Seòmar agus comataidhean

Good morning, colleagues. I am grateful for the opportunity to appear before the joint committee to reflect on the people’s panel’s report and to update you on the vital work that is under way to address the harms and deaths that, sadly, are caused by drugs and alcohol.

The last time I appeared before the committee was shortly after the publication of the 2023 drug deaths statistics. Those numbers told a story that, sadly, we have become all too familiar with, which is that, in 2023, 1,172 drug-related deaths were registered in Scotland, which was an increase of 12 per cent on the figure for 2022.

We must use every tool available to address the crisis. In that spirit, I welcome the work of the people’s panel. I thank the panel members and presenters, and the joint committee for instigating that important and valuable process. We should be heartened by the successes that are highlighted in the panel’s report, particularly our widely recognised naloxone programmes and the implementation of the Thistle facility in Glasgow. Those achievements were hard won, and I extend my gratitude to the people—especially the individuals with lived experience—who helped to make them a reality.

The panel calls for further and faster action, including on culture change, stigma and prevention. I assure you, convener and colleagues, that we remain committed to those principles across all our activity and focused on what works, and that we are using the evidence that we are aware of here and internationally to ensure that we target intervention and action where it is most needed. The Scottish Government has carefully considered the report’s conclusions and recommendations. As outlined in my written response to the committee, we are supportive of all the recommendations that have been made.

Since my previous appearance at the joint committee, our progress has continued at pace. The charter of rights, which was published in December, will support people who are affected by substance use to know and understand their rights in accessing support services. The value of lived experience and peer support in drug services has long been recognised, and we will publish new guiding principles on that this spring. Those principles, which are for all employers, regardless of sector, will set out how they can best support employees with lived and living experience to flourish in the workplace.

Whole-system and preventative change remains our utmost priority. In December, we published the mental health and substance use protocol, and we intend to publish the population health framework this spring. I am pleased to say that transition planning for after the mission ends in 2026 is also under way. In the statement to Parliament that I made earlier this month, I noted that we want to build on and learn from the foundation of the national mission to ensure that there is an on-going co-ordinated response to the harms that are caused by drugs and alcohol.

Scotland’s drug and alcohol deaths remain unacceptably high. Each death is a tragedy—a life lost too soon. However, we remain committed to change, driven by the belief that progress is both necessary and possible. In that vein, I welcome your questions and look forward to discussing the findings further.

First, what the panel’s report and statement demonstrate to me, not least in light of the fact that we have been able to support all the recommendations, is that, from a policy perspective, we are focusing on the right areas. From the panel’s perspective, we are focusing on the right areas. I am clear that we need to improve the pace, scale, co-ordination and consistency of the application.

As we build from the national mission, the services are being established, in some cases for the first time, and their co-ordination between different agencies needs to be supported. I heard that from the panel members who gave evidence earlier this morning, for which I am grateful. I accept that more needs to be done on that, and that there needs to be greater consistency. I am originally from Orkney, as Mr Balfour knows, and I know that ensuring that we get the provision right for people who live in rural and island communities, as well as those who live in urban conurbations, is critically important, as is ensuring that there is greater awareness—among not only those who have a drug dependency, but their families—of the services that are available.

In that respect, the situation is improving. The anecdotal evidence that I have obtained from speaking to family members, in particular, shows that action has been taken to reduce stigma and to provide clearer pathways for people to access services. Sadly, those pathways were not there for those whose lives have been lost. I have heard that directly from family members who have lost loved ones. However, they say that if their loved ones had experienced then what they would experience now, they would be in a different place. That tells us that we are making progress.

Mr Balfour asked who is responsible. Ultimately, it is me—of course it is me. I need to make sure that that information is available and is disseminated properly, and I need to do that in partnership with others.

Mr Balfour mentioned health boards and alcohol and drug partnerships. When it comes to, for example, the expectations around the delivery of the MAT standards, we need to ensure that the information is consistent, that the services are co-ordinated and that colleagues across the health service—Mr Balfour’s question pertained to this—are aware of them. Ultimately, that falls to me.

We are constantly driving to ensure that improvements are made. I hope that panel members, service users and medical professionals will recognise that improvements have been made, but there is more to do. The figures from last year demonstrate that. Too many people are still dying. The rapid action drug alerts and response statistics from the past quarter indicate a slightly more positive picture, but we cannot be complacent. I am certainly not, and if Christina McKelvie were here, she would say the same thing. We need to drive harder to ensure that there is consistency across the country and across all services.

Paul Sweeney will understand that I cannot give him all of what will be contained in the framework until it is published. He and I share the view—as do colleagues around this table—that it is central for us to tackle the pervasive impact that poverty has on so many aspects of an individual’s life and experience. We have a clear indication of the correlation that exists between poverty and deprivation and the likelihood of people having a substance dependency, which was mentioned by a colleague on the previous panel. We also know from the drug death statistics that there is a clear correlation between poverty and deprivation and someone losing their life to a substance dependency. That is why the Government’s central focus and number 1 priority is addressing child poverty and doing what we can to eradicate it. The same panel member reflected on the fact that we do not have all the tools in the box to do that—decisions that are taken elsewhere also have an impact.

Addressing poverty has an impact on education, on justice and on health. The drivers of ill health are absolutely clear, and the health professional who was on the previous panel will be very familiar with them. Health inequalities and health conditions are driven by poverty. If we could tackle poverty, we would hugely reduce the demand on health and social care services, and we would dramatically reduce the number of drug and alcohol-related deaths. That is why it is right for us to have a cross-Government focus on addressing child poverty.

Through the population health framework, there is a clear focus on doing what we can to resolve poverty, but the health service in and of itself cannot do that. The environmental and social factors that drive people into poverty are outside the control of the health service. We pick up the impact of poverty, and that is why having a co-ordinated approach across Government to address poverty is so important for us. Indeed, that should be an overriding priority of all Governments.

We support alcohol and drug partnerships to deliver some of those services. Obviously, our health services are there to deliver, and we have provided increased funding to our health boards and our local authority partners to ensure that they are providing services.

We have already referenced the support that is provided through the Corra Foundation to ensure that community and voluntary organisations are able to respond. The organisations in the community and voluntary sector are trusted and have a wide reach—they can reach much deeper into communities than statutory services can—and the role that they play has to be acknowledged. I certainly acknowledge that, and my commitment to funding those community organisations is clear.

If there are examples of where we need to do more in local areas, or if there is more that we need to do at a national level, I want to hear about that. We would always consider funding for services where the evidence is clear that they are helping to meet a particular demand.

There is not a huge amount of greater detail that I can go into. The work that the improvement hubs will deliver is obvious, but I note that Healthcare Improvement Scotland’s co-ordinating role and its work on ensuring that the pathways are working well are well established, too. As I have said, I do not have a huge amount of detail that I can go into or anything that I can go into in any greater depth—I do not know whether Laura Zeballos or Maggie Page wishes to add anything.

I thank Ms Haughey for raising the issue and the people’s panel for its work on illuminating this as an issue that needs to be addressed. I heard the gentleman on the previous panel make the point that he had not been aware of the naloxone programme but that, when he did become aware of it, he wanted to be involved. That speaks volumes about not just the powerful effect of the naloxone roll-out itself, but the need to ensure that we are not complacent and think that everybody has an understanding of the roll-out, as colleagues around the table do, and the fact that it has gone to various statutory organisations as well as others.

We will consider what more we can do to have an awareness-raising campaign and what might be effective in that respect, and I am happy to come back to the committee with our consideration of how that could work. The very illumination of the issue through the work of the people’s panel will be helpful, as will, I hope, our discussion here. I believe that all of us around the table have agency in being able to raise awareness. Mr Sweeney and the convener said that they had gone through training—indeed, Mr Sweeney was able to say how quick that training was. If we use our own agency as local leaders, that will be just as important as any Government or Public Health Scotland-led campaign in this space.

Yes. In short, I am happy to consider that. There are pretty clear pathways available for people who are seeking any form of medical support or advice. You mentioned 111, which is a route into primary care. There are various routes, but I recognise that a single point of contact, which we are deploying in other areas of the health service such as in cancer support, is something for us to consider. I am happy to take that away and consider whether we could do something in a more streamlined way so that, if that is not possible, people still have greater clarity about where they can access services. There should be no confusion. People should know that they can go through 111 or the mental health support that is available through NHS 24, which colleagues will be aware of, as well as taking the obvious route to access support and treatment through general practice.

I absolutely recognise that, as we heard again from members of the people’s panel today, many of the MAT standards are directed towards opioid dependency. However, many of the standards are applicable to people regardless of their substance dependency. In particular, those that relate to access to mental health support and treatment are in place regardless of the type of dependency.

I recognise in my written response that we need to look at what we can do to provide medicated assisted treatment that goes beyond opioids. Colleagues have had questions about the fact that, as the people’s panel observed, we are seeing a growing level of polysubstance use and, in certain parts of the country, a growing level of use of cocaine, benzodiazepines and other drugs including nitazenes. Clearly, we need to ensure that we are responding to the use of those drugs, too, and that is part of our consideration.

First, I point to an example of where what we are doing in that area is starting to work better. I gave Ms Mackay this example in the chamber in answer to a question that she asked following my statement on the MAT standards. I am referring to the employment of staff in the Thistle centre and the fact that the design of that service has been carried out with people with lived and living experience. They have been not just a part of it, but central to it—indeed, people with lived and living experience were on the staff interview panel. That tells me that we are starting to get to a better place from the point of view of our work to destigmatise and to value those experiences more highly.

We have more work to do on how we employ those people. However, funding is available for organisations—Maggie Page or Laura Zeballos will remind me of the details—to ensure that people can be supported into the workplace and that there is a route for them to value themselves more highly as they progress. The point about feeling value in themselves was made very strongly when the First Minister and I visited the Thistle and spoke to those with lived and living experience who had helped to shape the service by being involved in the interview process and were participating in its establishment. The feeling of value and worth was incredibly powerful during that visit.

Laura Zeballos might be able to point to the funding that is available for organisations that provide support.