Meeting of the Parliament [Draft]

Meeting date: Wednesday, February 5, 2025

Official Report 1035KB pdf

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Medication Assisted Treatment Standards

The next item of business is a statement by Neil Gray on implementing the medication assisted treatment standards. The cabinet secretary will take questions at the end of his statement, so there should be no interruptions or interventions.

14:48  

I take this opportunity to update the Parliament on progress regarding the implementation of the medication assisted treatment standards and the wider work of the national mission.

First, I acknowledge the suspected drug death figures that were published as part of Public Health Scotland’s latest rapid action drug alerts and response—RADAR—surveillance report, which highlighted that there were 215 suspected drug deaths between September and November 2024. The 10 per cent reduction on the previous quarter is welcome, but the number of drug deaths remains much too high and serves as a stark reminder of the work that remains to be done.

Behind every statistic is a person and a life that has been lost needlessly. Those people leave behind grieving loved ones, who bear those tragic losses. To them, I offer my sincerest condolences.

That is why the work of the national mission is so important. Its clear-cut aim is to reduce the number of drug deaths and improve lives through a holistic approach. The statistics on harms caused by alcohol are also alarming, and we are committed to tackling those in conjunction with drug harms.

I also acknowledge the recent report of the people’s panel on drug-related harms. We are considering its findings and I look forward to providing evidence to the joint committee and setting out our response later this month.

The MAT standards are a key element of our national mission. They take an evidence-based approach to enable the consistent delivery of safe, accessible and high-quality drug treatment across Scotland. In July 2024, Public Health Scotland published its third national benchmarking report, which provided an assessment of the status of implementation of the standards as of April 2024. Ninety per cent of standards 1 to 5 were assessed as fully implemented and 91 per cent of standards 6 to 10 as partially implemented. Although that is positive, I am fully aware that much work must still be done to ensure the successful implementation of all 10 standards. The benchmarking report acknowledges areas of good practice, but there is still some way to go before everyone, everywhere, can benefit from the same level of support. We continue to work closely with local areas and partners to ensure that measures are in place to support implementation.

More broadly, much of the work of the national mission supports the implementation of the standards and beyond. I will highlight a few of those areas now.

MAT standard 8 commits to improving advocacy for people who use drugs. In December, the First Minister and I had the pleasure of attending the launch of the charter of rights. Developed by the national collaborative, it draws on the experience of those with lived and living experience of substance use. The charter supports people who are affected by substance use to realise their human rights and seeks to empower them to demand the care and support that they need. It also provides those who deliver services with a clear reminder of their duties to ensure a standard of care that reflects those rights. Taking a holistic, person-centred approach that supports improved access and empowers people to make informed choices about their care will support a human rights and health-based approach to the treatment for any substance.

We recognise the importance of adapting services to ensure that people who seek help are able to get the right support at the right time. That is especially important in the area of mental health and substance use, where evidence suggests that needs can intersect and that, to effectively treat one, we must address the other, too. That is the focus of MAT standard 9.

The Government is committed to ensuring that we work across policies and portfolios to better understand common issues and how to resolve them. We are supporting better working links between services and driving a culture of inclusivity that puts the needs of individuals at the heart of everything that we do. In that vein, we commissioned Healthcare Improvement Scotland to produce an exemplar protocol on mental health and substance use, which builds on best practice from across the country and internationally. The protocol, which was published in September 2024, outlines how mental health and substance use services can work better together to deliver a whole-system approach. Building on that, we have commissioned Healthcare Improvement Scotland to support local areas to adapt that protocol to their circumstances, ensuring that the workforce have the tools that they need.

We also know that women who use substances often face unique, gender-specific challenges when accessing treatment and support, which is why we are committed to taking a gendered approach and ensuring that women can access the right services for them when they need them. That includes our work on developing a good practice guide to help local areas do more to support women who are affected by substance use—and their babies, during the perinatal period—along with efforts to upscale residential rehab services that keep women and families together.

More than £5.5 million has been committed, in conjunction with our whole family wellbeing fund, to support the establishment of two houses run by Aberlour Child Care Trust that are specifically designed to support women and their children through recovery. We confirmed last week that an additional £1 million of funding will be made available to support Aberlour’s important work with women and children who are affected by drugs. That additional funding will allow more women and infants to receive the support that they need during that crucial period.

Beyond that, we will also invest a further £1.5 million in broader alcohol and drug services in the next financial year. The additional funding will allow us to support even more people to achieve their own recovery. That whole-family approach is not only a key focus of our approach to recovery, but also a fundamental component of our commitment to keep the Promise. Today is the fifth anniversary of the Promise, and it is important that we acknowledge the important role of early intervention and prevention in keeping families together when it is safe to do so.

I recently saw for myself the impact that early intervention can have on young people’s lives when I attended the launch of the new routes service in East Lothian, which is delivered by Circle. It was one of the most impactful visits that I have had the pleasure of experiencing as a minister. The routes service meets young people who are affected by substance use where they are, providing whatever holistic support they need. The results speak for themselves—the service breaks intergenerational cycles of substance use and supports our young people to achieve their goals. Thanks to the whole family wellbeing fund, the service is now available in eight areas of Scotland.

A core pillar of our national mission is to increase access to and the provision of residential rehabilitation. Our vision is for residential rehabilitation to be available to everybody who wants it, and for whom it is deemed to be clinically appropriate, at the time that they ask for it and in every part of the country.

We are also committed to increasing by 300 per cent the number of people who are publicly funded for their placements, with the aim of funding 1,000 people per year by the start of 2026. A recent report that was published in December 2024 by Public Health Scotland concluded that we successfully achieved that target in 2022-22. However, we remain ambitious to sustain and build on that success, so we have made £2 million available this year via the additional placement fund to support that endeavour.

Delivering the MAT standards and advancing the broader national mission requires a skilled and resilient workforce. We are grateful to those who deliver drug and alcohol services, and we recognise that addressing current workforce challenges will not be a quick fix. In spring 2025, the Scottish Government will introduce and support the implementation of a suite of drugs and alcohol workforce publications that have been developed in collaboration with stakeholders. They will outline the knowledge and skills that are required by those who support individuals who use substances, and they will also facilitate access to a range of training opportunities and outline guiding principles for employers to ensure consistent care and support in the workplace for individuals with lived and living experience. As a package, those publications will help to support opportunities to enter, develop and sustain fulfilling careers in the drug and alcohol sector.

As we approach the final year of the national mission on drugs, our attention is turning to the future. Learning from our progress to date and ensuring a smooth transition to the next phase will be key. We have made significant progress in building prevention, treatment and support approaches to reduce the harms caused by substance misuse. However, reducing alcohol and drug-related deaths and wider harms will remain a key priority. It is our intention to work in collaboration with our stakeholders and partners, including those with lived and living experience, to plan for the next steps in addressing the harms caused by drugs and alcohol in Scotland. I look forward to progressing that engagement, including across the chamber.

Moving forward, continued implementation and sustainability of the MAT standards remains a priority. We must also continue to be responsive to emerging threats and ensure that services can continue to adapt to meet those new challenges. MAT implementation should remain at the forefront of our efforts through the remainder of the mission. The standards reinforce a rights-based approach to treatment and emphasise the importance of allowing people to make informed decisions about the types of help that are available to them, which is vital in delivering on the ambitions of our national mission.

In that respect, I hope that the Parliament will join me in supporting the efforts and actions that the MAT standards and the overall national mission set out to achieve. I look forward to the next benchmarking report publication in the summer. I believe that, if we work together, we will transform the lives of individuals and families across Scotland.

The cabinet secretary will now take questions on the issues raised in his statement. I intend to allow around 20 minutes for that, after which we will need to move on to the next item of business.

I declare my interest as a practising national health service general practitioner.

We still have the highest drug death rate in Europe. The MAT standards were announced in a fanfare in 2021, yet, four years later, people who are seeking help still face unacceptable delays, workforce shortages and a postcode lottery in treatment. Community-led services continue to struggle due to a lack of sustainable funding, and the Government’s slow progress is costing lives. Scotland needs urgent action, not more rhetoric, and that means real investment in rehabilitation and a commitment to the Scottish Conservatives’ right to recovery plan, which would ensure that everyone can get access to the treatment that helps them to get off drugs for good. The people of Scotland deserve better.

We need measurable results. Given that the Scottish Government’s latest project, the Thistle drug consumption room facility, is now operational, my questions are about how the Government will evaluate whether the Thistle is a success or otherwise. What specific—and I mean specific—criteria will be measured? Will the cabinet secretary commit to assessing the centre’s impact on not only users but the community that surrounds it? Did the Scottish Government evaluate the impact that was made by investing in the Thistle centre against the impact that that money would have had if it had been used for community-led projects such as the routes project that the cabinet secretary referenced in his statement?

I recognise what Sandesh Gulhane set out in the opening part of his response to my statement, which is that drug-related deaths in Scotland remain far too high. I acknowledged such in my statement as well. Even when I responded to the latest RADAR figures showing a 10 per cent reduction, I recognised that there can be fluctuation in quarterly data. The reason why the statement is so important is that the purpose of the implementation of the MAT standards is to reduce harm and deaths.

On sustainable funding, I am confident that we will achieve the £250 million national mission. That funding has created a significant amount of additionality in alcohol and drug partnerships, and there is also the likes of the Corra Foundation funding that goes out to community partners.

On the Thistle centre, as I have set out in relation to previous questions from Mr Gulhane and others, the aim of the pilot is to reduce drug-related harm and deaths and give people access to services that they otherwise would not have approached. We can already see from the evidence from those managing the Thistle centre that that is coming true. I hope that everybody will engage positively with the centre as an additional element of our national mission, because it has to be a holistic approach; no one element is going to fully respond to or resolve matters.

On residential rehab, a report on the capacity that we have available shows that there has been a rise in residential rehabilitation capacity from an estimated 425 beds in 2021 to a maximum of 513 in 2024. That is a rise of 21 per cent, which demonstrates our commitment to taking all possible steps to resolve the matter.

Scotland’s drug deaths crisis is a national emergency. Lives are being unnecessarily lost every day across the country, and we must not forget that every one of those deaths is a preventable tragedy.

Although the 10 per cent reduction in drug deaths from the previous quarter is a potential sign of progress, we know that there can be seasonal variations. It is frustrating that the minister would come to Parliament and tell us yet again that the MAT standards are not fully implemented, despite the fact that the national mission on drugs, which was launched four years ago, is now approaching its final year.

Interventions such as the official overdose prevention pilot in the east end of Glasgow will save lives—I had the opportunity to visit the centre recently—but they are not a silver bullet. The Government must properly support health boards to implement all the MAT standards. I am worried that the national mission on drugs will likely fail, given that we are now one year away from its end date and yet drug deaths in Scotland remain the highest in Europe, if not the developed world.

What is the cabinet secretary doing day to day to drive full implementation of the MAT standards across every territorial health board, being cognisant of emerging risks such as the rise of synthetic opioids?

I am absolutely cognisant of the rise in synthetic opioids and the linked action around the roll-out of naloxone. The naloxone programme in Scotland is so important here.

The action that we are taking is showing demonstrable progress on the implementation of the MAT standards. I share Paul Sweeney’s concern that we have not got full implementation, and I set out in my statement that we still have more work to do. We continue to work with local alcohol and drug partnerships and health boards to ensure that that is happening. However, I see from not only alcohol and drug partnerships but Public Health Scotland’s benchmarking report that we are making demonstrable progress that we can build upon. I will keep working with health boards, as well as with alcohol and drug partnerships, to ensure that that progress is maintained.

I remind the chamber that I am employed by NHS Greater Glasgow and Clyde as a bank nurse.

We need to ensure that care and support are available to people on the day that they ask for help, no matter where they live. Will the cabinet secretary inform me what action is being taken to drive up and ensure consistency in access to treatment across all alcohol and drug partnership areas?

In the national benchmarking report that was published by Public Health Scotland, 23 of the 29 ADP areas—79 per cent of them—were assessed as “fully implemented” for same-day access. In those areas, 75 per cent of people received their MAT assessment—the first date that the service offered for MAT assessment, when treatment can be initiated, if appropriate—either on the same day of initial presentation or the next day.

We recognise the particular challenges of implementing the standards in rural and island areas and those that have been assessed as “provisional green”, but I am pleased to see that the challenges of rurality are being overcome by maximising access and choice through technology, travel and the provision of different modes of care.

Our discussion is mostly about how we treat people who are caught in addiction. Is the Scottish Government looking at the social determinants that have led to Scotland being such an outlier on drug and alcohol deaths? If we cannot identify the problem, how can we address it properly? Why has Scotland been so bad for so long?

Brian Whittle raises a very important point, which has been debated by politicians and public health experts. There is undoubtedly a clear correlation between areas of poverty, social deprivation and deindustrialisation and areas that have high rates of drug-related deaths.

The national mission is important in addressing the issues that people who have a substance dependency face, but the wider work to tackle poverty, which has been the Government’s number 1 priority, is also critically important, because it goes to the heart of the health inequalities that drive some of the issues that we are facing today.

Brian Whittle raises an important issue that all of us must consider.

I remind the chamber that I chair Moving On Inverclyde, which is a local recovery organisation.

Will the cabinet secretary give an update on the steps that are being taken to ensure that there is local accountability in relation to the implementation of the MAT standards, with a view to driving improvements across Scotland?

I thank Stuart McMillan for the work that he does locally.

Integration authorities for health and social care have a legal responsibility to plan and deliver treatment and recovery services for people who experience drug harms. In June 2023, ministers issued a letter of direction to NHS chief executives and local authority chief executives and chief officers, which requested that they personally sign a public delivery plan for implementing the standards. Those bodies cannot work alone—they must work alongside others, through alcohol and drug partnerships, to ensure that people receive the integrated services that they need.

Following that ministerial letter of direction, the requirement for local areas to provide quarterly update reports on progress against their implementation plans is continuing.

On 16 January, the cabinet secretary met me to discuss the status of MAT standards in Dundee, so he already knows about my concerns that service users and providers in my home city are very sceptical about the continued improvement in the self-assessment reports. What independent validation of the MAT standards assessments is in place?

The experience in Dundee, where many of the recommendations of the Dundee drugs commission of 2019 remain undelivered, does not tally with the self-assessment that is in front of us today.

The assessments come through Public Health Scotland. I hope that that gives Michael Marra some reassurance, although I recognise the concerns that he raised with me, some of which we are following up on.

Michael Marra also sought clarification on what the Government’s intention is with regard to what will come after the national mission. Today, I have set out my willingness—in fact, my desire—for there to be collaboration across the chamber, as well as with local alcohol and drug partnerships and all interested parties, on what we do to build on the national mission. Paul Sweeney made the point that the work will not have been completed by the end of the national mission. He is right. We will still have work to do, and it will be in all our interests to ensure that we work together to agree on what the framework should look like and on the areas that we need to focus on to ensure that we continue the work to reduce harm and drug-related deaths.

In November, my office took part in naloxone training with the professional, diligent and caring specialist addictions nurse Ruth McCall. The more people who are trained in the use of naloxone, the quicker we will be able to address the issue and reduce the associated stigma. Can the cabinet secretary say more about the uptake of naloxone training across Scotland, especially in rural areas such as Dumfries and Galloway? What further action is being taken to reduce stigma?

I thank Emma Harper for taking the time to get herself and her office trained in the use of naloxone. I encourage everyone to take up the opportunity to do so as and when they can. Naloxone distribution has been a key priority for this Government, and we continue to work to ensure that it is available to anyone who wants it. Recent statistics from Public Health Scotland show that more than 75 per cent of people who are at risk of an opioid overdose have been supplied with a kit.

The supplementary question that Emma Harper posed was about the reduction of stigma, which is absolutely critical. The discussions that I have had with families who have lost a loved one to a drug dependency or who live with a family member with a drug dependency point to the reduction in stigma and the ability of people to access treatment as being key areas of improvement under the national mission, which can only be a good thing.

The MAT standards are supposed to drive down the number of deaths and ensure that people with lived and living experience see an improvement in how services are delivered. I welcome the increasing implementation of the standards, but we have to ensure that they are actually changing services. How is the cabinet secretary ensuring that the feedback from living experience is taken into account and used to further drive improvements in service delivery?

I again reference the interactions that I am fortunate to have had with families and people with lived and living experience. It is critical that we not just listen but act on what they have to say. We have to ensure that we get it right for everyone and that we have a holistic model that meets everybody’s needs.

I point Gillian Mackay to the example of the pilot at the Thistle centre in Glasgow, which Sandesh Gulhane mentioned. People with lived and living experience were involved in the design of the service there and in interviewing the staff to run it. They have therefore been absolutely central, which I believe has resulted in the early success that we have seen. I hope that the pilot at the Thistle will be an on-going success.

Through my engagement with colleagues who work in drug services, I am aware that concerns about access to formal mental health assessment continue, with people often being considered to be too chaotic or using too heavily, being passed between mental health services and, ultimately, struggling to access the care that they need. I very much welcome the cabinet secretary’s recognition of the importance of services adapting and the update on the development of the exemplar protocol. Will he provide further detail on the action that is being taken to ensure that there are clear pathways and timescales for mental health support, acknowledging the wider pressures on mental health services?

I thank Audrey Nicoll for raising that point, and I recognise that we still need to resolve that challenge. I see that in my constituency casework involving people arriving at health services with a substance dependency and a mental health issue. Working across mental health and drugs policy, we commissioned Healthcare Improvement Scotland to produce an exemplar protocol that builds on best practice from around the country and internationally. It outlines how mental health and substance use services can work together to deliver a whole-system approach, which will be absolutely critical to fully delivering and implementing MAT standard 9. That work will support local areas to integrate mental health and substance use services and will ensure that people with co-occurring conditions can get the help that they need regardless of which service they present at.

I want to ask the cabinet secretary about the mother and child recovery houses that will be provided through the Aberlour Child Care Trust, because the Liberal Democrats made the case for that service being in the budget. Will the cabinet secretary guarantee that every mother and child who needs access to the service will be able to access it in a location close to their home?

I thank Willie Rennie and Liberal Democrat colleagues for their engagement on the matter. I believe that Jenny Minto met him very recently to discuss it. I hope to visit Aberlour to see the fantastic work that the Liberal Democrats’ engagement in the budget process has helped to deliver, and I will report back on that in due course.

Can the cabinet secretary provide some clarity on how the implementation of MAT standard 2 ensures that individuals are fully informed of all recovery options, including abstinence-based treatments, detox and rehab, and not just the MAT standards? As she said, the Government has ambitious rehab targets, yet there are only 140 full-rehab beds available for Scotland, not the 513 detox beds to which the cabinet secretary referred earlier. How will those be made accessible for all, particularly when financial and geographical barriers exist? What mechanisms are in place to ensure that patient choice is genuinely respected and that MAT is not prioritised over other treatment pathways?

Making sure that people have a range of possible treatments is part of the MAT standards. The member referred to MAT standard 2, and we have increased residential rehabilitation capacity to a maximum of 513 beds in 2024. We have reached the target of 1,000 publicly funded places early, and we want to build on that. However, we also have to recognise that abstinence-based programmes are not for everybody and that we need to trust clinical judgment in the process as well. We need to invest in all aspects of the national mission, as no one element is going to resolve the situation for us. However, where there is a need and it is assessed as being appropriate, we must ensure that there is residential rehabilitation capacity in Scotland, and we are investing in that.

I apologise for being late to the chamber, Deputy Presiding Officer.

Will the cabinet secretary outline the resources that are being provided to recruit, train and retain staff in the ADP workforce?

We have given greater clarity in the budget for alcohol and drug partnerships, and we have baselined more of their funding to give greater certainty for their investments. We are also investing in the Corra Foundation so that the work that it does from a community perspective can deliver. I would be happy to write to Rona Mackay with more details on all of that.

How are MAT services working in partnership with the residential rehabilitation providers to create seamless pathways from medication assisted treatment to abstinence-based recovery? Are there established protocols or referral systems in place to facilitate that transition?

As we expand our residential rehabilitation capacity, we need to get clarity and ensure that those pathways are robust. That is part of the capacity building that we must deliver. I will provide greater detail on that to Douglas Lumsden in writing.

That concludes this item of business.