Chamber and committees

There are cost implications. We can write to you with what the SMC said when it assessed buprenorphine’s role in therapy. It did not say that it is the first line of action across the board, but it said that it is a very suitable alternative for those for whom methadone is not the appropriate drug. Although there are cost implications—as always with these things—the drug acquisition cost has to be balanced against the economic value. Work is going on to understand how much advantage there is to using methadone compared to using long-acting buprenorphine.

I can certainly check what our recent data shows. We are able to get access to some toxicology almost instantaneously. I have spoken before in the chamber about the incident that we faced in March, in which a batch of opiates contaminated with synthetic opiates came in to Scotland and there quickly began to be overdose incidents in our community, including in the Thistle centre in Glasgow.

Because those people were using in a supervised drug-consumption facility, it was possible to resuscitate them. They provided samples of the drugs that they had been using, which were very quickly analysed, and that meant that detailed information went out very quickly, using the Public Health Scotland rapid action drug alerts and response system, to ensure that every part of Scotland was aware of the risks from synthetic opioids.

With regard to drug testing, we are able to access information quite quickly, but there might be challenges with regard to post-mortem toxicology, which is slightly different, because there are often challenges with identifying substances. These nitazenes are incredibly potent, so they are present in very small quantities in a person’s bloodstream. The detection threshold has to be very low, so detection can be difficult. There are also challenges in that the ever-evolving synthetic market means that, even as we develop a test for them, more nitazenes are always appearing.

Richard Foggo has something to say specifically on the toxicology, but I will go back to your point about the increasing drugs deaths in prisons. I think that other witnesses at this inquiry have said that the use of drugs in prisons often mirrors what is happening in the community, and what we are seeing in the community is a really significant threat from the rise in synthetics. Looking back over the past five years that the mission has been on-going, we can see that, initially, we were very much up against opiates, but quite quickly, synthetic benzodiazepines came on to the market, caused challenges and contributed to deaths.

We have also had a rise in synthetic cannabinoids, which are significantly more potent and cause harm and can cause sudden death. We now have these exceptionally potent synthetic opioids—nitazenes. They were developed about 60 years ago, but it has never been possible for them to be used safely because they pose such an incredible overdose risk. They are causing real challenges for us. The thing to understand is that they cause challenges in how we disrupt supply, too. It is not just that they have different effects on our bodies when they are taken but that, as one paramedic said to me when they were training me in the use of naloxone, the potency is such that what used to fit into a suitcase now fits into a matchbox. That means that we now need an approach that is different to the traditional way in which we disrupted supply, and that is the case in our prisons as well as in the community.

With regard to how we deal with that, we have a naloxone programme in prisons. There are challenges with benzodiazepine overdoses. There is not a straightforward antidote that can be used outside a clinical setting, although that is being investigated and trialled—the University of Edinburgh is doing research into that. There are certainly challenges with the impact of taking synthetic cannabinoids and reversing the effects that those have on your body. However, we have an antidote that can be used for opiates. We have ensured that that is available throughout the prison service, and it is being used, at times, in prisons, so prison officers are trained in naloxone administration.

However, that is a solution to only one drug, and members will have heard, in relation to all the alerts that have been in the public domain over the past few months, that nitazenes are so potent and so dangerous that people are needing repeated doses of naloxone, which means that anyone who is administering naloxone is having to administer quite a lot more of it for quite a lot longer than they would have had to do for conventional opiates. As I keep saying in my role, we need to be agile and to recognise that things change, and we need to respond to those changes—and that is exactly the same in the prison system as in the community system.

It is probably useful to put on record that the Scottish Government is developing a national service specification for drug and alcohol treatment in Scotland, alongside guidance that has been informed by the UK-wide clinical guidance for alcohol treatment. That will aim to provide clarity on the types of treatment that should be available. The national specification will set out the types of treatment and recovery service that should be available across Scotland. It will also provide impetus for improved joint working between the public sector, third sector partners and everyone who needs to collaborate in order to improve outcomes for the individuals who are affected. That will apply in custody in prisons, as well as in our hospitals and primary care.

The group has quite broad representation. Martin Reid might want to talk a little more about it.

I will add a little more detail. One thing to be aware of about unionisation levels across the sector—which we are keen to increase, because we see that as a means of improving the pay and terms and conditions for the workforce—is that, as well as being relatively low, with around 20 per cent of the workforce unionised, union membership is concentrated in local government employees. Do not misunderstand me: we are keen to listen to and work with unions, but a large part of the workforce is not represented by the unions, so we need to ensure that we capture the voice of that workforce.

Another thing that has disrupted progress, in a good way, during the past few months is the issue that I am here to talk about today—the Employment Rights Bill, which we have had to take time to examine. We have been working on that through a voluntary arrangement in Scotland. The Employment Rights Bill is going through the UK Parliament because what it covers is largely reserved. We have had to take time to take stock and have a look at that proposal, which we broadly welcome, which is why I am here today.

The reason for focusing on commissioned services is that there are already arrangements in place for local authority employment.

Largely, people can raise issues with the Care Inspectorate, and there are protections in place, so those discussions are confidential. The identity of the person who raises concerns does not have to be in the public domain.

That troubleshooting mechanism was introduced because there were significant delays between our putting the money into the system for the uplift to the real living wage and people actually receiving the real living wage. That mechanism appears to have largely sorted the issue.

The issue of geography is always challenging. In the Highlands, we have always been quite keen on virtual options for meeting, because the distances involved are vast, but that has become much more of a factor since the pandemic, and now people can go online to gather together, work together and network virtually in a way that was not commonplace a few years ago. Therefore, issues of geography should not prevent union membership.

On the hostility towards unions, it is important that we remind people of the benefits of union membership. That includes reminding employers of the benefits that their organisations will realise if their workforce has union representation, an effective voice and better terms, conditions and pay.

We have worked really hard to work in partnership with the sector, despite the low unionisation level, which exists for all sorts of reasons. However, we are pretty keen on unionisation in the sector. I see union membership and increasing unionisation of the workforce as being strongly beneficial to the workers and to the sector as a whole.

To expand on that, the CCPS tends to represent not-for-profit providers and Scottish Care tends to represent private providers of varying sizes. Both organisations represent very large and very small organisations. It is complex to set up a sectoral bargaining organisation, especially as so many different parties are involved, including a large number of employers, COSLA, the Scottish Government and a variety of trade unions. The academic input has been crucial to unlocking the challenges that we face. We feel as though we are motoring and that we are pretty close to reaching an agreement; we just need to dot the i’s and cross the t’s on the sectoral bargaining proposal.