Meeting date: Tuesday, March 9, 2021
Health and Sport Committee 09 March 2021
Agenda: Interests, Drugs Policy, Subordinate Legislation, European Union (Withdrawal) Act 2018, Subordinate Legislation
- Drugs Policy
- Subordinate Legislation
- European Union (Withdrawal) Act 2018
- Subordinate Legislation
The next item on our agenda is an evidence session with the Minister for Drugs Policy, Angela Constance, on the Scottish Government’s updated plans and proposals for drugs policy in Scotland. I welcome the minister, who is accompanied by Morris Fraser and Michael Crook, both of whom are members of the Scottish Government’s drug deaths team. I thank you all for joining us today, and I invite the minister to make a brief opening statement.
Thank you, convener, and good morning to you all. I am grateful for the opportunity to speak to the committee.
Following the publication of the 2019 statistics on drug-related deaths in Scotland, the First Minister announced the need for the Scottish Government to lead a national mission to save lives and improve lives. In her statement to Parliament on 20 January, she pledged an additional £50 million in each of the next five years to drive forward the changes that we need.
Our mission is to get more people into treatment, as we know that that is a protective factor that keeps people safe. That is one of my immediate priorities. In order to do that, we need to improve our treatment offer and make it much more accessible to those who have the greatest needs.
A significant amount of work, including work by the drug deaths task force, is already under way to increase treatment numbers. The roll-out of the new medication-assisted treatment standards that the task force has developed will ensure that a range of treatment options are available to anyone who needs them, no matter where in the country they are, on the day that they request them. That also includes my commitment to increase the capacity of residential rehabilitation. I have committed to a significant uplift in the current provision of residential placements, and I have asked a residential rehabilitation working group to examine how we can do that quickly.
In addition, I am working on other improvements, such as expanding the reach of examples of good practice—for instance, the heroin-assisted treatment service, which is currently available in Glasgow but could be replicated elsewhere. We are also working to make long-acting buprenorphine more available as an option for those who would find it more suitable than methadone or other opioid substitutes. Those moves will help to ensure that treatments will be more widely available, which will mean that all areas will offer a more person-centred approach.
We are working with stakeholders to gear up the way in which we take account of those with lived and living experience, in order to ensure that our services, initiatives, plans and policies are informed by the views and experiences of people who have gone through treatment or who are in recovery and those of their families, as well as those of people who are not currently in treatment.
In order to step up our efforts to face those challenges, I will convene an implementation group, in which I and other Scottish Government ministers will work alongside chief officer or director representatives from health and social care partnerships, integration authorities and other organisations, such as the royal colleges, to ensure that we align our strategies and to support better delivery. In essence, that will allow us to ensure that our public health emergency response—our work to save lives—is far better embedded in our wider work to improve lives, whether it involves mental health, housing, adverse childhood experiences, education, prevention or poverty and inequality. The implementation group will draw on advice not only from the drug deaths task force, but from the new residential rehabilitation working group, as well as from organisations that represent those with lived and living experience and their families.
In all that we do, partnership working will be key. Since I came into post, one of my first priorities has been to meet as many organisations and individuals working in the field as I can. That has allowed me to hear a wide range of thoughts and opinions about how we can make improvements, reduce deaths and improve the lives of individuals and their families.
In my role as minister, it is my responsibility to build relationships and work positively with all those groups. In addition, I am clear about my responsibility to work with Parliament and parliamentary committees in order to ensure that, as we move forward, we can build more of a consensus across Parliament on the direction of travel. I hope that my time with the committee this morning is an opportunity to start to build that consensus.
I welcome the opportunity to answer any questions that members have.
Thank you, minister.
As you have described, you have a broad remit, and there is no doubt that a lot of your work will involve partnership building along with other aspects. Inevitably, however, there is a sharp focus on the rate of drug deaths. National Records of Scotland has reported that the rate in Scotland is 3.5 times that of the United Kingdom as a whole and higher than anywhere in the European Union.
Before I ask my first question, I say to your officials that, if they wish to come in at any point to supplement your answer, they should type R in the chat box in the usual way. Members will know the routines to follow. Our questions will, I hope, cover the whole range of your responsibilities.
What focused action to reduce drug deaths in the coming year do you envisage coming out of the processes that you have described, minister?
That is an important question, because we need a sharp focus on that aspect, and on leadership, resources and implementation. The purpose of declaring a national mission to address what is, to be frank, a national disgrace is, in essence, to get more people into treatment, because we know that the right treatment for the right person at the right time provides a protective factor.
As part of the national mission, there are five priority areas. The first is fast and appropriate access to treatment; all the evidence shows that people need to find ways into treatment much more quickly and effectively. Secondly, we have listened to the voices in Parliament and the lived and living experience community, and we are therefore focusing on residential rehabilitation. Thirdly, all our endeavours, both within and outwith Government, need to be far more joined up, particularly in respect of community services. Fourthly, there is a clear role for front-line organisations, especially those in the third sector. Lastly, we need to overcome the barriers around introducing overdose prevention facilities while focusing on what we can do now. Thus far, the heroin-assisted treatment work in Glasgow has been very successful, although it is in the early stages, and we need to look at what more we can do elsewhere in Scotland.
We are very much focusing on what we can do as quickly as we can. We need to ensure that, in our endeavours on both harm reduction and recovery, we are all pulling together in one direction.
Our focused work on saving lives, which you touched on, convener, needs to be embedded in our bigger, broader work on improving people’s lives. That is where the cross-Government endeavour must really kick in.
Absolutely. In summary, would it be fair to say that your top priority is access to treatment?
Yes. The five priorities that I have outlined all feed into our focus on getting more people into treatment.
It is clear from the National Records of Scotland statistics that rates of drug deaths are very high in some areas. The city of Dundee in particular is affected, as are places such as Glasgow and Inverclyde. Those are often areas of high social disadvantage. Would it be reasonable to expect that interventions will focus on areas that have higher rates of drug deaths, such as Dundee and Glasgow?
Yes. To put that in context, I will make two points.
You are absolutely right to highlight that the areas with the highest rates of drug deaths also have the highest rates of deprivation. We need to focus our attention on where the problem is most acute. To help with that, some of the initial emergency funding that we released—in particular, the £3 million for alcohol and drug partnerships—was allocated by taking into account the proportions of drug deaths in particular local authority areas.
However, it is important to note that it is a national mission and that we cannot leave any area of Scotland behind. I am conscious of the needs of rural Scotland and that some of the issues and difficulties in rural Scotland—in particular, service delivery—can be quite different. In addition, we always need to give special consideration to, and provide flexibility for, our island communities.
We absolutely need to target resources to the areas and the people with the greatest needs, and that points us to specific areas of the country. Nonetheless, we must do that in a fashion in which we leave no part of the country behind, because it is, after all, a national mission.
Before I call Emma Harper, Sandra White has a brief supplementary question.
First, I note that men represent 69 per cent of drug deaths in Scotland, which is very worrying. Secondly, prescription drugs are a huge issue in Glasgow and other areas. Have you looked at targeting males and at the issues around prescription drugs?
With regard to the gender balance, Ms White is correct to say that, in talking about drug deaths, we are talking mostly about men—or men over the age of 35. There are always particular challenges in ensuring that men can access services. We know that, with regard to health as a whole, men can sometimes be reluctant to go to their general practitioner for more physical ailments.
There are specific issues around the needs of men, and of—dare I say it?—men of a particular age. In talking about drug-related deaths, we are often talking about people who have a substantial history—perhaps 20 or 30 years—of drug use. The heroin-assisted treatment project in Glasgow is having some success, in particular in working with people who have extraordinarily lengthy histories of drug use.
Nevertheless, we cannot and must not ignore the fact that the number of women who are dying is increasing. Over the past two years, we have also seen an increase in the number of people under 25 who are dying and a significant increase in drug-related hospital admissions. Although those groups have much in common, we need to pay attention to the needs of men while also addressing the needs of women and younger people.10:15
With regard to prescription drugs, there is an issue in Glasgow and elsewhere with benzodiazepines, which are often used with other substances—in particular opioids. We see illicit benzodiazepines, as opposed to prescription medication, as much more of an issue. That is related to issues around the production of street valium. Police Scotland has told me that someone can, within hours, using a pill press, make half a million tablets and sell them for pennies. The people who produce those substances illegally have found ways to package them in blister packs and cardboard boxes so that they look pretty authentic, when, in fact, they are not. In addition to addressing issues around how we regulate pill presses and deal with illicit benzodiazepine production and use, we need to find alternative, and better, ways to treat benzodiazepine dependency.
Good morning. In her statement, the First Minister talked about investing in more public health surveillance so that we will be able, rather than waiting for annual statistics, to look at more focused or targeted information—for example, regarding the street benzodiazepines that you just mentioned. What plans are there to introduce more regular reporting on drug deaths in order to ensure that responsive and proactive action, such as more direct data management, can be taken?
There are two aspects to that. National Records of Scotland is responsible for collecting and publishing data on drug-related deaths, but as Ms Harper pointed out, those data come out annually, and I am keen to find ways of reporting much more regularly on drug-related deaths. Work is already under way on that with Public Health Scotland, NRS and Police Scotland, and with Scottish Government officials in respect of in-house analysis. There is a compelling case for moving to more regular reporting, and I want to do so.
I have held other portfolios in Government in which relevant statistics have been published. I am thinking back to my days in charge of the youth employment portfolio, and other portfolios, in which data were released monthly, quarterly or biannually. We need to move to more regular reporting, as that is an important piece of the jigsaw.
In addition, as a result of the pandemic, Public Health Scotland’s public health surveillance work has improved. As we begin to look to life beyond the pandemic, I want us not to roll back on that progress, but to build on it, so that we have better data and information that are nearer to real time. That will mean that Government and services in the community can be fleet of foot in responding to the needs of some of the most marginalised people in our society.
Our committee papers highlight that there has been some delay in the implementation of the Scottish Government’s drug and alcohol information system—DAISy—database. I assume that that delay is related to the pandemic, which we have been dealing with as a priority. How can DAISy be used to inform policy development? What impact has the delay in its implementation had?
DAISy is a Public Health Scotland tool. Emma Harper is correct to say that historical issues have affected its implementation, but my understanding is that those have been to do with the early pilots that some health boards undertook, rather than with issues arising from the pandemic.
DAISy has now gone live in four areas, as a precursor to the full system coming on stream on 1 April. Essentially, the system’s purpose is to enable us to get better data so that we understand better the impact of alcohol and drug treatment services with regard to who is accessing which services and what the outcomes are. Given that my focus, and the focus across our entire system, must now be on improving delivery and helping us to reach those who are most at risk or are hard to reach, that work is important.
However, it is important to highlight that the system builds on the existing data that are held by Public Health Scotland. It has two databases: one for drug and alcohol waiting times and one that contains more granular information about drug misuse. Much of the information is already available; my understanding is that DAISy will ensure that it is joined up and available in one place so that it can be accessed more quickly and used to better effect.
You mentioned that the system is being piloted in four areas. Those include Ayrshire and Arran and Dumfries and Galloway, which is interesting to me, as those are in my South Scotland region. The other areas are Grampian and the Western Isles. Has any information been received on how that is working so far?
I have not been alerted to any difficulties so far. There is a very short lead-in phase, from the end of last year to April this year, so those areas were selected because they have smaller populations. As with much in technology, it is good to start small and see how things go, but the full roll-out is on course for April this year.
Good. That was an answer to my final question. I was going to ask when we expect the roll-out to be complete, and you have just informed us that it will be done by April 2021.
Good morning. In a recent blog post, the Scottish Drugs Forum indicated that some
“57,000 people have a drug problem involving opiates and/or benzodiazepines”,
“one in … 80 adults”.
Several members of this committee have been involved with the work of the Scottish Affairs Committee, whose report, “Problem drug use in Scotland”, concluded:
“Addressing the root causes of problem drug use requires radical, whole-system change, rather than piecemeal reform.”
In a ministerial statement on drugs policy, the First Minister focused on five key areas that we need to address urgently. How are those five key areas decided on, and how will they be prioritised? I am interested specifically in how that resource will be allocated. You said that the alcohol and drug partnerships will be the gatekeepers for that money. My concern is that some third sector organisations might lose out on that resource.
I appreciate that question from Mr Whittle. He is absolutely right that we need to take a whole-system approach to the issues. The Government has some experience in this area—for example, through the work that was done in and around improvement sites in our health service, on safety and on reducing youth offending. We need a similar whole-system approach to driving down drug-related deaths.
On the question of how we selected those five areas of focus, our focus—as I said in response to the convener—is very much on getting more people into treatment that is right for them, and which enables them to access other services and support that get under the skin in order to look at the root causes of their addiction.
The prioritisation of the five areas—fast access to treatment, residential rehab, much more joined-up services, front-line services, including in the third sector, and the work around overdose prevention facilities and heroin-assisted treatment—is based on international evidence, of which Mr Whittle and his committee colleagues will be well aware, having participated in the work of the Scottish Affairs Committee, and on what we know from evidence in Scotland and elsewhere in the UK.
When I think of evidence, I think about clinical advice and research and evidence that academics have gathered over a number of years. However, what is particularly important to me, given my background in dealing with the communities and social security portfolios, is the voice of lived and living experience, and what people tell us about what is, and what is not, working on the ground.
I reassure Mr Whittle that I take very seriously the role of the third sector. From all my experience in Government—this is my seventh ministerial portfolio—and my experiences as a front-line social worker, I know that the third sector can reach people whom statutory services cannot reach. As we have seen during the pandemic, the third sector can react quickly and flexibly, and it is often the place where innovation can be led from the front.
I absolutely want to ensure that we fund alcohol and drug partnerships, and I will follow the money to ensure that the additional Government resource that is allocated to those partnerships gets to them and that they, as commissioning bodies, have good partnerships with local third sector and grass-roots organisations. However, I will also fund such organisations directly, and we have started to do that. Of the £5 million in emergency funding, £3 million went to alcohol and drug partnerships, and we set up two funds: an improvement fund to which organisations can apply directly for bigger sums of money, and a grass-roots fund.
As we move forward, I will lay out our approach and plans in respect of funding alcohol and drug partnerships, and our plans for the longer term in and around funding grass-roots and third sector organisations.
I am pleased to hear the minister discuss the importance of the third sector. I agree with her 100 per cent that the sector can sometimes have a reach that statutory services do not have, and that it can be a route, or a stepping stone, into those statutory services. It is crucial that we ensure that third sector organisations—although some of them could, constitutionally, be better than they are, they are nonetheless extremely effective—are involved in the process, and that we bring everything to bear to tackle the issues.
What analytical work will you undertake to ensure that that work is supported and that the finances and the resource get to where you want them to be?
With regard to financing third sector and smaller organisations, the early feedback that I have had from a range of organisations suggests that we have to look even more closely at how we can enable organisations to access funds. We also need to look at what support we can give organisations on the ground to facilitate the work of the internal structures within those organisations that are required to access funds. Our announcement of the £1 million grass-roots fund is not the end of the story in how we improve access or increase funding as we move forward.10:30
The analytical work is very important, and Public Health Scotland is developing an extensive programme of research, evaluation and monitoring. We need that close surveillance and detailed analytical work to inform our national mission—in a way, I am stating the obvious there.
The task force is also investing in research work, but Public Health Scotland’s role is especially important because it already has a responsibility to monitor and evaluate the “Rights, respect and recovery: alcohol and drug treatment strategy”. It does that through the monitoring and evaluating Scotland’s alcohol strategy, or MESAS, programme. We need to ensure that that work evolves into something that can better evaluate our national mission.
I will be interested, in particular, in how we monitor and evaluate the implementation of the medication-assisted treatment standards, which are about the principles and good practice behind the delivery of such treatments, and how we link them with other treatments that get under the skin to address the root causes of addiction.
How is the Government taking a cross-departmental approach to ensure that there is a more joined-up approach to delivering services? Much of the discussion right now seems to be about how we deal with people who have fallen into addiction, but the other side of the coin is how we create an environment in which people avoid falling into addiction in the first place. That involves thinking about community assets, and opportunities for people to engage in activities in the community. Treatment for mental health issues is another hugely important aspect in dealing with addiction. How is the Government working to deliver across portfolios to address the whole gamut of issues?
Mr Whittle is absolutely right to say that we need excellent cross-Government and cross-portfolio working. That is where the implementation group, which I will chair, will come into its own. I have spent a lot of time engaging pretty deeply with other ministers across various portfolios in advance of establishing that group. The implementation group, and the work that we do to evaluate the work that it oversees, will be really important.
I will give some practical examples. We know that at least half of those who have an issue with problematic drug use also have mental health problems, and that 23 per cent of those who have been lost to drug-related death had recently engaged with mental health services. The Minister for Mental Health, Clare Haughey, and I have already started some joint portfolio work. Our work on drug policy will need to be joined at the hip with our work on mental health policy. There is work under way in the mental health portfolio in relation to the pathfinder project in Tayside, which is about embedding mental health and addiction services together.
Hospital admissions are a key area in which the task force has done a lot of work. We know that the number of admissions to hospital, whether to accident and emergency or to psychiatric services, as a result of drug-related harms is increasing. When people present at hospital, therefore, we need to ensure that they are immediately plugged into services. Again, that is where the third sector comes into its own. Members will probably be aware of the work of Medics Against Violence and its peer navigator initiative. Work on peer navigators is starting to be rolled out to ensure that people are plugged into community services to enable their drug and mental health issues to be addressed. That is particularly important. In addition, there is a whole body of work on unplanned discharges from care.
I also engage a lot with Kevin Stewart, the Minister for Local Government, Housing and Planning, on homelessness, as we know that people who have a drug problem make up half of homeless deaths. Our work in that regard is focused on outreach. With regard to prevention, there is a big role for schools. Another aspect is the work in the justice system on diverting people into treatment at every opportunity.
I am conscious that I have spoken at length, and members will have questions. Nevertheless, I make one final point: we should not forget the importance of our work around poverty and inequality in addressing these issues.
Sandra White touched on the issue of prescription drug dependence. The committee has done quite a bit of work on that, as has the Public Petitions Committee, which I sat on for a number of years. I think that we would probably conclude that there is an overdependence on such drugs, and a medicalisation of mental health issues in particular. What work can the Scottish Government do to reduce the prescription of mental health drugs, which seems to be a problem, and to introduce other treatments, which would inevitably reduce prescription drug dependence?
First, I always give a little health warning when people speak very broadly about overdependence on mental health drugs. I am a former prison social worker and mental health officer, and I worked at the Carstairs state hospital for five years before I was elected to Parliament. There are people who have severe and enduring mental illness, and psychiatric illnesses such as schizophrenia, for whom medication plays a crucial and important role. We need to take a little care in how we articulate concerns, which can be legitimate, when we talk about medication. Over many years, when I was in the field, I was involved in work to encourage people to take medication in order to reduce the risk to themselves and to others.
That said, people should not be prescribed medication without having access to other treatments. People need choices and options for treatment, including medication. That is where the medication-assisted treatment standards are important. When you or I go to the doctor about any issue, we are treated like adults and given information, and we are enabled and empowered to make informed choices about our own health. We have to apply the same standards for people who are seeking assistance and treatment for drug issues.
I am conscious of the Public Petitions Committee’s work on prescription medications. I think that the committee looked at five classes of medication, including prescribed benzodiazepines. As I said to Sandra White earlier, much of my work focuses on the illicit use of benzodiazepines, which is quite different but nonetheless links in with the work on reducing dependence on prescribed benzodiazepines.
The Cabinet Secretary for Health and Sport has looked at recommendations flowing from the short-life working group that was established as a result of the petition that the Public Petitions Committee discussed. A consultation will run from March to June; that work is being taken forward by the health secretary, but we will keep close tabs on it.
In parallel with that work, the drug deaths task force is looking at how we can better treat benzodiazepine dependence, with a particular focus on illicit benzodiazepine dependence. We should bear in mind that the statistics since 2009 show that there has been a 450 per cent increase in drug-related deaths in which benzodiazepines were implicated. That is very different from the situation elsewhere in the UK, where there has been an increase of 53 per cent over the same time period. Scotland has a particular issue with illicit benzodiazepines, which is different from the issues around prescribed benzodiazepines.
I have some questions on the residential rehabilitation working group’s recommendations, which were published on 4 December. You mentioned residential places and on-going treatment. Are there timescales for meeting all the recommendations? I know that they are comprehensive. How will progress be evaluated and reported on?
I intend to continue in the way that I have started, by publishing information on the progress that we are making. As Ms White intimated, the Government responded positively to the work of the short-life working group on residential rehab, and accepted each and every one of its recommendations. There is work to do on equitable access; better capacity planning; much clearer pathways into residential rehab; different models of delivery; and—crucially—how we implement all the recommendations. That work will progress at pace. I have set up the newly convened residential rehab working group. While that work continues, I have ensured that there is more money in the system, because there is currently capacity in the system to enable more people to go into residential rehab. In addition to our work on sorting out pathways and access, there is now money in the system to facilitate more access to residential rehab.
You mentioned pathways. We know that a good practice guide on pathways into and out of residential rehabilitation is currently being developed. You also mentioned some of the work that has been taking place, and the money that is there. Can you elaborate on that, and on the development of the good practice guide? Do you have a timescale for its publication?
I do not have a specific timescale in mind for that, but I am happy to keep the committee informed. We will progress the work as fast as we can.
The new residential rehab group will need to do some pretty detailed work, looking in particular at issues around women, as there is a gap in residential rehab that is geared more towards the needs of women, especially those who have children. We want to do that work properly. However, as I intimated, there is £20 million available each and every year going forward to be invested in residential rehab. Many providers are operating under capacity, so there is already capacity in the system to be accessed.
With regard to the good practice guide, we want to do as much as we can, as fast as we can, to encourage alcohol and drug partnerships, and other bodies that have a role to play, to use that information to assist their work on the ground.10:45
Various services are already available. I have met Alternatives West Dunbartonshire, and folk will be familiar with the Lothians and Edinburgh abstinence programme There is a lot of work to do in and around residential rehab, in particular to ensure that rehab care and treatment are properly connected with aftercare services. That is why, in the medium to longer term, we want to take a more regional approach. If people in every part of Scotland are to be able to access residential rehab, we need to ensure that we have the right configuration of services and treatment available in different parts of Scotland too.
I completely understand what you say about women in particular. In Glasgow, it is very difficult for women to continue a course of rehabilitation if they have children. There has to be a choice. As you say, there is a lot of unmet need in terms of aftercare. How would you evaluate the level of unmet need in that respect?
Again, that is a fundamental part of the remit of the residential rehab working group, which will look at the best ways to evaluate the impact of residential rehab in Scotland and at how we can quickly increase capacity. I have already said that we want to use the capacity that is not being used, but we also want to increase capacity to ensure that we get the right level of service in the right places across the country.
Good morning, minister and officials. My questions relate to Covid-19. As the minister will be aware, the United States Centers for Disease Control and Prevention has suggested that the pandemic may have led to “an acceleration” in the number of overdose deaths. Has the Scottish Government carried out any research in that specific area?
Public Health Scotland has been producing regular surveillance reports throughout the pandemic. I am conscious that there is much about the impact of the pandemic that we may not fully understand, and I am always concerned about the potential for blind spots.
We know that we need to continue to build on Public Health Scotland’s improved surveillance work—we do not want to step back from that work as we look beyond the pandemic. I am conscious that, while services have done a lot to readapt their provision in the context of the pandemic, supply routes for illicit drugs remain active. In short, Public Health Scotland’s work in providing those regular reports is very important.
However, the intelligence that we get from organisations on the ground is also important. From those organisations, we know much about innovative practice, and we know that people have managed to use the enforced time and space arising from the pandemic constructively to find different ways to reach people and enable them to access services. I am also aware of the mental health impacts arising from the pandemic and the associated isolation.
I flag up the joint research project by the University of Edinburgh and the University of Stirling on the effects of Covid on those who use drugs. I am sure that you and your officials are aware of that—I certainly endorse the reporting from the project, and it would be worth while for the Government to look at how it could affect policy making.
My next question is about decision making on Covid-19 restrictions. Were the needs of marginalised groups, such as those who use drugs, assessed and taken into account when restrictions were made?
Yes—much of that work was done by my predecessor. It included messaging on when, and how, it would be safe for mutual aid support organisations, which are crucial to many people in the recovery community, to proceed with their work. The Government’s engagement with stakeholders, on the basis of information that we received from national health service boards and others, has allowed us to work with services on how they can take a different approach to outreach.
I am aware from one organisation in the recovery community, in north-east Glasgow, which wrote to me recently, that it is continuing to support around 500 people. To be frank, that is remarkable. The service provides face-to-face contact only in certain circumstances, but it is doing much more work online, and it is also running a lot of chat-and-walk sessions. Around a month ago, I announced a significant investment in digital participation—it was a substantial investment of £2.75 million. Services have improved in many ways, not just as a result of how people have needed to reach them during the pandemic, but because people have been looking for those improvements for a long time.
We have rolled out the slow-release depot buprenorphine injection—Buvidal—as an alternative to methadone and other opioid substitute therapies. It takes people away from daily interaction with a pharmacist or with medical personnel in order to get their daily dose, and frees them up to get on with other aspects of their life, and it potentially frees up support services to work on the root causes of addiction. We have increased access to Buvidal in prisons and the challenge for us will be to ensure that that medication is more freely available to people in the community.
I come to my final question, which the minister partially touched on in her previous answer. What support have drug treatment and recovery services had to enable them to remobilise?
It is to the significant credit of drug and alcohol services that they have remained open during the pandemic, although they have had to find different ways of working. As I mentioned, we will want to keep hold of some of the new ways of working, because they benefit people who receive those services, and they are indicative of better ways of working in general.
As part of the overall NHS remobilisation plans, there is a mental health treatment remobilisation plan that refers specifically to people who have drug and alcohol needs. Although I reassure Mr Stewart that drug and alcohol services are part of the remobilisation plans, many of those services have, in fact, found ways to remain open during the pandemic.
Emma Harper has a supplementary.
I am aware that, as the minister described, alcohol and drug services have stayed open during the pandemic. As part of the Covid vaccination process, are people who experience harmful effects as a result of drugs and alcohol issues, such as vascular issues or chronic obstructive respiratory disease, being prioritised so that they can enter recovery, rehabilitation or residential programmes such as Auchincruive in Ayr or Phoenix House? I am seeking clarity on the vaccination priority for people who are experiencing issues as a result of harmful drug use.
Ms Harper will be aware that vaccination priority relates to age and health conditions. She is right to point to the relationship between drug use and increased physical health problems, particularly respiratory problems. The physical health problems that go along with drug use can be heightened for women.
With regard to the vaccination programme in general, many people who have an addiction will, if they have physical problems, fall into a category that means that they are more of a priority for vaccination than younger, fitter people.
The real issue with the vaccination programme is how we reach those who are hard to reach. That is not just an issue in relation to people who have addiction problems, but a broader issue in relation to communities that are more adversely affected by poverty and inequality. Every health board’s vaccination plan will take into consideration how we reach those people. The Deputy First Minister is leading on-going work in Government—again, across portfolios—on public services, and we remain vigilant to ensure that we reach people who are hard to reach.
Primary care services have a role in that, too. Addiction services will be able to support people who have engaged with treatment to access vaccination when they are called to do so. However, not enough people are involved in treatment, so general practitioners and primary care services can play an important role by identifying and reaching people who are physically vulnerable, whether as a result of drug addiction or other reasons. A higher number of people with drug use issues are registered with a GP than are registered with a drug and alcohol addiction service.
I take the opportunity to acknowledge the minister’s cross-party engagement, particularly her engagement with me, in the past month since her appointment at the end of last year.
My question is about the causes of drug use and drug dependency. I appreciate that you have covered some of these points already, minister. How will the factors that cause drug use and dependency be addressed on a cross-portfolio basis? I am thinking about issues such as poverty and the need to reduce childhood adversity, improving housing and employment prospects, and addressing mental health?
A core part of that is about how services—especially health and education, as the big universal services—engage with and support families that may be struggling in some shape or form.11:00
In 2019-20, the Government targeted investment of almost £2 billion at low-income households. I am familiar with the work on child poverty because I took the Child Poverty Scotland Bill through Parliament a few years ago. Our plan, “Every child, every chance: The Tackling Child Poverty Delivery Plan 2018-22”, lays out actions that put money into people’s pockets, reduce living costs and support affordable housing. It also has clear measurements of the impact of child poverty, which I reiterate is dealt with across portfolios. The social renewal advisory board led by Aileen Campbell and Shirley-Anne Somerville will be an important factor in that.
Drugs policy must be joined at the hip to certain areas of Government. I spoke a lot about mental health and how Clare Haughey and I will work together on that. Maree Todd’s work as the Minister for Children and Young People allows the possibility of interventions that focus much more on families and provide a whole-family approach.
Much of the work sits in the context of our becoming a more trauma-informed nation, with our big universal services in particular being much more trauma-informed so that they include folk with difficulties, rather than inadvertently pushing them away.
Thank you for that detail. All cross-portfolio work requires co-ordination between the ministers and officials working on it. How is that co-ordination happening?
That is my job. That is why I was keen to pull together a cross-government implementation group. I started using that approach a few years ago in our work with Gypsy Travellers. You have to ensure that you have all the right folk in the room, particularly people who can make decisions and be agents for change not only in Government, but in the community and across local government and the health service. All that cross-portfolio work must be well rooted in and plugged into our formal and informal work with communities with lived and living experience.
How will the additional funding that has been announced by the First Minister be used to support prevention and early intervention?
That additional money is sharply focused on the emergency work that is required to save lives. As I have intimated a number of times, that must be plugged into the work that will not only save lives, but improve lives.
That brings us to the nuts and bolts of cross-government work. It is not only about how much of my portfolio budget is spent on prevention; it is about what is spent on prevention across Government, whether that be in health or in education.
I have spoken to Maree Todd about the launch in February of the £4 million promise partnership fund. Given the families who are likely to access the fund, we must ensure that they are also connected with the family support delivery group, which is connected to the work that is being done in drugs policy.
This is not just about how much of my budget is spent on prevention: there is a bigger question about how much health and education are spending on prevention.
My questions are around children and young people. What estimates does the Scottish Government have of problematic drug use among children and young people?
The Growing Up in Scotland study shows that, historically, young people are participating much less in risky behaviour. More recently, we have the “Scottish Schools Adolescent Lifestyle and Substance Use Survey (SALSUS): Mental Wellbeing Report (2018)”. The report is interesting because it shows that most pupils have never used drugs at all and that the number of pupils reporting using drugs has been gradually decreasing since the early 2000s.
However, there are always some wrinkles in those broad statistics, although they show a reassuring direction of travel. When we scratch below the headline statistics to the detail, we find that, for example, since about 2013, there has been an increase in the proportion of boys who report taking drugs in the previous month. We also know from the drug-related death statistics for the under-25s that there has been an increase in the number of young people dying in each of the past two years.
That group’s pattern of drug use is different in that they are far less likely to use opiates but are more likely to use drugs such as MDMA and cocaine. The number of hospital admissions of those young people has gone up by 48 per cent. As with the general population who have addiction issues, there are big challenges around ensuring that when young people present at hospital because of an emergency issue, which might be a cry for help, we plug them much more quickly into the treatment and support that is right for them.
You have partially answered my next question. Are any specialist treatment services available for children and young people?
The specialist approach is around family-inclusive practices and services that take whole-family and trauma-informed approaches. Our universal services, whether in health or education and whether for young people or adults, seek to ensure that those who present with challenging behaviour are not pushed away and that ways are found to keep them engaged with the services.
There is interesting research about the best way to empower young people to make positive choices. That tends to be around skills-orientated work in schools that targets a range of potentially risky behaviours by giving young people the skills, confidence and self-esteem to make positive choices. That curriculum for excellence work in schools is crucial, and I know that the part of it on educating about substance misuse is being looked at again.
People will be familiar with the work in and around the Know the Score website, for example, and the work done by Crew 2000 in engaging young people and educating them about a range of risky behaviours. However, work is also going on to reappraise prevention and substance misuse education in schools.
This is my final question. How does the Scottish Government’s work in relation to drugs policy align with work to reduce adverse childhood experiences and levels of child poverty?
I spoke a wee bit earlier about the work across Government to reduce child poverty. Unless there are specific points that Mr Torrance wants me to pick up on, I will not test the convener’s patience by repeating that.
On the work around adverse childhood experiences, that alignment is crucial. Any time that you speak to any individual with lived or living experience, or to any of the organisations in the sector that are working with or that represent people whose lives are affected by drugs, they will tell you that the link to adverse childhood experiences is right up there as a factor. The work around getting people into the right treatment and around medication-assisted treatment standards is really important, because the MAT standards recognise that it is not just about giving people informed choices in relation to medication, but about making links to other treatments and support. They also recognise that access to any treatment needs to be quick.
The work on ACEs and MAT standards is really important to embed. It is high-priority work, and I think that that is the best way to demonstrate how to put a human rights approach into practice.
The First Minister has announced an extra £5 million for drug services in this financial year. There was also a promise, should the Scottish National Party form the next Government, of £250 million over the next parliamentary session. That is not the only money that goes towards the partner agencies that you work with. Do you know how much money, on top of the money that the Government is putting in directly, goes to drug services? What is the total amount of money that is going into drug services currently?
Mr Adam is correct that we have made a commitment of £250 million over the lifetime of the next Parliament and that £5 million in emergency money has been made available in the last quarter of the current financial year, which is additional to the existing budget.
I can understand why the committee is interested in the total funding pot, and it is comparatively easy for Government to release information about our budgets, our spending and where we have directed funding. The picture gets a bit more complex when there is public money that comes from health boards in addition to Scottish Government resource, and there is local government investment as well. I am conscious that all that, at the end the day, is public money.
I cannot give you, here and now, off the top of my head, hard and fast figures that include health board and local government spend. I can say that part of the evaluation work that I spoke about earlier, which looks at the success and the outcomes of the national mission, is about better understanding the overall financial package.11:15
For my part, I will publish as much information as I can. In the next week or so, I will publish details of the £3 million of extra money that is being allocated to alcohol and drug partnerships. There will be breakdowns from each health board area and each alcohol and drug partnership within those. People will be able to see where that money has been allocated. We made a particular ask about the proportions in which money would be allocated to aspects such as residential rehab, improving access to services and harm-reduction methods.
My final question is on the back of what the minister has just said. How will the effectiveness of the additional spend be assessed? Partner organisations might spend the same money on similar issues. How will we ensure that we get as much as possible for every penny that is spent on alcohol and drug services?
We need to have a forensic focus when we are following the money. I want to be absolutely sure and confident that we will get additional impact from the money that the creation of my portfolio has generated. It will be a case of me getting down to brass tacks and following the money that flows from the Government to ensure that we get additionality for that. That will be part of the work that we do in the evaluation programme on the national mission.
This is my first opportunity to welcome you to your new role—congratulations on that. I know from our previous work together in the education field that the collaborative approach that Donald Cameron mentioned in his comments is one that you will bring to this portfolio, too.
You will be aware that, last week, the Royal College of Physicians of Edinburgh published a report that, among other things, backed the introduction of safe consumption rooms to tackle the record level of drug deaths. As well as pointing to support for decriminalisation of drug use, Professor Angela Thomas, the acting president of the college, commented on the report, saying that
“key interventions which can be taken now”
“the introduction of a drugs consumption room, and a heroin assisted treatment programme in all major centres in Scotland as we see already at the Glasgow pilot scheme.”
It might be early days, but have you had any engagement with the RCPE yet, or are you planning to speak to Professor Thomas and her colleagues as part of that collaborative approach so that we might see progress on the issue of safe consumption?
The Royal College of Physicians of Edinburgh’s report is important and welcome. It is encouraging that, even from a clinical point of view, there is acknowledgement of the role of poverty and inequality in all of this. Among clinicians, there is a deep understanding that the emergency work that they have to do to save lives needs to be embedded in every policy area across the board. There are various royal colleges that I will seek to engage with. I have certainly spoken to a range of clinicians who, as individuals, are involved with those colleges.
It is interesting to note that all the expert reports or pieces of evidence that are published have the same direction of travel. Some of that is about reinforcing what we already know about the benefits of, for example, heroin-assisted treatment and overdose prevention facilities. Such facilities save lives, but they also help people to get into longer-term treatment and to make longer-term improvements to their lives. They enable people to have more choices and chances. Although, in many ways, the RCPE’s report did not tell us anything surprising, it is another layer of evidence for the direction of travel that should be taken.
My approach is that, where I can do something, I will. The example of overdose prevention facilities is apposite. I will continue to work to find ways to do things, where the route might be less than obvious or where there are legal barriers. Where we can do things, such as with the heroin-assisted treatment, we will progress as speedily as possible.
Thank you for that response, which tends to suggest that we know what the direction of travel is. Progress might be frustratingly slow, but I hope that we will get there eventually.
In the meantime, the Lord Advocate has quite a lot on his plate at the moment, but will the minister commit to engaging with him on what more might be done on the advice that the Crown Office issues on the law as it stands? That might provide more scope and reassurance to those who are delivering services that are clearly saving lives, albeit in Glasgow only at this stage.
Yes, I have engaged with the Lord Advocate and the law officers, as you would expect. The Government’s policy position remains the same. The law officers are fully aware of the Government’s policy position. Those committee members who were involved in the Scottish Affairs Committee work will be aware of the Lord Advocate’s views and of what the legal barriers are. Nonetheless, the law officers and the Lord Advocate in particular gave a view on a specific proposition to deal with the circumstances that are being fought in Glasgow, where vast numbers of people are injecting and are involved in high-risk behaviour. The Lord Advocate gave a view on that specific proposal, which from the Glasgow health and social care partnership.
I will look at alternative propositions, and I will continue to engage with the law officers. Officials are actively engaged in that stream of work. I appreciate and share folk’s frustration about the situation. You will not be surprised to hear me say—this is a practical point as opposed to a political one—that I would much rather have the powers to legislate so that we could work together on legislation to provide a safe, legal environment not only for people who use overdose prevention facilities but for folk who would work in such a service. However, that will not stop me looking at alternatives and other opportunities to make progress on the matter.
I thank Angela Constance and her officials for their attendance. Clearly, the area is one that will continue to be a major policy focus in the next session of Parliament. It has been a useful evidence session.