Chamber and committees

You are quite correct to be making all those connections. It is important that strategies and approaches complement and connect with one another. There is a lot to learn from other campaigns and approaches.

One example is the use of Buvidal, which was introduced into the prison estate during the pandemic. Buvidal is a long-acting buprenorphine that can be administered as an injection weekly or monthly; it does not require a daily dosage. The use of Buvidal in prisons was evaluated very positively. It will not suit everybody—it is important to stress that no treatment will meet the needs of everyone—but it had some benefits in terms of clarity of thought and of not tying people to daily dispensing. It is also rarely associated with overdose, because it is a protective factor in relation to how opioids attach to brain receptors. It is a bit like a blocker: if you take an opioid on top of your Buvidal, you do not get the high from the opioid.

Having looked at the results of Buvidal in some of our prison estate, I was keen to find out how we could introduce it to the community and widen access to treatment. That is why this financial year there is a £4 million investment in widening choice to people, and that includes Buvidal. Widening that choice of treatment is a change in practice that occurred in response to the pandemic, but it is one that we want to continue and to implement further.

The committee has already spoken about our work around naloxone as well and how its distribution has widened during the pandemic. We do not want to detract from that change.

I outlined those in my previous answers. Perhaps Ms McNair’s connection is not very good. I talked about our work on Buvidal and naloxone. I did not talk about our £1.9 million investment in our work on prison to rehab.

The work and contribution of the lived-experience and recovery community throughout the pandemic should remind us well of the value of engaging meaningfully with—not just paying lip service to—the recovery community and those with lived and living experience. That is why we want to take that work further forward with our work on a national collaborative.

The £5 million in additional resource was released in the final quarter of the previous financial year, which was the first quarter of this calendar year. Of that, £3 million went to alcohol and drug partnerships—as I mentioned, we published their returns on how that was invested—£1 million was put into a grass-roots fund, and £1 million went into a service improvement fund.

At the turn of the financial year—after Easter, on 18 March—I announced four new funds totalling £18 million. I hasten to add that they are multiyear funds. Those four new funds opened in May. There is a £5 million recovery fund; a £5 million service improvement fund; a £5 million local fund, which again is geared towards grass-roots organisations; and a £3 million families and children fund. Those are available via the Corra Foundation for all non-profit organisations to apply for. We have worked really hard to make the application process accessible and quick. To date, we have funded in excess of 50 projects through that. Adding in other funding—for example, through work that the task force has done—I think that we have funded over 80 specific projects.

This year, we will invest around £13.5 million in residential rehab. That money will come from ADPs and from the recovery fund and other sources of funding within Government. I will outline to the Parliament in more detail the profile of that funding, because we have a commitment to provide £100 million for residential rehab and aftercare over five years.

On the £50 million for this year, there is also the specific £13.5 million uplift to ADPs that I have mentioned, and around £14 million is going on £3 million for outreach, £3 million for non-fatal overdose, £4 million on widening the distribution of Buvidal, and £4 million on implementing the MAT standards. I hope that that gives an overview.

A small amount of resource is going on research. Resources have also been set aside for the national stigma campaign and our lived and living experience strategy work on establishing the national collaborative.

Our commitment to increasing the capacity and the reach of drug services and to improving access to residential rehab applies very much to aftercare, too. We must recognise that drug addiction can be a chronic condition—it should be no surprise to anyone who is involved in the provision of drug services that people sometimes relapse. Progress in life is rarely linear, and it should not be that people run out of chances; we should give people as many chances as they need to get onto the road to recovery. The work that we do with local services and that integration with aftercare is crucial.

We also need to think about rehabilitation in a community context, as well as in a residential one. We know that risk can be elevated in times of transition, such as when someone leaves residential rehab, so people must have wraparound person-centred support that meets their needs. That approach also applies to people who leave prison or move from, or leave services. Our work and investments around outreach are particularly important in that area. We also need to be far better at following up when people disengage from services.

There is a lot in that question, but the member is quite right to make all of those connections. The point about access to residential rehabilitation is important. The work that the residential rehab development working group has undertaken is about the development of clearer pathways, because pathways vary across the country. I think that I am on record as saying that sometimes, pathways into residential rehab are as clear as mud, which is neither right nor acceptable.

There is also an issue about access to community services. There can be many barriers to people getting into treatment: you have to do this; you have to be on this level of treatment; you have to be abstinent and so on. With regard to residential rehab, which is an abstinence-based model, there are certain expectations around people’s personal commitment, detox and lowering substances to facilitate the process, but it is fair to point out that there are perhaps too many barriers to accessing other services.

An early action that I took was the result of information that Shelter provided. There is a bit of confusion about housing benefit rules. Anyone who knows anything about housing benefit will know about the minutiae of detail that often have to be unravelled. Different things were happening in different local authority areas to apply rules. I was not going to put up with people having to choose between keeping their tenancy and going into residential rehab. Funds have been allocated and are available to address that while we sort out the complexities of regulation or whatever. That is one example of how we can invest resource. We will sort out the situation, but we are not putting up with people facing that choice.

I have always been a big fan of the housing first approach and other housing models that do not put up barriers. We should take people as they are; the priority is to get them into a home, and we will work out the rest, whether that involves people’s drug use, health problems or other issues. I have spoken about parents and in particular mothers with caring responsibilities, so I will not repeat that.

The naloxone issue is important. Naloxone helps to save lives; it buys time for the emergency services because it temporarily reverses the impact of an opioid overdose. It is safe and easy to use. Because of the pandemic, the previous Lord Advocate issued guidance that enabled us to widen the distribution of naloxone to third sector settings.

I must give a shout-out to Scottish Families Affected by Alcohol and Drugs. As a result of our national naloxone campaign and people going to the Stop the Deaths website, more than 460 people have applied to that organisation for the naloxone kits that it provides through its click and deliver service. Families who have a loved one at risk can have naloxone to hand. More than two thirds of ambulance technicians are trained in naloxone use and can give out take-home kits to people they come across. It is important that people who distribute naloxone in non-drug services make the connections, support people and refer them to drug services.

I apologise for the length of my reply, but I hope that I have at least outlined some important connections.

The police have been carrying naloxone in three areas—the east end of Glasgow, Falkirk and Dundee. That pilot has been successful and the police have used naloxone 40 times. We have entered a review period and we will want to discuss with justice colleagues how the programme could be extended. It is important for statutory services to play their part, which also helps us to communicate with wider communities and the wider population that a tool can be used to help to prevent people from dying when help has been called for.

Of course we need to prevent people from having an overdose in the first place—we have covered that extensively. Naloxone is one piece of the jigsaw; other pieces involve preventing people from getting into crisis in the first place and how we connect people with support services when they survive an overdose.

That will be for others to decide. My focus is not my future; I have been in Parliament for some time and have been in Government before, and I had a life before I was a parliamentarian. My focus is on getting the work done.

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.