Meeting date: Thursday, January 30, 2020
Meeting of the Parliament 30 January 2020
Agenda: General Question Time, First Minister’s Question Time, Public Works Loan Board Rate, Business Motion, Portfolio Question Time, European Union Exit, Drugs and Alcohol, Scottish Biometrics Commissioner Bill: Financial Resolution, Decision Time
- General Question Time
- First Minister’s Question Time
- Public Works Loan Board Rate
- Business Motion
- Portfolio Question Time
- European Union Exit
- Drugs and Alcohol
- Scottish Biometrics Commissioner Bill: Financial Resolution
- Decision Time
Drugs and Alcohol
The next item of business is a debate on motion S5M-20635, in the name of Joe Fitzpatrick, on drugs and alcohol: preventing and reducing harms. I call Joe Fitzpatrick to speak to and move the motion.14:52
November 2018 saw the publication of two key strategy documents that were aimed at reducing the harm that is associated with alcohol and drugs. Those documents were: “Rights, Respect and Recovery” and the “Alcohol Framework 2018”. A year on, there is much that we can reflect on, learn from and celebrate. However, we can also agree that there is much that we, as a country, still need to do. Reducing problematic drug and alcohol use, and the associated harms and deaths, remains one of the most difficult challenges that we face.
Levels of alcohol-related harm remain far too high. In 2018, adults in Scotland drank an average of 19 units per week—some 36 per cent more than the low-risk guideline of 14 units per week. There were 1,136 alcohol-specific deaths in 2018—an average of 22 deaths every week.
On drugs, the story is even more stark, with 2018 having seen the highest number of drug-related deaths ever recorded. I have stated on numerous occasions that each and every one of those tragic deaths is ultimately avoidable.
We have also seen a significant rise in the number of hospital stays related to drug use, while the number of alcohol-related admissions remains at a similar level to that seen in 2017-18.
Will the minister take an intervention?
I am going to make some progress, but I will come back to the member.
Tackling the harms has to include addressing the underlying reasons for those addictions. Previously, we have focused too much on addressing the substances rather than the individual. Going forward, we must be more person centred in all approaches to treatment, but there are contributory factors that remain outwith an individual’s control. We know that people who experience socioeconomic disadvantage experience problematic use. The recent burden of disease study found that the overall burden for drug use disorders was 17 times higher in deprived areas. Both of our strategies identified that tackling poverty and inequality is central to reducing harmful use of alcohol and drugs. Suffering adverse childhood experiences also significantly increases the likelihood of lifetime illicit drug use and drug dependency, and it increases the chances of early alcohol use. The evidence for that is clear.
Will the minister take an intervention?
I am going to make some progress. I will come back to the member if there is time.
Understanding and addressing the impact of adverse childhood experiences is crucial to safeguarding children’s current mental and physical health and wellbeing. We have made a commitment to develop trauma-informed approaches in services, which will ensure that workers and staff have the necessary training in and understanding of these complex issues. Our approach on alcohol is rooted in the World Health Organization’s “best buys” of affordability, availability and attractiveness.
Scotland is a global leader on alcohol policy—we have delivered 915,000 alcohol brief interventions since 2008, we have legislated to ban irresponsible promotions and we have introduced a lower drink-driving limit. With support from across the chamber, we also introduced minimum unit pricing, which was a world first.
Will the minister give way?
As I said, I will make progress and, if there is time, I will give way once I have got through the important matters that I have to cover.
On Tuesday, NHS Health Scotland published the first full year of off-trade sales data since minimum unit pricing was introduced. The data are hugely encouraging and show a 3.6 per cent drop in sales per adult. That reduction in consumption marks real progress, which I am sure the Parliament will welcome. I have heard calls from some members for a higher price to be set. I will keep that under review alongside all emerging evidence.
Tackling attractiveness is also vital if we are to reduce consumption and harms. Our count 14 awareness-raising campaign launched its second phase last week, and I urge all MSPs to promote it and amplify its message—which is to keep risks low by staying within the maximum of 14 units per week. The evidence is clear that alcohol advertising being seen by children and young people is associated with their starting to drink alcohol or, among young people who already drink, their drinking more alcohol. We know that the earlier a young person begins to drink alcohol, the more likely they are to drink in ways that will be risky later in life.
To address that, the framework contains two significant actions to restrict alcohol marketing: pressing the UK Government to restrict television and cinema advertising of alcohol, and consulting on a range of measures within our devolved powers, including mandatory restrictions on alcohol marketing.
Will the minister give way on that point?
As I said, I want to make progress. I want to update the chamber on the task force’s work, which is the next item that I will cover.
I asked the Young Scot health panel to take forward the findings of the Children’s Parliament report, which was published last year, and it expects to report in the spring. As is set out in our alcohol framework, I will also bring forward a consultation on the issue, which I plan to publish later this year.
We will continue to take a public health approach on drug use and the current emergency that we have around drug-related deaths. That means examining the evidence on what we know works and what will help to keep people alive. There is no shortage of evidence on the topic; in fact, the past few months have seen the publication of a number of reports that have highlighted the issues. Those reports all note the challenges that Scotland faces and make recommendations on what we could be doing.
However, they all agree that there is no single solution to the problem—there is no silver bullet. Instead, what is required is a multi-layered approach from our health and social care sector and beyond. The need for a multi-disciplinary response is reflected in the make-up of our drug deaths task force—a membership that I selected specifically to effect change in key areas where new action is required.
Will the minister take an intervention?
As I said, I will outline some of the work of the task force, which I know members are keen to hear about. There will be plenty of time for debate later.
The task force will continue to develop pieces of work that will directly address the current number of drug deaths. In the short term, it has focused on making sure that, where possible, we provide people with the tools that they require to keep them alive, which, in relation to overdose deaths, is the drug naloxone. There has been a significant push to increase the availability of that drug, which can reverse the effects of an overdose. For example, yesterday, I announced the funding of a pilot with the Scottish Ambulance Service, which will allow it to trial distribution of naloxone to individuals following a non-fatal overdose. If that trial is successful, we expect that practice to become the norm and that it will be rolled out across Scotland.
Furthermore, the chair of the task force has been working with the chief pharmaceutical officer on a proposal to train all community pharmacists in the administration of naloxone and to have naloxone available if requested, thereby providing a potential life-saving service should they be approached in an emergency.
In December, I wrote to naloxone leads in health boards, requesting that they contact homelessness services to ensure that naloxone is made available to the shelters and facilities that are being used by some of our most vulnerable people during the coldest months of the year. Again, that was to ensure that kits, peer support and appropriate training are accessible when required.
The chair of the task force and I also wrote to alcohol and drug partnerships and integration authorities to provide them with the task force’s first set of formal recommendations for reducing drug deaths. We need to see those recommendations in local strategies for 2020-21. The recommendations cover targeted distribution of naloxone, improvements to medication-assisted treatment and immediate responses to non-fatal overdoses.
The task force is also working on a number of longer-term projects, including producing a set of national standards for the delivery of medication-assisted treatment. That work will help to reduce the variation in how services administer MAT, and it is backed up by strong evidence. The standards will give people choice in the type and dose of their medication as well as access to same-day prescribing of MAT, which is something that I am asked about regularly. That will mean not limiting people to methadone but also including buprenorphine and Suboxone.
I will respond to the amendments in my closing remarks, but I note that, in relation to the first part of Alex Cole-Hamilton’s amendment, the sub-group will also look at diamorphine-assisted treatment and will be able to recommend whether the current pilot in Glasgow should be extended and rolled out.
Another focus for the task force is the role of our justice system, recognising that there is more that we can do within and through the justice system to improve outcomes for individuals in appropriate cases. Both Police Scotland and the Crown Office and Procurator Fiscal Service are task force members, and the Lord Advocate fully supports its work.
People who experience problematic drug use are unwell and need treatment, care and an end to the isolation that drug use can bring. In Scotland, we continue to develop innovative—
Will the minister take an intervention?
Time is limited, and I am covering the actions of the task force—there is a lot to get through.
Actually, there is some time in hand—for all members—for interventions.
I think that time is going to be tight for my speech. If there is time—
Do not look so pleased, Mr Cole-Hamilton.
We continue to develop initiatives to enable people—
Bear with me, minister. It is a matter for members, but I do not want members all round the chamber to feel that they are under time pressure, because there is some time in hand in the debate.
Presiding Officer, that is good, but my challenge is to get through the range of actions that the task force is taking, because that is what I want to update the chamber on.
In Scotland, we continue to develop innovative schemes to enable people who come to the attention of the criminal justice system to be referred to the support services that they need. That is similar to initiatives that I have seen recently in Durham. I will not shy away from the fact that my party has chosen to view drug use as a health issue rather than a criminal offence. I know that that position is not shared by everyone in the chamber, but the international evidence for it is overwhelming.
The additional stigma that is created by criminalisation does not work, because it hampers personal change, reinforces isolation and can prevent people from accessing the help that they need. In British Columbia and Portugal, we see an appreciation of that set out in a grounded public health approach that is coupled with a sense of emergency and awareness of the need to bring compassion into a system that was designed to punish. The Misuse of Drugs Act 1971 is not fit for purpose because it is designed for a different time and a different purpose.
Alongside the task force’s work, we are continuing to deliver our strategy. We have published a partnership delivery framework that sets out how we work with partners and an action plan to deliver the strategy. The strategy asks services to adapt to target those who are most in need and deliver services that address their specific circumstances. It is built on an eight-point treatment plan for ADPs that will improve access to effective services and interventions, including through assertive outreach and other harm-reduction interventions for those at risk.
I have been on a number of visits to a range of treatment providers, and I have seen some fantastic work. However, one of the main things to have struck me is the need for variety, because no one approach will work for everyone. I hear regularly about the need for more residential rehabilitation—I note the reference to that in the Conservative Party’s amendment—and we are mapping current provision and trying to scope the level of demand. I acknowledge the call for additional resource for that service, to make that option available to more people.
Will the minister take an intervention?
No, the minister—
I am really tight for time.
Bear with me. Minister, you really must conclude.
I am almost there, Presiding Officer.
We need to get that mapping done and get evidence of the demand, as we need to know that we are using resources in the most appropriate way. We remain committed to ensuring that recovery is at the heart of service provision and that we have encouraged every ADP to develop a recovery-orientated care system not only for alcohol and drugs services but for housing, prison and employability services.
We have made commitments to improve—
I am sorry, minister, but you must move the motion. You are over time by nearly two minutes.
In moving the motion, I emphasise that the harms of alcohol and other drugs impact on us all. It is really important that we work together on this vital work, for the benefit of families and communities. I appreciate that, although parties across the chamber have different positions, we all hold heartfelt views on the need to make a difference.
That the Parliament believes that Scotland faces a public health emergency in terms of drug-related deaths, and that addressing this issue requires a public health-led approach; agrees that reducing the harms caused by alcohol and other drugs requires concerted action at all levels of public services and society; recognises that adverse childhood experiences and health inequalities both contribute to alcohol and drug-related deaths, and that stigma remains a significant barrier to people seeking treatment and support; welcomes the work to date of the Drug Deaths Taskforce, including its efforts to improve access and distribution of naloxone, optimised use of medically-assisted treatment, and piloting assertive outreach to support the most vulnerable; notes that the current Misuse of Drugs Act 1971 is not fit for purpose and poses a barrier to a public health-led approach, which has shown benefits in Portugal, British Columbia and elsewhere, and therefore calls on the UK Government to reform the Act or devolve powers to allow this Parliament to take further action to save lives.15:05
Last year, 1,187 people died. I say to the minister that that is the evidence.
The last time that the issue of drugs was debated in Parliament in the Government’s debating time was on 8 November 2012. It is thanks only to Opposition parties using our debating time that we have been able to discuss drug deaths or force Scottish National Party ministers to acknowledge that Scotland is facing a drug deaths emergency.
Every life lost to drug addiction is a tragedy. I know too many families in Edinburgh and across my Lothian region who have been affected by drugs and by those who prey on people living with addictions.
Scotland has seen an escalation of the drug deaths crisis over the past 10 years. Although I have welcomed the establishment of the drug deaths task force, we need to be honest and recognise that we need a radical new approach if we are to turn around the situation.
Yesterday, the task force outlined limited recommendations. Those are welcome, but ministers need to understand that we must have a root-and-branch rethink of drug rehab services. Like Monica Lennon, I consider that it was a mistake not to have cross-party involvement in the task force. To date, I have heard nothing that suggests that SNP ministers are developing the new approach that we need. I just hope that this is not another lost opportunity to tackle the crisis.
I want to make this debate about delivering something: a new drug rehab bed fund to start the work to give people hope and develop a new approach. It is time for SNP ministers and this Parliament to be totally honest. Scotland’s drug and alcohol partnerships have been underfunded for 20 years—they are the Cinderella service of our national health service. The cuts most recently made by ministers have significantly destabilised the sector. The pain is still being felt today, with vital third sector services being closed as we speak. Right in the middle of a drug deaths emergency, the fragile support is being limited and services are being removed.
I have tried to work with SNP ministers since my election to warn them of the developing crisis and to offer workable suggestions and ideas. This debate should be about finding solutions and using the powers and the budgets that the Government has to do this work. The starting principle should be the proper funding of drug support services, so that people with addictions can get the support that they need. That is what my amendment calls for. Next week, the budget comes to Parliament. Tonight, the Scottish Parliament can call on the Scottish Government to make available £15.4 million to properly fund residential rehabilitation beds.
The sad truth is that, over the past decade, the number of rehab beds has been slashed. In 2007, when this Government came to power, 352 beds were available to drug treatment services; today, there are just 70. If there is one thing that we know, it is that, in the past decade, the dramatic reduction in beds has coincided with the explosion in drug deaths. Today, that must end, and a new approach to rehab and national strategy should be developed by ministers.
Over the summer recess, I undertook visits to listen to front-line workers in drug and addiction services in all parts of Scotland. From speaking to services users who have their families engaged and are trying to get their lives back together, it was abundantly clear to me, as the minister has outlined, that access to services is a postcode lottery.
I was hugely impressed by what I saw at the safe as houses project in West Dunbartonshire. That is genuinely the only service that I have seen that truly embeds the principle of wraparound care for individuals. That needs to be embedded in all services.
For people living with addictions whom I have met, one of the key aspects to their lives is, as the minister mentioned, childhood trauma and ACEs, often stemming from their being sexually abused. For many, because of their zero self-worth or guilt, or because of their simply using drugs as a coping mechanism, substance misuse quickly spirals out of control.
We often hear stories in the chamber—I make no apologies for raising them—of the crisis that our mental health services face. We need bespoke substance misuse mental health services for those who need them, and they need to be developed as soon as possible. Only the third sector has the capacity to achieve that.
Over 30 years, we have built a system that is based on sustaining addiction, which does not try to address the underlying reasons for addiction. We need a radical new approach to access to mental health services. Let us be honest: that capacity is not in the NHS, so we need funding for the third sector.
We all want action that turns the current situation around, which even ministers accept is an emergency. If SNP ministers genuinely want a transformational approach—I hope that they do—we need to take forward more than what has been outlined today. We need an approach that covers drug and alcohol abuse, treatment, education and recovery. Only then can we, as a country, deliver the change that will help to save lives now and prevent a future generation of drug deaths and substance abuse destroying individuals, families and communities.
Regardless of party politics, we all want this unacceptable situation in Scotland turned around. That will take leadership and an honest approach to understanding that the services that we hope can address substance misuse in communities around Scotland are broken.
I move amendment S5M-20635.1, to leave out from “notes” to end and insert:
“, and calls on the Scottish Government to provide £15.4 million for residential rehabilitation beds in the upcoming Scottish Budget.”15:11
I wish that we did not need to have this debate. Nothing that we can say will heal the hearts of people who are affected by the harms and losses that we are discussing. Every life that is lost to drugs or alcohol is a devastating tragedy. Families have heard politicians express sympathy for their loss many times. We respond with task forces, summits and strategies; in reply, people warn us, “You keep talking; we keep dying”.
I am not embarrassed to admit that I feel frightened and overwhelmed by the scale of this public health emergency, and I am not convinced that we even know its full extent. It is not the fault of one Government, one public body or one law or policy. The blame game must end today. We will not succeed in preventing and tackling the harms that are caused by alcohol and drugs by stubbornly sticking to our fixed party positions. We need to make urgent changes at UK and Scotland levels and in all our communities.
The Scottish Government motion is right to call for reform of the Misuse of Drugs Act 1971, and it is regrettable that the Conservatives have lodged an amendment that would delete those words, making it impossible for us to vote with them. That is deeply frustrating, because the Conservative amendment rightly calls for substantial investment in residential rehabilitation.
My amendment sets out the need for adequate funding. Scottish Labour agrees with the Scottish Government on the need to explore legislative change, but we believe that we can be bolder with the powers that we already have. That is why we support the Liberal Democrat amendment. We back reform and the need for resources. That is the centre ground in the debate.
I think that we all agree on the need to urgently implement measures that will save lives. The evidence shows us what to do. People whose lives are gripped by substance use, those who work with them daily and people who are in various stages of recovery have told us what to do—many times.
When I led a members’ business debate in September 2019 on the scale of drug deaths, I pushed for the legal designation of a public health emergency. That was resisted by the Scottish Government and the task force. Four months on, there is recognition in the Government’s motion that it is a public health emergency. That acknowledgment is welcome, but a public health emergency demands immediate action.
I agree with Turning Point Scotland that the drug deaths task force is a welcome initiative but that it does not replace the need for agencies to demonstrate the actions that they are taking to reduce deaths.
Urgent and transparent action is needed. Anyone at high risk of a drug-related death must be fast-tracked into treatment and support services within 24 hours. Without that, people will continue to die in huge numbers.
If we are serious, we cannot accept a situation whereby the forensic toxicology service that analyses 90 per cent of Scotland’s suspected drug-related deaths is dysfunctional. That families have to wait several months to find out why their loved one died is cruel. Scottish Families Affected by Alcohol and Drugs is supporting people through those agonising waits, but they have already suffered enough trauma. They do not deserve that additional distress.
The Scottish Drugs Forum is right to raise concerns about the potential impact of delayed toxicology and post-mortem reporting on the publication of official annual figures. We cannot afford to have huge gaps in knowledge about trends in substance use. I am sorry to say that previous assurances from the Lord Advocate have amounted to nothing. That is what happens in the absence of a clear, nationally co-ordinated response to this public health emergency.
I agree with everything that Monica Lennon has said so far. Does she agree that the delays that are being witnessed as a result of the toxicology reports being delayed are causing further harm and distress to families who have been affected by drug deaths?
Absolutely. It is very upsetting. I am in touch with a number of families and I cannot believe that they are in that situation.
Joe FitzPatrick has been in his post since June 2018. Despite him not taking interventions today, I have found him to be engaging and receptive to both criticism and ideas, but no minister should be expected to tackle these complex and deep-rooted challenges on their own. A public health approach is crucial, as is cross-portfolio action. I say to the First Minister and all of her Cabinet, which includes the Lord Advocate, that they must step up, share the responsibility and ensure that every part of Government that can make a difference, no matter how small, is actively engaged in measures to prevent and reduce alcohol and drug harms.
My colleague Jenny Marra will use her time in this debate to talk about the drastic situation in Dundee. The Dundee drugs commission has made several important recommendations, but implementation has been too slow. Why do we continue to move at a snail’s pace when people’s lives are at risk?
The forthcoming summit in February is an important opportunity. The recommendations of the Scottish Affairs Committee and the Health and Social Care Committee are rooted in international evidence, and the UK Government should accept them. As a minimum, safe consumption rooms should be piloted in Glasgow, where rising HIV infection rates are an additional risk factor, and in Dundee, which is the city with the highest drug death rate in Europe. Our amendment highlights where funding has been cut—not to point fingers, but to confront the consequences and ensure that we make better choices in the future.
I hope that today’s debate will lead to immediate action to save lives and give people hope.
I move amendment S5M-20635.3, to insert after the first “public health-led approach;”:
“acknowledges that there were 1,187 drug-related deaths and 1,136 alcohol-related deaths in 2018; is concerned by reports that the number of drug-related deaths could increase further for 2019; considers up-to-date information and data to be crucial for understanding the extent and cause of drug-related deaths, as well as informing preventative interventions from public services; believes delays to forensic toxicology reports for deaths reported to the Crown Office and Procurator Fiscal Service are therefore unacceptable; recognises the role of frontline staff, volunteers, families and the wider recovery community in supporting people affected by substance misuse; affirms the need for adequate funding of treatment and recovery services following the £40 million cumulative real terms reduction in alcohol and drug partnerships funding between 2014-15 and 2018-19, which negatively impacted the provision and capacity of essential addiction services;”.15:17
I welcome this debate. It is an example of the business that the Parliament should be focusing on, rather than having debates about flags and the constitution. However, it is seven years too late. Much water has flowed under the bridge since the Parliament previously debated the drugs crisis in Government time, and the number of drug deaths in Scotland is soaring.
As Miles Briggs said, there were more than 1,000 drug deaths in Scotland in 2018. That is more than twice the figure a decade ago. We have the worst rate in Europe and the worst rate in the developed world. The Government must accept a large part of the blame for that. Despite the insistence that blame should lie in part with the UK Government, I say to the minister that our drug deaths are twice those in England.
The Scottish Affairs Committee said recently that the Scottish Government can do more with its existing powers. Instead, the Government decided in 2015 to make a 23 per cent cut to alcohol and drug partnership funding, which lasted for two years. That has played a pivotal role in our poor performance in terms of drug mortality rates. All told, it represented two years in which the budget for drug and alcohol services in our nation’s capital was reduced by £1.3 million each year. Dr Emily Tweed highlighted to the Scottish Affairs Committee that such funding cuts result in
“the withdrawal of services, reduced provision, under-staffing or under-skilled staffing, and lack of continuity in relationships for clients.”
Something has to change, and it has to happen now.
The monetary commitment from the Government, to restore cuts that had been imposed in previous years, is a start, but I am deeply alarmed that none of the Dundee drugs commission’s recommendations, published back in August of last year, has been taken forward. Same-day prescriptions for methadone in Dundee should have been implemented immediately following expert recommendation. There are still only two general practices that provide on-the-day prescriptions; most patients wait for about three weeks. It is simply not good enough.
Similarly, the Glasgow facility has been given the backing of the Home Office to treat patients with pharmaceutical-grade heroin, but it is not just about radical provision of heroin by NHS Scotland. Twice-a-day visits mean that on-going relationships are created with nurses who can introduce patients to onsite physical and mental health checks and treatments. That is radical. From international evidence, we know that it works. Yet, in the two years that it will take to evaluate the scheme, a further 2,000 people will die.
As we know, other parts of Scotland also have huge problems with heroin. I would be interested to hear from the minister, in his closing remarks, how the Government will establish proposals for a Scotland-wide network of facilities, instead of a single pilot in one city.
The Government’s failures on drugs and alcohol, and its myopic and savage cuts to funding, will cast a long shadow. We do not have to look far beyond the walls of the parliamentary chamber to see evidence of that. Figures from September 2019 show that NHS Lothian has consistently breached the waiting time target for alcohol and drug treatment. The Scottish Government’s local delivery plan standard states that 90 per cent of people should be waiting no longer than three weeks for treatment. That has never been met in Lothian. I would appreciate a commitment today that the Government will provide an above-inflation expansion of support for drug and alcohol services, to make up for years of cuts.
However, it is not only on drug treatment that the Government is failing. Families across Scotland are experiencing prolonged, painful waits for toxicology reports following the death of a loved one. They have contacted me; they have contacted all of us. Since February, around 2,000 reports have been delayed because of a staff shortage at the University of Glasgow. That is causing prolonged agony for families who have suffered the most unimaginable loss. I am certain that the families will have contacted the minister and the cabinet secretary to impart the abject distress that they feel. Each of them has a different story to tell, with the same theme. Once again, families are paying the price for the cuts that have been made to toxicology services.
The impact of such delays in confirming the cause of death can be profound on those who have lost a loved one. We are depriving them not only of answers, but of closure, too. Will the minister, in his closing remarks, give details of the Scottish Government’s attempts to remedy the situation?
I am pleased that the Scottish Government is beginning to see Scotland’s drugs crisis as a public health issue. I welcome that; my party has been calling for it for some time. The UK Government continues to treat drugs as a criminal justice issue. That perpetuates the problem, and enhances stigma and discrimination. As evidence has shown, such an approach is counter-productive. Accordingly, Liberal Democrats believe that the response must be framed through the lens of health rather than justice.
Unfortunately, the shift in focus from justice to health is evident only in part. In 2018, more people were imprisoned for possession of drugs for personal use than were given treatment orders. The political rhetoric is simply not percolating through. If the Scottish Government wants to call for greater powers to tackle the drugs crisis, it must start by showing that it is using its current powers effectively to do everything that it can to relieve services. That includes properly funding health services, and recognising the profound link between unresolved childhood trauma and adult drug and alcohol misuse.
I welcome very much the remarks that the minister made at the start of the debate. We need to heed the recommendations of former chief medical officer Sir Harry Burns, who said, in his review of NHS targets, that the one target that we are not capturing in the NHS is the prevalence of adverse childhood experiences. Without measuring those, we cannot get help to the children and young adults who have suffered them. For as long as we ignore that challenge in our society, every aspect of the strategies that we deploy will exist only to fight fires that have been burning in the hearts and minds of so many fractured people for so long.
I do not think that you moved your amendment. I like to be technical.
I move amendment S5M-20635.2, to insert at end:
“, for example, by extending the involvement of the Scottish Government in the development of UK-wide policy frameworks on drugs; agrees with the Scottish Affairs Committee that there is undoubtedly more that the Scottish Government can do within its existing powers to address problem drug use, and calls on the Scottish Government to coordinate a plan for a Scotland-wide network of heroin-assisted treatment facilities, divert people caught in possession of drugs for personal use into treatment and cease imprisonment in these cases, helping save lives.”15:24
I extend my thanks to all the organisations that provided briefings for today and I welcome the opportunity to debate this issue in Parliament. Too often, it is the most marginalised and vulnerable people in society who experience alcohol and substance misuse, so it is all the more important that we consider their needs, rights and experiences.
The Scottish Greens have long argued that drug-related deaths are a public health, not a criminal justice, issue. The Misuse of Drugs Act 1971 is outdated and must be overhauled if we are to minimise harm and tackle what has become an epidemic. Scotland is in the midst of a public health emergency; 1,187 people died of drug-related causes in 2018—1,187 entirely preventable, unnecessary deaths. That is an emergency.
Behind all the statistics are the human and social costs. Drug and alcohol dependence represents trauma experienced by individuals and their friends and families, not to mention wasted individual potential and opportunity. We continue to fail the people who are affected by drug and alcohol misuse at great cost to them, but also to society at large
It is a social justice issue. There is a well-established link between deprivation and alcohol and drug addiction. It is our collective responsibility to tackle the issue and to reach those people, who are often deemed unreachable. They are not unreachable; we simply have to try harder.
The motion rightly mentions stigma as a barrier to treatment. Pejorative terms such as junkie are hugely reductive and harmful, but they are still in common use today, too often in the media, which seeks to demonise people with substance misuse issues. We would not treat another health issue in that way. The systematic dehumanisation of drug users is nothing short of scandalous and I have no doubt that it has contributed to the high figure that we are faced with today.
If we are serious about tackling stigma, we must lead by example. Drug dependence is currently excluded from the Equality Act 2010, despite it being recognised as a health condition. The Scottish Affairs Committee, in its report on problem drug use, concluded that
“this can have damaging real-life consequences for many people who use drugs—often by preventing them fully accessing recovery services.”
That is a tragedy. The committee also called on the UK Government to immediately review the decision to exempt drug dependence from equality legislation and to assess the impact that the decision has on people who use drugs. I echo that call today.
Great work is being done to reduce stigma more locally, however, including around illnesses that are frequently associated with drug use. I, along with others in the chamber, am a hepatitis C parliamentary champion and I have seen at first hand the considerable efforts that are being made to engage with people who have, or are at risk of contracting, hepatitis C.
I have spoken before in the chamber about the excellent work that is being undertaken by the Edinburgh Access Practice. However, it remains the case that while an estimated 21,000 people in Scotland have hepatitis C, around 50 per cent of them remain undiagnosed. It is clear that efforts to tackle stigma and improve outreach must focus on reaching people who may have contracted diseases that are wrongly stigmatised, such as hepatitis C or HIV.
It is vital that we continue to highlight the impact of alcohol misuse on our society. Minimum unit pricing was a positive step and studies are already beginning to show its successes, but alcohol dependency still pervades Scotland. One in four people drink at hazardous or harmful levels and there were 1,136 alcohol-specific deaths in 2018. There is much still to be done and, as has been mentioned previously, action on advertising is key.
I will ask the question that I wanted to ask the minister. Does Alison Johnstone think that plain packaging of alcohol in Scotland is a good idea, making alcohol less attractive, as the minister said?
It is an absolutely splendid idea and one that we need to look at quickly and pursue. We only have to look at the marketing budgets of companies that produce alcohol to know how important they think the look of it is, particularly to young people.
Members may remember Professor David Nutt, the former UK Government drugs adviser, who was unceremoniously sacked in 2009. He has consistently argued that alcohol is more harmful than some class B and even class A drugs. We cannot afford to ignore lived experience or the advice of experts such as Professor Nutt, no matter how uncomfortable it makes us.
Alcohol Focus Scotland has highlighted the availability of alcohol as a key issue. Here in Scotland, alcohol is really easy to obtain, which means that regular alcohol consumption is a normal part of everyday life. There are approximately 16,700 premises licences in force in Scotland—that is 16 times the number of general practitioner practices. The alcohol licensing system is the main method of regulating the availability of alcohol, yet licensing boards approve approximately 97 per cent of licence applications, and the total number of licences is increasing. The Scottish Government has committed to reviewing and improving licensing, and I urge it to follow through on that commitment, because the current system is not serving the interests of Scotland’s people.
I appreciate that the Scottish Government is continuing its attempts to engage with the UK Government on drug-related deaths, and I eagerly await the outcome of the summit that is to be held in Glasgow on 27 February. However, as Alex Cole-Hamilton’s amendment states, there are steps that can be taken now. I welcome the three-month trial of paramedics supplying take-home kits of naloxone, but late-stage interventions, however welcome, important and effective they are, cannot be the only answer. We need to engage with people long before they reach the stage of near-fatal overdose.
Presiding Officer, I appreciate that I am over time, so I will conclude my remarks.
Well, I made allowances for the fact that you took an intervention. We now have a little bit of time in hand for interventions.15:31
I welcome the debate and hope that it will provide an opportunity to find areas of agreement rather than areas of division, to agree that there are no simple solutions to what are complex problems and to reject any infantilising of the issue. There is no single solution; rehab beds and safe consumption rooms are needed, along with many other changes.
As others have said, we need to be honest with ourselves and admit that, over the Parliament’s 20 years under Governments of different political colours, we have not managed to get to grips with the drugs issue. To date, maybe we have been too timid—I include myself in that—but I believe that that is changing. We are now openly discussing some very radical and controversial drug treatment models, such as those that are used in Portugal and British Colombia, and I am not sure that that would have been the case a few years ago. That is to be welcomed, and I pay tribute to Joe FitzPatrick for pursuing that approach.
Drug and alcohol harm affects all parts of Scotland but, as we know, Dundee has been particularly badly affected by the issue, and the number of drug deaths is at the forefront of our minds, as the minister outlined in his opening speech. We therefore need to face the challenges of drug and alcohol abuse head on and take the lead in identifying how we can be more effective in implementing new approaches to the issue.
Back in August last year, the Dundee drugs commission published its report, “Responding to Drug Use with Kindness, Compassion and Hope”, which did not shirk from identifying weaknesses in local systems and making a number of challenging recommendations. The implementation of those recommendations is an on-going process. In common with many other members, I would like that to happen more quickly, but I am encouraged that progress is being made, and I hope that the minister will take time to reflect on those positive changes and feed them into the Scottish Government’s task force.
I turn to what I think are areas of significant progress. Dundee alcohol and drug partnership produced an action plan for change, which has led to some highly encouraging developments in practice. Last November, a test of change was introduced to identify and establish a fast and effective multi-agency response to all non-fatal overdoses in Dundee. That new approach includes sharing information on non-fatal overdoses with the Scottish Ambulance Service and Police Scotland on a daily basis. The daily meetings involve staff from relevant statutory and third sector services discussing the cases and developing a plan; they also involve people taking lead responsibility for the actions to be taken in relation to each individual, and outreach workers attempting to contact people who are not known to services to offer advice and support so that they can engage with appropriate services. That work is hugely important, because we know that such people are the most at-risk group.
The member has spoken eloquently about the ADP in her area. Does she regret her Government’s decision to cut 23 per cent of ADP funding?
There are ADPs that underspend and ADPs that overspend. The performance of ADPs is hugely variable. The first thing that we need to agree is what services are needed and then we must fund the services that actually work. That is what today’s debate is about. The services must be adequately funded, but first we need to get what we are funding right—it must be evidence based and it must work.
I want to talk about same-day prescribing, which Alex Cole-Hamilton mentioned a few minutes ago. Following the test of change back in October 2019, same-day prescribing has now been fully implemented across the city. That involves the Dundee integrated substance misuse service running direct access drop-in assessment clinics, where people receive a comprehensive assessment of their substance use and other aspects of their lives and social circumstances.
Lifesaving training on overdose awareness and naloxone kits are available, and people are offered screening for blood-borne viruses. Support plans for welfare benefits and housing support are also developed if they are needed. That joined-up approach has been extremely successful and should serve as a model for the rest of Scotland.
Unplanned discharges, in which people simply stop taking their treatment or attending services, can lead many people to spiral back into addiction.
I am interested in the use of buprenorphine, which has the advantage of being a long-lasting injection that requires only monthly administration. I understand that it is used primarily when methadone is unsuitable, but I wonder whether the minister and the Government plan to look into the possible advantages of using buprenorphine more widely.
Some progress has been made, but there is much more still to be done. We need to keep up the pressure to ensure that the momentum for change continues. I will certainly be doing that.
I turn briefly to alcohol misuse and the emerging evidence of the benefits of minimum unit pricing—a policy that is very close to my heart. If minimum unit pricing tells us anything, it tells us that, when we are bold and take risks with public health approaches, we will see the benefits. That is what we need to apply to the drugs issue.
It is encouraging that the Government’s policy on minimum unit pricing appears to be bearing fruit. The reduction in alcohol sales is welcome and, I hope, is one step on the road to resetting our relationship with alcohol. I am also encouraged by research that indicates that the health gains that are anticipated by a reduction in consumption will be greatest for those who suffer the greatest harm: hazardous and harmful drinkers in poverty.
Finally, I am encouraged that positive steps are being taken and by the apparent consensus that we have across the chamber to work together to tackle the issues and to take more radical steps in both drug and alcohol policies.15:37
I welcome the opportunity to speak once again in a debate on the escalating addiction crisis in Scotland. I wish that I had a little more time to get in all the things that I want to say. As other members have said, it is really important that we try to keep the issue outside the political arena and away from political posturing.
In tackling addiction issues, we must consider how we can ensure a person-centred care approach is taken to those who are caught in addiction, as the minister mentioned. However, we must also consider the long-term goal of preventing people from falling into the addiction trap. To be effective in those objectives, it is crucial that the causes of addiction are recognised and that we accept that there is no blanket policy or silver bullet. Everyone with an addiction has a unique story, so the treatment framework should reflect that.
The conference “A Matter of Life and Death” was attended by some 110 organisations that are associated with the prevention and treatment of drug and alcohol abuse, including the chair of the task force. According to the conference’s conclusions, the main causes of drug and alcohol misuse include: marginalisation and exclusion; a lack of social structure; poor relationships; lack of protective factors; self-medication associated with masking the pain of ACEs and previous trauma; stigma; self-deprecation; barriers to achieving; and homelessness. Deprivation and inequality make all those things more acute and can lead to a situation in which it is more likely that the person has an inability to access quality treatment and help, a lack of access to general community services, an unmet complex health need and a lack of an effective support structure.
During a round-table discussion at the conference, we talked about how we expect those caught in addiction to travel to a limited number of outlets to access their methadone or other medication. I found out that there is a bus that travels into Kilmarnock that locals call “the heroin bus”. To get their medication, people have to go to the town centre. The question was therefore asked, “Why not take the service to them?” I bring that suggestion to the chamber because not only could a mobile pharmacy make access easier, but it could offer many other services, such as testing for hepatitis and HIV, or even providing the blood test for stage 1 and stage 2 lung cancer, which is another of the big killers among those in the lower quintiles of the Scottish index of multiple deprivation. I am simply asking the question.
Once someone has a drug problem, they also have more limited means to escape poverty. The chances of obtaining paid employment are much reduced by problem drug use or being in treatment and recovery. Having a criminal record, the lack of an employment history and the stigma of having, or having had, a substance misuse problem all play their part. Therefore, it stands to reason that resource should be allocated prior to addiction—that has to be the most cost-effective investment. Simply put, we know the areas that have the most problems, so how can we ensure that solutions and investment are targeted at them? If there are fewer community resources in those areas, we should develop resources to fit the communities. The systematic demise of community assets has to stop, because it is at such facilities that access to activities and inclusion is likely to take place. I have said many times in the chamber that the school estate is massively underutilised, and it is there that we could create the community cohesion that is an essential element of prevention.
A couple of Fridays ago, I was in the Kilmarnock recovery cafe, which is open on a Friday between 5 and 7. It serves a three-course meal for £2 and is run by people who are in recovery. There were 74 people in the cafe and the overwhelming feeling there was one of hope. Here were people gaining control of their lives and their addictions—people with a sense of purpose and belonging.
Mark, who runs the cafe, would love to take that model out into the surrounding communities every day. He would like to offer a 24/7 service for those in need; indeed, he would like to offer recovery beds. However, like many third sector organisations, the cafe operates on a shoestring. Mark is applying for funding to expand the service, so I ask the minister why the Scottish Government does not partner operations such as the cafe. They are incredibly successful, and they are where the hardest-to-reach people will be.
There are many services out there for those in the social care or criminal justice systems, or for those who are on the periphery of those systems. We need to give access to such services to those who currently do not know how to access them or who are wary of services, and we need to do so in a way that suits their needs.
As a rule, addicts need an incentive to quit—an incentive to take the first step. When someone is sitting doing nothing all day and has little money and no work, and little means of getting work, a hit is an out from a bleak reality. I suggest to members that they listen to stories from the participants in the homeless world cup and think about how that opportunity for inclusion can be the incentive that is needed to get someone on the path to recovery.
A conduit to services such as the recovery cafe in Kilmarnock is required, because established centres are the most likely entry point for those who are not already in the system. I am arguing for better—
Will the member take an intervention?
Do I have time?
Only if you finish straight away afterwards.
Sorry—I need to finish this bit.
I am arguing for better, consistent funding for those established organisations. I am also arguing that they should be linked to existing services, which would be more effective for the service user, less expensive and have a far greater likelihood of success. Recognising their value in the system is crucial.
Once a person gets into the system via places such as the recovery cafe, there has to be continuing pathway of options, such as access to other specialised third sector organisations, with NHS services, housing advice and Department for Work and Pensions advice on site. I think that social services would be willing participants if we could free up resource over and above what they get for their current case loads.
The Scottish Government seems set on creating new solutions—especially solutions over which it has little control. I say to the Government that if it invests in solutions that are already working and connects those services in a cohesive and progressive plan, it might find that its influence over those elements that it deems to be outwith its control would be greatly enhanced. The Government should stop hiding behind elements of policy over which it currently has little influence and invest in the multitude of proven options that are within its sphere of control.15:44
I am pleased that the Government has brought forward a debate on such a vitally important subject this afternoon.
We must protect children and young people from the marketing of health-harming products, especially alcohol. As co-convener—along with Brian Whittle and David Stewart—of the cross-party group on improving Scotland’s health: 2021 and beyond, I was struck by evidence that showed that young people recall examples of alcohol marketing and can identify alcohol brands, and that exposure to alcohol marketing is associated with increased consumption, higher-risk drinking, susceptibility to drink and brand knowledge among young people. Half of the young people who were surveyed had seen at least 32 instances of alcohol marketing in a month—one or more a day. That is too high.
Further disturbing evidence came from a study that Alcohol Focus Scotland conducted in 2015, which found that 10 and 11-year-olds were more familiar with certain beer brands than leading brands of crisps and ice cream.
Alcohol marketing is particularly prominent in sport, as brands are often high-profile sponsors of major events that are viewed by millions of adults and children. It is easy to see why clubs are attracted to the income that alcohol sponsorship provides, but marketing drives consumption and harm and there should be no place for alcohol marketing in sport. Tobacco sports sponsorship was banned 15 years ago and it is now unimaginable for any high-profile team to be brand ambassadors for tobacco, so why is that acceptable when it comes to alcohol? I am delighted that Scottish women’s football rejected health-harming sponsorship. I wish that the wider sporting community would follow that admirable example.
Alcohol marketing reduces the age at which young people start drinking and increases the likelihood that they will drink, and, if they already drink, the amount of alcohol that they consume.
With its progressive approach to preventing alcohol harm, Scotland has led the way internationally and continues to do so through its current framework, the “Alcohol Framework 2018”.
Pioneering measures have already shown positive effects in reducing harm. As has been recounted, earlier this week NHS Scotland published research showing that, during the first year of minimum unit pricing, the amount of alcohol sold in Scotland fell, whereas south of the border, where there is no such policy, sales increased. Modelling shows that minimum unit pricing is expected to save 392 lives in the first five years of implementation. Health gains are anticipated to be greatest for those who suffer the greatest harm—hazardous and harmful drinkers in poverty.
We have long recognised that drink driving is unacceptable, and Scotland’s stringent road safety laws were further strengthened by the SNP Government’s introduction of drug-driving limits and roadside testing in October last year. A zero tolerance approach to the eight drugs that are most associated with illegal use, which include cannabis, heroin and cocaine, makes it easier to hold drug drivers to account, as there is no longer a requirement to prove that someone was driving in an impaired manner.
Behind every statistic on alcohol and drug-related deaths, there are people, families and communities who are deeply affected by tragedy. That was brought home to me last week at the North Ayrshire summit on drug-related deaths in Saltcoats, where I joined the emergency services, third sector representatives, councillors, drug-experienced recovery development workers and others who are dedicated to reducing drug fatalities. With speakers including Catriona Matheson, chair of the SNP Government’s drug death task force, the event was informative and, at times, very moving. Ordinary boys and girls were shown in everyday settings, such as school, play or home—they once had hopes and ambitions, but we were shown the devastating impact that their subsequent addiction and deaths had on their families and communities.
We face a drug deaths emergency. A reformed addict said to those who were gathered at Saltcoats that finding addicts is easy. Most live in ordinary homes and are registered as tenants or for council tax. Engaging them in services is the difficulty. For that to happen, it is crucial to recognise the often horrific, damaged lives that many endured as children, and to remove the stigma from addiction.
Naloxone has a key role to play. As part of a pilot scheme in Glasgow, ambulance paramedics are to give patients who are at risk of a drug overdose medication that could save their lives. Scotland’s drug deaths task force is funding the three-month take-home naloxone trial, in which people who are treated by paramedics for a non-fatal overdose and who do not want to go to hospital will be given a naloxone kit to take home.
I agree with Kenneth Gibson’s comment about naloxone and the ambulance service. Does he share my concern that the Scottish Police Federation appears reluctant for officers to be trained on naloxone use and that we need to see more progress in that area between the Scottish police service and the Government?
Yes, I agree with Monica Lennon on that. We were strongly advised that as many professional groups as possible that have direct contact with people who misuse opioid products should be trained on naloxone. That should include the emergency services, including, of course, the police force. I thank Monica Lennon for raising that important point.
Naloxone training will be given on how to use the drug, which can reverse the effect of an opioid overdose. The medication can also be used in the event of any future overdose before the ambulance arrives, reducing the risk of death—and of course the police are often first on the scene.
Five hundred kits have been provided for the pilot and, if successful, the measure could be made permanent and extended to other areas of Glasgow and Scotland. Having naloxone available can—and does—save lives. Around half of those whose death was drug related had also suffered a non-fatal overdose at an earlier point.
The SNP Government supports the embedding of naloxone provision in NHS board areas, and now works closely with local partners to ensure that naloxone provision remains a priority and is accessible to those who most need it. I know that there are people in North Ayrshire who would benefit from that life-saving measure. I look forward to the outcome of the pilot and to naloxone provision being widened, if—as I anticipate—the pilot is successful.
Harm reduction is vital, whether through the provision of clean needles or methadone, or through the three priorities that the European Monitoring Centre for Drugs and Drug Addiction advocates in order to reduce deaths. The first priority is the establishment of consumption rooms. There are 87 consumption rooms in operation across European Union countries, but UK Tory Government has set itself against them. The other priorities are improving bystander response when an overdose takes place and, of course, developing take-home naloxone policies, which I mentioned.
We should remember that an overdose of over-the-counter and prescription drugs—from pain killers such as paracetamol to sleeping pills such as zopiclone—can also kill. Indeed, the deaths of many high-profile celebrities—from Michael Jackson to Prince—were the result of an overdose of prescribed medication. It is therefore important that patients are made fully aware of the potential impact of overdose and that they are not provided with too many tablets in one prescription.
Come to a close, please.
As over-the-counter tablets are more difficult to manage, warnings should be made more obvious.15:51
I will focus my remarks on drugs, since we have not debated the subject in this Parliament since 2012.
I found the minister’s conduct earlier, in the form of his failing to engage with members who wanted to engage on this serious issue—one that has killed thousands of our constituents across the country—absolutely shameful.
Will the member give way?
Carry on, please do.
I want to make the point that—[Interruption.]
Excuse me—I am here. I call Joe FitzPatrick.
I am sorry, Presiding Officer. I will close the debate and I will be absolutely happy to take interventions at that point. I had a lot of information to get through in my opening speech. However, if Neil Findlay has a particular question for me now, I will respond now.
That is quite all right. The minister can hear the tone of the debate. I think that he can understand why people in the chamber are unhappy with his conduct.
I will make a number of practical suggestions for change that are based on my experience of speaking to people who have been through addiction; their families, who are desperate for help; and those who are trying to provide support in underfunded and underresourced services. The suggestions are theirs, not mine.
This is their list. First, we should follow what some of the most progressive police and crime commissioners are doing in England and Wales, where offenders who have been involved with drugs sign a contract to undergo mental health and other treatment, and that help is offered consistently to address their drug use.
Secondly, we should bring together police, community and public health funding to deliver practical outcomes for those who are in need. Thirdly, we should set up mental health teams in police stations—that was the top ask from the police officers I spent time with over the summer. Fourthly, we should allow drug users who have not responded to other forms of treatment to be prescribed heroin in a medical setting. Fifthly, we should, yes, extend naloxone. However, it must be funded, minister—the complaints that I get back say that the funding is not following it.
Sixthly, we must establish early warning programmes to alert people about new drugs or risky behaviours on the streets, so that we can intervene early. Seventhly, we must stop cutting alcohol and drug budgets, and invest in treatment and mental health services. In my opinion, a few years ago, a political decision—Mr Whittle—by the then cabinet secretary, Shona Robison, who has already spoken in the debate, to cut ADP budgets cost lives. It was utter fantasy, what the cabinet secretary said at the time about integration joint boards somehow being able to find some magic beans to fill the gap. That was a cruel fantasy that was peddled. I notice that Shona Robison took no responsibility for her actions when she spoke.
Eighthly, we should test ecstasy and other drugs at festivals, concerts and gatherings to reduce harms and deaths, and to educate users. At the Elrow Town music festival at the Royal Highland showground last year, Police Scotland issued a warning before the event. It said:
“Please remember that you will be subject to a search before entering the venue and if you are found to have ... drugs ...”
“may face a criminal record. We have detection search dogs supporting the operation who have very keen noses!”
That is not a harm reduction or education approach; it simply drives more risky and life-threatening behaviour. We need to stop criminalising and jailing people for drugs use and instead treat them. We need to take action on benzodiazepines and other antidepressants, with a long-term gradualist approach to reduce unnecessary overprescription and overconsumption where that is appropriate. We need to stop people being displaced on to the streets to take street versions. Last year, 6 million items of antidepressants were prescribed, in a nation of 5 million people. Prescription and street benzos are a huge problem.
I cannot disagree with a lot of what the member has said, but he has not yet got to the other side of the coin, which is about how we prevent people from getting involved in drug culture in the first place. That is a key element, too.
Mr Whittle mentioned in his opening comments that he does not want the issue to be politicised, but it has to be politicised, because it is the political choices that Governments make, such as austerity, that drive people into the poverty and inequality that result in the downstream effect of their getting involved in drug and alcohol use. Whether we like it or not, it is a political issue.
We must extend the provision of mental health crisis centres such as the Penumbra one in Leith, which provides emergency crisis accommodation and a safe place for respite. That is the only one of its kind in the whole of Scotland. We need a network to be rolled out across the country. We need to get people off the streets and into accommodation with support. The HIV outbreak in Glasgow predominantly affects homeless drug users. We need to stop discharging people from hospital on to the streets with nowhere to go and no follow-up care—and, by the way, that includes people with any condition. We need to stop allowing people to drop out of the treatment system, because they are the ones who are most at risk of death.
We need to end the cuts to youth work, housing support, community education, voluntary sector funding and social work. All those cuts impact on the drugs crisis. Those services are the ones that civilise us as a society, and it is no surprise that the number of drugs deaths has increased as those services have declined. We need to extend projects such as Aid & Abet in Edinburgh, which works with offenders and young people, and we must provide the residential rehab that members have spoken about. People with deep pockets can go to the Priory to get intense successful residential treatment for their condition. We need the same for people without deep pockets.
If this crisis was impacting on cattle, sheep or chickens, or if it was affecting the people of Morningside, Bridge of Allan, Jordanhill or Bearsden, things would have changed a long time ago. However, it is not; it is a crisis affecting the homeless, the poor and people in housing schemes and in former industrial towns and villages across Scotland. It affects the weak and the vulnerable—people who it is easy for politicians and those in power to ignore. It is a class issue, and it is to our collective shame that good, decent working-class families are being failed by the system.
All speakers so far have gone over time, so we are running short of time. Speeches should be of absolutely no more than six minutes from now on.15:58
Too many friends, family members and neighbours have been lost to an avoidable early death caused by substance misuse. We are all impacted by problematic drug and alcohol use, and it is in all our interest to work together to prevent and reduce harm and to support recovery.
In 2018, 38 lives were lost in North Ayrshire as a result of drugs, and it is expected that the figure will be higher in 2019, so I will focus my remarks on drugs deaths. No one person, Government or organisation and no single intervention can end this tragedy of preventable and avoidable death. It is a tragedy. It is right to ask whether our collective response would be quicker and better if the same number of accidental deaths or poisonings was being caused by something else. In relation to the actions that we are taking, we need to ask that question of ourselves and of our Governments, IJBs, ADPs and health boards. If we are serious about the lives of those at risk—I believe that colleagues in the chamber are—we must show by our actions as well as our words that the lives that we are talking about are important and worth saving.
What Scotland faces in terms of drugs deaths is an emergency. I welcome the Scottish Government’s acknowledgement of that and its recognition that more can and must be done to improve the quality and provision of our services.
To save lives and prevent avoidable deaths, we must meet people where they are. We must treat all individuals with dignity, compassion and respect, and without judgment. We must do everything in our power to make things safer, using policy and practice for which we have evidence that they work. Harm reduction is important.
Yesterday, I was pleased to welcome the Scottish Government’s announcement that the drug deaths task force will support a three-month trial that will provide 500 naloxone kits to the Scottish Ambulance Service. The Scottish Ambulance Service already responds to many potentially fatal opioid overdoses by directly administering naloxone to reverse the overdose and save a life. The additional step of supplying take-home kits is very positive.
In 2019, 514 naloxone kits were handed out in North Ayrshire, and it has been reported that 45 lives have been saved. North Ayrshire Council is training additional community development staff to administer the life-saving drug—action that should be commended.
I thank Scottish Families Affected by Alcohol and Drugs not just for its good work but for its briefing. I add my voice in support of the asks of its family reference group. It considers naloxone to be a critical part of saving lives and asks that all workers coming into contact with individuals who are at risk should carry naloxone and be trained in its use. I agree. Police, the fire service, the Ambulance Service, housing and homelessness workers, and primary care and pharmacy services are all well placed to save lives.
I understand the reticence that some non-healthcare workers may have felt previously, as it used to be the case that naloxone had to be injected, which caused some concern. However, there is now a nasal application, which I hope removes that barrier. Those tasked with protecting lives in Scotland can also be life savers.
Although I recognise the need for local flexibility, I also concur with the ask that any postcode lottery in provision is removed. If housing officers in Ayrshire can save lives administering naloxone—and they have—those skills, procedures and processes should be replicated across Scotland. The sharing of knowledge, skills and best practice is essential. If drop-in access and same-day prescribing can be offered and work in one part of the country, that absolutely should be replicated elsewhere. It should not be easier to buy dangerous street drugs than it is to get safe treatment.
Truly person-centred treatment will meet people where they are, recognise the barriers that are in their way, and remove them. Providing same-day, flexible drop-in appointments along with scheduled appointments seems sensible. We must recognise that systems that work fine for one group can actually disadvantage others.
My party and others have rightly made much of the damage that punitive sanction regimes in the benefits system exact on people, so I was horrified to learn that they might be part of the system of drug treatment. That should be stopped immediately. Withdrawal of treatment for missing an appointment is outrageous. It does not sound person centred—that is me being kind—and it is not empowering, kind, compassionate or respectful. I know that the minister has those values, so I ask that he shares in his closing speech what action he will take to end the practice of punitive sanctions in drug treatment.
Lives are being saved and services are being delivered now by kind, compassionate, professional workers who share our pain and distress at the rising number of deaths. Importantly, we also have in our communities people who are in recovery who are supporting their peers to have hope and purpose in their lives. Let us listen to them, let us learn and, most importantly, let us act with urgency and immediately make the changes that we know will save lives—lives that are worth saving.16:04
In 2016, I gave evidence at a drug death inquiry for a young man who was just 16. During that evidence session, we talked a lot about what needed to change, what we could do and how we could do it.
The problem is that we have not done it, and we need to move forward.
I am going to talk about drugs, but I include alcohol in what I am about to say because alcohol is the drug that is most abused in this country. It causes the most deaths and the most problems, so let us talk about alcohol and drugs together.
To address drug and alcohol problems, we need to understand that the first thing that people need to be is motivated to change. The day that a person decides that they want to change, services must be available to them. It is no good if someone rings up a service and is told that they will be put on a waiting list and will be seen in three, four or six weeks. They need to be seen that day, because it is on that day that the person is in the right place to address the issues that they face.
Services have to be funded properly and available when and where people need them.
I know that the member has a very strong background in this issue.
Does she share my view that it is time that we implement a social responsibility levy on the windfall profits of large alcohol retailers, so that more alcohol treatment centres can be funded across Scotland?
The member has missed one thing in his intervention. Many alcohol retailers already fund a lot of treatments. The Robertson Trust is a huge funder of treatment and support. The service that I was part of received a lot of money from the Robertson Trust, and all that money came from alcohol sales.
We have to be careful that we do not use a penal approach when we are already getting a lot of services. In fact, Diageo offered me a lot of money to put support services in schools. It was the education system that told me that I could not use money from alcohol sales to support a system in schools that would prevent alcohol abuse. Some things do not tie up well; we need to be very careful about how we look at that.
There are a couple of things that have been interesting in the debate. One of those is that we need to recognise that substance misuse is a symptom of other problems. If we understand that properly, we are more likely to be able to change things. We have to address the things that lie underneath substance misuse.
Many years ago, when I was developing services, one of the things that became very stark is that we could almost not talk about drugs and solve the problem. What we have to talk about is what people’s vulnerabilities are, why they have low self-esteem, the ACEs that have affected their life, the loneliness and the peer pressure. Those are the things that we need to get a handle on.
One thing that has been absent in this debate—which has been largely consensual, but action still has to be taken—is the fact that the Scottish Conservatives’ wider UK party has taken billions of pounds out of the welfare system that so many of our most vulnerable citizens rely on. Michelle Ballantyne must agree that that is having an impact.
I was working in the drug and alcohol system before the changes to welfare took place, so I know that it is not as simple as that.
The problem with substance abuse is that it crosses all boundaries. I heard very clearly what the member said earlier about how it affects only working class families. I can tell her that it absolutely does not—it crosses all boundaries. However, we have to bear in mind that quite often the substance abuse comes after the poverty. Drug abuse does not cause homelessness; homelessness often causes drug abuse. There are definitely connections; we need to be aware of that.
I want to talk about effective treatment, because that is really what we are considering. What is effective? First, there should be early intervention and prevention. We absolutely need to upstream some money to talk about early intervention and prevention. We need to ensure that young people are not taking steps down the route that we are trying to prevent them from going down. We need to ensure that their esteem is high, and that they value themselves. We need to ensure that they get a good education and have opportunities, so that they do not end up going down the route of drowning their sorrows.
We also need to recognise that more than two thirds of children who live in substance-misusing households will go on to misuse. Therefore, if we park people as productive drug users and accept that a methadone programme is okay for them—year in, year out—we are confining their children to becoming substance misusers down the line.
Methadone was introduced to titrate people off drugs. It was never meant to be a long-term treatment. Last week, I was sitting down with a drug user at the food bank. He has been on methadone for 11 years, and he has lost his house. He said to me, “Well, I need to get a job first. I’ll need to get housing and then I’ll look at my drug misuse.” There is some sense in that, and the housing first programme is a positive move, in that we need to get people into stable positions so that we can address their problems.
Please come to a close.
I will quickly mention rehab beds. One of the problems with rehab beds is that quite often they are in psychiatric units. That is not appropriate; they need to be in appropriate places. I took a young person to a rehab bed—
You must come to a close.
They could let anybody in. They could not restrict who arrived, and guess who arrived on day 2—their drug dealer. We have to think carefully about what we do and how we do it—that is my plea.16:10
I know only too well the blight that the drug deaths crisis has had on the communities that I represent, and how it has destroyed too many families and unfairly stigmatised too many communities. Communities that are blighted by drugs are not second class or third rate—they are dignified and resilient, but they need all our help.
I welcome the pilot of the use of naloxone, which was announced yesterday by the minister, in Springburn in my constituency. As we know, the Scottish Ambulance Service will now not just use naloxone to seek to save those who suffer a heroin overdose but, crucially, it will also provide naloxone kits to survivors and their families and train them on how to use them should another overdose occur. I am confident that that is the right thing to do and that it will save lives in my constituency and beyond, and I welcome it.
One of the main risk factors for dying of an overdose is an earlier non-fatal overdose. As Shona Robison said, we must ask what support is available for those vulnerable individuals following a near-fatal overdose, not just wait for the next one. We must ask what interventions there can be at that point.
We know that addiction services are under strain, and that that makes it far more difficult to offer the personalised approach to supporting those in addiction or seeking recovery, which the minister referred to and which we all support. Of course that has to be addressed.
I want to make sure that any strategy that we have, such as the three-month naloxone strategy, is quickly rolled out. I think that, intuitively, we all know that that will be successful. I make the point that it is not just about doing the right thing; it is about the pace of delivery.
I will say a bit about the pathways to recovery, preferably before people get to the stage where they are overdosing on heroin. I will talk about rehab beds, which are one way to recovery. I saw an interesting comment on social media ahead of this afternoon debate, which was a challenge to the Scottish Government. The essence of the comment suggested that we should conduct research into the impact of the fall in the number of rehabilitation beds and related services for those living with addiction.
I have a suggestion for the minister on how to conduct that research: identify some key locations in Scotland, including Glasgow; secure additional rehab beds—of course we need more—and ensure that those beds are fully funded; and work with those who deliver services and those who have lived experience to jointly agree a suitable referral pathway, to allow those seeking recovery to secure those beds in the most sensitive and appropriate way.
That is quite similar to what we are trying to do in relation to housing first—I hope that it will be revolutionary—in providing wraparound support at the earliest point.
Will the member take an intervention on that point?
Do I have time, Presiding Officer?
That is up to you, but you cannot go beyond six minutes.
In that case, I apologise to the member for not taking the intervention.
There is a political consensus in the chamber that we should have additional rehab beds, whether we put numbers on it or not.
There is political consensus in the chamber that we should see funding increases, even if we are not necessarily putting numbers on that. That political consensus exists, but the time that we need it is when the Scottish Government sets its budgets. We all know the political reality in that regard: a minority Government has to make deals and accommodations.
When those deals are being made, lots of demands will be made by every party—that is the stuff of politics. I say to my Government and to all the Opposition parties that, if we are to have a national consensus on this, we should make sure that the absolute deal is about more money for addiction services and for rehab beds. However, parties should not then find an excuse for not supporting the budget. Let us try to come together as a Parliament to do that.
Will the member take an intervention?
I am sorry, but I do not have the time.
I will say a bit about the enhanced drug treatment service in Glasgow. Starting it was another positive step; up to 50 people who are drug addicts are using medical-grade heroin and are getting additional counselling support, housing support and benefit support. It is great that the programme is happening, but it is far too small and is just a drop in the ocean.
I have not been party political during the debate and I do not want to start now, but that approach surely has to be a precursor to having safe consumption rooms. Turning up twice a day, seven days a week to take part in that programme ain’t gonnae happen for many vulnerable people. Let us build up trust with those people who sustain their drug use and get them into recovery by having safe consumption rooms, whether through the powers of the Scottish Parliament or with the approval of the UK Government—let us just do it.
Let us have a drugs summit that looks to see what we can do in the Scottish Parliament and at a UK level to improve the lives of those whose lives have been blighted by drugs. We should come together and do that. Can we also have people from the faith-based community involved in the drug deaths summit? I think that that is important and I suggest that the Rev Brian Casey from Springburn would be well placed to fulfil that role.16:16
Nobody thinks, or is suggesting to the minister today, that this problem is easy to solve. The minister and I come from the same city and we both know that the problem has been building up over many years and has blighted the lives of people with whom we grew up and went to school. The people in our communities do not think that there are easy answers to the problem either, but they know that what is happening now is not working and that we need to try different things. There has been huge delay, though, which is what I will talk about in my speech.
We cannot deny the scale of the problem. Scotland has the highest drug death rate in the world and no amount of hyperbole in the chamber will ease the pain of mothers and fathers across Scotland watching their children’s lives wasted away by drugs. In August last year, the Dundee drugs commission published its report. It was a challenging report, which is written by families and experts after lots of evidence and consideration, and it published 10 immediate recommendations. Nearly six months later, very few of those immediate recommendations have been implemented—I think that there has been initial progress on one. We hear that work has started, but there are few concrete steps forward yet. The situation is urgent, because drugs workers in our city and across Scotland predict that the tally of drugs deaths in Dundee and Scotland will rise again this year.
Why have those recommendations not yet become reality? I believe, after talking to drugs workers and commissioners in the city, that the institutions that exist to treat and support drug users are not flexible enough and are lacking the leadership that is required to drive the changes through. For instance, one of the immediate recommendations in Dundee was to try to bring together drugs and mental health services, but nobody has been appointed to oversee that work. How can that change happen if no one person is tasked with driving the change?
We know that the national task force is doing its work, but I ask the minister whether he is not satisfied with some of the suggestions that have already come forward, for example from the Dundee drugs commission. How long can we wait to start trying new things, new ways of working? How long must the conversation and analysis go on, given that much of it has been said and done already and that people believe that there are workable solutions already on the minister’s desk?
I will give an example. Problem drug users in Dundee are known locally as ISMs—that is a reference to the integrated substance misuse service, the drug centre where patients are referred to a psychiatrist. The minister already has evidence on his desk recommending that that high-tariff, expensive way of treating patients is not always necessary. One recommendation is that more drugs workers on the ground working with families in their homes and encouraging people into treatment would be a more effective use of some of the money that is spent on that service.
Will the member take an intervention?
Not right now. Sorry.
We have 10 recommendations for immediate action from the commission. What exactly are we waiting for? We do not have time to wait, and I will tell members why. Recently, I had a stark reminder of the situation in Dundee, when I heard about a young girl who was taken into care after her dad died of drug use. Unless we take radical action to stabilise the lives of men and women my age who have children, we will have more and more children left without parents in our city and across our country, with all the subsequent trauma and vulnerability in their lives, including vulnerability to addiction, that that brings.
An important debating point, which has also been an important life-saving matter in Dundee, is same-day prescribing. I was interested to hear Shona Robison say that that has been fully implemented. That is not my understanding. I understand that a very small group of people are still part of a test for change. However, the clinically qualified commissioner on the Dundee drugs commission said that that test for change is not necessary, because the clinical evidence for same-day prescribing already exists. Indeed, same-day prescribing happens in Lothian. Therefore, at best, we have a huge and unnecessary delay to implementing that life-saving policy in Dundee.
The involvement of that small group of people allows the Dundee partnership to say that it is making the required changes. However, the Dundee drugs commission said clearly to the minister that the real change will come when faster access is achieved, same-day prescribing is available across the city and GPs are involved. None of that is happening. The change will happen when people who present and are willing to get treatment, can get that treatment in two, three or four days, rather than, as Michelle Ballantyne said, the weeks and months that the majority of people in Dundee must wait.
I take the opportunity today to recognise the work that my colleague Monica Lennon has done on the delays to forensic toxicology reports. She has told us about the heartache to the families. That is the most important point. However, another consequence of those delays is that the police cannot track day-to-day or week-to-week trends in drug consumption on our streets and in our homes, which would allow them to know and prevent what is happening. We must consider that aspect, too.
My remarks have focused on the delay and the continual conversations that are delaying much-needed action. I urge the minister to do a desk assessment on Monday morning of all the recommendations that he has received and just try to get on with some of them. I also call on the minister for more debating time on this topic in the chamber. We have not even scratched the surface when it comes to the issue of drugs, and we have given only a small amount of time to discuss alcohol. We need at least a month to debate the issues, so having a week would be very welcome.16:23
I welcome the Government bringing forward this debate because, as we have heard today, there is no ignoring the fact that we continue to face a public health emergency. The number of drug-related deaths increased by 27 per cent in 2018; it has more than doubled in the past five years. Let us be honest: we must also take into account the likelihood that that number misses many deaths from suicide, illness or infection related to drug use. However, I can confidently stand here and say that the Government takes the problem seriously, as we have been hearing, and has undertaken a wide range of actions to address the issue and, ultimately, to decrease the number of drug-related deaths.
As has been mentioned, a dedicated task force has been set up to recommend steps that will reduce the harms that are caused by drugs. I am delighted that the Scottish Government has invested almost £800 million to tackle problem alcohol and drug use since 2008.
I highlight the importance of a report by the Scottish Affairs Committee, which strongly suggests that we should amend the law to allow a range of response that are public health focused. It outlines evidence to show that the UK Government’s current approach to drugs is not evidence based and is therefore ineffective. The Scottish Government will continue to urge the out-of-touch Tory UK Government to take action as quickly as possible and to provide the most adequate solution for the problem, which is to devolve power to Scotland.
Will Fulton MacGregor give way on that point?
Not at the moment.
The UK Government routinely accepts recommendations that are in favour of tightening drug law but rejects those that are in favour of liberalisation. Drug abuse is not simply a criminal justice matter; there is an array of evidence to show that criminal justice sanctions are counterproductive. That was my experience as a social worker and I worked in the criminal justice sector for some time, which I have spoken about before.
We need to take a health-based approach. One of the most important and simple steps that the UK Government could take right away to reduce harm is to end austerity. It is really quite simple. I respect where Brian Whittle is coming from and I know that he always gives a measured response in debate. He said that we should be looking at the issue on a non-political basis, but I do not see how we can do that, because austerity is the root of much of the problem.
Given that I have mentioned Mr Whittle, I will take his intervention.
If we are going to bring politics into the debate, will Fulton MacGregor explain to me why, with the same rules applying around the whole United Kingdom, people in Scotland are three times more likely to die from drug issues than those in the rest of the UK? How can that possibly be laid at the feet of Westminster? It is time to take control of the issue up here.
I did not say that the blame should all be laid at the feet of Westminster; I said that austerity was having a major impact. In response to Brian Whittle’s question, I note that austerity is having a disproportionate impact on Scottish communities, which perhaps has led to the figures that he suggests. Ending austerity is something that the UK Government could do right now.
As we have heard from many members, there is overwhelming evidence to show that having places where people can consume drugs in a safe environment with sterile equipment while being supervised by medical staff reduces overdoses and lowers rates of infection. It is shocking that the UK Government continues to block that idea, with places such as Dundee, which we have heard a lot about, and Bob Doris’s constituency in Glasgow continuing to suffer, despite overwhelming evidence that similar facilities in Portugal, Germany and Canada have reduced the amount of drug-related deaths.
Will Fulton MacGregor take an intervention?
Will Fulton MacGregor give way?
Do we have a double act here? Make up your mind, please, Mr MacGregor.
I give way to Stuart McMillan
I remind members that I am on the management board of Moving On Inverclyde.
Does Fulton MacGregor agree that, although Miles Briggs commented that we should have everything on the table and discussed, the Conservatives do not want to discuss that particular policy which, sadly, will continue to have a negative effect on Scotland?
I agree. We need everything to be on the table, which I think was the point that Brian Whittle made.
Tomorrow, I will visit the North Lanarkshire addiction recovery team, which is based at Coathill hospital in Coatbridge in my constituency. I have heard great things about that new service and I am looking forward to seeing the support that it offers to those in my constituency who are living with addiction. The service offers a range of interventions that support people to make changes to their lives that can improve their physical, mental and social wellbeing. It is vital that we all support such services to be the best that they can be in tackling this important issue.
The minister and his officials will probably be sick of me again mentioning the fabulous Reach Advocacy Scotland charity, which is based in my constituency. I had planned to say a lot more about the fantastic work that it does in the local area and around Scotland, but I realise that I am running out of time.
We need to think outside the box. I am looking at Monica Lennon and her colleagues in the Labour Party, because we are in the process of getting a new hospital in the Monklands area and there is a discussion about what we can do with the current site. I say to colleagues in the Labour Party that we should have a discussion about what we can do to meet the needs of the area. Perhaps we could have a drug and alcohol rehabilitation service where the current hospital is, instead of focusing on using the site for the new hospital. As I said, we need to think outside the box.
Monica Lennon rose—
No, Ms Lennon.
I appreciate that I mentioned Monica Lennon’s name, but I will not have time to give way. I apologise about that.
On that note, Presiding Officer, I will close.
I am glad to hear it. Ms Harper, I have to cut your time. I can give you five minutes.16:29
Thanks, Presiding Officer. The joys of being last in the open debate.
Too many fathers, mothers, brothers, sisters, sons, daughters and friends have lost their lives from harm caused by drugs and alcohol. I appreciate the detailed speeches that members across the chamber have made in the debate. In my speech, I will focus on some of the work that I have been involved in locally in Ayrshire and Dumfries and Galloway and nationally as deputy convener of the Health and Sport Committee.
Dumfries and Galloway is a large rural area that has many unique challenges with regard to helping people who are affected by drug and alcohol addiction to access support. Rural challenges need to be included in future policy. I have met Justin Murray, who is leader of NHS Dumfries and Galloway’s drugs and alcohol service at Lochside in Dumfries, a few times now, and we have discussed some of the challenges that are faced both by those who live with addiction and by his service, and what could be done differently.
I was interested to hear that an estimated 1,100 to 1,600 of D and G’s 148,000 residents have problems with drug use and that, although more people are accessing the drugs and alcohol service, there was a 30 per cent drop in the number of needles that addiction services handed out to those with addiction last year. That means that fewer people were injecting heroin or other injectable drugs than in previous years.
Justin Murray has done some research that shows that many of those people in D and G are moving away from heroin and other injectable drugs and are changing the way that they acquire substances. Previously, people contacted their local dealer, who would then either meet them or deliver the drugs by taxi. Many people are now ordering their illicit substances online—on social media or the dark web—and having the pills, including Xanax, which is a powerful benzodiazepine tranquillizer, delivered to their front door by mail.
Information that has been released by BBC Scotland shows how significant that issue is. Its investigation showed that, in the south of Scotland between 2012 and 2017, controlled substances were recorded as the cause of death on 70 death certificates, while heroin or opiate addition was recorded as the cause of death on 51 death certificates. It is interesting to note the difference in those statistics.
The worry for Justin Murray—I ask the minister for a reassurance on this—is whether people who suffer from addiction in rural locations such as the south-west are absolutely on the Government’s radar and will be looked at as part of the new addiction pathway.
Last year, along with my Health and Sport Committee colleagues Dave Stewart and Brian Whittle, I took part in the Westminster Scottish Affairs Committee’s inquiry into drug deaths in Scotland. Its two key aims were to better understand the causes and reasons for drug addiction and drug deaths in Scotland and to recommend action that could be taken to better address drug deaths.
The inquiry heard evidence from numerous experts across drug and alcohol services, including clinicians, academics, counsellors and those who have lived with addiction. The findings were unanimous and clear, and there were some recommendations on what we need to do in order to truly address the issue. The recommendations, which are also based on international evidence from Spain, France, Italy and Canada, include decriminalising small amounts of drugs for personal use, allowing the establishment of safe consumption rooms and, importantly, treating drug addiction as a public health issue and not as a criminal issue. I encourage members to read the inquiry report, because it was helpful for me.
I will briefly mention a project that I have been working closely with in my South Scotland region.
Will the member take an intervention?
I am sorry, but I do not have time. I have only five minutes because other members went over their time.
River Garden Auchincruive, near Ayr, is a really important place. I visited it with the minister last year and I will be there again soon. It is a great example of work to tackle drug and alcohol harm and help people who have experienced it. The residents start by engaging in a three-month programme, which becomes a three-year programme. They are provided with accommodation, a job and pay. They live on site and work, planting seeds, growing their own fruit and vegetables and nurturing them through the seasons. That is really important. They then use the fruit and vegetables in the on-site cafe, which is open to the public. That helps to reduce the stigma that members have mentioned, including Alison Johnstone. The whole place is supportive of a model that is effective for recovery, and evidence from the San Patrignano community in Italy has shown that that model is worth continuing to support.
Presiding Officer, I know that I am out of time. I thank the Government for pursuing the topic and taking action, and I look forward to the closing remarks.
Thank you very much for cutting down your speech. Time is very tight for the closing speeches. I call Alex Cole-Hamilton for no more than six minutes.16:35
Thank you very much, Presiding Officer. Unsurprisingly, the debate has been very full, involving a lot of empirical evidence, many suggestions and much consensus across the chamber. That is unsurprising because seven years have passed since the Government last used its time to debate the absolute human crisis in our public health sector.
So that we do not have to wait another seven years for a Government debate on the subject, does the member agree—and perhaps the minister can refer to this in his summing up—that we should have an annual debate, in Government time, around the publication of the drug death statistics?
I thank Neil Findlay for his intervention; I would like to associate myself and my party with his exceptional idea.
I start by addressing my amendment; I apologise for forgetting to move it earlier. I know that the Government is nervous about the precise wording of my amendment, in relation to the diversion into treatment and away from prison of people who are caught with drugs that are for personal use.
I do not believe that that would step on the toes of the Lord Advocate. Neither is it my intention that the amendment be prescriptive about how we achieve the suggested new policy position; I do not think that we should interpret it in that way. However, what is needed first, and what we have yet to receive, is the Government’s political support for the policy and the principle of diversion. That would require the Government to say that it backs the new approach to people caught with drugs for personal use. It would also require ministers to ensure that diversion services—the treatment and education that people would receive instead of going to prison—are in place.
Section 12 of the Criminal Procedure (Scotland) Act 1995 says that the Lord Advocate can issue guidance to the chief constable about how police officers deal with such situations, but surely he would not do so without guarantees about other alternative support services, or indeed without ministers having voiced their support. That is the intention of my amendment today, and I ask the Government to support it.
The minister’s opening remarks were wide ranging. He covered in granular detail the role of the task force. I have met Professor Catriona Matheson. I do not doubt her credentials, nor her passion. However I am anxious that the Government may not act on the task force’s recommendations. I ask the minister to make a cast iron commitment that, in so far as it is within the Parliament’s competence, the Government will take action based on the evidence of the expert task force that it has established.
I am grateful to Miles Briggs for developing the argument about the link between childhood trauma and drug and alcohol use in later life. They are inextricably linked. What is more, we know that no one is beyond hope of healing from those. Even elderly citizens, traumatised and damaged by events that happened even half a century ago, can be helped to heal. I echo Mr Briggs’s comments about the need for investment around the debate on child and adolescent mental health, and in adult psychiatric services as well.
Monica Lennon was right to link the drugs death crisis to the HIV epidemic that started in Glasgow in 2015 and is still growing. When those vulnerable groups were facing an outbreak of a horrific and highly-contagious infection, this Government cut funding to the services that were fighting to keep them alive.
HIV is just one of the co-morbidities associated with intravenous drug use. I am grateful to Alison Johnstone for raising the prevalence of undetected hepatitis C in our drug-using population. It is incumbent on us all to get people to come forward to be tested and into treatment. It need not be a life sentence.
I intervened in Shona Robison’s well-delivered speech that came from the heart; her community is suffering more than most as a result of the crisis. I was dismayed that, even now, some two years after she left ministerial office, she cannot accept the damage that has been caused by a budget cut that amounted to a quarter of all funding. She stated that we need to identify what works, and then fund accordingly. It is hard to identify what works, when a third of the staff are on notification of redundancy.
We have heard several helpful suggestions during the debate. Brian Whittle’s suggestion of a mobile pharmacy bears further consideration and Neil Findlay made an important point about linking up police, community and public health funding and bringing them together in the same space so that we are all working in the same direction. Mr Findlay spoke with typical passion on the issue, on which he and I have worked together closely over the past four years; his indignation was righteous and evidence based. It was also right to move the debate on to the issue of benzodiazepines and barbiturate prescribing. I share his perspective on the abject health inequality attached to that issue. I also share some common ground with Michelle Ballantyne on the issue of being parked on methadone. It can be a twilight world. It is a short-term solution for stabilisation, but it can become a life sentence.
If we are to answer the challenge that was held out to us by Jenny Marra—another MSP who has worked tirelessly on the issue for her constituents, who are perhaps blighted by it more than most—that the number of drug deaths is likely to rise, year on year, without further action, we cannot wait another seven years for another debate on the issue.16:41
I think that we all agree that the time available today has been limited and that we need to have a further discussion like this very soon. Reflecting on today’s debate, I think that we all agree that actions speak louder than words. However, there is a word that needs to be said, which was missing today. That word is “sorry”.
We are sorry that we did not respond to the pain, despair and hopelessness of mother, father, husband, wife, partner, son, daughter, brother, sister, grandchild or friend—some people have lost a number of those people; sorry that we did not see you or listen when you were desperate for our attention, when you were searching for that fast track into treatment or for a safe place that is free from judgment and stigma and for your rights to be respected; and sorry that we score points while you count the dead.
Collectively, we did not act on the warnings, which led to confirmation last summer that Scotland now has the highest rate of drug-related deaths in the world. Alcohol-related deaths also remain at historically high levels; we did not have enough time to discuss that issue fully today.
As everyone has said, we need urgent, nationally co-ordinated action that will lead to an immediate reduction in the devastation that is being heaped upon thousands of Scottish families each year. Jenny Marra is right that the recommendations are sitting on the minister’s desk, but the same also applies to UK ministers. Announcements in recent days, particularly on naloxone, are positive. Overall, however, we are light on action and delivery.
Outcomes are not improving. We have heard members talk about their own areas—Ruth Maguire talked about rising numbers of drug deaths in North Ayrshire—but we are seeing pockets of strong leadership in such areas. I pay tribute to Councillor Louise McPhater, who is in the gallery, for her drive and courage. Sadly, Louise lost her beloved sister to a drug-related death. Together with Councillor Joe Cullinane and, indeed, the full council in North Ayrshire, she is giving serious attention to preventing and reducing drug harm in their communities.
Bob Doris mentioned the Rev Brian Casey, who welcomed many of us to Springburn parish church in Bob’s constituency. The recommendation that the minister should involve the Rev Brian Casey in the task force was a good one. The visit to Springburn was very poignant. We walked through the streets on a Friday night with candles, behind a group of mothers and grandmothers. Later, inside the church, we could see the grief, worry and loss etched into their faces. It was absolutely heartbreaking.
Many colleagues mentioned the importance of reducing alcohol harm. We heard from Kenneth Gibson, who has done a lot of work in that area, and from Alison Johnstone. There were also some good interventions: David Stewart reminded us that we have a social responsibility levy on the statute books and we should use that, and Jenny Marra suggested plain packaging for alcohol.
I know that Fulton MacGregor did not have time to take my intervention. I would be happy to consider anything in our area of Lanarkshire that would help people in their lives. My immediate concern about the situation in Lanarkshire relates to my inability even to get an out-of-hours emergency phone number for a family who told me that their son had been in hospital, had attempted suicide and was addicted to alcohol and street valium, and that they did not know what to do. I had to sit in NHS Lanarkshire’s headquarters for 40 minutes to beg for a phone number. So overstretched is the organisation that it was reluctant even to give that phone number to a member of the Scottish Parliament, in case I shared it with others. We cannot be in that situation. That is why I said earlier that I am frightened.
Is Monica Lennon hopeful, as I am, that the new drug and alcohol service that is being set up by NHS Lanarkshire will help to alleviate some of her concerns about the experience of her constituents?
There is no point of disagreement between me and Fulton MacGregor on that, but I would be happy to speak to him for longer after the debate.
There is not a lot of time left. I am mindful of the fact that today is young carers awareness day. We have talked about families; we must talk more about the impact on young people, particularly young people who might be caring at home for relatives who have alcohol-related brain injury, an issue of which there is very little awareness.
Earlier, I made a point about the need for the entire Scottish Government and the entire Cabinet to take action in this area. I would have liked ministers who have responsibility for education, housing, communities, justice and finance to take part in the debate. I strongly believe that it cannot be left to the health team alone to address the issue. If we are genuine about making trauma-informed responses and understanding adverse childhood experiences, we must have a joined-up approach.
I welcome some of the progress that has been made and the positive reports that we have had. Brian Whittle asked us to avoid political posturing on the issue. I agree, but we cannot escape the fact that there are political choices to be made.
I have not yet received an invitation to the UK-wide summit that is coming to Glasgow; I do not know whether any member has received one. However, I think that we all want to be there, so perhaps the Parliamentary Bureau could suspend Parliament that day so that we can be there with as many of our constituents as possible. We must take action, and we must do so now.16:47
I have listened to all the contributions in the debate, and I am glad that we are finally taking the time to talk about drug deaths at length in the Parliament.
Some in here have said that we do not have the powers to tackle drug deaths. Out there, in the real world, some will say that we do not have the will to do it, and no wonder—the power of this Parliament has not been used.
FAVOR Scotland started a campaign with the simple message, “You keep talking, we keep dying.” That message is bold, powerful and in your face, and it is absolutely spot on. That phrase should make everyone stop and pause. In 2018, 1,187 people died from taking drugs. Who knows when we will find out how many died in 2019?
I can walk along my street and point out the houses where families have been torn apart by drugs. When I have gone to events organised by FAVOR in Springburn and Possil, I have felt humbled standing in those rooms, knowing that I had even the tiniest opportunity to change things.
We must use the powers that we have as MSPs to make a difference here and now. The Parliament can act. We can give people hope. If we all agree on the need for more rehab beds but we do not vote for that, people should never forgive us. Does anyone in the chamber think that we should not provide more rehab beds? I will happily take an intervention on that point.
I think that we all support further capacity and investment in rehab. However, as I explained, we cannot support the Conservatives’ amendment because they have brought politics into the debate and have put down a red line. Their amendment would delete a substantial part of the Government motion because they do not want to consider the responsibility of the UK Government. That is not the right way to approach the issue.
We will continue to argue and make the case for that additional funding, which might need to be more than £15.4 million. We will not take any lectures on that point.
I would say that I was grateful for that intervention, but actually I am quite disappointed by it. I do not see why we cannot all agree on this topic. I will come to the other points that Monica Lennon raised at the end of my speech.
Will the member give way?
No, I will not. I need to make progress.
The Conservative amendment calls for money and rehab beds—that is it. If we cannot unite to back that, I am at a loss. Are we going to sit here and pretend to be a Parliament or are we going to act like one?
We go round in circles on some of the issues. I have heard members from several parties talk today about decriminalisation. Many of the contributions are sincere, but with the same sincerity, I say that when I hear that decriminalisation and consumption rooms are the only solutions and we have to wait for the UK Government’s approval because nothing else will work, it does not confuse me—it angers me. [Interruption.]
That is all I have heard.
Will the member take an intervention?
No, I will not.
Twelve years ago, half the number of people died—half. Even then, it was too many, but it has got worse. Something has gone wrong in the past decade and it has been even worse in Scotland than anywhere else in the UK. What has changed? It is not decriminalisation—we did not have that a decade ago. It is not consumption rooms—we did not have them either. However, we had hundreds and hundreds of rehab beds.
There are only 14 beds in Glasgow now. Across Scotland, there are fewer than 70 rehab beds. Those beds are gone and that is the responsibility of the Scottish Government. I have been open in saying that I do not think that decriminalisation and consumption rooms are the right solution. However, even those who think that they are must acknowledge that they will work only if we have high-quality treatment and rehab.
The Government seems to think that we can set up a consumption room in Glasgow and forget it. Shift the people with addiction out of sight and it will look like we have done something—job done. We could put 100 consumption rooms on every corner from Govanhill to Springburn, but if there are no residential rehab beds—and there are practically none—
Will the member take an intervention?
The member is just closing.
If people are being turned away from rehab—and they are—it does not matter how many consumption rooms we have because, without treatment and rehab services, nothing will change.
I have one last comment: rehab works. Just last week, a mother wrote to me. She said:
“I have a son who entered a rehabilitation centre in Greenock called Jericho House ... His addiction has ripped my family apart and if I had not found Jericho, I believe he would be dead. It is a travesty that a centre like this is being ignored by the Scottish Government.”
You must close now.
If members are not prepared to vote for money for rehab beds today, I hope that they are prepared to tell that mother why not.16:53
I thank members from across the Parliament for a good debate, in which member’s speeches covered a range of topics. I will try to respond to as many of them as possible. However, before I do, I want to touch on an announcement about on-going work that I did not manage to cover in my opening speech.
A few members talked about prevention. In our strategies, we made a commitment to improve our helpline services for alcohol and drugs. This week, we are introducing an improved way to offer more direct help to people who call our alcohol and drug helplines, drinkline and know the score. From 1 February, the service will be operated by Addaction Scotland on our behalf. The new service will build on the existing webchat services, which are already up and running in some parts of the country. We know that more people engage with webchat services than phone services, so the offer of immediate links through webchat will greatly increase the access to services that everyone deserves. Addaction is an organisation that many members will know, so I hope that members across the chamber welcome that development.
My intervention relates to a very specific point, before the minister moves on to address points that were made during the debate. I made the suggestion to Alex Cole-Hamilton that we have an annual debate in Parliament when the drugs and alcohol statistics are published. The minister’s boss is sitting next to him, so could we get confirmation of whether that will happen? If not, will the minister confirm that he will write to all members once he has seriously given consideration to the suggestion?
Neil Findlay will be well aware that it is for the Parliamentary Bureau, not for me or the cabinet secretary, to decide what business is debated in the chamber.
I will address some of the topics that were discussed, particular in relation to the amendments. There are two main parts to the Labour amendment in the name of Monica Lennon. Although I cannot agree with the final part of the amendment, which relates to budget, the rest of it, which talks about the impact on toxicology—
Will the minister take an intervention?
I will finish explaining my approach. The points in the amendment that relate to toxicology are important, but I will not stand here and argue about budget lines from four or five years ago when people are dying today. The Government will support the Labour amendment because the points that it makes about toxicology and other matters, up to the point about protecting the budget, are important.
I am glad that the minister has confirmed that the Government will support the Labour amendment. As I said in my opening remarks, it is not about looking back to apportion blame or point fingers but about making sure that we never again make the decision to underfund critical services and then have to debate the fact that we have the highest record of drug-related deaths in the world.
As I said, I am not going to stand here and have that discussion, because a number of important points were made during the debate that I want to focus on and respond to.
Miles Briggs and the Conservatives made a point about “residential rehabilitation”. I have said that I am not closed to that suggestion. I said in my opening remarks that we are currently mapping out what provision is available and what demand there is for those services. It is important that we use our resources in ways that will work and deliver.
Miles Briggs mentioned the service in Clydebank, which is a good example of good-value residential rehabilitation. There is a very good service here in Edinburgh, the Lothians and Edinburgh abstinence programme, which is an NHS service. We need to look at various models across Scotland, including the Phoenix Futures service in Glasgow, which I hope to visit soon, to make sure that, if we are spending money on such services, there is demand for them and they are what people want, rather than what people have been told to want.
The problem is that we have seen a dramatic loss of the service—there are only 70 beds now available across the whole country. We need to see beds being put back, which takes action. I warned ministers two years ago that we needed to stop seeing the loss of those beds and that is what my amendment can achieve. We need to fund those beds and do so from today, not have another feasibility study.
The Conservative amendment does not recognise that there has been a reshaping of services across Scotland. When those services are being reshaped, it is imperative that it is done with the involvement of the service users, which is what has happened in Glasgow. There has been some criticism of the changes in Glasgow, but they have been driven by the people who want to use those services. That said, although it is for local ADPs to look at the services that are provided and the demand in their area, the Scottish Government is looking to map out what provision is available across Scotland. I think that it was Bob Doris who talked about making sure that the pathways into those services are available.
We have rushed through the points. The interventions have taken so much time that it has been difficult for me to respond to most of the points that have been made. It is almost time for me to finish.
The points that Bob Doris and others made about the Rev Brian Casey being involved in the UK drugs summit are important. There is no questioning his commitment to this area. I have called on the UK Government to make sure that he has a central role at the start of the summit to put into context why the summit is happening in Glasgow, given the human tragedy that exists there. I hope that the UK Government accepts that suggestion. I was surprised by the approach that it took in bringing forward the summit and the way in which it was announced, but I have made clear to the UK Government that I am determined to work with anyone who will help us to save lives. That is what we are doing and that is what is happening across Scotland. The drug deaths task force is leading that work.