Seòmar agus comataidhean

We know that emergency interventions and harm reduction interventions such as safe consumption rooms and the heroin-assisted project in Glasgow not only help to reach people where they are at any particular time and help them to reduce the risks that they face; they also form part of a longer conversation and journey to help people connect with other services. That may involve connecting with primary care and connecting with services for blood-borne viruses. It may involve helping people with the practicalities of addressing other issues in their lives, whether those are problems with personal care, housing or some of the underlying causes. As all the evidence would show, the importance of harm reduction lies in meeting people where they are now and working with them through the good times and the bad and sticking with them in whatever onward journey they choose.

Turning to the distillation that you made, convener, we indeed need to increase the capacity of services, and that will involve workforce planning. There is a lot of baseline information that we do not have, so we need to update our work on prevalence—we are in the process of updating that—and on baseline information about the number of people in treatment. That will help us to make progress on our target for treatment, for instance.

This is clear, and people on the committee will know the issues that are reserved and those that are devolved, but the challenge for us is to leave no stone unturned so that, whatever our powers and whatever resources we have at our disposal, we make all the vital connections and take every opportunity to implement evidence-based practice.

As you know, MAT standards are important for laying a foundation for change. The implementation and embedding of the new MAT standards is really important for making further progress and building on that foundation, particularly when it comes to widening access to treatment, integrating addiction and mental health services further and making the links with primary care that we discussed earlier.

For the first time, we have published the MAT standards. There is a financial resource for their implementation: £4 million was allocated to that for this financial year. Crucially—and this lies at the nub of Mr O’Kane’s question—we have the MAT standards implementation support team, or MIST. It is examining the reported progress from different areas, testing that progress and engaging with people in local areas about what support they need. I was very keen for us to have MIST.

The scale of the challenge in implementing MAT is significant: we are moving away from the three-week waiting-time target that our system operates around, turning the ship around and providing MAT standard 1, for example, for same-day prescribing. There is a lot of work to do; progress is being made, but it needs to happen over the whole area. As with other matters, we will keep the Parliament informed.

Although we are absolutely serious about the April 2022 target, support will not simply stop at that point. As the quality improvement, quality assurance and support role played by MIST is part of a three-year programme, it will continue. What we cannot do is get this over the line and embedded and then go, “Whew! Job done!”; we are going to have to keep on it. The target is next April, but we will continue that monitoring and support role, and there are also some clear asks from particular local authority areas for resource and help that we are seeking to deliver on as quickly as possible.

On alcohol and drug partnerships, I think that it is fair to say that we are making a bigger ask of them as part of the quid pro quo for the bigger investment in funding that has been made. They have had an uplift this year of £13.5 million from the national mission funds, and we have been specific about the proportions of that fund that are to be spent on family and child services, residential rehabilitation and aftercare and other front-line services.

We have also agreed a framework in and around governance with the Convention of Scottish Local Authorities. I will speak with COSLA to see whether it has information on that which might be of interest to the committee. Reporting is not just writing an annual report on what has been done—it is about undertaking more work to assess local need and evaluate what is being done. There is some external validation built into the process. It is essentially about forward planning and what the partnerships will do over the next year. Again, we are supporting ADPs in and around how to do that.

We also came to agreements with COSLA on the role of chief finance officers in integration joint boards in this area and the role of service-level agreements between alcohol and drug partnerships and the people with whom they commission services. I am cognisant too of the role of alcohol and drug partnerships vis-à-vis the role of integration joint boards.

On your fundamental question about understanding the total spend, there is a clear need for Government, in the drugs policy division, to articulate how much we are spending and what it is spent on. There is information on what we spend on drug and alcohol services overall in all our budget documentation. However, I appreciate that, when we look at what local government puts in from its funds, and at the additional funds that come from IJBs or the NHS, the picture becomes far more complex.

I understand the committee’s interest in this area. It would indeed be beneficial to know the size of the total investment; I too am interested in that question. I hope that some of the work that we are undertaking in Government might help with that, but it may be helpful, when I next meet Councillor Currie of COSLA, for me to discuss these issues with him.

I know that the committee has expressed an interest in these matters over a number of years, and I will discuss with Councillor Currie, who is COSLA’s health and social care spokesperson, the need to look ahead, building on the new governance arrangements that we have agreed for the here and now, and think about how we might begin to shed light on that.

The information should be available at a local level, but we will try to unravel the issue. I add, for the sake of my officials, that we will not necessarily do so quickly, because they are engaged in increasing capacity in residential rehab, implementing MAT standards and a whole host of other work. I undertake, however, to at least explore the issue with COSLA.

You are absolutely right to make those vital connections. We have a national mission in the first place because we need to take a helicopter, whole-systems, approach. At the core of that approach we have early intervention and prevention, which includes our work on poverty and with young people in our health and education systems.

We probably know much more now about what works with young people than we did, say, 20 years ago. In the context of curriculum for excellence, we note that young people respond better to approaches that are about upskilling them and increasing their personal resilience, self-esteem and confidence. There are also opportunities for diversionary activities in communities.

The point about housing is well made. There is massive investment planned to increase the supply of affordable housing over the current session of Parliament, with some very stretching goals, including provision of 110,000 houses by 2032. All that work must connect with the getting it right for every child and keeping the promise agendas. There are, in the drugs policy part of my portfolio, examples of our investment in supporting family-inclusive approaches, including specific funds for work with families and children. It is vital that drugs policy be connected with every aspect of Government policy.

I am keen to look at the bill in detail; it needs to be published before I can consider it fully. If Ms Wells pursues a member’s bill, she will follow a well-trodden path for the requirements on the member to consult, engage with and convince others of their proposition and a well-trodden path for the considerations that the Government applies to a member’s bill.

I have a track record of always giving members a fair hearing and I will look at the proposal on its merits. I have never ruled out further legislation, but I will want to test whether the bill would do what is claimed. I do not want the legislative process to hold us back from doing things now. I will want to see how any bill would help us with the integration of services.

I have outlined my rationale for why I wanted alcohol and drug services to be part of the national care service consultation. Before the Government introduces a bill to establish that service, the consultation responses will help to inform whether and how drug and alcohol services are part of that.

In thinking about the national care service, I note that there is a strong argument for national commissioning of residential rehabilitation. I can say more about that if members wish.

Further down the track, the Government is also committed to human rights and implementing international treaties. How do we make human rights real in people’s lives and communities? That broad issue will inform my thinking about my response to the proposed bill.

I apologise for the time that I am taking, convener, but it is also important to say that we have made a commitment to a national collaborative on how those with lived and living experience plug into the national mission. A national collaborative is not something that we will do to people; it will enable the wider lived and living experience community to have its say on a range of issues.

We will look at the detail of the proposed bill when it comes.

I will not repeat what I said in response to Mr O’Kane about the purpose of getting more data and what we are doing to acquire more meaningful information, but I assure Ms McNair that the purpose of the work that I am leading in the Government is to turn words into actions.

On the link between deprivation and drug deaths, I refer to my answers to Ms Mackay about the additional funding and action on measures such as the child poverty action plan and annual report; the tracking work; the fair work agenda; the work that is being done in and around social security; the massive expansion of early years provision for our youngest citizens; and the work to reduce the attainment gap. All that is absolutely connected and, at its core, it addresses the impacts of deprivation on every aspect of people’s lives.

Ms Mackay has made a really important point. Person-centred care lies at the core of this. We can get into areas of real complexity; I know that there are medication-assisted treatments, including methadone and Buvidal, that are geared towards opioid dependency and opioid substitution therapy, but we have to watch that we do not silo services. The number of deaths in which cocaine was the only implicated drug is comparatively small—I think about 16. We are therefore looking at cocaine in the context of poly-drug misuse. Because that picture is much more complex, we have to take action at the level of the individual, with services engaging with individuals as individuals first and foremost, and working out what support and help they need.

The point about cocaine is important, given the 23 per cent to 25 per cent increase in its implication in drug-related deaths. We have heard a lot about its purity increasing as well as its price being lowered, and in thinking about our approach to services, we also have to bear it in mind that cocaine use is more a feature among younger people. I realise that I am generalising, but it tends to be people over 25 who use opioids, whereas there has been a rise in cocaine use among younger people. As a result, some services will have to be age appropriate, given the different pattern of drug use among young people.

There are no easy answers. We need to think about whole packages of care and support and to get underneath the skin of the reasons why people use drugs and particular substances.

We know that stigma is a huge barrier to people accessing treatment, and that it has a huge impact on people’s wellbeing and on how people are treated in services and the community. Parliamentarians, as well as people in the media, care services and the wider public sector workforce, have a role to play in that situation.

Some of the work around a trauma-informed workforce is really important in this regard, too. Ms Harper raised an issue about the anti-stigma charter that has been developed by lived-experience representatives, in engagement with other lived-experience groups. The purpose of that charter is for it to be used by different organisations and services, and it can be adapted. I would describe the charter as having a core purpose, but it can be adapted to other services.

Part of the national naloxone campaign is about stigma. We are talking about lives that we can and must save, and here is how to do it. It is about engaging the wider population in what they can do, as part of the national mission, to help save lives. Later this year, we will report back to Parliament about a national campaign on stigma.

In relation to the quality assurance and quality improvement that will underpin the on-going work of MIST, when I introduce a target for treatment, which will be at the turn of the year, the indicators that underlie that target will relate to qualitative information that will be informed by our experience of implementing the MAT standards.

The average cost of a residential rehab placement is £17,000, although it is greater in some areas. The length of placements also varies. The residential development working group has looked at that in detail. I do not want to be prescriptive about the length of stay in residential care, which should be person-centred and flexible. As Ms Mackay said, we must recognise that there is a link between residential rehab and aftercare and that there is also a link to detoxification services. Some residential rehabilitation units have in-house detox; some do not. It is important always to think about the journey that people will take and the services, opportunities and care that they need on that journey.