Chamber and committees

Thanks very much, convener, and good morning, colleagues. Thank you for having me along to your committee and giving me the opportunity to update you on work that is under way through our national mission to reduce the number of drug related deaths and harms.

I have been in post now for nearly three months, so I am not quite new, convener. I thank my predecessors for laying a solid foundation on which I am able to build, and thank all the people working in the sector across Scotland. I have had the privilege and pleasure of meeting many of them over the past few weeks.

Since taking on the portfolio, I have made clear my commitment on continuing our national mission, following the evidence of what works to reduce the number of drug deaths while ensuring that we are providing a full range of treatment options, so that individuals are able to obtain support wherever they are with their substance use and recovery journey.

I have been clear in my desire to approach the matter in a cross-party and cross-United Kingdom manner. Problem substance use has no respect for borders, and, with some of the challenges that we face, along with the new threats related to synthetic opioids, it is vital that we work together to tackle all of those.

In the short time that I have been in post, I have met a range of stakeholders and people who are directly affected by substance use—those using substances, their families and friends and people who generally just love them. I have heard and learned a lot about the issues that most impact all of their lives.

Recently, I had a visit to the Bothy in Craigmillar—one of the first visits that I made in Edinburgh—to hear from peer mentors about the work that they are doing in that community to support people, which is incredibly inspirational. When communities, particularly recovery communities and others, come together with local and national organisations and the statutory sector, you can see real change and hope for people in their lives. What really touched me that day was the hope. Peer mentors who live, work and support people in those communities have lived experience. One of the people who is using that service said to me that, when they take the big step to walk through the door, it is really helpful that somebody on the other side is saying, “I understand. I know where you are. I’ve been there.” That is incredibly powerful.

The other part of that is about how we engage with and support the workforce. I was really pleased to be in the Glasgow city chambers the other week at the graduation ceremony for the people who were undertaking the addiction worker training, which will now be renamed as a national traineeship. The hope, joy, dedication and commitment, and the opportunity for those people to go into the workforce and support the work that we need to do, was very clear on that day. I was sad to leave—I had to come back to the Parliament to vote—but it was a joy to be in the room with so many people who had taken their experience and turned it into a qualification and will now use that to be in the workforce. Just to see how proud their families were was absolutely amazing.

It is clear that the national mission has changed how we think about these issues and how we respond to them, which is not least due to the work of the many partners who are driving this forward, including those whom you have just heard from earlier today. I managed to catch some of the brilliant evidence that the previous witnesses gave you on the work that they are doing and the challenges that they give me, as a Government minister, to do more and better. The change is also due to the work of Dr Priyadarshi, who is beside me today and who is a real champion for this work. You will be very privileged and honoured to hear his evidence today, too.

Nevertheless, after welcoming the reduction last year, we have seen a rise in suspected drug-related death figures, and I do not take any of that unseriously; I take it very seriously. That is coupled with the very real threat that we are now seeing of new substances and behaviours. It is vital that my focus remains on delivering what the evidence says works and making sure that it has the effect that, I think, we all want.

I will finish there, convener, because I know that you have a lot of questions. I and, no doubt, Dr Priyadarshi will be happy to answer your questions. Thank you very much for having me along.

I will just make a final point on the previous question. One piece of work that we are doing is to roll out naloxone kits. I think that about seven out of 10 people who are identified by services as being most at risk are now carrying naloxone kits. That is a clear intervention and a way in which we can reduce harm and the number of deaths. That is just an additional point to the points that I made earlier.

The amount of stigma that has been directed to anyone who has a substance dependency and to their families and communities is not unknown to any of us. That stigma is a real barrier for people seeking support. The national mission was tasked with looking at how we can change the situation on stigma and discrimination. It is not difficult to understand where that comes from, given that a reservation in the Equality Act 2010 means that a certain group of people do not have the same rights as anybody else. We would like to change that.

The stigma in systems and communities and among people has been signposted to us as a huge barrier for anybody accessing services. That gets nuanced when we are talking about people from specific communities or people who have caring responsibilities. For instance, it is very difficult for mums to take that step over the threshold and ask for help, because of the stigma and the fear that they would lose their children, too.

Professor Alan Miller was tasked with coming up with a charter of rights, which is now in draft form and is being consulted on by the excellent organisations that have sat round the table to develop it. On Friday morning, I was at the Health and Social Care Alliance Scotland headquarters in Glasgow with the change group, which is a group of people who are delivering front-line services with organisations such as the ones that you heard from this morning as well as people with lived and living experience. They are sitting at the table working on what a charter of rights should look like.

As I say, the charter is in draft form and is out for consultation, and we hope to bring it forward. That is a bit of the foundation for the bigger human rights framework bill that we want to introduce. If we change the attitude to stigma and shift the issue clearly into a public health rights arena, that changes the complexion of all of it. It will mean that people with a substance dependency will have the same rights and deserve the same parity of health esteem as anybody else. It is an incredibly important piece of work to change that cultural attitude.

You will not be surprised to hear that the Government is pulled in all different directions because different people have different ideas on the best way to do things. I am taking my lead from the people whom I have met very recently—people who either are in recovery or have just finished recovery. Yesterday, at Abbeycare Scotland, I met all those groups of people plus people who have completed their recovery and are now volunteering in the service. They all say that they had tried this or that approach and that it had not worked for them and then this approach did. Then, I hear from people in other recovery pathways that are not based on abstinence—it might just be stabilisation, for example—and they say, “I needed to be stable first to get everything else in my life sorted out to allow me to think about the pathway to abstinence.”

If we truly want to take a person-centred approach, we need to take account of all those views, and we need to provide all the services for the people who are telling me what works for them.

Yes. I can write to the committee with a much more detailed report on where we are with the stigma plan and the work that is being done. I do not disagree with some of your points. We all want that work to have been done yesterday, and, if we had tackled stigma a long time ago, we would not be where we are now with regard to some of the ways that we approach people who have a dependency. That is the case generally in the UK and globally.

Another point is that the people with lived and living experience whom I met on Saturday morning—I met a group of people in Edinburgh who are working on that particular piece of work—and the change group that I met on Friday want the action plan to be right. It is very hard to take a human rights-based approach to participation and co-production if we say, “We need to get this done by four weeks on Friday.” That just has not worked for that group of people. They need some time to work through all this.

That does not answer your questions so far, but we met only this weekend, so let me provide in writing a much clearer update and timeline with regard to where we are. I can say that the people whom I spoke to on Saturday want us to get this right. They want massive change—it is massive cultural change that we are talking about—at every level of public service and in all the services that they come into contact with.

That is not an answer to the question of how fast and how far we have progressed, but there is a draft charter now, which I think is marked progress, and I can ensure that we share that with you if you want to see the draft work. Professor Alan Miller, who is leading the work and is well known for being a driver for change, would no doubt be happy to speak to you, too.

That is what I meant, along with the fact that the way in which the reservations in the Equality Act 2010 are worded means that anybody who has an alcohol or drugs dependency that has not come about as a result of a medical intervention does not have the same rights as everybody else—they are carved out as being reserved—and public authorities, health boards and other systems have approached the issue from that perspective. That is the foundation of the discrimination, and it should change.

That approach has created systematic discrimination that has resulted in people feeling that they cannot get the actions or access the services that they need. One of the reasons for driving up the MAT standards was to tackle some of that, as well as the issue of people feeling that they have been passed from pillar to post because they have been told that they have to sort out their drug dependency before their alcohol issues can be addressed, or sort out their mental health issues before their alcohol dependency can be addressed. We want to make sure that a joined-up approach is taken to people’s treatment.

There is a foundational structural inequality in everything that we do in Scotland and the UK, based on that reservation, and that has an impact on how the services are delivered. That needs to change.

Families want answers, and sometimes, sadly, toxicology becomes very important in giving them an understanding—that is the answer that they get. It also gives everybody else involved in the care and treatment of people an understanding of what that toxicology tells us.

The three-monthly RADAR reports bring in a few things, including toxicology results, primarily to see what is in the system. All that information is incredibly important, but it is all after the fact. One thing about learning about what the causes are is that we can look at how to create the treatment pathways that prevent people from coming to harm and losing their life, so we are working very hard with toxicology colleagues.

The drug-checking facilities—

I said that we do not have a naloxone for cocaine overdose or harm, which means that supervised detox is the only option and the only form of recovery. Cocaine Anonymous and other organisations are very helpful in supporting people who are in that situation, which is why increasing the number of residential rehab beds and the delivery of front-line services is important.

Synthetics may be the new thing in town, but we are still attempting to deal with some of the more traditional substances, such as cocaine, in a way that will reduce harm and deaths, as well as giving people a recovery pathway.

Yes, in Glenochil.

That is the work that Dr Priyadarshi has just spoken about. There will be continuous monitoring and evaluation of what works and what does not work and how we can modify that so that it works. We will keep monitoring how the consumption room operates and what it delivers.

One thing that I can say about the building is that the architects came up with a plan, but the Simon Community’s women’s group then worked with the architects to bring about a new design that that group felt was much more user friendly. Even at that stage, we had people with lived and living experience influencing the structure of the building and how things should flow. That has been incredibly helpful, because it allows us to design out some of the barriers that are sometimes designed into building facilities.

You asked about scalability. The Lord Advocate has given us very clear guidance on this consumption room. We will certainly consider whether we can scale that up and have consumption rooms in other places.

When I visited Aberdeen a few weeks ago, I met people from Alcohol & Drugs Action, the first organisation to put in a licence application for a drug-checking facility, and they said to me, “We’re watching what’s happening in Glasgow to see if there’s something that will work for us.” Given the sensitivity involved in siting such a service, the impact on the community and the reactions that people might have, we need to take a measured approach and allow local areas to decide what will work for them locally.

It is about taking a much more flexible view but, as far as Glasgow is concerned, it still comes within the confines of the Lord Advocate’s guidance and how much we can actually do in that respect. We will then see how we can use that experience in other ways across the country. Lots of cities have eyes on what is happening in Glasgow, and they will be really interested in the real-time evaluation to see how it could work for their areas. I think that we need to give them that space to allow these things to develop.

Yes, absolutely.