Chamber and committees

On your point about the evidence around heroin-assisted treatment, I should say that it is used more frequently in other countries—in Switzerland, for example, about 8 per cent of people with problem drug use receive it—and there are different models elsewhere that, arguably, are more cost effective. We have a very high-threshold model, partly because of Home Office regulations.

With regard to the national mission, I have been absolutely crystal clear about residential rehabilitation. It is not for everyone but, under my stewardship, we will invest £100 million in residential rehabilitation and aftercare and in improving pathways to accessing it.

The statistics—the evidence—show that more and more people are being publicly funded to access residential care. For me, it has always been a balanced ticket. We need to be serious about abstinence-based recovery and the option of residential rehabilitation, but we must also be fearless about harm reduction.

Accountability is important—I have never made an appearance in Parliament or in front of a committee without talking about accountability. It is probably the thing that I have spoken about most in my current role. I never walk away from my own accountability, and I am always open to scrutiny. We need accountability at each and every level. Families and service users are right to point out where it is not working, because, through our work on residential rehab and MAT standards, we now have more information than ever before about what is and is not working. As we progress with the national mission, we will sort what needs to be sorted.

I will talk about evaluation and the monitoring of resources, but first and foremost, I want to say, as a point of principle, that I do not hear many, if any, debates and discussions about the cost of treatment for other health conditions. It always seems to me that we have more in-depth discussions—or, if I can put it this way, more concerns are raised—about the cost of treating people with drug and alcohol problems. We have to move beyond that, because part of our problem relates to stigma and the perception that exists sometimes in our society that some people are deserving and others less so.

My starting point in all of this is to ensure the right treatment for the right person at the right time. Different treatments cost different amounts of money. There is a difference between the cost of methadone and the cost of Buvidal; residential rehabilitation is considered expensive by some people, and I think that it is fair to say that heroin-assisted treatment is expensive, too. However, I am determined to get the right treatment for the right person at the right time.

The HAT project will, of course, be evaluated by Glasgow Caledonian University, and that evaluation will put all the facts in one place. Heroin-assisted treatment works for some people. Indeed, there is an international evidence base showing that, for people who have very long histories of using, in this case, heroin and other substances and for whom other treatment has not been successful, this treatment provides an opportunity to stabilise them, engage with them and have a discussion about other supports that they might need. The evidence also shows that such treatment reduces the use of street drugs. If, as I have done, you have ever met parents who have lost a child, you will well understand that the priority is not necessarily the cost of a particular treatment, but whether the treatment will work for a particular individual.

All of us are at one on that, I think. I do not need to repeat to this audience the worldwide evidence about safe drug consumption facilities, which is irrefutable. They are not a silver bullet but they save lives, and the scale of the challenge in Scotland is such that we need all solutions at our disposal.

There would have been an easier way to do it. I will happily answer questions on that, if required. However, I and my party made a commitment that we would leave no stone unturned.

It is not all in my gift. We have an operationally independent police force, and the Lord Advocate and the Crown Office are independent; nobody here needs me to give a lecture on why that is. However, it is encouraging that the proposal that was submitted to the Crown Office was supported by Police Scotland and Glasgow City Health and Social Care Partnership.

It will be for the Crown Office and the Procurator Fiscal service to take matters forward. They are continuing to work well with Police Scotland and it is important that they continue that work, which, as the committee will know, is around the policing of any facility, should it be required. It is imperative that clarity exists on that point for both the public and police officers.

I have done everything that I can up to this point. As everybody else here is doing, I am waiting on the conclusion of those vital discussions between the Crown Office and the police and on any forthcoming decision from the Lord Advocate. I will have to respond to that decision—whatever it is—in due course, and I give you my absolute commitment that I will do anything that I can within my gift, because safe drug consumption facilities work.

That is why we should not look at the whole-family approach in isolation. It is why our response to the task force came from Government as a whole, although individual work to tackle poverty and inequality is being led by Shona Robison and there is work to reform our justice system and an investment in housing. All those things are connected.

The idea that drug policy must not be seen in isolation lies at the heart of the national mission. The social determinants of good or poor health must be tackled. The cross-Government approach means that we are making commitments not just for this year but for future years.

Our equalities framework has six outcomes and six cross-cutting themes, one of which is recognising equality. That includes the particular needs of women but is also about how we can better reach the black and minority ethnic community.

As well as the Aberlour work that you outlined, and the work of Phoenix Futures at Harper house, which I will touch on in a moment, it is also really important to look at the perinatal mental health work that Kevin Stewart and Clare Haughey are involved in. There is substantial investment in refreshing and updating that work to support women who have mental health issues or use drugs. Much work has been done to change generic, universal and specific health services.

I had the great pleasure of visiting the first of Aberlour’s mother and child recovery houses in Dundee a month or so ago. It was quite an experience. The initiative is part of our work to keep the Promise. As a former social worker, I know the impact of families not being kept together.

We also know that, although significantly more men than women die, the rate of increase among women has been faster in recent years. Ten or 15 years ago, the ratio of deaths between men and women was wider; now, it has narrowed. To take, as you suggest, a gender-informed approach, there are many reasons for that, but at the heart of it are the trauma and grief that women experience when they lose their children. We need to work harder to keep families together—to keep mothers with their babies.

Aberlour will open another mother and child recovery house in the central belt. I await an update on that and I hope that we will have more to say on it in the not too distant future.

The work that Phoenix Futures is doing in Harper house will also be revolutionary. It is a national family service for mums, dads and children aged up to 11. Not just as a minister but as an MSP, I take very seriously my obligations to keep the Promise. Families should not be parted due to a lack of support and a lack of service. The evaluation on Harper house will inform us all for many years to come.

Sorry—would you repeat that?

My sense—it is just my sense—is that we are further away from the start of this journey and are now closer to a conclusion, although I appreciate that it is perhaps not the specificity for which Mr O’Kane and other colleagues are looking.

I will say, and I hope that this is reassuring for the committee to hear, that, given the journey that the task force underwent and the work in which the Crown Office and Police Scotland were involved, we have come to a point at which we as a country and with all our different partners understand what the evidence tells us.

The question that remains is ultimately one for the Lord Advocate, around what she can and cannot do within her powers around statements of public prosecution policy. Criminal Justice Committee members will remember the statement that the Lord Advocate made to the committee about the need for a “detailed and specific” proposition that the community and Police Scotland would buy into. That is what we have worked towards. I am not the arbitrator or the judge of that work—that duty lies with someone else—but, whatever the outcome of this journey, I will always look to get the right solutions in place.

So far, I have committed to and allocated an investment of almost £40 million for existing or new services. That investment touches upon seven services. Those are in Argyll and Bute; at Harper house in Ayrshire; in the Lothians and Edinburgh alcohol abstinence programme; and the new mother and child recovery house in Dundee. We recently announced funding for the north-east, where Phoenix Futures will take forward a project to address the needs of that area. There is also additional investment for Crossreach in Inverness. Those are among the seven distinct investments in new and existing services or projects. That £38 million will increase capacity by 40 per cent.

I am pleased to say that some of those new services are now up and running. We made a commitment to go from 425 to 650 beds. The investment thus far takes us to 600, with some of those beds already in use.

As well as increasing capacity, we are improving access. We wanted to ensure that the existing capacity within the system was being fully utilised. Our information is now a couple of years old, but some establishments were not full to capacity following lockdown. That is why we directed £5 million of funding for residential rehabilitation and aftercare to ADPs across the country. We should never forget aftercare, which is a crucial part of the whole-system approach.

I hope that is helpful.

That is a very important question. A range of colleagues across the Government have a direct interest in throughcare standards. You can well understand that, although they may be primarily a matter for justice ministers, there has to be an interest from housing ministers and other ministers who are focused on community services.

From my perspective, aftercare is one of the key issues. When people are released from custody, there is a period of transition, and any period of transition comes with risks. We know from all the evidence that, for some people, there can be a heightened risk of overdose when they are released from prison. That is why the peer-to-peer work that we are funding—which will be extended into all prisons—in respect of naloxone, for example, is so important.

I should perhaps have mentioned in my general update that we published on Monday our updated pathway from prison to rehab. I am a big advocate of prison to rehab. Rehab is not for everyone, but it should be there as an option for everyone for whom it is considered appropriate. We needed to do further work to ensure that both prison staff and people who are leaving custody are better prepared for what to expect when someone moves from a custodial setting into rehab.

It is about the continuity of connections with a community, even if the person been removed from that community. Planning for someone’s release should not be left to the last minute. I have a great personal interest in this area given that I have been a prison social worker in three establishments and my last post, prior to being elected to the Scottish Parliament, was at the state hospital. As with all planning, it needs to start not just early but at the point at which people start their sentences.

I can well understand why the committee has grappled with that, because unplanned discharges from court with little or no support elevate risk. The baseline approach is that we need to reform and change the whole system. That begs the question of whether remand should be used less so that we can get better bail arrangements in place. That would help to prevent those unplanned discharges from court.

Some interesting work is being done around the country in this area. In Edinburgh, there is a really interesting nursing team that does crucial court work. I met it some time ago. Again, that is all about continuity of treatment for people with substance use difficulties.

I absolutely agree that we could reduce the number of unplanned discharges from court by reforming the use of bail—where that is appropriate, obviously, because public protection is always paramount—and reducing the number of people who are on remand. It really has to be about every part of the system—whether it is justice, health or social work—being in a position to respond to needs much more quickly and swiftly. That goes back to the importance of the throughcare standards.