Chamber and committees

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.

We must stick with people. There is an important role for us in changing how our statutory, NHS and local government services work and how they meet the needs of people who struggle with drugs and the needs of their families.

The third sector has a valuable role. We have taken a belt and braces approach. As well as increasing the investment in ADPs, many of which will enter into agreements with the third sector, we have set up the four multiyear funds that are within the £18 million pot and are available to third sector organisations. The third sector is vital, along with our public services and the lived and living experience community. Those are the three strands of the partnership: the lived and living-experience community, the third sector and statutory services.

A lot would depend on the nature of the care that they are receiving. If we are talking specifically about medication-assisted treatment, that needs to be delivered by someone who is qualified to prescribe. The important thing about the medication-assisted treatment standards is that they make connections with other aspects of treatment—what is collectively known as psychosocial treatment and work to help people to address past trauma. A lot would depend on the type of care required and the type of care available in a local practice.