 The next item of business is a statement by Angela Constance on medication-assisted treatment and workforce update. The minister will take questions at the end of her statement and so there should be no interventions or interruptions. I call on Angela Constance up to 10 minutes, minister. Presiding Officer, every life lost to drugs is as tragic and unacceptable and I want to convey my condolences to those who have lost a loved one and reaffir my commitment to saving and improving lives. Today I will provide Parliament with an update on progress in implementing math standards and in tackling the related workforce challenges. But first I would like to say a few words about the quarterly figures based on the data from Police Scotland which were published today. Police Scotland has reported that during the first nine months of 2022 there were 797 suspected drug deaths, 21 per cent fewer than the same period for 2021. While that cannot be used to make accurate predictions about the status of the annual report for 2022, which will be about confirmed cases, it does enable services to identify where help may be needed and keeps Parliament abreast of developments. In June when I provided my last update to Parliament on math standards, the Public Health Scotland benchmarking report was published. That report confirmed that while most areas had at least partially implemented math standards 1 to 5, performance fell short of the challenge I had set to embed math standards by April of this year. While the report demonstrated that progress was being made on the ground, the pace and scale of change was neither good enough nor quick enough, especially around math standard 1 same-day treatment. That is why I took the unprecedented step of issuing a letter of direction to delivery partners, asking them to personally sign a timed and detailed implementation plan for all 10 standards. I can confirm that all areas have submitted their plans. We are now finalising the details and ensuring that they have been published on websites. Areas are already reporting regularly to the Scottish Government on progress either monthly or quarterly. I am continuing to meet chief officers and math leads from each area to discuss their plans and learn more about how they are meeting their local challenges. There are some areas that have achieved good things already, such as in the Borders. The Math Implementation Support Team, led by Public Health Scotland, has also reported good progress being made on implementing same-day treatment across other parts of the country, with special mentions for the work that has been done in Inverclyde, Eastern Bartshire, Murray and Western Bartshire. The MIST team has noted increased involvement from senior leadership in many areas, as well as improvements in pathways for people access and treatment and better inter-organisational sharing of best practice. MIST also notes that reach rights-based advocacy training has now been delivered across multiple ADP areas with further training planned. However, there are areas with challenges still to overcome, and the MIST team is supporting them to address recruitment, local communication issues and unnecessary structural barriers. That includes a persistence in some areas to not involve third sector partners closely enough. Those are the focus of teams locally to ensure that changes and improvements necessary are being actioned at pace. We know that many people with substance use problems also have a mental health concern. To address one, we often must also address the other. That is why I, along with the Minister for Mental Well-being and Social Care, commissioned a rapid review into the care for people with co-occurring mental health and substance use concerns. The findings from the review, which were published on 30 November, will help inform our work to better integrate mental health and substance use services and deliver MAT standard 9. The review includes recommendations on how to better integrate services, but it also reaffirms the challenges that exist. A survey of practitioners found that over a third of the respondents worked in substance use services which do not offer mental health support. That is troubling, as a lack of integration between mental health and substance use services is a key barrier to accessing adequate treatment and support. We are considering the recommendations now and will engage with stakeholders and local partners. I will update Parliament in the early part of next year on how we will accelerate the integration of services. In relation to workforce, we know the challenges all across health and social care. This is one of the reasons we need a longer term workforce development plan for the delivery of MAT standards and for our wider national mission. Today, I would like to set out how we plan to expand and upskill the workforce. I have seen firsthand and heard directly from those delivering life-saving work in this often challenging environment. I know that there have been issues around recruitment, retention and service design. Those points were echoed through the research published by the Scottish Government in March. In June, I outlined to Parliament that the majority of the additional £10 million per year MAT funding would be focused on recruiting more than 100 additional staff. I am encouraged to learn that, although it is not without challenge, many local areas are reporting that they have made significant progress towards the targets that they have set for themselves. In order to support and strengthen the workforce, the Scottish Government has brought together an expert group with front-line and real-life experience to develop a longer term workforce plan, as recommended by the Drugs Desk Task Force. The plan, which we will publish in the summer of next year, will set out the medium and longer term steps that are required to overcome key workforce challenges. The group has been able to successfully agree on a number of short-term outcomes and have already begun to drive those forward. An example of that is the development of a single platform for access to training and key workforce resources. That will be launched by the summer of next year and will support the upskilling and retention of staff through improved access to continuous professional development. People with lived and living experience need better support to pursue careers within the sector. This expert group has developing guidance, which will put in place the right support to help peers to play a more active role in the design and delivery of services. Cross-Government work will also be progressed to provide employment support to people who use drugs through the no-one-left-behind strategy. It is anticipated that those measures will, to some extent, contribute to improved staff wellbeing, a key priority. However, the Scottish Government has also made £12 million available to support this and introduced a national wellbeing hub. We know that workforce planning needs to be grounded on a firm grasp of the diverse landscape of services providers, locations and professionals working in this sector. In order to establish that service mapping work is under way, alongside much-needed work to improve workforce data capture. There has been much discussion around the timescale for full implementation of MAT standards. Indeed, the ambitious target I set to have the standards embedded by this year was clearly a really stretching target for services. With drug deaths at a record high, immediate change had to be driven hard and momentum put into the system. I want all 10 standards to be implemented in a sustainable way that will make a long-term difference for all of those in treatment. We have not chosen an easy path in judging whether the standards are in place or not. We have set the bar rightly high by insisting that only when areas have positive experiential evidence from people using the services on the ground will they be able to claim that better services are in place. This is the measure that ultimately matters the most. The work being done to support local areas, implement the standards fully, has thrown some of the challenges we need to overcome into sharp focus. In light of the scale of some of those, particularly in justice settings, I am accepting the timescales for full implementation in community injustice settings as recommended by Public Health Scotland in its benchmarking report of June 2022. The phased approach recommended by Public Health Scotland between now and April 25, with clearly identified milestones, means that we can continue to progress with the breadth and depth of the programme to ensure that the MAT standards work for people delivering them, but most of all they work for those who need them. Public Health Scotland will continue to provide support to deliver against its timescale and will continue to publish progress reports. I will continue to update Parliament next year in June and December. In time for my next update in June, Public Health Scotland will once again publish a full rag report to track progress. We need more than just these 10 standards. I want to see an expansion of standards for other kinds of drug treatment as well. I want to expand the scope of the standards so that they include leadership, women and children and the whole family approach and treatment options for benzodiazepines. This extension links to actions called for by the task force on the national specification for treatment and recovery services and the Government will be responding to the recommendations of the task force in the coming weeks. The work on MAT is interlinked to the whole of the national mission and the actions being taken forward as part of the cross-Government plan. This work is saving lives. It is tackling stigma. It is giving those who thought they had no voice a voice. It is giving a stigmatised population and workforce a platform to change and save lives. Thank you. 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 item of business. I would be grateful if members who wish to ask a question were to press their request-to-speak buttons now. I call Sandesh Gulhani. I would like to start by commending the minister on her candor. In 2021, there were 1,330 drug-related deaths in Scotland. This is not just a number. It is 1,330 families suffering in anguish due to failure of SNP drugs policy. Scotland's drug death rate is 3.7 times that of the UK as a whole. It is also higher than that of any European country. This is not just a stat. These are our communities. These are Scottish communities up and down the country who are suffering through a drug epidemic. There is a lot of high-level policy and management discussion in this statement. What we have to see is actual delivery and improvements on the ground. I hope that the minister will be able to provide that at her next update. Now that plans are finally in place, is the minister confident that MATS standards 1-5 will be met by 2023? What action will the minister take if milestones are not achieved? I am sure that Mr Gulhani will agree that MATS standards define absolutely what is needed for safe, accessible and consistent treatment at the length and breadth of Scotland. They are not optional and they are most certainly not a tick box exercise. I have and will continue to be clear and direct with Parliament and our partners about progress and pace. I have also taken unprecedented action which are providing unprecedented scrutiny and also unprecedented support. That is about maintaining momentum to ensure that we can deliver on the ground. I am accepting public health Scotland's findings and recommendations that are based on a robust evidence-based plan that they have published. They do indeed remain challenging, they are ambitious, but I believe that they are achievable and the public health Scotland report has set out clear milestones. I am determined that we will, each and every day, put a shoulder of the field to ensure that the progress that has been made that we will indeed build upon that. My final point, Presiding Officer, is that the importance of public health Scotland's work in this area and that it will once again come June shine a light on what has been achieved and what is not. I can assure Mr Gulhani and the chamber that, depending on those findings, they will very much inform future action both in terms of support and scrutiny. Clare Baker. Thank you, Presiding Officer, and thank you to the Minister for Advanced Sight of the Statement. According to today's Police Scotland publication, there have been nearly 800 suspected drug deaths in January through to September. On the current trajectory, it is likely that by the end of this year, since a public health emergency was declared by the Scottish Government, deaths will be in excess of 3,500. While the focus is on reducing fatalities, can I ask if the Government is developing an understanding of which policy approach is having the most impact to inform future practice? The minister says that she accepts public health Scotland's recommendations that standards 1 to 5 should be implemented by April 2023, but I have to ask again, is she confident, based on the reports that she is receiving, that we don't have access to at this point in time, that the target will be met by 2023? While the target for 6 to 10 is more than two years away, at the pace of progress so far, we need to see work in these areas right now. Is the funding in place to support implementation of 6 to 10? Finally, of the 100 additional staff she referred to, how many have been recruited? I very much appreciate Ms Baker's unswerving and unequivocal support for the implementation of the medication-assisted treatment standards. She has the right to point out that one death is one to many, and while the suspected drug deaths that have been reported on this morning, while they show in terms of the most up-to-date quarter published, that the lowest recorded number of suspected drug deaths in a single calendar quarter since January to March 2007 is, of course, I always add all the caveats to the suspected drug deaths statistics, because that is not the same as the actual confirmed deaths. In terms of our national mission plan, there is an outcomes framework, and we have done in-depth work to be very clear in response to the outcomes and to be able to track and monitor where we are having more success and to where challenges remain. I repeat what I said to Mr Gohani. The timelines for this work are indeed challenging. There are various challenges that we are all familiar with across the health and social care sector, but I do believe that they are achievable. As I always do, I will give my Parliament and this Parliament an undertaking that where problems exist or where by shining a light we uncover more issues they will have my full and undivided attention. The point that she makes about standards 6 to 10 is that those standards are of importance, while standards 1 to 5 are about the standard of care that individuals receive. Standards 6 to 10 are about the systemic changes that we must make. The identification of senior leads in every area with regard to that is of particular importance. She is quite correct to point that there is £10 million based on locally agreed plans. While the recruitment challenges remain, I am encouraged that some areas have done well against their own targets for that area. I am happy to discuss that further with her. It is also important to note that we are beginning to see a much better shift in that standard 1 same-day treatment away from red to amber and, in some cases, green. I will, of course, keep the member updated. Gillian Martin to be followed by Sue Webber. The minister mentioned a whole family approach in her statement and the MAT work principles state that families affected by substance use need to be reached at both local and national levels. Can I ask the minister what supports currently being provided to establish advocacy services in local areas? Power families have a voice in ensuring that systems and services are non-discriminatory and actively put their lived experience at their heart. Minister. Families are partners in the recovery of their loved ones. Families are also partners for the change that we need to see in terms of how services are provided across the country. MAT standard A is clear that people using services should have access to independent advocacy, whether that's for their treatment, housing, welfare and income. People should also be fully informed about those advocacy services that are available locally. We, as I've indicated in my statement, will continue to work very closely with the MAT implementation support team. The Government has made substantial funding commitments around the whole family approach and the family inclusive practice, and we are auditing the outcomes of that, both in terms of Cora funds and alcohol and drug partnerships. It is also imperative that families receive support in their own right. I would also, Presiding Officer, just quickly pay tribute to Reach Advocacy, who are funded via the Cora Foundation to embed a human rights-based approach to service delivery. The Reach Advocacy project provides SQA accredited training to practitioners, families and people who use drugs. Sue Webber, to be followed by Jofas Patrick. Thank you, Presiding Officer. I'm going to firstly apologise for my late arrival in the chamber. The minister has stated that this work is rightly about saving lives. It's about tackling stigma. It is about giving those who thought they had no voice a voice. Angela Constance stated that we need more than just these 10 standards. I want to see an expansion of standards for other kinds of drug treatment as well. Minister, would you listen to the faces and voices of recovery favour that have called on the Scottish Government to introduce our right to recovery bill to ensure that MAT standards are properly implemented? Presiding Officer, I will give a fair and listening ear to all stakeholders and all MSPs across the chamber in terms of the right to recovery bill. I will look at that with great interest once it is published. She will understand that, meantime, the Government has to pursue its own legislative programme, which, for example, is in and around the national care service and provides that single framework of accountability. We will also be consulting on the human rights bill next year. I am sure that we can all agree that it is about achieving the highest attainable standard of physical and mental health. Of course, the work that the national collaborative, the voice of living experience and families to bring forward a charter of rights that will inform the human rights bill is important. I thank the minister for her update. The minister knows how important the implementation of the MAT standards is, but I wonder if the minister can provide us with an update on progress towards establishing a diamorphine-assisted treatment in Dundee for those most vulnerable members of the community. Scottish Government officials have met with the Dundee alcohol and drugs partnership on a number of occasions to discuss the potential of establishing diamorphine-assisted treatment, otherwise known as DAT or HAT. The last meeting was at the end of November. Discussions focused on work that Dundee are considering to undertake a fully-costed scoping study to establish the need for such a facility. That has been done in partnership, particularly with the third sector, and the Scottish Government has confirmed that there would be funding available to support the scoping work. Cranston, a charity that many of us in the chamber will be familiar with, has also made clear their desire to establish a DAT facility in Dundee and have been in talks with partners. Dundee ADP understand to have considered a proposal for Cranston at their meeting on 6 December, where they also agreed to move forward with the scoping study, and the independent chair of the ADP has written to Cranston to keep them appraised. Scottish Government officials are due to meet again with colleagues from Cranston on 19 December. Paul Sweeney, to be followed by Audrey Nicholl. Thank you, Presiding Officer. The minister advised Parliament in June that the remainder of the £10 million a year mat funding had been earmarked for the recruitment of over 100 additional staff. She has highlighted that progress has been made in some areas. However, given that Glasgow has the highest proportion of drug deaths in Scotland and that not a single mat standard has been fully implemented in the city by the target date that the minister herself set, can she update the Parliament on how many additional staff have been recruited in Glasgow and how much of that £10 million has been allocated to Glasgow in particular? The funding that comes through the mat standards work was based on locally agreed action plans. I can provide Mr Sweeney with further information on some of the specifics in and around Glasgow. There is significant amounts of Cora funding has also went to Glasgow and in terms of funding via NHS and integrated authorities there is a substantial investment in Glasgow that from memory amounts to £12 million. I will provide Mr Sweeney with some of the specifics that he is looking for. The mat standards emphasise a multi-pronged approach to treatment and residential rehabilitation as one potential course for support. In the work to ensure that the mat standards are met could the minister provide an update on efforts to increase the number of people who have been recruited in Glasgow? Is really important that the work to implement mat standards is also fully connected with pathways into residential rehabilitation and some of the work that we are doing with our agencies is about making sure that we have that wider connectivity. I think that the chamber is well aware of the Scottish Government's commitment to ensure that a minimum of 1,000 places are funded publicly funded. It is important that the work to implement mat standards and a minimum of 1,000 places are funded publicly by the end of this parliamentary term. We are also providing alcohol and drug partnerships with £5 million per year to facilitate additional placements into residential rehabilitation and detox placements are also supported via the prison to rehab pathway and Public Health Scotland again are providing quarterly reports and we are seeing a steady increase over the last quarters with an increasing number of placements being made via ADPs and the last published quarter reported 170 referrals that's the highest on record and the national mission to date has supported over 700 referrals into residential rehabilitation. Alex Cole-Hamilton to be followed by Stuart McMillan. Thank you very much. I have just exchanged on this topic in the chamber which is around issues surrounding rurality despite the progress that is being made around mat standards and that is welcome there is still proving very difficult to access those same-day services in rural areas with clinics being few and far between and a huge issue around accessing those services is transport and the difficulties many have in accessing them because they are that distance away. We can ask the minister what the government's plans are to increase the provision of same-day services in rural areas and what the government would consider doing in exploring ways to provide such transport accesses as needed to ensure that those who need urgent same-day care can access a clinic that is far away from them. Minister. Mr Cole-Hamilton is quite correct to make the links with transport when I next come back to Parliament to present the cross-government action plan recommended by the task force I can assure him issues of transport will feature in that. He is also quite correct to point to some of the challenges in our more rural communities particularly our island communities there are some authorities at Gail and Butte for example that has 22 islands but what we are seen through the mat standard implementation support team is we are seen some real creativity and commitment in our rural areas to do things differently I think partnership with the third sector in this area is absolutely vital and I know I gave a commitment to Mr Cole-Hamilton when I was last at committee to provide some case studies on that very point to exemplify the good work that has been done. Stuart McMillan to be followed by Gillian Mackay. Thank you, Presiding Officer. I'd like to remind the chamber and the vice-chair of Moving on in for Cloud local addiction service. What considerations have been given to assisting the third sector with regard to prescribing? The Scottish Government fully supports the need for prescribing services to work closely with third sector partners who often have prescribers for the services that they provide. The work being undertaken by the missed team will allow local areas to deliver greater access and choice of treatment through identifying local third sector prescribing options. The MAT implementation support team has also restarted a non-medical prescribing forum for non-medical prescribers delivering MAT and this includes the third sector. As an example of what can be done turn in points Scotland who have nursing staff employed in their Glasgow service and it's important to remember that under MAT standard 5 that there is scope to encourage local areas to involve third sector to provide more joined up prescribing and bearing in mind that MAT 5 is in and around the retention of people in training treatment which is crucial to achieving our overall treatment targets. I thank the minister for advance sight of her statement. In her statement the minister refers to the upskilling of the workforce. We know Stigma plays a large part in why some may not present services in the first place or why some may not continue in treatment. We are obviously also aware of the stigma attached to those who work in the sector. As part of this upskilling what is being done to embed practice that does not further embed stigma and assists with culture change. I have already interpreted in my statement the shorter term actions that are currently being pursued but in terms of that longer term action plan that we will bring forward next year will outline core skills knowledge, values and mandatory training that will be required. It is true that many staff don't feel valued in the same way as other health and social care staff or other staff who work in emergency settings. It is crucial that we improve public awareness of this vital work and that is one way of challenging stigma and increasing attractiveness into the vital work in this sector. There are some great programmes out there. We want to develop better educational pathways and the Scottish Drugs Forum addiction workers training programme is a really good example of what can be done to bring people with lived and living experience into the sector and since 2005 they have had more than 300 people enrol in that excellent training programme. The panel follows on from Gillian Mackay's question. Can I ask the minister to outline the resources being provided to recruit, train and retain staff within the ADP workforce? Minister. It is important to remember that alcohol and drug partnerships bring together local delivery partners who are responsible for commissioning and the development of services. I have already spoke about the £10 million per annum that is dedicated to support the implementation of MAT standards but it is also worth remembering that in this financial year, 2022 to 2023, that £106 million is being made available to alcohol and drug partnerships to support local and national initiatives and that a skilled and resilient workforce is a cross-cutting priority which underpins all our work in the national mission. My intention and training challenges is absolutely key to our workforce development. The Government's failure to fully embed MAT standards is a cause of growing concern and comes alongside cuts to primary care, front-line policing, council budgets and justice. The minister says that there is a clear link between drugs policy and mental health policy yet the Scottish Government has just slashed the mental health budget by £38 million. When it comes to ending the harm done by drugs, avoidable SNP budget cuts are sadly setting Scotland on a path to failure. Minister. Let me make clear that the work that we are doing and that we are engaged in rolling out MAT is key to removing the barriers that persist in and around people accessing mental health. There is work under way and joint work between myself and Mr Stewart and in and around pathways. There is £2 million current investment to expand that pathways work into five health boards. The mental welfare commission report as well as the rapid review that I commissioned all point to the same solutions, the pragmatic solutions and I suppose in terms of resource I would point to the fact that in terms of the mental health investment for the last financial year that was around £1 billion and the key challenge for me and other colleagues in Government is to ensure that people who use drugs or who are in recovery that they get their access to those resources that do exist. Thank you. That concludes the ministerial statement on medication assisted treatment and workforce update. I'll allow a moment or two for front benches to get themselves organised.