Chamber and committees

Last week, I met the UK Minister for Crime, Policing and Fire, Chris Philp, and we discussed the possibility of the position statement coming from the Lord Advocate. Although it is within the UK Government’s powers to prevent us from moving ahead with the pilot, I do not think that its colleagues in this chamber will stand in our way; they have said that they would welcome the evaluation that a pilot would provide. I urge the UK Government to listen to its colleagues here and to the rest of the chamber and allow us to move forward with what I know will be a life-saving facility in Glasgow.

We need to recognise that the proposal that was put in front of the previous Lord Advocate was much wider in its scope. That proposal asked the former Lord Advocate to change the law, which he was not able to do. In his response to that request, he set out the reasons why he could not do that.

That was why it was important for time to be taken to work through a proposal that would meet the parameters that the new Lord Advocate set out to the Criminal Justice Committee in November 2021. The proposal was worked on solidly by officials in the Scottish Government and partners in the Glasgow health and social care partnership and Police Scotland, to ensure that the information that was set in front of the Lord Advocate allowed her to come to the position that she came to yesterday.

I share and echo Alex Cole-Hamilton’s desire to see a network of such facilities across the country, because that is how we will interrupt the most amount of harm and save lives. The Lord Advocate has set out the position that she is willing to take on the specific proposal that was in front of her, and we will have to evaluate the pilot in order to understand how such facilities operate. The Lord Advocate’s statement does not give us the right to roll out other such facilities across the country. That is the limitation that we are operating under with the position that the Lord Advocate has taken, as opposed to our having the full powers to provide such services ourselves or the UK Government working with us to ensure that we have safe drug consumption facilities right across the UK.

The proposals that the Glasgow partnership will put before its integration joint board will include some of the details that Dr Gulhane asks about. The consultation with the community will be vital, because we need to ensure that there is no stigma associated with it and that communities definitely feel as though they have been part of the decision making. We know that between 400 and 500 people are injecting in alleyways in Glasgow city centre, so I anticipate that the proposals will include a city centre location. That is for the Glasgow partnership to set out, and we wait to see what it takes to the integration joint board.

I confirm that we identified 425 beds from the “Pathways into, through and out of Residential Rehabilitation in Scotland” report that we commissioned in 2021. Since then, we have had two rounds of funding for the rapid capacity programme, increasing the number of beds across the country by 172. That represents a 40 per cent increase on the figures that we started with. By the end of this parliamentary session, I anticipate that, through other means, including further money going to ADPs and third sector organisations, there will be an increase to the 650 beds that we have asked for. That will result in a 50 per cent increase in the number of beds available.

It is important to recognise that we need to think about the placements as well as the beds. We anticipate that the 650 beds that we will get to will allow us to have 1,000 publicly funded spaces available every year for people in Scotland to access residential rehab treatment. In the past year, 812 people accessed that service, and the past quarter saw the highest number of referrals to date.

It is important that local areas publicise their residential rehabilitation pathways, and they are on the majority of ADPs’ websites. We are working with Scotland Excel to see whether we can create a directory that would give people choice and scope as to where they could go in Scotland to access the treatment that they need.

I thank Jackie Baillie for her question, but I will point out, before I answer the substance of the second part of her question, that the position that the Lord Advocate took yesterday concerned a very specific proposal that was placed in front of her by us and the Glasgow health and social care partnership. That varies hugely from the original proposal that went to the Lord Advocate previously. Although the law has not changed, we needed a very specific proposal for the Lord Advocate to look at.

Regarding the budget that we have in front of us, I must ensure that people understand that there are no cuts to the budget. Those claims are based on a misrepresentation of a recent answer to a portfolio question, not the total budget available to alcohol and drug partnerships or the third sector, and do not represent the full drugs and alcohol budget. In 2021, the total drugs and alcohol budget was £140.7 million; in 2022-23 the total budget was £141.9 million; and there has again been an increase in the budget, to £155.5 million, for 2023-24.

It is important to point out that no one has proposed any reduction in funding for our community justice response within settings, including in Glasgow and Turning Point Scotland’s 218 service.

It is now for Glasgow’s health and social care partnership to take the proposal to the next meeting of its integration joint board, which I understand is scheduled for 27 September. To proceed, the partnership will need to provide an update to its integration joint board and be instructed to undertake public consultation work, as requested by the Lord Advocate, to establish the evaluation framework for the pilot. That public consultation work is so important.

We have been clear in our commitment to establishing a safer drug consumption facility in Scotland. Following the position from the Lord Advocate, we will continue to work closely with colleagues in Glasgow to agree the next steps and review options around implementation, including funding.

We saw the findings of the Scottish Drugs Deaths Taskforce. Some of those findings on drugs can be extrapolated to alcohol harms. However, as Carol Mochan pointed out, the picture is complex. We need to continue to examine the matter to understand what is driving consumption in our communities. Some of it is to do with poverty and inequality but a lot of it is to do with other matters. The increase in over-65s is particularly perturbing to me. Is there something to do with retirement age that means that people’s habits start to change? I assure Brian Whittle that examining that matter over time is a key part of what I want to do.

I cannot, sorry. I do not have enough time. There is just too much to talk about. That speaks to why we need a further debate in the chamber.

We have just commissioned Healthcare Improvement Scotland to take forward work to enable us to deliver our mental health and substance use plan. The first part of that work is currently under way as HIS works with stakeholders to develop an exemplar operational protocol to set out how mental health and substance use services should work together. That is vital, given the number of alcohol-specific deaths that were caused by mental or behavioural disorders. We cannot allow people to be bounced between services.

Workforce—recruitment in particular—is a challenge across all services at the moment. In the autumn, we will publish a workforce action plan on alcohol and drug services to help shape recruitment, retention and service design. That should help to create service capacity to make improvements, such as establishing alcohol care teams in hospitals to identify people with underlying alcohol problems earlier. I am meeting the chair of the group on that this afternoon.

I am meeting local leaders across the country to ensure that they are committing effort and resource to ensure services are in place, accessible and effective. I also recently wrote to ADPs to reassure them that it is welcome if they use national mission resources to support services that offer treatment and support to people who are impacted by alcohol use alongside those who are impacted by drug use. Any concerns that they have should be flagged to my officials.

To help to ensure that changes are delivered, the Government has committed to developing treatment standards to offer people better access to support and a wider range of choices in treatment, in line with what is available through the medication-assisted treatment standards. The standards will be informed by the United Kingdom-wide clinical guidelines for alcohol treatment that will be launched in the coming months. The implementation of those guidelines and our proposed standards will provide the impetus for improving the identification and testing of patients who are at risk of liver disease in primary care. As we have heard from Stuart McMillan, that is welcome.

On recovery services, we are encouraging specialist services to link more closely with recovery communities and we continue to provide funding to third sector recovery groups. We are on track to increase our beds from 425 to just shy of 600 in this session of the Parliament, which is a 40 per cent increase. That represents about 1,000 publicly funded placements, which is important.

There are innovations such as the Simon Community’s managed alcohol programme, which seeks to drive harm reduction for people who are drinking at the most harmful levels.

There is so much in the issue that I cannot get through all of it. However, as the minister with responsibility for both drugs and alcohol, my role is to drive improvements in outcomes for people who are impacted by alcohol, drugs or both and do so in all the ways that help to tackle the twin public health emergencies. The Government will continue to work with statutory and third sector partners to deliver the plan to reduce alcohol harm and alcohol deaths. I will work at pace to bring all of that together to ensure that our ambition is communicated effectively, and I will seek to bring the matter back to the Parliament.

14:00 On resuming—  

I thank Carol Mochan for lodging her really important motion, and I also thank members for their considered contributions this afternoon. From the outset, I want the chamber to know that I support the motion.

We all agree that urgent action is needed to address the number of deaths from alcohol and to reduce alcohol-related harm. I offer my condolences to all the families who have been impacted by alcohol deaths and restate my commitment to do everything in my power to tackle this public health emergency. As a member of a family that has been affected by the matter, I have to say that it is personally important to me.

As we have already heard, National Records of Scotland has reported a 2 per cent increase in the number of alcohol-specific deaths in 2022. The mortality rates in the most deprived areas are more than four times as high as those in the least deprived areas, and according to Public Health Scotland statistics, admission to hospital was six times higher from the most deprived areas. Those gaps are reducing over time, but they are clearly still far too large, and tackling poverty must remain a clear focus for us all.

I am also particularly concerned by the reported rise in the mortality rate for women and the over-65s. We must ensure our prevention policies and treatment services address the specific needs of those groups and are tied into the work being carried out across Government that Brian Whittle and others have talked about. We need to respond the health inequalities that are experienced acutely by women but by other groups, too; indeed, we should also note the increase this year in the deaths of women by suicide. We need to look at how all of these things are tied together and whether, as Alex Cole-Hamilton has suggested, some of this has come out of the pandemic. It remains to be seen whether the situation will continue, but we really need to keep a close eye on it.

The motion asks Parliament to note its belief that

“a plan is needed to address”

this “public health emergency”. In response, I will set out the Government’s plan for doing so. However, I agree with everybody: the issue is so large that we need to find time to bring it back and Government time to start considering it fully.

On pricing, we will soon be laying our report on the operation and effectiveness of minimum unit pricing in line with our commitments under the Alcohol (Minimum Pricing) (Scotland) Act 2012. I look forward to discussing with Parliament the next steps for that flagship policy, as well as launching a public consultation on its future. It is, as some members have said, not a single magic bullet, but is part of a suite of things that we are trying to do.

Minimum unit pricing was a whole-population attempt to drive down consumption. From the reports that we have seen, we know that there has been a 3 per cent reduction in overall consumption, but I am acutely aware of how that impacts dependent drinkers, so I will keep that under close consideration. We will have a full debate on that when we get to it.

Linked to that work is the outcome of our alcohol marketing consultation, which closed in April. In the coming months, we will publish the findings and our next steps, including how we further engage on this critical issue. We will also continue to keep any proposals for a levy under consideration.

On harm reduction, alcohol brief interventions can help clinicians and patients to identify harm-reduction behaviours or the need for outside support in reducing alcohol intake. We have just completed a comprehensive review of ABIs, which will be published shortly. It will include recommendations, and we will provide Parliament with details of the actions that will be taken in response to those to make improvements that help reduce harm and can improve outcomes for people impacted by alcohol.

The earlier that we can do the work to identify people who are drinking at harmful or hazardous levels, the better. I welcome the work that Drinkaware is undertaking on helping people to self-identify issues and I look forward to seeing how that can work in tandem with the review of alcohol brief interventions.

On increasing access to treatment, we have asked Public Health Scotland to investigate the reduction in numbers for referrals to services. We need to ensure that referrals are made wherever appropriate and that there is capacity within services to meet peoples’ needs. Therefore, it is vital that we understand what is behind the data.

I also want to understand where the gaps in data are, as Pauline McNeill mentioned. How do we understand how many people are engaged in fellowship organisations throughout the country? Those organisations are vital and help many people.