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Chamber and committees

Meeting date: Tuesday, November 28, 2017

Meeting of the Parliament 28 November 2017

Agenda: Time for Reflection, Urgent Question, Alcohol and Drugs Strategies, Equally Safe, Business Motion, Parliamentary Bureau Motion, Decision Time, World AIDS Day 2017


Contents


Alcohol and Drugs Strategies

The Presiding Officer (Ken Macintosh)

The next item of business is a statement by Aileen Campbell on refreshing Scotland’s alcohol and drugs strategies. The minister will take questions at the end of her statement, so there should be no interventions or interruptions during it.

14:15  

The Minister for Public Health and Sport (Aileen Campbell)

Next year marks the 10th anniversary of “The Road to Recovery: A New Approach to Tackling Scotland’s Drug Problem”, which signalled a landmark change in the way in which Scotland dealt with problem drug use, setting out a new vision in which all drug treatment and support services were based on the principle and hope of recovery.

During those 10 years, much has been achieved. We have an impressive and growing recovery network in Scotland, which has proven invaluable in promoting a civic and cultural shift in attitudes towards problem drug use. In treatment services, we have seen a shift in attitudes through the introduction of recovery-oriented systems of care. We have implemented innovative harm-reduction measures, such as the world’s first take-home naloxone programme. We have also established ambitious waiting times targets for access to alcohol and drugs treatment. Those all come against the backdrop of almost a decade of record investment. Since 2008, we have invested £689 million to tackle problem alcohol and drug use.

The main principles behind “The Road to Recovery”, which had cross-party support, still remain relevant. However, 10 years on, we must be alert to the changing nature of Scotland’s drug problem and how we respond to new and emerging challenges. Our understanding of the underlying causes of addiction and substance use has developed, aided by an ever-growing evidence and research base. There is a greater understanding of the effects of deprivation, poverty and adverse childhood experiences in driving the reasons why so many in our communities turn to drugs or alcohol as a way to escape painful trauma and experiences.

That is why my intention is to bring forward a combined alcohol and drugs treatment strategy in spring next year. Although there are clear differences between the two, the root causes and the fundamental culture of the responses by services have too much in common to be kept apart. The legal status of alcohol means that there is much that is different in policy terms around availability and accessibility. Indeed, the United Kingdom Supreme Court judgment on minimum unit pricing for alcohol, which is an example of the different levers that we have at our disposal for preventative interventions, marked a landmark moment in our ambition to turn around Scotland’s troubled relationship with alcohol. Therefore, I still plan to bring forward in early 2018 a refreshed alcohol strategy that sets out my plans for preventative action.

Turning to treatment and recovery support, the focus of our efforts must be on improving the experience for patients and their families. With rising numbers of drug and alcohol deaths, evidence of the devastating consequences of problematic substance misuse is clear across Scotland. Those substances are significant contributors to the early deaths and excess mortality in Scotland. We know from the work of NHS Health Scotland, the Scottish Drugs Forum and the Glasgow Centre for Population Health that a generation was made more vulnerable in part by the economic and social decision making of the 1970s and 1980s. The people who were impacted are now reaching an age when multiple social and health issues are meeting years of problem substance misuse, with devastating consequences.

However, I fully recognise the importance of resources for treatment, which is why the £20 million per annum that was announced as part of our new programme for government is crucial for the refresh. It represents £60 million of additional funding over this parliamentary session to help to deliver improved services that will be delivered with the person, not the addiction, at their heart and to enable a greater consistency of quality services across Scotland. The funding will also support alcohol and drug partnerships and services across Scotland as we instil the principles of the seek, keep and treat work, which I will say more about shortly.

Our refreshed strategy and the resources behind it must be innovative in approach, guided by evidence of what works and informed by people with experience, whether practitioner or patient. To stand any chance of delivering the impacts that we seek, the strategy must be authentic and must empower the people who seek to make improvement. The growing demands that are placed on health services by ageing drug and alcohol users require, in particular, services that are realigned to appropriately and collaboratively link into other areas, including mental health and primary care. That will remove some of the current stresses that are placed on the system by emergency and unplanned hospital admissions.

We must continue our recovery-oriented systems of care approach. Recovery must prevail as the mainstay of our policy, with care centred around the person and connecting into work on homelessness, employability, mental health and family support. The refreshed approach must be viewed as providing an opportunity to enable support to reach out to those who are most vulnerable but who cannot access the sustained help that they need with health and wider social issues. That is vital, because we know that being in treatment offers protection against a drug-related death.

There is a strong sense that that is also true for alcohol, but I want to ensure that the evidence base is robust, which is why I have asked Scottish Health Action on Alcohol Problems to lead work to enhance our understanding of the circumstances and contributory factors of alcohol-related deaths. That work will develop actions to further develop the evidence base on alcohol death prevention and treatment services.

We know that the cohort that is most at risk and vulnerable is often furthest away from services, which is why the refresh will develop our seek, keep and treat philosophy to services. We must actively seek out that hard-to-engage cohort through assertive outreach, advocacy or new innovative approaches. We know that retention among that cohort can be improved. Much is already being done to ensure service quality, but it is clear that there is a need to consider whether the range of services on offer can keep more people in treatment by responding to their care needs in a way that addresses all aspects of their wellbeing. We also know that it is imperative to treat people appropriately by providing person-centred care and support alongside social and clinical interventions. Increasing evidence points to factors such as social isolation and stigma as major barriers to continued engagement.

Seek, keep and treat will be the guiding principle for additional investment to secure change. I expect services to be redesigned to be more active in identifying those who are disengaged from treatment. People should be discharged only for the right reasons and should be appropriately supported as they move on their treatment journey. We will seek to measure levels of retention and treatment outcomes that are consistent with that approach.

We must consider ways in which services can provide wide-ranging support to keep people engaged. That must include an acceptance that some individuals will not be ready to immediately embark on a journey of recovery or abstinence, an acceptance that some will stumble and relapse—numerous times in some cases—and agreement that that must not preclude them from receiving high-quality support and treatment when they return.

Earlier today, I met alcohol and drug partnerships and health and social care partnerships to begin to give shape to a shift that is cognisant that those services currently face high demand and pressure. That is why the resources that I outlined earlier are important to enable a move to invest in models that work.

Transformation will take time, commitment and energy. It will also require our health and social care systems to assess their current practices, to reflect on their effectiveness and to be innovative and open to change if evidence points to a need to improve.

The recent efforts to introduce a safer consumption facility in Glasgow are an example of how ambitious and innovative responses are being generated at the front line. There, we see stigma being challenged and a huge public health problem being responded to in a way that meets the needs of that population. The law does not currently allow that facility to proceed, but we must not let that be the final word on the matter. I have written to my UK counterpart to ask for discussions on how the Scottish Parliament can obtain the powers to allow us to meet a significant public health challenge.

Treatment can no longer be just clinical; it must also address deep-rooted social and economic circumstances that people face. It is therefore fundamental that we join the dots better between health and social care partnerships and alcohol and drug partnerships, and that we ensure that the provision of addiction services according to robust local needs assessment is a priority that is set out in their respective delivery plans. That will require cross-portfolio, cross-cutting and cross-discipline working. It will require my ministerial colleagues and I to align our work and collaborate across the areas of housing, mental health, justice and employability.

I also aim to engage thoroughly with people with lived and living experience of addiction and with families and people at the front line who dedicate their lives to doing what they can to support and help those with addictions. The strategy must be based on strong evidence and research, but it must also be authentic and relevant to all those who interact with it. It must be focused and it must drive the improvements that we desperately want. However, we should not lose sight of the improvements that have been made and the need to continue with good work that has been impactful.

There are no quick solutions. Lives are complex, and they can be chaotic. People may have suffered great trauma. The issues that we see in an ageing and vulnerable population are long standing and deep rooted. Developing a refreshed approach to respond will be a challenge, but we will not shy away from that challenge. Individuals, families and communities that can be devastated by addiction should expect no less.

Just as parties united 10 years ago to back an approach to substance misuse, I intend to work with colleagues across the parliamentary divide and bring back to the chamber a refreshed strategy in spring next year.

The Presiding Officer

The minister will now take questions.

Miles Briggs (Lothian) (Con)

I start by thanking the minister for advance sight of her statement. It is important, though, that the Scottish Government does not try to rewrite history around drug and alcohol policy in Scotland. Let us start with the Government’s £15 million cut to Scotland’s alcohol and drug partnerships. That has had a hugely destabilising effect, and I would have expected an apology from the Government today on that issue.

The Conservatives see how the issue needs to be addressed and we have long called for a cross-party approach. What assurances can the minister give that the new strategy will indeed provide some truly radical thinking designed to tackle the cultural and societal issues? Will she agree to establish a cross-party MSP working group on the issue, ahead of the strategy being published?

Aileen Campbell

The new strategy will be aimed at ensuring that we explore all options available to us, so that we can deliver a strategy that is cognisant of the new landscape that we face and have an enhanced understanding of the current challenges across the country. However, we will not put to one side the impact that “The Road to Recovery” has had—I outlined in my statement the fact that it has had an enormously positive impact on many aspects of life for those who have addiction challenges.

We certainly will not rule out any other innovative ideas. I set out one idea that has been taken forward by the Glasgow health and social care partnership, and I intimated in my statement that I intend to write to the United Kingdom Government. If that is something that Miles Briggs would like to support, so that we can get the powers here in Scotland to have bold, ambitious and exciting ways of treating substance misuse through a public health lens, I would certainly welcome that.

It should be recognised that, since 2008, we have put record funding into alcohol and drug partnerships, and we are committed to ensuring that we work with them on the refreshed approach. That does not ignore the fact that there are financial challenges across all of public life, but that is why £20 million has been made available to enable innovative models of work to deliver improvements for the most vulnerable people in our society, and that is why we should welcome this opportunity to refresh our approach.

I look forward to working with MSPs across the chamber and will give consideration to an MSP working group.

Colin Smyth (South Scotland) (Lab)

I, too, thank the minister for advance sight of her statement. Scotland has a long history of drug and alcohol misuse, which damages far too many lives, families and communities and costs billions of pounds every year. Drug deaths in Scotland are now the highest in Europe per head of population and, last year, alcohol-related deaths rose by 10 per cent. When the Government publishes its combined strategy next year, radical action will be required, but it will also have to be fully resourced, particularly support for those battling addiction. Will the minister say what assessment has been made of the impact of the 24 per cent cut in support for addiction services and of cuts in local government funding for such services?

Aileen Campbell

I thank Colin Smyth for his continued interest in the subject. I remind him that, since 2008, we have put record levels of investment—£689 million—into tackling problem alcohol and drug use. It is also important to remember that the total financial resources available in any given year are significantly higher than the contribution that is provided by the Scottish Government, as they include direct contributions from the national health service and other statutory partners. However, we recognise the financial challenges that exist in public life, which is why I reiterate that the £20 million is important and will enable us to develop new ways of approaching some particularly difficult and challenging cohorts of drug users in Scotland—those who unfortunately present in the drug death statistics that we see every year. That is why I have committed to refreshing our approach, because we need to do something that enables us to tackle that problem and that challenge head on.

There are particular reasons why there is a problem in Scotland. NHS Health Scotland did some analysis of what is happening in Scotland in the context of drug deaths in the here and now and pointed to economic and social policies of the 1970s and 1980s, which exacerbated feelings of isolation and neglect. Lessons should be learned, to ensure that the austerity policies that the current UK Government is shamelessly pursuing do not store up problems for 30 years’ hence.

There are lots of ways in which we can improve services. That is why resources are important, as is engagement with front-line practitioners, to ensure that we have a strategy that is authentic and relevant and that effectively tackles the challenges that we have in Scotland.

Stuart McMillan (Greenock and Inverclyde) (SNP)

I refer members to my entry in the register of members’ interests: I am a member of the management board of Moving On Inverclyde.

I welcome the minister’s announcement of the new strategy and new funding. Will she say whether the new strategy will examine and seek to address how different statutory and non-statutory organisations work together to ensure that treatments are truly person centred and are regularly reviewed so that they remain appropriate?

Aileen Campbell

As I said in my statement, I met ADPs and integration joint boards today and discussed the challenges and issues at local level and how they impact on local planning and delivery. The discussion will continue to develop over the coming weeks and months and will help to inform the strategy.

The work on the strategy offers us an opportunity to join the dots more effectively, not just for the immediate, front-line treatment of drug addiction but so that we can have an impact on wider service delivery, with links to homelessness, employability and mental health provision.

On reviewing treatment, the Information Services Division is currently developing the drug and alcohol information system—DAISy. NHS Scotland is developing a monitoring and evaluation framework. Both pieces of work will enable us to get a bigger and better picture of the way in which addiction manifests itself across the country, and that evidence will enable us to take forward the best and most effective approaches to tackling addiction in Scotland.

Brian Whittle (South Scotland) (Con)

We now know that, according to the Scottish National Party Government, policies in Westminster some 40 or 50 years ago raised Scotland to the position of having the highest level of drug-related deaths in Europe; it has nothing to do with anything that the SNP has done over the past 10 years, even though drug-related deaths have doubled since 2006 and 80 per cent of those people were under 50.

The minister’s statement focused on treatment, but what does the Scottish Government plan to invest to help to prevent substance misuse and poor relationships with alcohol?

Aileen Campbell

Brian Whittle does the research and analysis by NHS Health Scotland a real disservice—

Brian Whittle

It is a Government body.

Aileen Campbell

It is with no great happiness that we say that some drug deaths today are, in part, the result of policies that were pursued in the 1980s. That is the reality, and we would all do well to listen and to reflect on the fact that economic policies in the 1980s have an impact on public policy and social policy in the here and now. That should be a lesson for the Conservative Party, which, in Westminster, continues to pursue harsh austerity measures—I make the point with no great satisfaction, as I said.

The Tories would do well to listen to the calls of not just the SNP but every other political party in this Parliament to halt the roll-out of universal credit and to end austerity policies, because all that such policies do is store up problems for the future—as the examples of the past show.

We will continue to do what we can to pick up the pieces and to support vulnerable people, who deserve to be seen through a public health lens and to have support services delivered to them in a holistic way so that they can go on to contribute to society.

Brian Whittle does a disservice to the research and analysis that others have undertaken, lending their expertise to us to enable us to develop a strategy that will help many people in Scotland.

Neil Findlay (Lothian) (Lab)

I could not give a toss about the party politics of this—[Interruption.]

Clare Haughey (Rutherglen) (SNP)

That was unparliamentary language.

Neil Findlay

I could not give a toss about the party politics. Drug and alcohol addiction is one of the greatest issues that communities across Scotland—most notably the poorest communities that we all represent—face.

People are dying years before their time. The streets are awash with illegal drugs and organised criminals are growing fat on the profits of misery. Is it not time for a radical change in direction? If not, we will back here in another ten years with so many more sons and daughters having become a grim statistic as a result of our collective failure.

Aileen Campbell

That is why we have come to the chamber to engage on this. I am not somebody who shies away from engaging with other people, regardless of party politics. The reason why I want to take this refresh forward is because of the drug-related death statistics that have been published, because they are not just statistics; they represent individuals who have lost their lives, individual families who have suffered, loss of potential, and huge devastating blows to the communities those individuals came from. That is why I am focused on making sure that we get this strategy right, why we have £20 million extra going into services and why I will continue to focus my work on engaging with people who are constructive in their approach to creating a strategy that we can ensure delivers for those people who are in the greatest need of help.

Clare Haughey (Rutherglen) (SNP)

I refer members to my entry in the register of interests. I am a registered mental health nurse who holds an honorary contract with NHS Greater Glasgow and Clyde.

As the minister set out in her statement, the proposal for a safer consumption facility fell recently. It was an ambitious, innovative proposal by NHS Greater Glasgow and Clyde. I note that she has written to the UK Government seeking a change in the law to allow such a facility to proceed. If the UK Government refuses to act, will she request that the necessary powers be devolved to Scotland so that this Parliament can make the decision?

Aileen Campbell

Absolutely. We support Glasgow city health and social care partnership’s proposal, particularly in the light of the increasing number of HIV cases in the city. However, as I mentioned in my statement and as Clare Haughey outlined, the law in Scotland does not allow us to proceed with the proposal. We are grateful to the Lord Advocate for providing advice on that. Drugs legislation is currently reserved and we are waiting to hear back from the UK Government before making any decisions. If we are unable to take the proposal forward, we will make the case that responsibility for drugs policy should rest with this Parliament.

John Finnie (Highlands and Islands) (Green)

I thank the minister for early sight of her statement and for her reply to the previous question. She rightly identified the unacceptable number of drug-related deaths at the moment. There is currently an HIV outbreak in Glasgow, with 105 new cases identified since October. A large proportion of those presenting have a hepatitis C co-infection, which is a problem throughout Scotland. The enforced closure of the busiest sterile injection equipment supply facility in the country has led to a significant decrease in the number of clients accessing such equipment. The minister touched on the Lord Advocate’s advice. It is clearly a health rather than a justice issue. Would she accept that, rather than refreshing something that is clearly failing, a radical overhaul is required, including consideration of decriminalisation?

Aileen Campbell

I appreciate the way in which John Finnie has articulated the issues. The HIV outbreak in Glasgow is a matter that gives me great concern. The needle exchange service closure is an on-going issue. Humza Yousaf and I are continuing our engagement with Network Rail and Glasgow city health and social care partnership to achieve a satisfactory solution to the issue.

John Finnie would do well to engage with some of the ADPs. Those with which I spoke earlier were at great pains to say that they did not believe that the road to recovery strategy had failed and that we should not disregard its achievements. I outlined where there have been huge improvements throughout Scotland, and the ADPs were keen to make sure that we do not disregard that good work, which refreshed how we approach drug taking in Scotland. There is an opportunity for us to be bold and ambitious, but we have to be cognisant of the fact that improvements have been made through the strategy. We will continue to work through front-line practitioners with those who have lived and living experience on what more can be done to improve services throughout the country to ensure that people are at the heart of service design and delivery.

John Mason (Glasgow Shettleston) (SNP)

The minister and I attended a very moving service on Thursday evening, organised by the Family Addiction Support Service, which was really a remembrance service for those who have died as a result of alcohol and drugs. The minister mentioned a £60 million fund. Will some of that be available to support families, as well as mental health services, homelessness services and so on?

Aileen Campbell

Like John Mason, I pay tribute to FASS for its work to support families across the city of Glasgow and beyond who are coping with the impact of addiction, and for its tribute at the service last week to those who have lost their lives.

John Mason rightly outlined the need to ensure that we engage with families. Part of the intention of the strategy is to ensure that we do not just listen to clinicians or practitioners but engage meaningfully with those with lived and living experience of addiction. We should also ensure that we engage with their families, who often have to deal with the consequences of the addiction or are left devastated by the impact on a loved one. We have engaged and continue to engage with organisations such as FASS, Scottish Families Affected by Alcohol and Drugs and others that will be able to contribute to the development of the strategy.

Alex Cole-Hamilton (Edinburgh Western) (LD)

Does the minister accept that we cannot begin to build an effective strategy while her Government will not accept the failures of its administration? The Government defunded drug and alcohol services by a similar amount to that which it is presenting today as new money. On its watch, we saw a 23 per cent increase in drug deaths last year alone, making us the worst in Europe, and it continues to send people to prison instead of treatment for drugs possession. After 10 years, is this really the starting point that the minister would have chosen for her Government’s new strategy?

Aileen Campbell

I reiterate that, since 2008, we have invested significantly—£689 million—in tackling problem alcohol and drug use. The problem is not as straightforward as the way that Alex Cole-Hamilton articulates it. The trend of rising drug-related deaths has been in evidence since 1996, so it is difficult to see how there is a direct correlation between funding levels and drug death trends.

Alex Cole-Hamilton would do well to recognise that, as I outlined in a previous response, the total financial resources available in any year is significantly higher, given additional contributions from health and other statutory partners, as well as the direct contribution from Government.

We look forward to engaging with parties across the chamber to develop our new strategy. We recognise the opportunity provided by the additional resource to ensure not only that we refresh our approach and are bold and ambitious, but that what we do delivers the impact that we need for this vulnerable group of people in Scotland.

Richard Lyle (Uddingston and Bellshill) (SNP)

Will the minister outline how people with lived experience of substance abuse will be able to inform the new strategy?

Aileen Campbell

There is a good case for ensuring that we actively engage with those who have lived and living experience. That has been the hallmark of our partnership for action on drugs in Scotland group, which has been looking to tackle the issues around stigma.

We held a recovery community gathering in Glasgow in July, which was the first time that we had brought together recovery communities from across the country so that they could influence and have a direct input into the work that the Government is taking forward. That engagement will continue and we will continue to seek out ways in which the new strategy can reflect the voices of people with lived and living experience.

Donald Cameron (Highlands and Islands) (Con)

Given the continuing public debate surrounding the efficacy of Scotland’s methadone programme, will the minister confirm whether the new strategy will review the use of methadone in treating addiction?

Aileen Campbell

It is important that we do not characterise that as wholly negative. Replacement therapy is one approach that has allowed harm reduction to take place and people to have functioning lives. Families recognise the positive impact that replacement therapy has had on people who require support.

Adam Tomkins (Glasgow) (Con)

But methadone deaths are up.

Aileen Campbell

Members want me to ensure that there is direct engagement with people with lived and living experience so, although there is heckling from the Conservatives, I will continue to work and engage with people who are telling me about the positive impact that replacement therapy has had on their lives—by reducing harm in communities across the country, by reducing the criminality that other members have talked about and by enabling us to allow those who require support to embark on a journey of recovery when it is appropriate for them to do so.

Alex Neil (Airdrie and Shotts) (SNP)

I welcome the minister’s statement and her commitment to cross-party working, which we must have on this issue. She is absolutely right to say that we cannot disregard the successes of certain programmes, and there have been very good examples of success up and down the country. However, there is a need for new thinking. I will suggest to the minister four areas, although there are many others—

The Presiding Officer

I am sorry, Mr Neil, but four areas sounds like a rather long question.

Alex Neil

I will mention nothing more than the headlines, Presiding Officer.

The Presiding Officer

Very briefly, please.

Alex Neil

First, we need to look at what more we can do to prevent children, in particular those who live in poorer communities, from becoming involved with drugs. Secondly, we need to evaluate the impact of the methadone programme and look at alternatives that have been tried in other countries. Thirdly, we need to do more in relation to prisoners. Finally, we need to do much more in poorer communities, because we all agree that there is a link between poverty and drug and alcohol abuse. We need to tackle the problem at source by reducing levels of poverty and deprivation.

We all need to do some new thinking in all those, and other, areas. [Applause.]

Aileen Campbell

I thank Alex Neil for making those points. We will continue to engage with him on the four headlines that he mentioned.

He mentioned the issue of children, which is important. We have continued to focus on ensuring that we support that vulnerable group of young people, as we do not want a life of substance abuse to be predetermined for them. We need to take a life-course approach to the issue.

I have set out some of the innovative thinking—which no member has asked about today—such as the seek, keep and treat approach, which involves assertive outreach to seek out people who are harder to reach and who cannot engage with services because of certain barriers. It is important to keep them engaged, because that gives us the best chance of preventing a drug-related death. That approach is certainly bold and ambitious, but no member has, in their question, acknowledged that point or developed it further.

I mentioned NHS Health Scotland’s analysis of drug-related deaths, which states that there is a huge link between drug misuse and poverty in Scotland. We will certainly look at poverty as an issue. It is interesting that Conservative members decided to clap when Alex Neil made that point. They should take a close look at some of the policies that their UK counterparts are carrying out in Westminster.

Brian Whittle (South Scotland) (Con)

Ten years!

Aileen Campbell

I hear Brian Whittle talking about 10 years. For how many years will he and his Government continue to pursue harsh austerity measures and consign generations of children across the whole of the UK, not just in Scotland, to poverty? How many problems is his party storing up for 30 years from now, and who will be left to pick up the pieces?