Seòmar agus comataidhean

Thank you for the opportunity to appear before this joint meeting of the committees today. I look forward to updating you on the vital work that is under way to address the harms and deaths that are caused by alcohol and drugs.

Since the previous joint meeting of the committees, in February, updated statistics have been published by the National Records of Scotland. In 2024, 1,017 drug misuse deaths were registered in Scotland. That is a decrease of 13 per cent compared to 2023. It is also important to note that alcohol-specific deaths statistics showed a 7 per cent decrease in deaths, falling to 1,185, which is the lowest number since 2019.

Let me be absolutely clear that, although it is welcome that both of those statistics show a decline, the figures are still far too high. We know from recent surveillance that there are new threats, and the drug-related harms in Scotland are still high. Every death is a profound tragedy, and every death is one too many. Crucially, every death is preventable, so we must use every tool available to address this crisis.

In that spirit, I very much welcome the work of the committees and the recommendations of the people’s panel and Audit Scotland, and those in “Changing Lives”, the 2022 Drug Deaths Taskforce report. Collectively, 164 recommendations were offered, and I am reassured by the many common themes and alignment. Our written evidence to the committees details our response to and progress against each recommendation, and how the recommendations have helped to shape our approach to the national mission.

Since launching the national mission in 2021, we have taken a range of actions. We have made £38 million available between eight projects across Scotland to provide additional residential rehabilitation beds; we have invested more than £4 million in widening access to life-saving naloxone; and we have opened the Thistle, the globally recognised safer drug consumption facility in Glasgow, which is the first in the United Kingdom. Since opening, it has overseen more than 4,000 injecting episodes, and has responded to more than 50 on-site overdose incidents. I have absolutely no doubt that lives have been saved. Those achievements were hard won, and I extend my gratitude to those who made them possible, especially individuals with lived experience.

I would like to highlight some of the key progress that has been made since the previous joint meeting.

We are helping to build a skilled and resilient workforce through the publication of new guiding principles and two employability toolkits. We are also seeing good progress in MAT implementation. The June benchmarking report indicated that 91 per cent of MAT standards 1 to 5 were assessed as fully implemented, and that 75 per cent of standards 6 to 10 were assessed as fully implemented. We have also seen progress in residential rehab. In August, we saw the official opening of the new CrossReach facility in Inverness. That is the latest of eight new or extended facilities that have been supported through our funding of £38 million.

I recognise that we need to go further, and I have heard the calls for further and faster action. We are developing a refreshed alcohol and drug strategic plan, in consultation with key stakeholders, including people with lived and living experience.

After five years of emergency response to the drug deaths crisis, it is time to build on our progress, to move to a model of sustainability and to embed long-term change. We are committed to change, driven by the belief that progress is both necessary and possible.

I welcome your questions and look forward to discussing the findings further.

As I said in my opening statement, I am confident that lives have been saved in the unit, which I visited in June. The evidence is anecdotal at the moment but data is being collected and it is being well analysed by excellent academics in Scotland. As time goes on, we will get a better understanding of the work that is going on at the Thistle. The staff who I spoke to were clear with me that people would undoubtedly have died during the cluster of overdose incidents in March and April had they not been using in the Thistle. Across Scotland, other people took similar drugs and died.

There is no doubt that there is concern in the community. I was pleased to hear from the witnesses today that some of those concerns are being allayed as they, along with the people who run the Thistle, are working to tackle the concerns of the community and businesses.

I was pleased to hear about the holistic and person-centred approaches that they are taking to the individuals who come through the door. There is not a set path for those people; they meet them where they are, encourage them in and, for example, help to find them accommodation, which, for many people, can be the very first step on the road to recovery.

We work alongside the individuals from the Thistle; Maggie Page might want to come in on that. We also work closely with the organisations that run the Thistle, but it is largely down to them to work with the Lord Advocate to meet the criteria that she might set to ensure that conditions within the unit can change. It is a long process to get those permissions and to persuade that the legislation that covers the rest of the country can be lifted under certain circumstances.

The Scottish Affairs Committee at Westminster recently reported on the Thistle and made some suggestions for different models. The challenge with that is that we have not been able to persuade the Westminster Government to review the Misuse of Drugs Act 1971 and, because of that, what is happening at the Thistle is a one-off situation. Each time the model is modified, it will have to be agreed locally with the Lord Advocate. That means that it is difficult and that careful steps must be taken to make any changes to the model that operates there. Maggie, do you want to say more?

RADAR gives us rapid information that can be disseminated out to exactly where it is needed across the country, and it is making a difference to the harms experienced across Scotland.

RADAR is not perfect. My sense, a few months into this job, is that the longer that it takes to produce the data, the more rich and robust it is. We get early data that tells us something, but, often, the longer we wait for the data, the richer it is. However, we do not have time to wait. We are in a drug deaths crisis and we need fast information, and we need to get that fast information out to the front line—out to the health boards and to the places where people are likely to go to receive treatment for overdose. We need to get it out to the front line so that the paramedics and the alcohol and drug services know what they are dealing with. That is vitally important.

Thank you—that is a really excellent question, and I think that Maggie Page will want to come in with a little bit more detail on it.

We think about three strands when we are thinking about the next steps around treatment and access to residential rehab. We focused a lot on providing funded places, and we are on track to reach the 1,000 funded places that we committed to. We also focused on increasing residential rehab capacity, and we have really increased the number of available beds. I think that we will get a report on where we are with that next November, but, again, there has been a substantial increase in provision.

The bit that will probably require a bit more focus in our strategy next year is the pathways around access to residential rehab, which is about access to stabilisation and detox, and how we get things lined up for people. Your previous panel of witnesses talked about access to abstinence-based residential rehab, for which people are required to go through medical detoxification before they can start. It would be ideal if the residential rehab lined up right at the end of the detox, without a gap or a long wait for detox, when somebody is ready for residential rehab and wants to get in. We are working hard on those pathways to improve access into services, because that is an area where we can achieve real improvement.

I agree that there is an issue with implementation, which is a challenge that all ministers face in all portfolio areas at all times. We often set out great ideas and produce fantastic policies and great legislation, but that is not how it feels on the ground for the people who access our services. As a minister, one of my challenges is to close that implementation gap, so that the reality meets the ambition.

I am the first to acknowledge that there is a gap. For me, one of the crucial ways in which to close it is through the involvement of people with lived experience. If we have the voices of lived experience at the heart of our policy and legislative development, it keeps us right. It means that we are usually on the right track, because we are listening to the right people.

That also holds our feet to the fire on delivery, which helps us to close the gap. The situation is always evolving. Nobody is saying that we get it 100 per cent right. Lived experience, particularly in this area, where there is a huge amount of passion, does not speak with one voice, but that approach helps us to get it right.

We get lots of data coming in, and lots of monitoring and supervision. In fact, some people feel quite overburdened by the reporting that we request from them, but we are pretty keen to understand what is going on out there. My sense is that we are very much aware of the challenges. We are providing support where we can, so that local areas can rise to those challenges.

Maggie, do you have anything to add?

We have not explored that, because the barriers are not being removed and we have been unsuccessful thus far in removing them.

If I remember rightly, efforts to bring the Thistle to life started in 2015, so that means that it took 10 years until it opened this year. That predates the national mission. Those efforts began at the start of the rise in the number of drug-related deaths, but the reason behind considering whether to have a safer drug consumption facility at that time was to reduce the number of cases of HIV, because there had been an outbreak—a cluster—of HIV in the area, and such a facility was seen as a way of reducing that harm.

You are right that, at the moment, we are in the thick of a drug deaths emergency, and very early data shows that lives have definitely been saved in that unit. Therefore, it is understandable that we recognise that it is a life-saving facility; it definitely prevents deaths. We will do a more thorough evaluation of what happens there and what the benefits and disbenefits are, and we will consider where to go when we have a bit more information.

At the moment, I am not seeing barriers to scalability across Scotland, or even to sustainability, being removed. We had a change of Government in the UK last year, and I thought that there would be an opportunity for a change in approach, but I am not sensing that at all. I have to focus on the here and now and on the emergency that we are in, and find a way forward now.

It would concern me if we thought that the only measure of success was referral into treatment. We heard the statistic that more than 50 people have been referred to treatment. That is reasonable if we think about the level of chaos that the people who came through the door in the first six months were experiencing. To have 50 people referred for some form of treatment—not necessarily residential rehab—within six months is a reasonable number.

With reference to the national testing laboratory at the Leverhulme centre, the Government as a whole has been working closely with the University of Dundee since last year on the challenges that it has faced, and the Government has been providing a great deal of support, including financial support. We are pretty close to a resolution on the issues that the Leverhulme was facing in getting the national testing laboratory up and running, so I am confident that things are on track. Maggie, do you have more to say about where we are?

I would like to hope that those efforts will have a positive impact on that gentleman’s life. We heard from the previous witnesses about the outreach work that is going on from the Thistle centre. We heard from the community representatives about the lengths that the staff go to in order to meet people and encourage them to access help and support. I am confident that, if the Thistle is not the place for him, it could help him to access help and support in other places.

We heard from the previous panel that, anecdotally, there are concerns about an increase in the number of people in the area and about faces that are not recognised. It is quite difficult to capture that. As both community representatives on your previous panel said, it is undoubtedly an area where drug consumption was happening anyway. The drug consumption happens close to the market. It is long established that this is an area where people come to buy their drugs, so it is difficult to capture how much change there has been since the Thistle opened its doors in January.

In general, safer drug consumption facilities reduce the levels of crime, drug paraphernalia and street litter in the areas that they are sited in. As well as being a life-saving intervention, part of their purpose is to reduce the harm that is experienced by individuals and by the community because of drug use happening in it.