Chamber and committees

The funding arrangements for general practice sit with the Cabinet Secretary for Health and Social Care, and I assure you that he engages well and often with the GP community on the host of issues that flow from the GP contract. I have opportunities with the additional resource that we have to reduce drug-related deaths, but it is not prescriptive—I have not said that all that money goes to ADPs or the third sector. It is about investing in services and approaches where the evidence shows that lives can be saved.

I am absolutely committed to getting more information and data that will help us to improve our services and our offering. That will tie every step of our national mission to being based on evidence on the issues that we know exist in Scotland. I think that Paul O’Kane’s question is about how we link information and data. In very general terms, the annual report gives us some quite rich information about substances. That information is also available by local authority and month by month.

It is important that we are able to understand more about other health problems in the context of drug use, and about the involvement of other services. We have some of that information, so we know about such things as drug-related admissions to accident and emergency departments and psychiatric admissions, but there is a time lag in receiving that information. Some of our work with Public Health Scotland is on how to get that type of detailed information more quickly.

Notwithstanding the time lags, in time we can gather quite a lot of information that tells us about the circumstances of people’s tragic deaths. I suggest that we need to know more about people’s lives. Although some of the information that we gather absolutely connects with our lived and living experience strategy and people’s engagement with services locally, other data could tell us more about the lives that people lead, which could help us to shape services.

We also need more data in order to set the quality indicators that will underpin our treatment target.

That is a really good question. I reiterate this often: it is absolutely about connecting emergency life-saving work with work that improves life chances. The statistics speak for themselves. We know that people in the poorest communities are 18 times more likely to suffer drug-related death than people in the least-deprived communities.

It is important to stress that drug-related deaths and drug use are an issue throughout Scotland. Drug-related deaths in the Highlands are the lowest in Scotland, but they are still higher than drug-related deaths in the north-east of England. That shows that this is an all-Scotland problem.

However, there is no doubt that the increase in drug-related deaths is being driven by an increase in the number of the poorest people in our communities dying such deaths. Therefore, work on child poverty, for example, is absolutely crucial. We have a £23 million tackling child poverty fund, a cross-Government child poverty action plan, and colleagues will be well aware of the Scottish child payment. That work must connect with drugs policy work.

There is also greater Government action, through which £2 billion of our resources are invested in low-income families. A proportion of that—half, I think—is focused on households with children. That £2 billion investment is intended to alleviate pressures on low-income households.

All that is connected with our economy, the fair work agenda and so on. We could talk about all those things in detail, as well as the work that is being done on adverse childhood experiences and trauma. ACEs, of course, have a huge link to people’s living environment.

For me, it is always about following the evidence and what works, and listening to the people who are most affected by drug deaths in their communities. That is people with lived experience, but also people with living experience.

When it comes to encapsulating where we are and the question of why our challenge in Scotland is so acute and severe, I have my own views. In the past, there have been many discussions about culture, patterns of drug use and concentrated levels of poverty. However, I always distil our challenge in Scotland into three areas.

We have a higher proportion of people who use drugs. I suppose that the reason why is quite an existential question, and much research has been done on it. However, we need to recognise that a higher proportion of our people use drugs, and therefore we have proportionally more people with problem drug use. The rate of drug use in Scotland is about double that in England.

Another issue is benzodiazepines. The use of illicit benzodiazepines is an issue across the United Kingdom, but it is more acute in Scotland—again, the facts show that. Since 2009, there has been a 450 per cent increase in Scotland in the implication of benzodiazepines in drug deaths. By comparison, south of the border, it is 53 per cent.

Again, to be frank—this is at the heart of the matter—we do not have enough of our people in treatment. That is the core of my assessment. We know that treatment is protective, and so we need a culture of change and a culture of compassion in our services. That will enable people to access those services more easily, and services can be more fleet of foot in following people up. People should be able to make informed choices about their services and treatment.

We have made progress around other preventable deaths. We must consider drug deaths not just as tragic but also as preventable. While the scale of the challenge is massive, we can and must turn it around.

That is certainly my understanding. A very high proportion of police officers will carry naloxone after they have undertaken the training. I speak to families—I am sure that many committee members do, too—and they will give many examples of how naloxone has saved the life of a loved one. When we speak to people about their lived and living experience, they talk about the range of services that have helped them on their journey. The key challenge for us now is to widen that distribution and for it not to retract. We will participate in a four-nations consultation about permanently widening the distribution of naloxone. Although it is safe to use, naloxone is a controlled drug.

The Lord Advocate, as a result of the pandemic, was able to use his discretion to give confidence to widen the distribution of naloxone to non-drug services, such as homelessness services. We now need the changes that the Lord Advocate made as a result of the pandemic to be made permanent. We are participating in a UK-wide, four-nations consultation. I had some concerns about some of the language used in the consultation and about its scope. Nonetheless, the Scottish Government has participated in that four-nations consultation, because we want a permanent change to the arrangements that are made, so as to widen the distribution of naloxone.

I do, convener. I am grateful to the committee for the opportunity to provide evidence on my priorities over the next five years.

The loss of life from drug-related deaths is as heart-breaking as it is unacceptable. I once again offer my condolences to all those who have lost a loved one, and I restate my continuing commitment to do everything possible during this parliamentary session and beyond to turn the tide on drug-related deaths.

This morning, the Scottish Government published the first of its quarterly reports on suspected drug deaths, which focuses on management information from Police Scotland and covers the first two quarters of 2021—the first six months of our national mission. Although that report is not a replacement for the national statistics on confirmed drug-related deaths, which National Records of Scotland publish annually, as those official statistics are based on death registration records that information from the Crown Office and forensic pathologists supplement, it will help services to respond quicker to what is needed and Parliament to monitor progress, and will provide a barometer of drug death trends over time.

We can cautiously take some encouragement from what appears to be a slightly lower figure of suspected drug deaths than for the same period in 2020, but I stress that there is a long way to go, because both suspected and actual drug-related deaths remain too high in Scotland today.

My priorities start with getting more people into protective treatment and recovery on the back of our commitment to an additional investment of £250 million, which includes £100 million for residential rehabilitation, over this parliamentary term. Information from quarterly reporting will allow me to set a treatment target for 2022, which is one of my main priorities.

The implementation of the medication-assisted treatment standards by April 2022 is a key priority as well. Those standards set out what people should expect and can demand from services—in particular, same-day treatment and access to a wider range of MAT options. That implementation is part of our overall approach to making people’s rights a reality. However, the options that we offer people must also include access to residential rehabilitation, which is clearly a priority for us all.

We recognise that the number of cases of poly-drug-use deaths involving methadone and benzodiazepine has risen. We need to understand how that situation is happening and be able to offer safer alternatives, such as Buvidal and new treatments, to reduce overdose cases. The role of prescribers, including general practitioners, will be crucial in that work.

In October, the Advisory Council on the Misuse of Drugs will have its first meeting in Scotland, and there will be a four-nations drugs meeting in Belfast later that month. I will use that opportunity to continue to press the United Kingdom Government on the evidence for drug-checking facilities and safe consumption rooms, while pursuing further action via our devolved powers.

I will continue to prioritise people with lived and living experience, through local panels and a national collaborative. That approach already plays a vital role in service design and delivery across Scotland, but my priority will be ensuring that we make everyone’s rights to the highest standard of healthcare a reality.

We will also continue to strengthen the links across portfolios. Our mission is linked to other vital work to improve mental health, to address poverty and inequality, to ensure that we are keeping the promise to our children, to build resilience through education and prevention and to bring public health approaches to our justice system. Another priority will be to develop and scale up women-specific services. I have announced that Phoenix Futures has been successful in principle in a bid to establish a new national specialist family service. That facility will be the first of what, I hope, will be many new residential rehabilitation facilities. I will soon set out to Parliament our milestones for further growth over the next five years.

I will continue to prioritise the use of naloxone. Those services have made great strides, but I want to see more. Last month, we launched a national naloxone campaign that has already significantly increased demand through our third sector partners. I am encouraging community pharmacists to be more active in the use of naloxone, too.

In November, we will launch a campaign to tackle stigma, which is still, for many people, a barrier to accessing life-saving services. I am also making it a priority for alcohol and drugs services to be featured in the proposed national care service. This is a real opportunity to consider how we can better support some of Scotland’s most marginalised and vulnerable people.

I am conscious that it is not possible to cover in detail every priority for the new parliamentary session in the time that we have available. I hope that this summary is helpful to the committee and is the start of a conversation that we will have over the years. I will, of course, continue to update Parliament regularly.

As you will have heard Mr Kevin Stewart often say, the national care service is the biggest reform of the national health service since 1948. Although it will be immensely complex and challenging to build such a service and deliver it over the lifetime of this parliamentary session, the proposition itself is also very significant and exciting. At a fundamental level, it is about how we care for people and how we value those who do so. Given that people with drug-related difficulties are amongst the most marginalised, excluded and stigmatised in our communities, it is important that we ask about the benefits of making drug and alcohol services part of the biggest change in our national service in over 70 years.

Some of the synergies in what we are trying to do to improve services have a strong connection with the work on the national care service and its focus on person-centred care and informed choice. It is not just about caring and treating folk but about helping them live their lives, and I therefore feel strongly that questions about drug and alcohol services should be part of that consultation. What we need to test and explore in the consultation are opportunities via the national care service to improve accountability, governance and, indeed, the status of drug and alcohol work. I know people working in and delivering these services who feel that it is not just those whom they serve who are stigmatised; sometimes they, too, feel a bit forgotten and that the service itself is somewhat stigmatised. I also believe very much in accountability at every level and I have an interest in and focus on governance in that respect.

The challenge with alcohol and drug partnerships is that partnership needs to happen at a local level—and sometimes at a very local level if we are going to reach into the most deprived and disadvantaged communities. Those are the issues that we are testing at the moment.

The national care service is about taking a rights-based approach, which fits with what we are trying to achieve in drug and alcohol services. It is in the consultation, and there are some quite deep and fundamental issues that we need to test out.

People experienced challenges in accessing services during lockdown. The work of the lived-experience community was particularly helpful and imaginative. The Government worked with organisations such as the Scottish Recovery Consortium on guidance about how to continue having meetings, whether online, in open-air settings or over the phone. I know that the recovery community in Glasgow did amazing work throughout the pandemic.

Other smaller organisations such as Recovery Enterprises Scotland, which is based in East Ayrshire, were under enormous strain during the pandemic. That is why some of the new funds that I introduced are particularly geared at smaller and more local grass-roots organisations and give them access to funding that can help with work in their communities. We have worked hard to make it as easy as possible to access that funding.

There is no doubt that so-called welfare reforms have an impact on the lives of the poorest. The frustration for many of us round the table is that, although increasing investment in the Scottish child payment will lift tens of thousands of children out of poverty, the ending of the temporary increase to universal credit means that £20 a week will be taken away from people when we are still not out of Covid and are far away from recovery, both socially and economically.

Primary care is multidisciplinary and often led by general practitioners, and it is located in our communities. It is often the first port of call and is supported by nursing staff. There are efforts to connect GP practices with the voluntary sector and welfare advice, such as the work around deep-end practices. I am sure that my health and public health colleagues may have a more technical definition or description, but that is how I see general practices.

Practice varies. For example, my understanding from NHS Lothian is that the majority of GPs are involved or could be involved in prescribing medication-assisted treatment to their patients. In other parts of the country, such as Tayside, the practice has been that people have been referred to more specialist centralised addiction services. As well as supporting GP practices with the resources and the range of services and support that they need to serve our communities, we have to recognise that there are vital connections for patients who are receiving medication-assisted treatment and who have primary care needs.

Laying aside the issue of who prescribes a medication-assisted treatment, every GP that I have engaged with says that they could do more at a community level—for example, for the physical needs that people who live with drug use experience. You will know better than me that people often have other health issues that can be addressed by accessing primary care.