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Ms Mackay knows that I firmly support safe drug consumption facilities. I had the opportunity to visit a facility in East Harlem in New York. Before there are any questions about that visit, please note that I was in the States in my own time and at my own expense.

The evidence shows that safe drug consumption facilities work and that they save lives. They are not a silver bullet, but they have a role to play. We have worked very hard with our partners, including Glasgow City Health and Social Care Partnership, the Crown Office, Police Scotland and others to develop a service specification proposition, which has been submitted to the Crown Office.

More specifically, the Crown Office has been gathering further information, as I understand, from Police Scotland, and it is nearing the point at which it can give advice to the Lord Advocate. You will appreciate that I cannot speak on behalf of the Crown Office or our independent Lord Advocate.

There is a role to play when it comes to tackling stigma, understanding drug and alcohol issues as a public health issue and understanding people’s attitudes towards various treatments. Sometimes, people have views about the location of any service in their community, so it is important that local services engage and have open dialogue with local communities.

I want to make two broad points. We are still waiting on the Lord Advocate to give us a view on whether the service specification and operational procedures are within our powers and whether it rests within her powers to determine prosecution policy and what is in the public interest. That is a core consideration of the matter.

Mr O’Kane is right to point to other health-related legislation. The other legislation that we cannot ignore is the Misuse of Drugs Act 1971. We have worked hard with partners to devise a proposition that is, we hope, within what we can currently do in Scotland, but I am not the final arbiter of that, hence the role of the Lord Advocate.

You also allude to Gillian Mackay’s point that there are other models and other ways to implement safer drug consumption facilities. There is the fixed model with fixed premises, there are clinical medically led models and there are other models that are voluntary sector-led. Of course, there are models of mobile safe drug consumption facilities as well. Although I would ideally rather have started from the position of considering which model will best meet the needs of our people, because of the 1971 act, we are framing a service in relation to our powers.

The work has been detailed, difficult and precise, but the approach that we are looking at is not the ideal way to do things. There are other models. We are framing our proposition around what we hope is within our powers, but I am not the final arbiter of that, as you will appreciate.

You will indeed.

That is a fair point. I will not sugar-coat instances in which progress has not been good enough or fast enough. You are right to allude to the fact that, although the majority of the red-amber-green statuses in the benchmarking report by Public Health Scotland were amber, there were not enough greens and there were too many reds, particularly in and around MAT standard 1, which is that crucial, life-saving, same-day treatment. That is why, for the very first time, we have a ministerial direction that places certain requirements on chief officers and chief executives of health boards, integration joint boards and local authorities.

I am due to update the Parliament imminently—maybe in the next fortnight or so; certainly in the next month—on progress since my last update. That is based on the improvement plans that we have received from every area. Some areas are in a cycle of quarterly reporting. Others, where the challenge is greater, are subject to monthly reporting.

We are beginning to see some good and innovative practice in and around rural areas, and perhaps we should share some case studies with the joint committee. I point to the Borders, which is a rural area and is the only area that was able to secure green status across MAT standards 1 to 5. If we can do it in the Borders, we can do it elsewhere. Let us not underestimate the challenge, but that can and should be done.

There is accountability at each and every level. I am stepping up accountability for local areas, but I stress that I am not asking other people to do anything that I am not prepared to do myself. Accountability and leadership are crucial not only at local level but at senior levels in IJBs, local authorities and Government. Accountability is needed at each and every level. We are accountable to ourselves and one another and we need to challenge ourselves and one another.

That is an important point and is reflected in our national drugs mission plan. You will see in our outcomes framework the importance of not only tackling poverty and inequality but focusing on equalities and different groups.

I have already spoken about women and young people. My concern is that we are not doing enough to reach into other communities. I am conscious that, sometimes, services can have stereotypes and misconceptions about other communities. I assure Mr Choudhury that my officials and I have begun to make better contacts with groups.

The visibility of the recovery community is a factor as well. That has encouraged other groups. I recently made contact with the lady from the Scottish women’s Muslim group, for example. I am conscious that, although drug and alcohol problems can be hidden across our society in general, they can be even more hidden in some communities. Some of that can be related to our false perceptions of other communities. We really need to think more sharply about how we reach out to other communities. If members, especially Mr Choudhury, wish to engage further on that, I would be delighted to do so.

I distil that into three important factors. It is complex, and we have deep-rooted challenges in Scotland. The task force and various other academics have written extensively about the acute poverty in particular areas of the country. We all know the research on the relationship between substance use, past trauma and poverty.

You asked specifically why there is an issue in Scotland. First, according to the information that we are able to gather, there is a higher prevalence of problematic drug use in Scotland. There is an existential question as to why that is.

The second point is the prevalence of heroin and benzodiazepines in drug-related deaths. It is not always possible to make direct comparisons, because England is a bit different when it comes to the underlying work on drug misuse deaths and the proportion of cases that go through toxicology and forensic screening. However, benzodiazepines are much more greatly implicated in our deaths than is the case in England and Wales—although I have noticed that some reporting and recording have begun to indicate a rise in benzodiazepine problems south of the border. The higher implication of opioids and heroin in our drug deaths speaks to higher-risk behaviours, more injecting and the lethal combinations of polydrug misuse and people with multiple and complex needs.

Thirdly, it is about treatment. Time and again, I have been utterly frank that not enough of our people are under the protection of treatment. We need to get more people into treatment—and, if they fall out of treatment, we need to follow up on that. That speaks to the importance of the MAT standards, and not just investing in services but reforming them. I have opinions on other aspects—for example, the Misuse of Drugs Act 1971. However, a core part of the national mission is about the need to invest in and reform our treatment services, which we are doing. Crucially, however, that must not be done in isolation from the other cross-Government work that is so important.

Thank you very much, convener, and good morning to all your colleagues. I very much appreciate the opportunity to come back to this tripartite committee as we embark on the national mission, particularly in our work to respond to the vital final recommendations of the Drug Deaths Taskforce, which are essentially about ensuring that all aspects of the public sector and all parts of Government are aligned. Although it is not for me to tell the committees how to proceed with their scrutiny of Government, it appears to be a fitting approach for scrutiny to be joined up, too.

You raise two crucially important aspects of our drug death challenge. When we look at the annual report that was published in the summer, we see that, although more men die, and significantly so, there has been a disproportionate increase in the number of women who are dying, and that has been a trend for some years. The annual report shows a small decrease in the number of men who are dying, but a continued increase in the number of women we are losing.

We know that the issue is complex. It relates to trauma, including past life trauma, but it also relates to women who are mothers. If we think that people who use drugs are stigmatised, that is even greater for women, in my view, and particularly women who are mothers. We know that the removal of children has a huge, traumatic impact and is a contributory factor to deaths.

We are working through the recommendations of the Drug Deaths Taskforce, and we will be supporting alcohol and drug partnerships to do likewise and, indeed, to develop pathways. You may have noticed that, earlier this week, we published the first annual report on the national mission and the alcohol and drug partnerships. We need to make more progress with some specific care pathways for women. Some of our investment in residential rehabilitation and residential services has been prioritised to meet that need.

On young people, the annual report that was published in the summer shows that, although the number of young people under 25 who had died reduced in 2021, it remains too high. It is important not to look at one year’s figures in isolation; we know that the three preceding years showed concerning increases. As you will see in the annual report, although alcohol and drug partnerships all have services and supports available for young people, we need to do much more to be clear about the types and range of services that should be available in each area. That, in part, is why we have a stream of work specifically on young people, which relates to the co-design of standards of care and treatment and to the range of services. That work is proceeding, and I will endeavour to keep the committee and Parliament up to date on it.

The member is probably aware that separate statistics are produced about deaths that relate to illnesses or health conditions that can be traced to the problematic use of alcohol. I know that we are talking about statistics but, for the record, we are also talking about lost lives and people. I will try to do that as sensitively as I can, rather than get into a too dispassionate discussion of statistics.

The annual figure for drug-related deaths is in relation to the use of illicit substances and controlled drugs. That is the purpose of those statistics—they show how many deaths happen as a result of controlled drugs and illicit substances. You are right to point to the figure that 93 per cent of the people we lose have more than one substance in their system. Of those we lose, 11 to 12 per cent also have alcohol in their system. That figure is down on previous years. In some years, it was up to about 30 per cent. That speaks to the growing problem with other substances, as opposed to a reducing problem with alcohol.

There is another area in which we need to distinguish. The national mission is absolutely focused on those who are at risk of dying, and therefore on developing treatment options for opiates, benzodiazepines and cocaine. However, if we speak to organisations such as Scottish Families Affected by Alcohol and Drugs, they will say that their number 1 concern about the families and people that they support is still alcohol. The work done by David Nutt and published in The Lancet details the harms caused to individuals, society and others by various substances, and it shows that alcohol is at the top of the list.