Chamber and committees

Thank you very much, convener, and good morning to all your colleagues. I very much appreciate the opportunity to come back to this tripartite committee as we embark on the national mission, particularly in our work to respond to the vital final recommendations of the Drug Deaths Taskforce, which are essentially about ensuring that all aspects of the public sector and all parts of Government are aligned. Although it is not for me to tell the committees how to proceed with their scrutiny of Government, it appears to be a fitting approach for scrutiny to be joined up, too.

You raise two crucially important aspects of our drug death challenge. When we look at the annual report that was published in the summer, we see that, although more men die, and significantly so, there has been a disproportionate increase in the number of women who are dying, and that has been a trend for some years. The annual report shows a small decrease in the number of men who are dying, but a continued increase in the number of women we are losing.

We know that the issue is complex. It relates to trauma, including past life trauma, but it also relates to women who are mothers. If we think that people who use drugs are stigmatised, that is even greater for women, in my view, and particularly women who are mothers. We know that the removal of children has a huge, traumatic impact and is a contributory factor to deaths.

We are working through the recommendations of the Drug Deaths Taskforce, and we will be supporting alcohol and drug partnerships to do likewise and, indeed, to develop pathways. You may have noticed that, earlier this week, we published the first annual report on the national mission and the alcohol and drug partnerships. We need to make more progress with some specific care pathways for women. Some of our investment in residential rehabilitation and residential services has been prioritised to meet that need.

On young people, the annual report that was published in the summer shows that, although the number of young people under 25 who had died reduced in 2021, it remains too high. It is important not to look at one year’s figures in isolation; we know that the three preceding years showed concerning increases. As you will see in the annual report, although alcohol and drug partnerships all have services and supports available for young people, we need to do much more to be clear about the types and range of services that should be available in each area. That, in part, is why we have a stream of work specifically on young people, which relates to the co-design of standards of care and treatment and to the range of services. That work is proceeding, and I will endeavour to keep the committee and Parliament up to date on it.

The member is probably aware that separate statistics are produced about deaths that relate to illnesses or health conditions that can be traced to the problematic use of alcohol. I know that we are talking about statistics but, for the record, we are also talking about lost lives and people. I will try to do that as sensitively as I can, rather than get into a too dispassionate discussion of statistics.

The annual figure for drug-related deaths is in relation to the use of illicit substances and controlled drugs. That is the purpose of those statistics—they show how many deaths happen as a result of controlled drugs and illicit substances. You are right to point to the figure that 93 per cent of the people we lose have more than one substance in their system. Of those we lose, 11 to 12 per cent also have alcohol in their system. That figure is down on previous years. In some years, it was up to about 30 per cent. That speaks to the growing problem with other substances, as opposed to a reducing problem with alcohol.

There is another area in which we need to distinguish. The national mission is absolutely focused on those who are at risk of dying, and therefore on developing treatment options for opiates, benzodiazepines and cocaine. However, if we speak to organisations such as Scottish Families Affected by Alcohol and Drugs, they will say that their number 1 concern about the families and people that they support is still alcohol. The work done by David Nutt and published in The Lancet details the harms caused to individuals, society and others by various substances, and it shows that alcohol is at the top of the list.

We have information from some of the surveys that are done in education. We know that young people are different from those in other age groups—I refuse to use the term “older”. We know that young people are less inclined to use heroin, and that cannabis and cocaine are bigger factors in young people’s drug use patterns.

I did not address the part of your earlier question about what we are doing on education and prevention. That is why we have a national mission. Our drugs policy and our work in the here and now to prevent people from dying cannot be in isolation from the longer-term and very necessary work. I do not want to read too much into the reduction in the number of young people dying in one year’s statistics, because it is always important to get underneath the headlines.

The work in schools is crucial. There is work with young people that is about substances overall. We should not overly fragment that. We must engage, and we are engaging, with young people through a curriculum that looks at tobacco, alcohol and illicit substances.

One of the asks in the cross-Government plan is to review what we are doing, and there are strong arguments with regard to the need to up the data. Last year, we published research on interventions, which must be about increasing young people’s resilience, confidence and knowledge. Although we want young people to have particular information so that they are equipped to reduce the harm that is associated with substances, there is a broad approach that is about upskilling young people and increasing their resilience.

There is a larger agenda outwith education about diversion from the criminal justice system. I am interested in the way that some areas are looking to adapt—not just shift and lift—aspects of the Icelandic model. That model is about not just treatment and diversion from the criminal justice system but investment in young people and their resources, pastimes and broader health and wellbeing as well as other purposeful activities.

That is a fair point, and it is important to remember that our focus on the national mission and on drug deaths sits in the context of wider efforts to improve the health of the population as a whole. My understanding is that some data is collected with regard to deaths for specific reasons, including deaths as a result of HIV. Information is published on issues such as wound care and blood-borne viruses. However, I will consider whether enough of that information is routinely published—it is a conversation that I have with Ms Todd—as well as where that sits with regard to management information and experimental information and whether there is an appropriate regular publication cycle. That issue sits very much in the terrain of improving overall population health. I will come back to the member on that.

I agree that it is important that we have a wide and appropriate dashboard of information so that we can understand all the harms as well as the contributing factors to drug-related deaths. It is important that we have that information about all drug-related harms. Through the publication of the national mission plan in September and the national mission annual report and the ADP annual report, I hope that I have demonstrated, at least to some extent, that we have an outcomes framework. In the national mission plan and the national mission plan annual report, you will see the information that we are using and that feeds in so that we can capture those harms. However, if the committee came to the view that we were not capturing all that, we would endeavour to address that.

I will say something that, I hope, is positive but is perhaps also a bit defensive. The housing first model is good in that it is designed to provide enough flexibility to meet the needs of individuals. It recognises that it is unrealistic that some people, because of the chaos and trauma that they live with, will be able to sustain their tenancy on their own, so we should not step back from the housing first model.

However, you have a point about other models of care. In relation to drug treatment, we have strong and clear commitments on residential rehabilitation and the abstinence-based recovery model—we are not stepping away from that—but there is a need for other models of care. Supported accommodation is clearly part of that, and that links with the work on homelessness and mental health.

There will be an opportunity for the Parliament to consider our approach when the homelessness prevention duties are refreshed. There is something very powerful about the ask and act approach. Too many people are in inappropriate temporary accommodation. As a constituency MSP—although I do not represent a city—I have encountered young people being put into inappropriate accommodation, and that is not keeping the Promise or doing our best by every child.

I appreciate that there are challenges in and around cities. Through our work on the cross-Government action plan that we will produce, we are thinking about specific things that we can do more of to scrutinise and support cities, bearing in mind that, as we know from the annual report, Glasgow, Edinburgh and Aberdeen all had rising drug death rates.

First, Mr Findlay, that was not a Government report; it was a Public Health Scotland report. You are right to say that an error was established in the information that Public Health Scotland had received from Glasgow. Therefore, the quarterly figures had to be revised down, and there was transparency around that.

Regarding the quarterly figures to which you refer, 170 residential rehab placements have been funded by the Government, which is the highest-ever number that has been funded in any quarter.

One reason that we publish information is so that we can scrutinise what is happening in every local area. I know for a fact that, in the past financial year, we have supported the funding of more than 500 residential rehabilitation placements and that, over the lifetime of the national mission, we have supported the funding of more than 700 residential rehabilitation services. I accept that it is important to distinguish between stabilisation services and residential rehabilitation.

Ms Mackay knows that I firmly support safe drug consumption facilities. I had the opportunity to visit a facility in East Harlem in New York. Before there are any questions about that visit, please note that I was in the States in my own time and at my own expense.

The evidence shows that safe drug consumption facilities work and that they save lives. They are not a silver bullet, but they have a role to play. We have worked very hard with our partners, including Glasgow City Health and Social Care Partnership, the Crown Office, Police Scotland and others to develop a service specification proposition, which has been submitted to the Crown Office.

More specifically, the Crown Office has been gathering further information, as I understand, from Police Scotland, and it is nearing the point at which it can give advice to the Lord Advocate. You will appreciate that I cannot speak on behalf of the Crown Office or our independent Lord Advocate.

There is a role to play when it comes to tackling stigma, understanding drug and alcohol issues as a public health issue and understanding people’s attitudes towards various treatments. Sometimes, people have views about the location of any service in their community, so it is important that local services engage and have open dialogue with local communities.

I want to make two broad points. We are still waiting on the Lord Advocate to give us a view on whether the service specification and operational procedures are within our powers and whether it rests within her powers to determine prosecution policy and what is in the public interest. That is a core consideration of the matter.

Mr O’Kane is right to point to other health-related legislation. The other legislation that we cannot ignore is the Misuse of Drugs Act 1971. We have worked hard with partners to devise a proposition that is, we hope, within what we can currently do in Scotland, but I am not the final arbiter of that, hence the role of the Lord Advocate.

You also allude to Gillian Mackay’s point that there are other models and other ways to implement safer drug consumption facilities. There is the fixed model with fixed premises, there are clinical medically led models and there are other models that are voluntary sector-led. Of course, there are models of mobile safe drug consumption facilities as well. Although I would ideally rather have started from the position of considering which model will best meet the needs of our people, because of the 1971 act, we are framing a service in relation to our powers.

The work has been detailed, difficult and precise, but the approach that we are looking at is not the ideal way to do things. There are other models. We are framing our proposition around what we hope is within our powers, but I am not the final arbiter of that, as you will appreciate.