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Official Report: search what was said in Parliament

The Official Report is a written record of public meetings of the Parliament and committees.  

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Dates of parliamentary sessions
  1. Session 1: 12 May 1999 to 31 March 2003
  2. Session 2: 7 May 2003 to 2 April 2007
  3. Session 3: 9 May 2007 to 22 March 2011
  4. Session 4: 11 May 2011 to 23 March 2016
  5. Session 5: 12 May 2016 to 5 May 2021
  6. Current session: 12 May 2021 to 20 December 2024
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Displaying 822 contributions

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Criminal Justice Committee, Health, Social Care and Sport Committee, Social Justice and Social Security Committee: Joint Committee

Reducing Drug Deaths in Scotland and Tackling Problem Drug Use

Meeting date: 24 November 2022

Angela Constance

I agree that it is important that we have a wide and appropriate dashboard of information so that we can understand all the harms as well as the contributing factors to drug-related deaths. It is important that we have that information about all drug-related harms. Through the publication of the national mission plan in September and the national mission annual report and the ADP annual report, I hope that I have demonstrated, at least to some extent, that we have an outcomes framework. In the national mission plan and the national mission plan annual report, you will see the information that we are using and that feeds in so that we can capture those harms. However, if the committee came to the view that we were not capturing all that, we would endeavour to address that.

Criminal Justice Committee, Health, Social Care and Sport Committee, Social Justice and Social Security Committee: Joint Committee

Reducing Drug Deaths in Scotland and Tackling Problem Drug Use

Meeting date: 24 November 2022

Angela Constance

I will say something that, I hope, is positive but is perhaps also a bit defensive. The housing first model is good in that it is designed to provide enough flexibility to meet the needs of individuals. It recognises that it is unrealistic that some people, because of the chaos and trauma that they live with, will be able to sustain their tenancy on their own, so we should not step back from the housing first model.

However, you have a point about other models of care. In relation to drug treatment, we have strong and clear commitments on residential rehabilitation and the abstinence-based recovery model—we are not stepping away from that—but there is a need for other models of care. Supported accommodation is clearly part of that, and that links with the work on homelessness and mental health.

There will be an opportunity for the Parliament to consider our approach when the homelessness prevention duties are refreshed. There is something very powerful about the ask and act approach. Too many people are in inappropriate temporary accommodation. As a constituency MSP—although I do not represent a city—I have encountered young people being put into inappropriate accommodation, and that is not keeping the Promise or doing our best by every child.

I appreciate that there are challenges in and around cities. Through our work on the cross-Government action plan that we will produce, we are thinking about specific things that we can do more of to scrutinise and support cities, bearing in mind that, as we know from the annual report, Glasgow, Edinburgh and Aberdeen all had rising drug death rates.

Criminal Justice Committee, Health, Social Care and Sport Committee, Social Justice and Social Security Committee: Joint Committee

Reducing Drug Deaths in Scotland and Tackling Problem Drug Use

Meeting date: 24 November 2022

Angela Constance

First, Mr Findlay, that was not a Government report; it was a Public Health Scotland report. You are right to say that an error was established in the information that Public Health Scotland had received from Glasgow. Therefore, the quarterly figures had to be revised down, and there was transparency around that.

Regarding the quarterly figures to which you refer, 170 residential rehab placements have been funded by the Government, which is the highest-ever number that has been funded in any quarter.

One reason that we publish information is so that we can scrutinise what is happening in every local area. I know for a fact that, in the past financial year, we have supported the funding of more than 500 residential rehabilitation placements and that, over the lifetime of the national mission, we have supported the funding of more than 700 residential rehabilitation services. I accept that it is important to distinguish between stabilisation services and residential rehabilitation.

Criminal Justice Committee, Health, Social Care and Sport Committee, Social Justice and Social Security Committee: Joint Committee

Reducing Drug Deaths in Scotland and Tackling Problem Drug Use

Meeting date: 24 November 2022

Angela Constance

Ms Mackay knows that I firmly support safe drug consumption facilities. I had the opportunity to visit a facility in East Harlem in New York. Before there are any questions about that visit, please note that I was in the States in my own time and at my own expense.

The evidence shows that safe drug consumption facilities work and that they save lives. They are not a silver bullet, but they have a role to play. We have worked very hard with our partners, including Glasgow City Health and Social Care Partnership, the Crown Office, Police Scotland and others to develop a service specification proposition, which has been submitted to the Crown Office.

More specifically, the Crown Office has been gathering further information, as I understand, from Police Scotland, and it is nearing the point at which it can give advice to the Lord Advocate. You will appreciate that I cannot speak on behalf of the Crown Office or our independent Lord Advocate.

Criminal Justice Committee, Health, Social Care and Sport Committee, Social Justice and Social Security Committee: Joint Committee

Reducing Drug Deaths in Scotland and Tackling Problem Drug Use

Meeting date: 24 November 2022

Angela Constance

There is a role to play when it comes to tackling stigma, understanding drug and alcohol issues as a public health issue and understanding people’s attitudes towards various treatments. Sometimes, people have views about the location of any service in their community, so it is important that local services engage and have open dialogue with local communities.

Criminal Justice Committee, Health, Social Care and Sport Committee, Social Justice and Social Security Committee: Joint Committee

Reducing Drug Deaths in Scotland and Tackling Problem Drug Use

Meeting date: 24 November 2022

Angela Constance

I want to make two broad points. We are still waiting on the Lord Advocate to give us a view on whether the service specification and operational procedures are within our powers and whether it rests within her powers to determine prosecution policy and what is in the public interest. That is a core consideration of the matter.

Mr O’Kane is right to point to other health-related legislation. The other legislation that we cannot ignore is the Misuse of Drugs Act 1971. We have worked hard with partners to devise a proposition that is, we hope, within what we can currently do in Scotland, but I am not the final arbiter of that, hence the role of the Lord Advocate.

You also allude to Gillian Mackay’s point that there are other models and other ways to implement safer drug consumption facilities. There is the fixed model with fixed premises, there are clinical medically led models and there are other models that are voluntary sector-led. Of course, there are models of mobile safe drug consumption facilities as well. Although I would ideally rather have started from the position of considering which model will best meet the needs of our people, because of the 1971 act, we are framing a service in relation to our powers.

The work has been detailed, difficult and precise, but the approach that we are looking at is not the ideal way to do things. There are other models. We are framing our proposition around what we hope is within our powers, but I am not the final arbiter of that, as you will appreciate.

Criminal Justice Committee, Health, Social Care and Sport Committee, Social Justice and Social Security Committee: Joint Committee

Reducing Drug Deaths in Scotland and Tackling Problem Drug Use

Meeting date: 24 November 2022

Angela Constance

There are a number of layers to that. I return to a point that I made earlier: the reason why we are publishing lots of local information about what is happening with additional investment is so that it can be scrutinised and so that, where there are issues, they can be addressed. The member will be aware from our previous discussions, which I will not rehearse, that every area now has a pathway into residential rehabilitation.

What I hear about most from my engagement with people on the front line and people with real-life experience is the fragmentation of services. That is why we have a national mission and a Drug Deaths Taskforce, which has made some strong and challenging recommendations, and not just about no wrong door—there should be no closed doors to people.

The biggest frustration that people have is being bounced around between services. The ask and act homelessness prevention duties will help. It is not just about people being passed from pillar to post. In key posts in the public sector, people have duties to ask and then act.

The work on mental health and substance use services is also critical. Our response to the Drugs Deaths Taskforce will align with our response to the two reports that the Mental Welfare Commission for Scotland published this year and the rapid review into mental health and substance use services. Some of that is about services on the ground being really clear that they cannot deny somebody a service or treatment until the individual is, for example, abstaining from drugs or alcohol.

There needs to be much clearer understanding about what the lead service should be—whether it is mental health or substance use—and when the other partners should be brought in. We will come back to the Parliament on that.

Criminal Justice Committee, Health, Social Care and Sport Committee, Social Justice and Social Security Committee: Joint Committee

Reducing Drug Deaths in Scotland and Tackling Problem Drug Use

Meeting date: 24 November 2022

Angela Constance

It is fair to say that stigma about certain types of treatment exists in certain quarters. Some of the discourse that we read or hear about methadone, for example, is unhelpful. Time and time again, I have said that I am not interested in supporting harm reduction or medication-assisted treatment at the expense of residential rehab and abstinence. Neither am I interested in supporting abstinence over harm reduction. The only thing that I am interested in is supporting people, and they need to have informed choices and options.

There is a large international evidence base on different strands of medication-assisted treatment. However, medication should never be our only offer to people, hence the importance of implementing MAT standards that involve treating drug and alcohol issues on a par with other health conditions. If any of us sitting here were to trip up to our doctor with any other health condition, we would be given information and choices and we would have a bit of a discussion about what is best. The same ethos should apply here: people should always have choices, options and the space in which to engage and make informed choices about what is best for them.

I am not interested in false arguments around, for example, harm reduction versus abstinence. We have to dump our own ideological perspectives—my views on many things have changed over the years—and we must follow the evidence, but it is crucial that we listen to what each individual wants and needs.

Criminal Justice Committee, Health, Social Care and Sport Committee, Social Justice and Social Security Committee: Joint Committee

Reducing Drug Deaths in Scotland and Tackling Problem Drug Use

Meeting date: 24 November 2022

Angela Constance

The proposition could change depending on the feedback that we get from the Lord Advocate and the Crown Office in due course. Our work has centred on one service in one city, but there has been a broad range of work. The correspondence around that work is not all mine; the committee will appreciate that there is a central role for the independent Police Scotland and the integration joint board.

My approach in Government has been to facilitate and support that work, and to enable people to build from the ground up a proposition that is framed within the powers that we have. I will look at what it would be appropriate for me to share, because I appreciate the great interest in that aspect.

I also appreciate that there is strong parliamentary support for safe drug consumption facilities. Although I know that some Conservative members have reservations, I take them at their word that they are not looking to stand in the way of a pilot.

Criminal Justice Committee, Health, Social Care and Sport Committee, Social Justice and Social Security Committee: Joint Committee

Reducing Drug Deaths in Scotland and Tackling Problem Drug Use

Meeting date: 24 November 2022

Angela Constance

There is accountability at each and every level. I am stepping up accountability for local areas, but I stress that I am not asking other people to do anything that I am not prepared to do myself. Accountability and leadership are crucial not only at local level but at senior levels in IJBs, local authorities and Government. Accountability is needed at each and every level. We are accountable to ourselves and one another and we need to challenge ourselves and one another.