Chamber and committees

People experienced challenges in accessing services during lockdown. The work of the lived-experience community was particularly helpful and imaginative. The Government worked with organisations such as the Scottish Recovery Consortium on guidance about how to continue having meetings, whether online, in open-air settings or over the phone. I know that the recovery community in Glasgow did amazing work throughout the pandemic.

Other smaller organisations such as Recovery Enterprises Scotland, which is based in East Ayrshire, were under enormous strain during the pandemic. That is why some of the new funds that I introduced are particularly geared at smaller and more local grass-roots organisations and give them access to funding that can help with work in their communities. We have worked hard to make it as easy as possible to access that funding.

There is no doubt that so-called welfare reforms have an impact on the lives of the poorest. The frustration for many of us round the table is that, although increasing investment in the Scottish child payment will lift tens of thousands of children out of poverty, the ending of the temporary increase to universal credit means that £20 a week will be taken away from people when we are still not out of Covid and are far away from recovery, both socially and economically.

Primary care is multidisciplinary and often led by general practitioners, and it is located in our communities. It is often the first port of call and is supported by nursing staff. There are efforts to connect GP practices with the voluntary sector and welfare advice, such as the work around deep-end practices. I am sure that my health and public health colleagues may have a more technical definition or description, but that is how I see general practices.

Practice varies. For example, my understanding from NHS Lothian is that the majority of GPs are involved or could be involved in prescribing medication-assisted treatment to their patients. In other parts of the country, such as Tayside, the practice has been that people have been referred to more specialist centralised addiction services. As well as supporting GP practices with the resources and the range of services and support that they need to serve our communities, we have to recognise that there are vital connections for patients who are receiving medication-assisted treatment and who have primary care needs.

Laying aside the issue of who prescribes a medication-assisted treatment, every GP that I have engaged with says that they could do more at a community level—for example, for the physical needs that people who live with drug use experience. You will know better than me that people often have other health issues that can be addressed by accessing primary care.

Thank you for that question. On the information that was published this morning on suspected drug deaths, you are correct to point out that it is based on police divisions. It concerns deaths that are suspected to involve drugs, on the basis of enquiries by attending police officers. The information does not tell us things such as what substances are involved. We get that level of detail from the annual report on confirmed cases.

A lot is being done. A few weeks ago, I visited the Glasgow overdose response team. That service seeks to quickly follow up with people who have survived a near-fatal overdose. We know from successive annual reports that more than half our people who die have a history of overdosing, so when people survive a near-fatal overdose, we really need services to kick in quickly.

A range of projects are funded through the new community funds that we have opened—for example, through local alcohol and drug partnerships. Some of the drug death task force projects are specific to Glasgow.

Information is available by region on specific services and projects or tests of change. It might be helpful if I were to pull that together to share with the committee. The committee includes a broad selection of MSPs from across the country; I know that you will be very interested to look at that in detail.

We know that there is often great fear among women with regard to reaching out for help and disclosing the level of their drug use, especially when they have children. That is one of the reasons—there are many—why we are investing in whole-family approaches and family-inclusive practice.

The committee might recall that I announced in my statement to Parliament on 3 August substantial investment in an organisation called Phoenix Futures, which is to establish a national residential family service for the whole of Scotland. The announcement outlined that, subject to various approvals and consultation within communities, the facility would be able to accommodate up to 20 families, including mums and dads who have children aged from birth to 11. As well as thinking about services at the national level, we need to think about them at the regional level. That is one example of a step forward. There will be other work and announcements, in due course.

We have channelled funding through alcohol and drug partnerships, in which there is a specific allocation of £3.5 million for local ADPs to invest in whole-family approaches.

We need to support families as collective units, but we also need, within families, to support individuals in their own right. We will publish a framework on what family-inclusive practice should look and feel like on the ground. We are making progress in that area, and I will keep the committee informed.

I have a focus on governance and implementation. I answered the same question from Mr O’Kane. As well as the practical support provided through MIST to get the 10 standards embedded by next April, its work covers at least a three-year period for quality improvement and quality assurance. I said to Mr O’Kane that the last thing we want to do is to put all that additional investment, time, resource and support to embed the standards and then sit back and relax. We cannot sit back and relax; we need to keep on this.

We know from that information that 13 per cent of beds that were accessed in that timeframe came from alcohol and drug partnership funding, and that there were also publicly funded places from housing benefit and social security. People would be accessing private and charitable funding as well.

Regarding the first quarter of this calendar year, you might recall that we published information on how the emergency funding was used. In the period from January to March, we quickly initiated £5 million out the door, and £3 million of that went to ADPs. Some of that money was for a separate improvement fund that people could apply for. There was also a grass-roots fund. We published information on how ADPs allocated that money, so that is available. We are currently gathering further information from ADPs and, again, we will make that available.

As for what we know about current capacity, earlier this year we published information on how, overall, the 20 facilities in Scotland were operating at about two-thirds capacity, so we know that there is capacity there to be utilised. I have given a commitment to return to Parliament with our milestones over the next five years. That is about how to improve access—and, as Ms Wells rightly points out, it is also about the extent to which we will improve capacity over the next five years. We will come to Parliament with much more detail on that.

Social isolation is also a public health issue. Committee members might be aware that a few years back the Government introduced a tackling isolation and loneliness strategy, and there is a range of investments and funds around that.

With regard to tackling drug-related deaths, I have to point to the lived experience and recovery community, because much of what they do is based on their own, real-life experience and the expertise that they bring to the community.

Mobilising the lived-experience community can help to reach people that services might struggle to reach. The relationship aspect of support is crucially important. The peer navigator system that Medics Against Violence have been strong proponents of in our prisons and hospitals is also really important. Peer navigators with lived experience from organisations such as Aid & Abet make contact with people when they come into police custody. All of that is about making connections and building relationships with people to support and help them in their onward journey, and it goes along with referring them to services.

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.