Chamber and committees

There is no research available which directly links funding for services as a causative factor in the rate of drug-related deaths. The reasons behind the rising number of drug-related deaths are complex and many-fold; the reasons being reflective of Scotland’s unique challenge when it comes to tackling problematic drug use. This is recognised by the work of the Drug Deaths Taskforce which draws its membership from a wide range of areas, sectors and expertise – including people with lived and living experience. The Taskforce has identified a range of initiatives to directly tackle drug deaths and is supporting a range of innovative programmes and research.

Annual information on unplanned discharges from drug treatment is published by Public Health Scotland. The most recent publication is available here https://beta.isdscotland.org/media/3879/2020-03-03-sdmd-tables.xlsx .

Equivalent information on unplanned discharges from alcohol treatment is not available. This will be collected on the DAISy system which will start to go live from 1 December 2020, and so this information will be available for future years.

There is a wide range of data and research that analyse the impact of opioid substitution treatment on individuals. Much of this information shows that OST is an important treatment with a strong evidence base.

The use of OST as a treatment is in-line with the current ‘UK Guidelines on the Clinical Management of Drug Misuse and Dependence’ and the ‘Advisory Council on the Misuse of Drugs’ who state that methadone can be a very helpful part of treatment and recovery for heroin dependence. Its use was also reviewed by a Scottish Independent Group in 2013 who found that it remained an effective treatment and should remain as a significant element of the treatment options available.

The Drug Death Taskforce Medication Assisted Treatment sub-group is taking forward work that will define national standards for the consistent delivery of medication assisted treatment (which includes OST) in Scotland, and to help partners achieve it through a quality improvement approach. This work also involves establishing measures of success for people who use MAT.

2020-21 funding from the Drug Deaths Taskforce was allocated through 3 methods:

• £3 million was allocated to Scotland’s Alcohol and Drug Partnerships;
• £5 million was allocated to the DDTF and its sub-groups for an Innovation and National Developments funding programme; and
• £1 million was allocated to a specific research programme.

Of the organisations represented on the Drug Deaths Taskforce, those who have received support in terms of funding allocated to the Taskforce are as follows:

• Borders Alcohol and Drugs Partnership
• Police Scotland
• Scottish Ambulance Service
• Turning Point Scotland
• University of Stirling

The definition of an ageing cohort in relation to substance use, and in particular the identification of that ageing cohort starting at the age of 35, came from the report published by the Scottish Drugs Forum in June 2017 ( http://www.sdf.org.uk/wp-content/uploads/2017/06/Working-group-report-OPDPs-in-2017.pdf ).

That report states that ‘The challenges of responding to needs of older people with a drug problem (OPDP), defined in this report as over the age of 35, are significant and will increase considerably over the coming years. Among people with drug problems, those aged over 35 will become the main client group in specialist services for the foreseeable future.’ It goes on to say ‘over half of those with drug problems in Scotland are now aged 35 years or over and face ageing much sooner than the general population in terms of both morbidity and life expectancy. Drug use and social deprivation have led to older drug users having health problems generally associated with people in the general population who are fifteen years older (Vogt, 2009)’.

There are no other areas of healthcare where a person is considered to be part of an ageing cohort at age 35 but the information above sets out why this age has been used in relation to substance use.

In Scotland the responsibility for the planning, designing and commissioning of alcohol and drug services is delegated to Integration Authorities. Integration Authorities issue directions to NHS Boards and Local Authorities as providers and purchasers of alcohol and drug services setting out the intention and required delivery of the function, financial resource attached and the intended outcome. Directions should specify in some detail what the Health Board, the Local Authority or both are to do in relation to carrying out a particular function to deliver services. The Integration Authority is required to review the delivery of directions as a part of its approach to performance management, scrutiny and audit. Further information is available here https://www.gov.scot/publications/statutory-guidance-directions-integration-authorities-health-boards-local-authorities/#:~:text=Directions%20should%20include%20detail%20on%20the%20required%20delivery,in%20the%20same%20report%2C%20using%20a%20standard%20format.

NHS Boards and Local Authorities can also act as purchasers of services and hold legally binding contracts with third sector providers of alcohol and services. These contracts enable these public sector organisations to hold third sector services to account and include expectations over governance as well as measures or targets relating to performance and outcome delivery.

We have invested around £895 million in services to tackle alcohol and drug use since 2008. The total financial resource is higher than Scottish Government funding and includes contributions from NHS and other statutory partners.

Details of funding to NHS Boards can be found https://www.gov.scot/publications/alcohol-and-drug-partnerships-funding-allocations/

The Scottish Intensive Care Society Audit Group (SICSAG) is part of the Scottish National Audit Programme (SNAP) within Public Health Scotland (PHS) and has the aim to improve the quality of care delivered to critical care patients in Scotland by monitoring and comparing activities and outcomes across Scottish critical care units.

The SICSAG database held within PHS focusses on patient information, and, therefore, this resource does not include data which would allow the monitoring of the number of empty beds within each unit. We do not therefore have the information to answer the PQ.

As part of the COVID response, NHS Boards worked to put in place the surge capacity to double and triple ICU capacity should it have been required.

In their June 2020 report, SICSAG said that the baseline capacity for the most complex level of ICU care (level 3 care) was exceeded from 31 March 2020 to 24 April 2020. This activity peaked at 46% above baseline on 09 April 2020.

URL: https://beta.isdscotland.org/find-publications-and-data/population-health/covid-19/scottish-intensive-care-society-audit-group-report-on-covid-19/3-june-2020/

The Scottish Ambulance Service always make decisions on requirement to convey patients to Hospital on an individual and clinical basis.

Whilst receiving no direct advice from the Scottish Government, SAS implemented a specific protocol on 3rd April 2020 commonly used during a pandemic to help understand the clinical acuity of patients presenting with Covid-19 symptoms in order for SAS to respond appropriately.

Following a standard methodology of structure questions, this protocol helps to identify priority symptoms and assess levels of clinical risk to support decision making.

The Scottish Ambulance Service does not have a ratings score system.

The decision to admit patients to hospital is made by either the Emergency Department or Primary Care, not the ambulance service.

In terms of categorisation of calls, these have not changed during 2020.