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You mentioned that you had not been aware of the naloxone public health initiative prior to joining the people’s panel. How did you come to be aware of it during the panel’s work? Were you briefed on it, or did you take part in training to administer naloxone? I am interested in how members of the panel came to be more familiar with it.

Thank you, convener. I second your thanks to the staff of the facility for enabling Pauline McNeill and me to visit on behalf of the committee on 9 January, just prior to it officially opening on 13 January. We were given a comprehensive walk-through of the facility by the staff, and what struck us was how well planned the facility is in terms of how people present at it, how well fitted out it is, and how welcoming and non-clinical the space is.

People can come into a reception area, register and go into a consultation room, then proceed through a small corridor into a large space where they are handed sterile equipment and allocated a booth. They are then able to prepare and inject the substance under supervision at a step back from it at a desk or a nurse’s station. The mirrors were orientated in such a way that they provided some privacy. Nonetheless, if assistance was required, someone could come over and help—not with injecting the substance, but with finding a vein and so on. We went through all that in detail. If someone has an overdose, crash mats and first aid provision are available, and they are taken care of in an adjacent clinical room.

Just behind the administration area, there is an area with soft furnishings where someone who has just injected is able to let the drug take effect. After that, there is more of an informal cafe-type break-out area, almost like a kitchen area, where people can sit and relax and get informal advice from the staff about options around housing, mental health, physical health, social security and so on, to try to ensure that there is a degree of stability. Then, of course, they are able to leave.

There is also an outdoor smoking area although it was stressed that it is only for smoking tobacco. Other substances are not permitted to be smoked on site, although it was discussed that it would make sense to have some form of facility for smoking, because we know that is a characteristic of people who use drugs. Smoking substances is another issue, so why not provide the facility for that? We heard that indoor inhalation would involve significant ventilation requirements and that there might also be issues with the smoking ban. However, the outdoor area is quite well provisioned. Whether that would be a useful adjunct or expansion of the scope of the facility might be something to look at in the future.

People are given orientation information and are free to leave at a reasonable point after the injection of the substance.

All in all, it is a well-provisioned, spacious, well-designed and thoughtful facility that takes street injection behaviour into a controlled environment. There is no scope to leave with any substances and there is no provision of substances on site. Sterile equipment and debris are disposed of on site. People may attend multiple times in a day or more infrequently. It is very much there when it is needed. Some questions were raised about the opening hours, which are from 9 to 9, which is only a 12-hour operating window.

The discussion that the committee had previously was purely about whether it is a starting point and whether we should see how we progress with it. It has now been operating for just over a month and it certainly seems to be performing well so far, although it is in its very early days.

One area of concern that was noted was the potential nervousness of the community about drug-dealing and other associated antisocial behaviour. I was certainly reassured that that would be kept under review as part of the evaluation of the facility.

In our walk-through and discussion on site, we found it to be very impressive, based on my experience of visiting other facilities in the world, particularly in Copenhagen. I found it to be a well-planned facility and thought that the staff presented a comprehensive and effective plan of operations.

Let us turn to the people’s panel recommendation on information and education. You noted in your response that the Scottish Government supports the recommendation that financial support and provision be provided for external organisations to support education in schools from primary 5 to P7 and onwards, and for wider outreach in communities. What work is the Government doing to combat misinformation and even disinformation surrounding the nature of Scotland’s drug deaths crisis?

I know of a particular case that might be worth the cabinet secretary commenting on, which relates to the opening of the Thistle facility on Hunter Street in Glasgow—a video has already been produced on social media that has garnered more than 50,000 views. Three core claims have been made about the facility. The first is that, since the Thistle opened, it has caused a large amount of injection equipment to be discarded around the Morrisons car park opposite the facility, presenting a threat to public safety. The second claim is that the Thistle is supplying medical-grade heroin to any individual attending, that staff are injecting the majority of those attending and that people are able to leave in possession of drugs. The third claim is that there has been a surge in the number of people injecting heroin and cocaine or smoking crack cocaine in the car park.

Will the cabinet secretary address each of those points and provide a factual response? Will he also use that as a basis to discuss the wider issue of disinformation and misinformation relating to harm reduction measures such as those provided by the Thistle?

That is really useful. It is surprisingly straightforward to learn how to administer naloxone—it took me half an hour. Thanks for raising that.

In your response to the people’s panel report, you note that the Scottish Government, either directly or through alcohol and drug partnerships, supports a number of

“high tolerance/low threshold services.”

Do you believe that a sufficient number of those services are already in place, or are more required? If more are needed, would the Scottish Government be prepared to provide the logistical and financial support that would be necessary to allow that expansion?

I thank the witnesses again for their powerful contributions today on behalf of the people’s panel. I want to pick up on harm reduction measures such as naloxone. One of the key recommendations was to do a much bigger public awareness campaign about naloxone. Will you expand on what practical aspects you think would be useful in a public campaign? What could it look like in reality?

That response more or less covered the question that I was going to ask.

Thank you for coming to this meeting, cabinet secretary, and for reflecting on the recommendations that were made by the people’s panel. It recommended that there should be an urgent examination of issues around poverty. In your response to its report, you advised that the Scottish Government is developing a population health framework to be published in the spring, which will

“consider what more can be done to mitigate against the social and economic drivers of ill health”.

Will you provide the committee with more detail of what that will look like?

Yes. Thank you, convener. I appreciate your patience in accommodating me this morning. I am here to speak in general terms in support of the petition. I believe that it merits further scrutiny by the committee, perhaps in collaboration with the Health, Social Care and Sport Committee, of which I am deputy convener.

There are significant issues with the capital investment programme across the NHS estate, not simply with capital budgets—finance is one thing—but with how efficiently investment is made and whether it is made in the right locations. An example that I encountered on a recent committee visit to the Isle of Skye was the recently reconstructed Broadford hospital, where clinicians said that the health board did not adhere to their feedback or guidance on how the hospital should be designed and laid out and that it could have been better optimised. They are now dealing with the consequences of that.

Similarly, we hear from surgeons that the focus on national treatment centres is not necessarily helpful in the context of underutilised operating theatres and that the capital investment might be better focused on the primary care estate, for example, which is often crumbling and decrepit.

It might be interesting for the committee to consider wider consultation with the clinicians who operate in those facilities on whether the capital investment programme that the 14 territorial health boards are developing is as good as it could be or whether it ought to be reviewed, taking greater cognisance of clinical feedback and design, so that we get the best use of that budget. The budget feels scarce but, even when it is spent, it is not necessarily realising the best benefits for the patients and the healthcare system.

It is hard to balance risks. There are risks in every aspect of human behaviour and situations are complex and varied.

It is clear that there will be an offence if someone is coerced into making a first or second declaration. Might one influence on a person’s thinking about whether to undertake an assisted death be the lack of provision of alternative medical treatments, such as palliative care? Could the denial of timely treatment act as a coercive influence on a person’s thinking, and might that lead to legal disputes about access to other treatments? Might family members consider the denial of those alternative treatments to be the stimulus that caused a person to undertake an assisted death and might that lead to a criminal case?