Seòmar agus comataidhean

I have recently had some meetings with Ms Robison on strengthening the homelessness prevention duties. There is something very simple, powerful and fundamental about the ask and act duty, because it should not just be a case of asking somebody and then acting by referring them on somewhere else. That might be appropriate at times, but the whole ask and act philosophy is also about how you can act before you refer someone on. It is culturally important in giving a sense of ownership and ensuring more collegiate working across the different workforces.

I am looking closely at the work that Ms Robison is leading, because it contains something important that we might be able to learn from and implement in our drugs policy, and which also connects with the MAT standards. It is all about how we make people’s rights real in reality.

I really appreciate that question, because there are a number of issues around residential treatment, and I am committed to taking a balanced approach to securing a whole system of care. Residential rehabilitation is an important part of that. It has historically been supported and funded less, and this Government is now seeking to address that.

When I made my statement to Parliament in November last year, a whole suite of information was also published, some of which was meant to shine a light on where things were not operating as they should be. Some of it was also about the work that is being done to improve access to funding and improve access pathways, and some of it was about how to improve accountability, within the Government but also at a local level, so that people could see where the funding was going and how many places were being funded by alcohol and drug partnerships in each area.

I know that the pandemic had an impact on some services. I am not sure whether I picked up correctly what Mr Choudhury said, but I am not certain about any on-going concerns. The residential rehabilitation working group continues to liaise very closely with residential rehab providers, and where there are issues to iron out, they will be proactive about it. There is a housing support fund to ensure that people do not have to choose between maintaining their tenancy at home and going into residential rehab. That was set up to mitigate some issues in which the rules for housing benefit were implicated.

I hope that that answers Mr Choudhury’s question.

Absolutely. We have tried to take a belt-and-braces approach. The new funds that are available to stakeholders and third sector organisations include a specific children and families fund, which is managed by the Corra Foundation, to which services and third sector organisations can apply for direct Scottish Government funding. Direct-funding opportunities have been very popular. I also point out that, before Christmas, we published our whole-family approach framework, which came with a funding package for ADPs.

Again, all the evidence from home and abroad indicates that we need to support families not just as a whole but as individuals, whether they be children or parents. We know that for every person with a drug or alcohol problem there is an impact on 11 other people. Supporting families and, where possible, keeping them together, is therefore crucial. The involvement of the family in an individual’s treatment needs to be considered as an appropriate option and choice for that individual. This is about services working with the family as a whole, which some do very well, as well as being about serving individuals’ needs.

Last year, we announced our national family residential service, which will support up to 20 families at any one time. Of course, that is part of our work to keep the Promise. I will not go into detail, unless I am pressed, but I will say that the Promise is highly germane to the work that I am doing.

We also need better standards of service and more bespoke services for women, because there has been a gap in that respect. Although it is mostly men who lose their lives, the number of women who are losing their lives is rising at a disproportionate rate.

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.

Thank you for that question. On the information that was published this morning on suspected drug deaths, you are correct to point out that it is based on police divisions. It concerns deaths that are suspected to involve drugs, on the basis of enquiries by attending police officers. The information does not tell us things such as what substances are involved. We get that level of detail from the annual report on confirmed cases.

A lot is being done. A few weeks ago, I visited the Glasgow overdose response team. That service seeks to quickly follow up with people who have survived a near-fatal overdose. We know from successive annual reports that more than half our people who die have a history of overdosing, so when people survive a near-fatal overdose, we really need services to kick in quickly.

A range of projects are funded through the new community funds that we have opened—for example, through local alcohol and drug partnerships. Some of the drug death task force projects are specific to Glasgow.

Information is available by region on specific services and projects or tests of change. It might be helpful if I were to pull that together to share with the committee. The committee includes a broad selection of MSPs from across the country; I know that you will be very interested to look at that in detail.

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.

We know that there is often great fear among women with regard to reaching out for help and disclosing the level of their drug use, especially when they have children. That is one of the reasons—there are many—why we are investing in whole-family approaches and family-inclusive practice.

The committee might recall that I announced in my statement to Parliament on 3 August substantial investment in an organisation called Phoenix Futures, which is to establish a national residential family service for the whole of Scotland. The announcement outlined that, subject to various approvals and consultation within communities, the facility would be able to accommodate up to 20 families, including mums and dads who have children aged from birth to 11. As well as thinking about services at the national level, we need to think about them at the regional level. That is one example of a step forward. There will be other work and announcements, in due course.

We have channelled funding through alcohol and drug partnerships, in which there is a specific allocation of £3.5 million for local ADPs to invest in whole-family approaches.

We need to support families as collective units, but we also need, within families, to support individuals in their own right. We will publish a framework on what family-inclusive practice should look and feel like on the ground. We are making progress in that area, and I will keep the committee informed.

Our commitment to increasing the capacity and the reach of drug services and to improving access to residential rehab applies very much to aftercare, too. We must recognise that drug addiction can be a chronic condition—it should be no surprise to anyone who is involved in the provision of drug services that people sometimes relapse. Progress in life is rarely linear, and it should not be that people run out of chances; we should give people as many chances as they need to get onto the road to recovery. The work that we do with local services and that integration with aftercare is crucial.

We also need to think about rehabilitation in a community context, as well as in a residential one. We know that risk can be elevated in times of transition, such as when someone leaves residential rehab, so people must have wraparound person-centred support that meets their needs. That approach also applies to people who leave prison or move from, or leave services. Our work and investments around outreach are particularly important in that area. We also need to be far better at following up when people disengage from services.

There is a lot in that question, but the member is quite right to make all of those connections. The point about access to residential rehabilitation is important. The work that the residential rehab development working group has undertaken is about the development of clearer pathways, because pathways vary across the country. I think that I am on record as saying that sometimes, pathways into residential rehab are as clear as mud, which is neither right nor acceptable.

There is also an issue about access to community services. There can be many barriers to people getting into treatment: you have to do this; you have to be on this level of treatment; you have to be abstinent and so on. With regard to residential rehab, which is an abstinence-based model, there are certain expectations around people’s personal commitment, detox and lowering substances to facilitate the process, but it is fair to point out that there are perhaps too many barriers to accessing other services.

An early action that I took was the result of information that Shelter provided. There is a bit of confusion about housing benefit rules. Anyone who knows anything about housing benefit will know about the minutiae of detail that often have to be unravelled. Different things were happening in different local authority areas to apply rules. I was not going to put up with people having to choose between keeping their tenancy and going into residential rehab. Funds have been allocated and are available to address that while we sort out the complexities of regulation or whatever. That is one example of how we can invest resource. We will sort out the situation, but we are not putting up with people facing that choice.

I have always been a big fan of the housing first approach and other housing models that do not put up barriers. We should take people as they are; the priority is to get them into a home, and we will work out the rest, whether that involves people’s drug use, health problems or other issues. I have spoken about parents and in particular mothers with caring responsibilities, so I will not repeat that.

The naloxone issue is important. Naloxone helps to save lives; it buys time for the emergency services because it temporarily reverses the impact of an opioid overdose. It is safe and easy to use. Because of the pandemic, the previous Lord Advocate issued guidance that enabled us to widen the distribution of naloxone to third sector settings.

I must give a shout-out to Scottish Families Affected by Alcohol and Drugs. As a result of our national naloxone campaign and people going to the Stop the Deaths website, more than 460 people have applied to that organisation for the naloxone kits that it provides through its click and deliver service. Families who have a loved one at risk can have naloxone to hand. More than two thirds of ambulance technicians are trained in naloxone use and can give out take-home kits to people they come across. It is important that people who distribute naloxone in non-drug services make the connections, support people and refer them to drug services.

I apologise for the length of my reply, but I hope that I have at least outlined some important connections.