 The next item of business is the statement by Elena Whitham on implementing the medication assisted treatment standards. The minister will take questions at the end of her statement, and hence there should be no interventions or interruptions. I call on Elena Whitham to speak around 10 minutes, please. Thank you, Deputy Presiding Officer. Today I want to assure the chamber that I am determined to continue to work across those benches across all sectors, across each and every community the length and breadth of Scotland to embed the critical aims of the national mission to save and improve lives. My thoughts are with everyone impacted by the loss of a loved one. To begin I would like to acknowledge the suspected drugs deaths figures published last week by Police Scotland. That management information report provided an indication of current trends in suspected drugs deaths. It covered the period from January to September 2023 and it reported that there were 900 suspected deaths, which is 13 per cent more than the same period of 2022. I am absolutely steadfast and determined to turn the tide on drugs deaths, and what is a real concern for me right now is the increasing appearance of synthetic opioids in the drug supply. That increase is being seen across the United Kingdom. I will cover that later, but those new drugs, especially netizens, are being found in a range of substances and they bring with them increased risk of overdose, hospitalisation and death. That is why the mat standards are so important. The second annual benchmarking report published in June illustrated that there was clear progress being made in a number of areas across Scotland. I would therefore like to take this opportunity to again thank everyone involved in working to change services for the better. Change is happening for my meetings with individuals and various stakeholders over the last few months. I have heard about and witnessed for myself the will and the drive to improve access to treatment and support. For example, on mat standard 3, the mat standards implementation support team is working in collaboration with colleagues from across Scotland to develop guidance to ensure that all people at risk of drug harms are identified and provided support, ensuring pathways extend beyond the ambulance service and the emergency department, but into housing, family members, justice, third sector organisations and people using any substances problematically. It is important to acknowledge the hard work and determination that is made in relation to implementing the mat standards, but I am not shy away from the work that is still to do to ensure that successful implementation is achieved and sustained across all of Scotland. That is why, following the ministerial letter of direction that was issued in June last year, I have maintained the requirement for the majority of areas to report to the Scottish Government on a quarterly basis. For seven areas, there has not been significant progress and so those areas will provide updates on their progress on a monthly basis. However, I do not wish to demotivate or demoralise any member of staff or individuals in those areas who are working above and beyond to implement the standards, as there have been local challenges to overcome. The minister is working closely with each of those areas and I can report that, for most, good progress has been made with a view to full implementation of standards 1 to 5. It is also my intention to meet with those areas in the coming months to hear for myself how barriers are being overcome. I have also heard from individuals and from families in supporting services of how our aims are not always translating into positive experiences on the ground and I will discuss those cases as I meet with local leaders. We know from this year's benchmarking report that standards 6 to 10 require new approaches and I acknowledge that some of those are taking time to embed but I remain committed to implementation in 2025. However, I see services working together more closely than before. For example, Matt 9 criteria and the mental health strategy set clear expectations that people with co-occurring mental health and substance conditions should have access to high quality and integrated care and work is on going to improve care by getting the local foundations right, empowering the workforce and embedding clear lines of accountability. As part of Matt standards 8, we are working alongside Public Health Scotland and experts across the field to ensure that advocacy and support are in place at local level. For Matt standards 7 and primary care, although that can be seen as challenging, areas are exploring different service models such as shared care, non-medical prescribers and better joint working. Community pharmacy also has a role in improving outcomes for people. For example, there is a programme of work that has been successful in improving education around substance use for pharmacy teams. That includes the rolling out of training for naloxone use by all community pharmacies and supporting the pharmacy network in Scotland to deliver undergraduate and postgraduate pharmacy training around substance use. For Matt standards and justice settings, the MIS team has led in partnership with others to develop a resource kit to support police and present staff to implement the standards. There is also innovative work going on with an HMP Perth to promote recovery and to ensure that those at highest risk of drugs harm are followed up by community services. There is improvement work being undertaken in NHS Highland to support those most vulnerable in police custody, offering nursing support at first point of contact. Within police custody in Kilmarnock, the organisation with you is attending to help people there with regards to Matt. Matt implementation needs to be based on hearing and listening to the voices of people who use services. However, areas need to go further than listening. We need to drive improvement based on the feedback gathered from those with lived and living experience. That will often mean making changes to how we do things. Last week, I had the pleasure of attending the launch of the national collaborative draft charter of rights. The charter helps people to understand their rights and sets out the kind of actions public bodies, including the Scottish Government, will be expected to take in the context of the forthcoming Scottish human rights bill. That strengthens efforts already under way as part of implementing the Matt standards. Crucially, it ensures that people are involved in decisions that affect them. Successful implementation of Matt and indeed our national mission requires a skilled, resilient workforce. It is therefore crucial that services are able to attract, retain and support staff. We are engaging extensively with partners to get a clear understanding of the specific steps required to drive improvement. Those steps are set out in the Drugs and Alcohol Workforce Action Plan, which was published earlier this month. The action plan details the key workforce priorities that we will deliver over the next three years. I want to offer the reassurance that significant progress has already been made towards delivering a number of those. Although I am committed to ensuring that Matt standards are fully implemented, I fully recognise other emerging threats that we need to be aware of and tackle, including the threat from synthetics such as netizine. We have improved our surveillance to monitor drugs trends and what is in the supply through our rapid action drug alerts and response or radar system. That has allowed Public Health Scotland to issue two public health alerts this year on specific substances, with one for synthetic opioids. Alerts aim to raise awareness of risk for individuals, families and for service providers to deliver vital harm reduction, including the provision of naloxone. We have already seen synthetic opioids appear in the supply through surveillance. Those substances, which are significantly stronger than regular opiates, are a massive concern for everyone, not just in Scotland but across the UK. The UK Government issued its own alert around netizines in the summer, and the National Crime Agency last week published information estimating that there had been 54 netizine-related deaths in the UK in the last six months, nine of which were in Scotland. I discussed the issue with the UK Government and other devolved Administrations at the UK drug ministerial meeting held last month, and I am committed to continuing to work with UK colleagues on that issue. I also recently met international experts to discuss their experience, and I will hold a round table with stakeholders to discuss operational issues early in the new year. We know that naloxone works on synthetic opioids, so our aim is to continue to increase the number of kits in general circulation with the public to provide initial medical treatment. In addition, we are working with our cities to establish drug checking facilities, of whom we are aiming to submit licence applications to the Home Office to allow those to be established in the coming months. In Glasgow, we are supporting the setting up of a safer drug consumption facility, and that will be able to offer emergency care in the instance of an overdose, which is even more important if there is an increase in consumption of synthetic opioids where an overdose is more likely due to their increased strength. In Glasgow, the enhanced drug treatment service treats people who have had prolonged heroin use and have had little or no response to traditional opioid treatment methods. That has been evaluated to work safely and effectively and has ensured a safe supply of diamorphine as a harm reduction method for this population. We have also seen an increase in use of cocaine and the harms associated with it. There is, however, no medicine available that can act as a substitute, but there are other types of treatment such as psychosocial interventions and supervised detoxification. There are third sector organisations that are leading the way in helping people with cocaine problems. Indeed, the Healthcare Improvement Scotland Mat Learning System website recently published a blog that detailed how a charity in Ayrshire, Harbour Ayrshire, are helping people into recovery from cocaine. Moving forward, continuing implementation of the mat standards will drive further change, and I remain committed to the timelines that have been set out. We must also be alive to the emerging threats, and services have to adapt if they have been doing admirably less fire to meet the new challenges. To conclude, Mat implementation should remain at the forefront of what areas we are doing. This work is saving lives. Stigma is being tackled. Workforce is being valued in areas that are sharing learning and best practice, with everything coming together to save and improve lives. Finishing, I must pay due respect to the continuing commitment from this chamber. Your challenge and desire to see change is welcome as we look to full, equitable and sustained implementation of the mat standards in all areas across Scotland. The minister will now take questions on the issues raised in her statement. I intend to allow around 20 minutes for questions after which we will move on to the next line of business, and it would be helpful if those members who would wish to seek to ask a question could press the request-to-speak buttons. I call Sue Webber to be followed by Jackie Baillie. I thank the minister for advance sight of her statement in a very timuous manner for that one today. Last week, data released by the Scottish Government revealed that drug deaths have risen for the first time in nine months, for the first nine months of 2023 by 13 per cent, compared to the same period in 2022. This is an additional 103 lives that I have been tragically lost to lie to drugs and is unacceptable. The Scottish Government is focused primarily on harm reduction and the de-stigmatisation of drugs. The 10 mat standards are their vehicle to deliver this, but one they are failing to deliver, having pushed back the full implementation of these now until April 2025. The minister has mentioned specifically in her statement progress with mat standards 7, 8 and 9, but perhaps the most important mat standard is mat standard 1, same-day access. It means that people can access treatment or support on the day they present to any part of the service. Yet national drug and alcohol treatment waiting times were published today, showing that only 5 out of 13 health boards did not meet the standard that 90 per cent of people referred for help will wait no longer than three weeks for specialist treatment. If health boards and ADPs cannot provide treatment within three weeks to 90 per cent of the people, how many are capable of achieving same-day access to treatment? In other words, mat standard 1. Minister, you stated that you are absolutely steadfast and determined to turn the tide on drug deaths. If that is true, every avenue must be explored. Will the minister finally get behind the right to recovery bill? I recognise Sue Webber's commitment to working on this area and her passion for that. From the outset, access to specialist treatment is slightly different than access to same-day treatment for mat standards, so perhaps there is a little bit of work that I need to do to communicate that more effectively. We are seeing progress in achieving mat standard 1 right across the board, which is very welcome. What I would say with regard to looking at harm reduction is that harm reduction is a form of recovery, and I do not think that we can separate the two out. I absolutely am committed to making sure that we extend access to residential rehabilitation. We have committed over £37 million to seven capacity projects where we are seeing people accessing that in numbers that we have never seen before. Last year, we had 812 people access a publicly funded placement into residential rehab, which was a 50 per cent increase. I am committed to working across the chamber, and I am also committed to looking at the right to recovery bill when it is published, because I am really interested to understand how they have addressed some of the concerns that were raised about unintended consequences at the consultation stage, but I absolutely give my commitment to have a look at it once we see the detail of it. I remind all members who wish to seek to ask a question to make sure that they press their request-to-speak button. I thank the minister for advance sight of her statement, although I found it to be wholly depressing. Mat standards 1 to 5 are still not fully implemented, and there is no guarantee on whether standards 6 to 10 will be delivered by 2025. As we have already heard, the fact that the number of drug deaths has increased by 13 per cent when compared to last year is simply shameful. Since a public health emergency was declared four years ago, almost 5,000 lives have been lost. So any progress on Mat standards and on a safe consumption room pilot in Glasgow are steps in the right direction, but much more needs to be done. The massive cuts that are handed down to the health and social care partnerships by the SNP Government have resulted in the reduction of men's rehab services and the planned closure of Turning Point, which provides women's rehab services in Glasgow. Their funding was slashed by £850,000. Despite rising numbers of drug deaths, the SNP has cut funding to alcohol and drug partnerships by £46.3 million in real terms. That tells you all that you need to know about SNP priorities. Can the minister tell me what she is doing to stop the cuts for drug rehabilitation and treatment services so that more people do not lose their lives in Scotland? I absolutely recognise that we have lost far too many people in our country to wholly preventable deaths. What I would say to Jackie Baillie is that we have drug and alcohol services have seen significant increases in funding as a result of the national mission. That increase in funding into drug policy represents a 67 per cent increase in funding from 2014-15 to 2023-24 in real cash terms, according to figures published by Audit Scotland last year. Although I recognise that there are issues in funding, we have to recognise that in the year prior to where we traditionally think of the services having a reduced budget, we have seen a 67 per cent increase in real terms. With regard to Turning Point and other services such as that, those are decisions that are not taken by this Government. I anticipate and understand why people are afraid of what might happen with the closure of such a service, and I am actually looking to the health and social care partnership to explain how they are going to support some of the most vulnerable women, especially within their city centre, who are experiencing multiple and complex needs. I am alive to all those issues and I am determined that with the budget that I am in control of, I am going to make sure that those moneys get to the places where they need to be and that it is going to give us the most result for the money that we can invest. There are a number of members who wish to seek to ask questions, so we will need brief questions and brief answers. I call Audra Nicollad, followed by Slandish Gohani. During recent engagement with my local ADP service lead, the issue of medication costs was raised. Can the minister provide an assurance that health boards are meeting the costs of medications that potentially save lives, such as buvidol and naloxone, in the same way that other patient groups would have access to life-saving medication? I thank Audra Nicollad for that question. It is a really important one at this point. Buvidol and naloxone are medicines that need to be available everywhere to help save lives of some of the most vulnerable people in our communities. It is simply unacceptable for health boards and IJBs to single these medicines out to be treated differently to all other medicines. If we think about stigma, stigma is pervasive in all areas of our culture when it comes to issues around drug use. My officials have met chief finance officers and ADPs to ensure that the costs of those medicines are being provided for appropriately. For boards where there may still be confusion, we will be writing out shortly to give clear instructions on the need to properly fund the availability of buvidol and naloxone. I call Sandish Gohani to be followed by Emma Harper. Your statement today, like many statements that we have heard before, does not actually say anything except that drug deaths have gone up by 103 more people, real people, with real families. That is completely unacceptable. Minister, you also stood there and said that you are absolutely steadfast and determined to turn the tide on drug deaths, yet your record does not back up your rhetoric. When will we see the introduction of safer consumption rooms in Glasgow? I recognise that across this chamber we all want to see the reduction. I recognise that each and every one of those people is an individual. I have met with several families so far in this job, and I know of far too many people and families who have suffered that loss. I am going to remain steadfast. One of the things that we can do to support those individuals who sometimes are at most harm within the city centre, who are injecting in public, who we know from the report taken away by the chaos in 2016, require that safer consumption facility. The Glasgow Health and Social Care Partnership is working at pace to make sure that it has staff members in place come this spring and that we hope that that facility will be opened by the summer months once we have the infrastructure in place. Emma Harper is to be followed by Paul Sweeney. The minister will be aware that I have been working to ensure that the match standards are implemented for rural parts of Scotland, such as in Frees and Galloway and the Scottish Borders. Can the minister provide an update on how implementation is working in rural areas versus urban areas? Can she comment on how stigma reduction work is progressing in rural Scotland, such as through the importance of local recovery cafes, such as borders in recovery group, which takes place in Hawick, Galloway, Kelso, Imouth and Bebles? Both small teams and those in remote and rural settings have particular challenges. However, ADP areas with remote and rural settings have demonstrated innovation in terms of maximising the use of technology and flexible models of care so that people could benefit from equitable care and treatment. I think that those in our remote and rural communities have always had the adage that Huft is a good maester, as my grandpa would say, and they are very innovative in their approaches. Emma Harper has mentioned borders and recovery. That is an organisation that I would like to get down to in the near to actually meet and discuss with them how they deliver their support services within such a rural setting. However, I am keen to make sure that we see our rural services develop. We know that stigma prevents people from accessing the treatment and support that they need and that they are entitled to. It can have specific impacts in rural areas. There is work taking place locally to reduce stigma, with all ADPs reporting that they consider stigma reduction within written strategies or policies, including the mat standards implementation plans alongside a range of other actions. Nationally, we published our stigma action plan last year, which outlines our plans to develop a voluntary accreditation scheme to tackle structural stigma and to implement a national programme of activity to challenge social stigma. I will keep the chamber updated on the progress of that plan. An evaluation of Glasgow's dimorphine-assisted treatment service pilot found that those who engaged with the service decreased heroin use and saw improvements in their overall health and wellbeing. There are very positive signs, but the evidence shows that dimorphine-assisted treatment works, but the Glasgow service has helped just 30 people since it was launched in 2019—a very restrictive capacity. What is the Scottish Government doing to increase that capacity so that more people who use drugs with complex needs can access this treatment in line with mat standards 2 on choice? I absolutely recognise the question that Paul Sweeney puts to me. I recognise that the model that is in offer within Glasgow started during Covid and we saw that there was an interruption to the amount of people that were brought on board. We know that that is increasing as time passes on from Covid, but I am also aware that there are other models that we can implement across the country. There has been funding that has been made available for projects to look at whether there are scoping exercises in local areas to take it on. I have had discussions with Cranston and other organisations about how that can be delivered in different parts of the country and in different models. I am willing to work with any local area that wants to do that. The Government is ready to stand side by side with local partners. I call Stuart Millan to be followed by Alex Cole-Hamilton. I would also like to remind the chamber that I am the vice-chair of moving on to Inverclyde, a local recovery service. There are important differences in drug-related deaths data collection methods across the United Kingdom. Can the minister speak to those differences, the consequences for the comparability of the figures and the continued steps that have been taken to ensure that improvements in data collection takes place here in Scotland? The definitions used for drug deaths statistics are consistent across the United Kingdom, but there are important differences in data collection methods and in the death registration systems that affect the comparability of the statistics due to different levels of missing data across the UK nations. The same problem from comparability found with identifying drug misuse deaths also applied to the figures for all individual substances and drug categories. The drug misuse death definition is the main headline figure used in Scotland, but the drug poisoning death definition is the more accurate comparator with the rest of the UK. The Scottish Government remains committed to improving our data and surveillance around drug deaths and harms, for example, through a rapid action drug alerts and response surveillance system to assess emerging threats, which we have seen come into its own just recently, and to share information to reduce the risk of drug-related harm and to recommend rapid and targeted interventions. We have also seen great advances in toxicology reporting in Scotland, and that is something that I know ministers in the rest of the UK have looked towards us for leading in that, because the more that we can identify the substances, the more that we can then introduce harm reduction measures. The minister will be aware that she carries the good wishes of these benches in her mission in this regard. In November, I raised with her the threat posed by synthetic opioids, which can be up to 100 times stronger than morphine. In the United States in 2012, 2,500 people died after using them. By 2022, that number had lept to nearly 80,000 deaths a year. That could be the canary in the coal mine for what is happening here in Scotland. We know that there has been an increase in the use of nitocenes, a synthetic opioid, that has been linked to nine deaths in the last six months. If she will commit to more regular monitoring and updates of Parliament about nitocene use and mortality so that we can be clear if this is a wave that is about to break here. I thank Alex Cole-Hamilton for his question, and it is something that I have been pondering myself as to how we can make sure that the information that we get from the radar reports, the information that we collect from the Queen Elizabeth hospital and their programme that they have where they are monitoring people in real time as they come into A&E, that we can actually collate that information and look at it in totality, because I am really concerned about what might be facing us coming down the line. I have visited local organisations just this week and heard where we have had to have a deployment of four doses of Ralloxone within a service to actually reverse an overdose. That is really concerning, and what is concerning me as well is that these nitocenes have been found in substances that are not linked to heroin, so somebody is not anticipating that they are taking a nitocene. They are perhaps buying an illicit benzodiazepine or even using a vape that is supposed to be a cannabinoid type vape, and there are nitocenes contained therein. I will commit to keeping the chamber abreast of the emerging threats, but also to try to figure out how we respond in an even quicker timeframe. Annie Wells, to be followed by Jackie Dunbar. Thank you, Presiding Officer. In your statement, Minister, you said that there has been a rise in cocaine use in its associated harms, and you also said that there was no medicines available as a substitute. There are other treatment methods available, one being supervised detoxification. Can the minister explain how supervised detoxification will be delivered, and if there will be a requirement for residential rehabilitation, and if so, can the minister explain how those residential placements will match demand? Annie Wells asks a really important question, because the rise in cocaine use, and we are seeing it right across the country. We are seeing it in different age groups and different cohorts of individuals. Whilst at this point in time there is no medication substitute for such a stimulant, detoxification actually can work very well. We have committed £5 million per year at the moment to actually look at our stabilisation and detoxification provision across the country. Three million of that is to increase that provision, and there's two million that's actually about a rapid capacity building fund. One I would ask is that local areas look perhaps to work together collectively on that, so that we can increase the provision in terms of the placements for stabilisation and detox, because they are a key part in our mission, and there's also that key link between community recovery settings, into that detox setting, stabilisation setting and then perhaps on to residential rehabilitation, if that's right for the individual. I'm so happy to keep Annie Wells informed as we go along there. I call Jackie Dunbar to be followed by Elaine Mackay. Thank you, Presiding Officer. The MAT standards emphasise a multi-pronged approach to treatment and residential rehabilitation as a potential course for support. Can the minister provide an update on the progress being made in expanding and improving access to publicly funded residential rehabilitation? Following on to the question that Annie Wells has just posed to me, Jackie Dunbar asked another really good question. We are committed to expanding access to residential rehab. We have an investment of £37 million in seven residential rehabilitation capacity projects across the country, and through that and other funding over the course of this Parliament, we are working to increase overall residential rehabilitation capacity by 50 per cent, which is an increase from 425 to 650 beds. We are also moving at pace to develop a standardised approach to commissioning residential rehabilitation services through work with Scotland Excel, and they have supported us to create an online service directory that will be available soon to allow services and individuals to see what is on offer across the country. We are providing funding to support residential rehab placements, including £5 million per year to ADPs, and additional funding through our present to rehab scheme and through our capacity programme. This morning, Public Health Scotland published its report, which shows a further increase in the number of referrals in the first two quarters of 2023-24, with a total of 477 statutory funded placements being approved. That is an increase of 126 placements when compared to the same period in the previous year, where 812 placements already showed a 50 per cent increase in placements overall. We aim to increase the number of statutory funded placements by 300 per cent over the next five years, so that by 2026, at least 1,000 people are publicly funded for their placement in residential rehab. Drug use is not a simple issue, but rather something that is compounded by factors such as deprivation, poverty and exclusion. Training is being provided to ensure that those interrelated and interlinked issues are being dealt with. Given the minister's acknowledgement that experiences on the ground are not always good, how are we ensuring that when things go wrong, they are evaluated, addressed and, where appropriate, are being used to improve knowledge and individual practice? I thank Gillian Mackay for that question. It is a very important one with several facets to it. As per MATS standard 8, the Scottish Government is working with Public Health Scotland and experts across the sector to ensure that people who use drugs have access to independent advocacy and support for their housing, welfare and income needs. The Scottish Government is committed to ensuring that those who use alcohol or drugs are supported to access services and that staff are trained to understand the wider complex needs of people who use drugs. In order to ensure that those important but complex interlinked issues are recognised, reach advocacy has been awarded funding to deliver training on the implementation of MATS standards as part of a wider human rights-based approach. That training allows front-line staff and managers across statutory and third sector services to develop their knowledge of MATS standards and human rights legislation in order to provide holistic and rights-respecting care. There is also a fundamental part about where we recognise where things have gone wrong, where we really take on board that learning and that learning can be cascaded to other front-line services. I am cognisant just now after hearing directly from front-line services yesterday about how the impact of repeated overdose reversals is having on those members of staff. We are also looking towards supporting members of staff's wellbeing as well. As the minister is aware, Standard 9 states that all people with co-occurring drug use and mental health difficulties can receive mental health care at the point of medication-assisted treatment delivery. I note that the minister mentioned Standard 9 in her statement. Can she give a further update and further information on the progress of implementing this MATS standard? I thank Clare Haughey for the question, because this is a real fundamental part of ensuring that people who have co-occurring issues with substance use and mental health issues are not bounced around services, which happens far too often. We have commissioned Healthcare Improvement Scotland to produce an exemplar protocol that will build on breast-practice from across the country and internationally. That will ensure that every area has access to a high-quality document that it can base its own protocol on. Once the exemplar protocol is made available to the local areas early next year, HIST will offer strategic change management support, and that support will help local areas to adapt the exemplar protocol to their own circumstances, pilot elements of the protocol and then implement it fully. In addition, we will work with HIST and stakeholders, including NEST, to ensure that we have the appropriate training and data reporting to support and monitor improvements. By implementing the exemplar protocol, local areas will also be implementing MATS standard 9, with co-occurring support where it is needed. However, the protocol is not limited to opiates or medication-assisted treatments and will support much more people in terms of their substance use.