Chamber and committees

Where we need a cultural shift or a shift in mindset is that, first and foremost, we need to see families as partners because, at the end of the day, they often know their loved one better than any service provider does. As well as working to support the loved one who is affected by substance use, we must ensure that individuals within families receive support for all their needs. Families have expertise that we really need to tap into, respond to and listen to. That is the raison d’être of the family-inclusive practice that is at the heart of the whole-family approach. We have attached funding amounting to £6.5 million a year to that via ADPs and the Corra Foundation. There is continuity of that funding.

That is why the audit is really important. Although it might not make me universally popular, I am asking for more information than ever before about what people are doing with Scottish Government funding, because it is important in improving consistency and accountability. I am accountable to Parliament and local services and local politicians are accountable to their communities. We are currently working through that audit.

As well as bearing down and scrutinising what is or is not happening, we are, through the multidisciplinary expert group, trying to provide practical, hands-on support.

There is on-going engagement with my officials, as you would expect. I would have to check when I last spoke to Police Scotland. In the past, I have had lots of engagement with Assistant Chief Constable Gary Ritchie, who was very involved in the task force.

Yes, I believe that it has. As it often does, Audit Scotland made an important and serious point about our needing transparency. The criticism of that is that we will have to ask for lots of information that we then have to publish and people will complain about the resource that is attached to that. We have heard Ms McNeill raise a fair point about the bureaucracy around that.

For clarity, I accepted Audit Scotland’s point, and I believe that we have demonstrated transparency through our reporting on the national mission; our annual report, which is available for people to read; and the publication of quarterly reporting around things such as publicly funded residential rehabilitation.

That is an important point. Obviously, local partners are accountable for the implementation of both reports from the Dundee drugs commission. The commission has done an impressive amount of detailed work. From my engagement with the local ADP and, crucially, senior leaders in the integration joint board and the health board, I know that there is a commitment to taking that forward.

What is most notable to me is that there have been attempts at a real reset of the relationship with the third sector. We have not spoken much about the third sector this morning but, not just in Dundee but elsewhere, we need leadership in that regard. We need meaningful partnership and a bit more parity of esteem between statutory services and the third sector. I see some movement on that in Dundee. I am happy to provide further information on that to Ms Chapman directly.

I just want to say—very briefly and without trying to interfere with the management of the committee—that my officials met with police on 17 January in relation to safe drug consumption facilities. They also met with the Crown Office on 18 January, and they met with the Glasgow Health and Social Care Partnership on 23 January. I want to put that on the record.

The charter was published in November, and the stigma action plan was published in January as part of our response to the Drug Deaths Taskforce report. The principles of the plan are that stigma kills and we need to tackle it, that people who are impacted by drugs and alcohol need to be at the heart of shaping and informing service and, crucially, that we need to consider drug and alcohol problems as health conditions first and foremost. However, the purpose of the plan is to take the charter and turn it into concrete action, and the vehicle for doing that will be the accreditation scheme that will be developed.

It is important to say that the Scottish Government will start by looking at where in our policies we are inadvertently excluding people as opposed to proactively including them. It is also an important point that the Government will lead by example.

We have had considerable local interest—people are beginning to approach us and ask more about the action plan and how they could be involved in any accreditation scheme—and there is also a bit of international interest in the work that we are pursuing in the area. Although some of the work of the national collaborative is focused specifically on the human rights bill, it will also amplify voices, and part of its work will be on the sharing and dissemination of best practice in tackling stigma and responding in a human rights-based way.

It is fair to say that we are on a journey and we still have some distance to travel, but the Scottish social attitudes survey provided some quite interesting reading about people’s responses to a public health approach.

The majority of people who took part in the survey said that they are not concerned about working next to someone who has a drug or alcohol problem but, when asked whether they would be concerned about living next door to someone with a drug or alcohol problem, they gave different answers. We are beginning to see a shift—although I appreciate that that may appear to be anecdotal—where people are moving toward a public health approach, and they want to focus on what actually works to get people the help that they need and get them into treatment and recovery.

Of course, I think that the zeitgeist in all this is the lived experience community, because that community is visible proof that recovery is possible, and we know from the Scottish social attitudes survey and other evidence that contact with someone who has lived or living experience is what changes people’s attitudes the most.

That is where our support of the work that is led by Public Health Scotland is really important. I know that Mr O’Kane is familiar with the RADAR—rapid action drug alerts and response—work, which is about putting out alerts when there are reports of new or novel substances.

We know that there was a spike from October to November. The overall figure for suspected drug deaths in 2022 was down 16 per cent, but there was an increase in the final quarter of last year. The figure in that quarter is the highest since 2021, although the number of suspected drug deaths for the year as a whole is the lowest that it has been in five years, and the figure in the quarter in which there was a spike was the ninth lowest out of the past 24 quarters. Nonetheless, I reiterate the point that I always make, which is that the figure remains too high.

We will have to wait for the passage of time. We will get more evidence when we receive the annual report, which deals with confirmed deaths. Until then, we will not know whether there is a relationship between the spike in deaths that we saw in the last quarter of last year and the public health alert in relation to nitazenes.

Synthetic opioids worry me greatly. Although we have a problem with synthetic benzodiazepines, that is not so much the case with synthetic opioids. However, it is necessary only to look at the experience in America and Canada to realise why I am deeply concerned. As far as engagement is concerned, I attended last week’s United Nations conference on narcotic drugs, which was in Vienna, although I can assure the committee that I saw very little of Vienna. That was an opportunity to engage with countries where synthetic opioids are an issue. I wanted to get a better understanding of treatment opportunities and what we would have to do differently.

If we were to have an issue with synthetic opioids, that would add to the case for safer drug consumption facilities, but the American experience thus far points to the fact that some of the treatments for opioids would continue to be effective. There are some issues that need to be managed with regard to the introduction to treatment—from a clinical point of view, that can be a bit harder—but the international evidence-based treatments for opioid addiction can work for synthetic opioids. We are highly alert to that.

I have been around Parliament and Government for a long time. When I came into this post, I very much brought with me work that had been done in and around social security experience panels, which was about how we build things from the ground up and meaningfully engage lived, living or, indeed, front-line experience, to help build a system or new services. Again, that needs to be core business not only in drugs policy but elsewhere because, ultimately, services will not be as effective as they should be if they are not built in collaboration with the people who are going to use them or need them. That sounds obvious but, historically, many of our systems, such the healthcare system, can be quite hierarchical. With no disrespect to the clinicians out there, there can be a bit of “Doctor knows best”.

Over the past five to 10 years, we have begun to see a shift in mindset. It is about cultural change, which is why the work of the national collaborative is really important at national level, as is the work locally. There is funding for work to take place at local level to meet our expectation that every area needs to engage with lived and living experience. It is a fundamental principle in our work to tackle stigma that those who are impacted by drugs and alcohol have an expertise, and it is not just about listening to their voice—they have a role to play in redesigning services. That actually makes sense for everybody.

There is certainly publication around where the Corra Foundation money is allocated. That is publicly available, and I will double check how often it is published. There is a great deal of scrutiny of alcohol and drug partnerships, much of which is published, too, either quarterly or through our annual report.

That is fundamental to the work that I lead on MAT standards, residential rehabilitation and improving support for families. Accountability and scrutiny are important at every level. The Government must model that to demonstrate that we are accountable and will engage constructively with any critique or performance review, and that we expect to find that throughout the system.

We must use every lever that we have available to us, and some of that will involve more regular reporting. We have quarterly reporting of residential rehabilitation placements that details area by area where the placements are being funded, and we can see a general improvement across the country. Similarly, on MAT standards, some areas are subject to monthly reporting and others are subject to quarterly reporting. It is also about investment and our following that investment very closely. There is a belt-and-braces approach. There is much more rigorous scrutiny and regular reporting, but that is coupled with additional investment.

There is a hands-on approach. Given the nature of the portfolio, my officials are in regular engagement with each and every area, and I spend a lot of my time directly engaging with families and local services. I will give the example of the work of the medication-assisted treatment standards implementation support team. We are being pretty hands-on with that. It needs to implement and ensure that we have an acceptable standard of delivery irrespective of where an individual or a family resides, notwithstanding that some areas will need to do things a little differently.

On our investment in family-inclusive practice and the whole-family approach, money has been directed to ADPs, but money has also gone to third sector organisations via the Corra Foundation. Through our multi-agency expert delivery group, we are doing an audit of how ADPs have utilised that uplift. We are currently working through that.