the quality assurance and quality improvement that will underpin the on-going work of MIST, when I introduce a target for treatment, which will be at the turn of the year, the indicators that underlie that target will relate to qualitative information that will be informed by our experience of implementing the MAT standards.

The average cost of a residential rehab placement is £17,000, although it is greater in some areas. The length of placements also varies. The residential development working group has looked at that in detail. I do not want to be prescriptive about the length of stay in residential care, which should be person-centred and flexible. As Ms Mackay said, we must recognise that there is a link between residential rehab and aftercare and that there is also a link to detoxification services. Some residential rehabilitation units have in-house detox; some do not. It is important always to think about the journey that people will take and the services, opportunities and care that they need on that journey.

We must stick with people. There is an important role for us in changing how our statutory, NHS and local government services work and how they meet the needs of people who struggle with drugs and the needs of their families.

The third sector has a valuable role. We have taken a belt and braces approach. As well as increasing the investment in ADPs, many of which will enter into agreements with the third sector, we have set up the four multiyear funds that are within the £18 million pot and are available to third sector organisations. The third sector is vital, along with our public services and the lived and living experience community. Those are the three strands of the partnership: the lived and living-experience community, the third sector and statutory services.

A lot would depend on the nature of the care that they are receiving. If we are talking specifically about medication-assisted treatment, that needs to be delivered by someone who is qualified to prescribe. The important thing about the medication-assisted treatment standards is that they make connections with other aspects of treatment—what is collectively known as psychosocial treatment and work to help people to address past trauma. A lot would depend on the type of care required and the type of care available in a local practice.

The funding arrangements for general practice sit with the Cabinet Secretary for Health and Social Care, and I assure you that he engages well and often with the GP community on the host of issues that flow from the GP contract. I have opportunities with the additional resource that we have to reduce drug-related deaths, but it is not prescriptive—I have not said that all that money goes to ADPs or the third sector. It is about investing in services and approaches where the evidence shows that lives can be saved.

I am absolutely committed to getting more information and data that will help us to improve our services and our offering. That will tie every step of our national mission to being based on evidence on the issues that we know exist in Scotland. I think that Paul O’Kane’s question is about how we link information and data. In very general terms, the annual report gives us some quite rich information about substances. That information is also available by local authority and month by month.

It is important that we are able to understand more about other health problems in the context of drug use, and about the involvement of other services. We have some of that information, so we know about such things as drug-related admissions to accident and emergency departments and psychiatric admissions, but there is a time lag in receiving that information. Some of our work with Public Health Scotland is on how to get that type of detailed information more quickly.

Notwithstanding the time lags, in time we can gather quite a lot of information that tells us about the circumstances of people’s tragic deaths. I suggest that we need to know more about people’s lives. Although some of the information that we gather absolutely connects with our lived and living experience strategy and people’s engagement with services locally, other data could tell us more about the lives that people lead, which could help us to shape services.

We also need more data in order to set the quality indicators that will underpin our treatment target.

That is a really good question. I reiterate this often: it is absolutely about connecting emergency life-saving work with work that improves life chances. The statistics speak for themselves. We know that people in the poorest communities are 18 times more likely to suffer drug-related death than people in the least-deprived communities.

It is important to stress that drug-related deaths and drug use are an issue throughout Scotland. Drug-related deaths in the Highlands are the lowest in Scotland, but they are still higher than drug-related deaths in the north-east of England. That shows that this is an all-Scotland problem.

However, there is no doubt that the increase in drug-related deaths is being driven by an increase in the number of the poorest people in our communities dying such deaths. Therefore, work on child poverty, for example, is absolutely crucial. We have a £23 million tackling child poverty fund, a cross-Government child poverty action plan, and colleagues will be well aware of the Scottish child payment. That work must connect with drugs policy work.

There is also greater Government action, through which £2 billion of our resources are invested in low-income families. A proportion of that—half, I think—is focused on households with children. That £2 billion investment is intended to alleviate pressures on low-income households.

All that is connected with our economy, the fair work agenda and so on. We could talk about all those things in detail, as well as the work that is being done on adverse childhood experiences and trauma. ACEs, of course, have a huge link to people’s living environment.

For me, it is always about following the evidence and what works, and listening to the people who are most affected by drug deaths in their communities. That is people with lived experience, but also people with living experience.

When it comes to encapsulating where we are and the question of why our challenge in Scotland is so acute and severe, I have my own views. In the past, there have been many discussions about culture, patterns of drug use and concentrated levels of poverty. However, I always distil our challenge in Scotland into three areas.

We have a higher proportion of people who use drugs. I suppose that the reason why is quite an existential question, and much research has been done on it. However, we need to recognise that a higher proportion of our people use drugs, and therefore we have proportionally more people with problem drug use. The rate of drug use in Scotland is about double that in England.

Another issue is benzodiazepines. The use of illicit benzodiazepines is an issue across the United Kingdom, but it is more acute in Scotland—again, the facts show that. Since 2009, there has been a 450 per cent increase in Scotland in the implication of benzodiazepines in drug deaths. By comparison, south of the border, it is 53 per cent.

Again, to be frank—this is at the heart of the matter—we do not have enough of our people in treatment. That is the core of my assessment. We know that treatment is protective, and so we need a culture of change and a culture of compassion in our services. That will enable people to access those services more easily, and services can be more fleet of foot in following people up. People should be able to make informed choices about their services and treatment.

We have made progress around other preventable deaths. We must consider drug deaths not just as tragic but also as preventable. While the scale of the challenge is massive, we can and must turn it around.