Chamber and committees

It is not so much about a gap in the information as the availability and transparency of the information at the national level. More information is gathered about what happens with the prescription of OST in police custody settings than in other settings. That goes back to the nub of the issue. We have lots of information about where OST is dispensed, whether it be from a hospital or pharmacy, but we have much less information about where it is administered. The amount of information that is gathered in the police custody setting is much greater than that gathered in, say, homeless settings, where there are in-reach medical provisions.

That is an accurate summation about the information that is currently gathered by Police Scotland. In terms of me satisfying myself about what is happening on the ground, the major stream of work on that is around the implementation of MAT standards. We have a lot of granular information about what is happening at the local level. Colleagues might be aware of the supplementary information that was published in August that gives an area-by-area breakdown of where individual areas are with their MAT standards. The MAT standards implementation support team—MIST—is providing practical, hands-on support to local areas on how to gather information better and how to change the ways in which they are working while being fully cognisant of the need to challenge stigma, discrimination and culture. We have improvement plans in from all areas. We also have quarterly—or monthly, in some cases—reporting.

Through the serious and significant endeavours to implement MAT standards, we have much more information at the local level, which gives us a real connectivity between government and communities that we have not had previously.

In general, I agree that community pharmacies are an underused resource. The task force has made some interesting recommendations about an enhanced service contract, and there are some parallels with that around arrangements with general practitioners and primary care.

There are 1,250 pharmacies in Scotland. That is quite an extensive network that we could be tapping into. There is innovative, progressive and helpful use of pharmacist services in different parts of Scotland, but there is a network and expertise there that we need to make more use of. It is imperative that we use all the assets that are at our disposal and community pharmacies are very much part of that.

That is an area that we have given considerable thought to, and I understood that the committee was raising the issue because there could be a gap in information. Part of the underpinning evaluation of our national mission to save and improve lives is to ensure that we have the right measurements in place.

I will not repeat what I have said about MAT standards, but ultimately issues such as these are resolved through the delivery of MAT standards.

I will just take a slight step back from the question to introduce some context. Public Health Scotland already publishes a range of information about OST, such as the number of people who are in treatment, for example. The committee is also well aware of the information that is held on the prescription of healthcare at the local level. The information that we are talking about is available, but it is held in Police Scotland’s national custody records. We are giving some thought to that. The task force has made more broad recommendations about ensuring that our healthcare and justice systems speak to each other, and other important recommendations about information sharing.

On information that is held by a statutory organisation such as Police Scotland, there are particular complexities around unravelling that. I am aware that His Majesty’s Inspectorate of Constabulary in Scotland has access to a range of information that is held by Police Scotland, so I am contemplating whether that is a potential route and whether I, as minister, should engage with the inspectorate.

I do not know whether the committee has considered that. The information is available to the inspectorate through the inspections that it has done. Indeed, this time last year, it did an inspection that involved the Elgin custody suite and it made a number of recommendations. I am informed that that led to increasing nursing provision in custody so that there is now full-time nursing cover in that centre.

There is a lot of work to do, and a lot of work is on-going. Members will be aware of the ministerial direction that I issued in June because I was not content with the scale and pace of progress. Part of the purpose of the statement that I will make to Parliament next week is to reflect on the information that all areas have provided on their improvement plans. All areas are subject to regular reporting on progress. For most areas, that will be done quarterly, but for areas that have particular difficulties, it will be monthly.

The other purpose of my statement next week is to inform Parliament of the Government’s view not just of the task force’s recommendations but those of Public Health Scotland’s benchmarking report, which was published in June.

I very much welcomed the task force’s report, as I had been looking forward to receiving its vital recommendations. The task force has made a comprehensive suite of 20 recommendations with 139 action points, and we will issue our full response to those at the start of the new year.

We have given an initial response to the report to the Health, Social Care and Sport Committee, the Criminal Justice Committee and the Social Justice and Social Security Committee. We gave some indication of our direction of travel, but the culmination of our response will be presented to Parliament at the turn of the year.

Like you, Mr Ewing, I am not a clinician. You have, however, heard the evidence from Dr Carole Hunter, who is a senior pharmacist of many years’ standing.

This is one of the issues that I have written to NHS Grampian about. On the specific point about dihydrocodeine, while prescribers can make judgments on a case-by-case basis, based on clinical judgment and health and safety, the bottom line—as I understand it as a non-clinical person—in accordance with the United Kingdom guidance that Dr Hunter referred to and the guidelines for Police Scotland and healthcare professionals, is that the routine use of alternatives such as dihydrocodeine does not meet the required level of support for MAT standards, and they should only be used in exceptional circumstance, not routinely. That is what I have stated in my correspondence with NHS Grampian. Essentially, it is a reiteration of the guidance.

For information on the broader context of my correspondence with NHS Grampian, convener, I have written in fairly direct terms to say that it has come to my attention and I am aware that, despite the longstanding nature of the issue, it still does not routinely provide OST in all circumstances. The issue is around the routine nature of the provision. Yes, Dr Hunter spoke about exceptional circumstances but the health board should be in a position to provide OST routinely and it should not be disrupting people’s medication. I have therefore asked NHS Grampian if that is the case, and if it is, what is it going to do to remedy it, and when? I would be happy to share that letter and any response I receive in due course with the committee, if it would be helpful.

Good progress has been made in increasing the distribution of take-home naloxone kits. Quarterly figures were published on either Monday or Tuesday that approximately 6,500 take-home naloxone kits have been distributed. Members can refer to those published figures at their leisure but they give a breakdown of the settings from which they come, including prisons, community pharmacies and the Scottish Ambulance Service.

There are 13 alcohol and drug partnerships that have a prison within their catchment area, and 85 per cent of those have made specific arrangements with their community justice partners around identifying risks, part of which is the issuing of naloxone. In some cases, good use is also being made of peers, peer networks and people with lived experience who are now in recovery going into prison settings and supporting people with training on the take-home naloxone kit.

There is another statistic that we monitor. I hate talking about statistics in this fashion, convener, because, at the end of the day, we are talking about lives, but the reach of Scotland’s national naloxone programme continues to increase, and it is estimated that 66 people out of every 100 who are at risk of opioid overdose have been provided with a take-home naloxone kit.

Naloxone is very important but it is just one part of the solution, which is a whole system of care, treatment and support. I believe that we are making progress but we need to continue on our trajectory.

On the broad point, health boards and IJBs should monitor that. Through their routine reporting structures, they can and do raise workforce issues with the Government and NHS Scotland.

On the work that I and my drug policy officials are pursuing on the implementation of MAT standards, a financial resource is attached to that implementation. When I spoke to the committee before the summer recess, I said that approximately 100 posts were going to be funded. That figure has increased. To be specific and more helpful, I know that Moray, where Elgin custody centre is, has been successful in recruiting staff to work in and around MAT standards. Similarly, NHS Aberdeenshire has sought a number of staff and has largely been successful with that.

I am not disputing that there are issues with the workforce but there are examples of where those have been overcome, either through additional resource to help with recruitment or through the redesign of services.

There are two points there, Mr Torrance. One is a more global point about the implementation of MAT standards. They are vital and they are a big part of the Government’s reform programme. They are about ensuring that people have quick access to and informed choice about their evidence-based treatment, and that services are planned and operate in a way that they anticipate people’s needs. All of that is connected to mental health and primary care, and the MAT standards are therefore crucial and not optional. Members will be aware of the statement that I made to Parliament earlier this year, and I will make a further statement next week.

On the specific issue of the prescription of medicine or opiate substitution therapy in police custody settings, MAT standard 3 requires people’s treatment to be provided to them irrespective of their setting. OST needs to be routinely available to those for whom it is prescribed in custodial settings if MAT standard 3 is to be met. All health boards, alcohol and drug partnerships and integration joint boards have accepted the importance of that and our shared agenda for implementation of MAT standards.

We have been engaging on the issues raised by the petitioner in committee with various police and healthcare networks, such as the Police Care Network and, to the best of my knowledge, the only place where there appeared to be an issue was in Elgin. However, I want to be clear—and the guidance and MAT standards are clear—about what should happen.

In my view, as Minister for Drugs Policy, any interruption of a person’s medical treatment is utterly unacceptable because of the consequences that the committee is well aware of. The interruption of someone’s medical treatment is discriminatory and not acceptable. Ultimately, the implementation of MAT standards will resolve the issue where it exists, and as I said, the issue appears to be specific to Elgin.

I hope to convey to the committee in the strongest terms that the practice, where it exists, is discriminatory and that we treat drug and alcohol problems as a health condition, so drug and alcohol treatment has to be on a par with any other treatment for any other condition.