Chamber and committees

I have a long-standing interest in drug policy and the work to reduce the number of drug-related deaths across Scotland—not only as a registered nurse, but as a member of the Health, Social Care and Sport Committee during this session and as a member of the Health and Sport Committee in the previous session of Parliament. I also participated in the joint inquiry into drugs deaths in Scotland, which was carried out by the Scottish Affairs Committee at Westminster and led by Pete Wishart.

I will, in my short contribution, make three points. They will address the evidence-based action that the Scottish Government is taking, using the powers that are available to us to reduce drug-related harm; the importance of continued action to reduce drug-related stigma, which others have mentioned; and the response of the UK Government to the tri-committee inquiry.

First, since the national mission to reduce drugs deaths was announced in 2020, the Scottish Government has taken action to transform our approach to drug policy, within the constraints of the outdated Misuse of Drugs Act 1971. We have changed our approach, and are moving away from one that focuses on criminalisation to one that puts first the health and medical needs of those who are impacted by drugs. In health, that has included roll-out of carrying naloxone to save the lives of people who experience a heroin overdose; development of better outreach services; increased provision of rehabilitation beds; and development of non-fatal-overdose pathways and MAT standards.

Another form of unintended overdose that occurs in Scotland is one in which benzodiazepines—whether illicit or prescribed—are taken and mixed with other substances, including alcohol. It is worth highlighting that those overdoses are a cause of death, especially in rural areas.

Naloxone works only for reversal of opioid overdoses. From my experience as a nurse, I know that there is a reversal agent for benzodiazepines called flumazenil. There can be side effects to use of flumazenil. Can the minister tell us whether any work is being done to pursue a naloxone-type reversal drug that would apply to use of benzos, especially in rural areas?

In education, the Government is bolstering teaching on drug and alcohol harms, thereby ensuring that children are educated at an early age about drug safety and the harms that addiction causes. By taking forward those and other measures, the Scottish Government is creating a new whole-system approach, and is implementing an integrated person-centred and medical, rather than punitive, approach to tackling drug harm.

I also welcome the work of project MATCH—matching alcoholism treatments to client heterogeneity—which takes a person-centred and client-centred approach to recovery. Harm reduction is also part of recovery, because we must remember that recovery includes relapse as well as support.

I turn specifically to stigma. By addressing stigma and the silence and alienation that it causes, we make it easier for people to seek help. Stigma is not only damaging to an individual’s mental health and sense of worth; it also discourages them from coming forward to seek the help that they need.

The media have an important role in addressing stigma. For example, in my South Scotland region, when I put out a press release welcoming drug funding and the progressive approach that is being taken in Scotland and the focus on stigma, a local newspaper used a stereotypical picture of a metal spoon with powder on it, next to a used syringe. The paper has agreed to consider changing the images that it uses in the future. I would welcome other print media also addressing addiction sensitively in order to help to tackle, and possibly eradicate, stigma.

It is welcome that the drug deaths task force has developed a strategy that identifies actions to help to reduce stigma. However, I often hear from constituents and others that an issue with stigma still exists among a minority of health, social care and allied health professional staff.

In a debate in January, the minister agreed to my request that the possibility of an e-learning module on drug stigma be explored—for example on the NHS learning system Turas—for our healthcare professionals, including pharmacists. I ask the minister, when she closes the debate, to give an update on whether that e-learning model to tackle stigma is progressing.

There is strong evidence from other countries that safer drug consumption facilities help to prevent fatal overdoses, and that they encourage people who use drugs to access longer-term help. The European Monitoring Centre for Drugs and Drug Addiction and the Advisory Council on Misuse of Drugs both support use of drug consumption rooms and have said:

“The effectiveness of drug consumption facilities to reach and stay in contact with highly marginalised target populations has been widely documented.”

I will if I have time, Presiding Officer.

Will the member take an intervention?

Does the member not think that it is a bit disproportionate that the Scottish Government has given £20 million more for the Borderlands growth deal than the UK Government has invested? Is that levelling up or is that just losing out?

I welcome some of the funding, but I do not like the fact that the money is going to places in relation to subject areas that are devolved to the Scottish Government. I would ask whether the member is happy that this place is being tramped upon in devolved areas by the UK Government.

SOSE is working with Stranraer Furniture Project in relation to the Community Reuse shop, led by project manager Paul Smith, to support that social enterprise to grow and expand. It is also incorporating fair work practices. From a phone call this morning, I know that the Furniture Project now has 22 employees and is working to the wider benefit of the community. I encourage members to look at the wide range of activities that Paul Smith and his team are undertaking.

In Castle Douglas, Stewartry Care, a provider of homecare with almost 100 employees, is beginning a Democracy Collaborative model of employee ownership. That is already happening. Some members are saying that we are looking at the stars and that this is a pie-in-the-sky idea, but that is not the case—it is happening on the ground, right now. With SOSE’s help, Stewartry Care is encouraging employees to take leadership and ownership roles in the company.

One final example of a Dumfries and Galloway community wealth building trailblazer is Jas P Wilson, a forestry equipment manufacturer and distributor in Dalbeattie. The company has donated a car to the local first responders, so that they do not have to use their own car, it has financed premises for a local playgroup and it has supported the local theatre group, the Birchvale Players, in its move to new premises.

All those companies demonstrate how community wealth building is already working across Dumfries and Galloway. I welcome these examples across the south of Scotland, and I invite the minister to come and visit any of them, if his diary allows.

Community wealth building is a practical, place-based and focused model that can play a central role in growing Scotland’s wellbeing economy. A community wealth building approach puts an emphasis on local people and on ownership, with a view to growing the number of people who have a genuine stake in the economy. I want more people and local communities in Scotland to have a bigger stake in our economy, share the ownership and build resilience to create a fairer and more secure economic future.

I welcome the opportunity to speak in the debate.

When I looked into the work of the Democracy Collaborative, which is led by Ted Howard, I realised the huge potential of community wealth building. There is no one-size-fits-all approach, but the bottom-up approach centres around democratic ownership of the economy and community self-determination. I am saying that it is not just a one-size-fits-all approach, because what happens in the central belt and in Glasgow will be different from what happens in rural areas such as the south-west of Scotland.

I lived in California for many years, where I witnessed wealth inequalities and the consequences. The Democracy Collaborative has outlined what I want to see in Scotland—wealth redistribution and benefit to our communities. That approach is in sharp contrast to what the UK Government is doing with its hard-right, individualist policies. By its fundamental design, today’s corporate capitalist system takes wealth that would otherwise reside in local communities and concentrates it in the hands of a small elite. The Office for National Statistics reported that there are an estimated 27.8 million households in the UK and that 263,000 of them control 45 per cent of our country’s wealth.

Ted Howard’s model of community wealth building proposes an economic model with more local, good-quality jobs; improved access to public contracts for local businesses, which is particularly important for our agriculture and forestry community; more land being placed in community ownership; and support being offered to businesses that are exploring employee ownership.

Community wealth building supports renewable energy development, with the wealth that is generated being distributed back to the community. For me, that means the potential to develop renewable offshore energy in the south-west—perhaps in the Solway Firth. I would be interested in exploring that potential in the next round of ScotWind licences. When I visited Eyemouth harbour last year, it was evident that high-value jobs worth millions of pounds had been and will be brought to the community through renewable energy investment.

When it comes to how money is spent and how services are commissioned by our institutions, cost is often the dominant determining factor in who gets the contract. Environmental credentials, social value and decent employment conditions tend to be weaker considerations. We need that to change.

As others have said, with community wealth building we can create legal change in our procurement processes. That can ensure that small local and medium-sized enterprises and employee-owned businesses support local jobs and have a greater tendency to recirculate wealth directly to our communities. For example, it can allow our agriculture community to provide local produce to our schools, hospitals, social care settings, prisons and other institutions, which is something that I have been pursuing in my area but in relation to which I have faced local bureaucratic barriers. Therefore, I welcome the Government’s commitment to reforming procurement processes, and I ask for a commitment that that will be taken forward at pace.

Ahead of the debate, I spoke with Rob Davidson, the community wealth building manager with South of Scotland Enterprise. The minister has described some of the work that SOSE has already done with registered social landlords. SOSE hit the ground running at the beginning of the pandemic, giving practical support to businesses fae Selkirk to Stranraer to promote community wealth principles.

I have a quick question about upstream causes of health inequalities, the balance between downstream and upstream interventions and how we address that.

I have a paper from the National Institute for Health and Care Research that uses the river metaphor to talk about public health: downstream interventions focus on things such as behaviour change and treatments for illnesses, and upstream interventions focus on social factors that contribute to health and prevent illness, such as housing, employment and education. What is the balance between upstream and downstream interventions in that regard? I think that Claire Stevens mentioned something in relation to that in her opening comments.

This is a quick supplementary that relates to what Evelyn Tweed and Gillian Mackay were saying. Rishi Sunak could make changes in policy that would address the cost of living crisis, which will probably exacerbate health inequalities. National insurance contributions have gone up, people are in fuel poverty, and people are having to choose between heating and eating. Luckily, summer weather might be coming now. Universal credit has been removed—or, at least, a portion of the uplift was taken away. What is the barrier to the Chancellor of the Exchequer setting a windfall tax or to addressing some of those things? Is it a political issue? What are the constraints?

I will be pretty quick. In our private sessions, one person who gave us information said that inequalities impact assessments are not being made routinely in planning, for instance, and that wider engagement is needed in thinking about how people access services. Do the witnesses have any thoughts on how inequalities impact assessments could be done better in order to tackle health inequalities?

Down the line in our inquiry, we might have more clarity on how health inequalities impact assessments are used. Claire Stevens said that she would support further use of those assessments. I am interested in hearing whether you think that it should be a requirement for public sector organisations to conduct health inequalities impact assessments so that health is considered in every portfolio.