 The next item of business is a statement by Angela Constance on improving care for people with co-occurring mental health and substance use conditions. 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. I will update Parliament on our plan to improve care for people with co-occurring mental health and substance use conditions. First, I want to acknowledge the most recent suspected drug deaths that were published last week. While I very cautiously welcomed the 16 per cent decrease in suspected deaths in 2022 compared with 2021, I am only too aware that far too many people are still losing their lives to drugs. As we all know, the link between mental health and substance use is clear and unequivocal. Unfortunately, the links between those services are not always as clear. We recognise that services must work together to deliver person-centred care. That is why the Minister for Mental Well-being, Social Care and I commissioned a rapid review into mental health and substance use services last year. The recommendations from that review were preceded by the Mental Welfare Commission's report ending the exclusion and the match standards, especially standard 9, which is focused on mental health. Those reports set a very clear way forward. Our vision is of a joined-up healthcare system where people with co-occurring conditions get timely access to the help that they need. To deliver on that vision, our plan has three clear objectives. First, we have to get the foundations right in every local area. Second, we must empower the workforce to stop people being passed from pillar to post. Thirdly, we must embed clear lines of accountability so that we know that services are delivering better care for people on the ground. That plan also forms part of our cross-government response to the final drug-desk task force report change in lives. The objectives of that work will help to fulfil the task force's sixth recommendation, that the principles of no wrong door should be at the heart of a whole systems approach. The plan is underpinned by a funding of £2.4 million, which I announced earlier this year. Together, that will deliver better outcomes for people with co-occurring conditions. To have the right foundations in place in every local area, we need to be clear about expectations. To support our workforce to deliver the kind of holistic, joined-up care that we know they want to give, we have to make sure that it is clear how services will work together. To give that clarity to our workforce and, of course, to the people who use the services, we will require every local area to have a publicly available protocol that sets out exactly how mental health and substance use services should work together. To make sure that those protocols result in better care on the ground, Health Improvement Scotland will develop a gold standard protocol against which all local protocols will be assessed. The protocol will set out how services should interact to meet all of a person's needs, their other healthcare needs and their social needs too. We must also acknowledge that care must be personalised depending on the substance a person uses. It may look quite different for someone who uses cocaine as opposed to opiants, and the gold standard will be available to local areas by October 2023. To be truly person-centred, we must address the additional needs that some groups may face when seeking support. For example, we know that young people face specific challenges with both substance use and mental health. We are currently undertaking work to co-design with young people what service standards should look like for young people who use drugs. In addition to our commitment to the expansion of the planet's youth and routes programmes of prevention, that work will build on and contribute to that work to support our young people. The protocol will deliver on the recommendations of the rapid review, ending the exclusion, the relevant match standards and supporting the forthcoming adult secondary mental health standards. To make sure that we get it right, Health Improvement Scotland will work with a reference group consisting of the Mental Welfare Commission, NHS Education for Scotland, the MAT implementation support team, people on the front line and, most importantly, service users. As important as the nuts and bolts of delivery are, we know that a protocol is not enough, it must lead to change on the ground and we will therefore ask all chief officers of integrated joint boards to nominate an appropriately senior person who will oversee and take ownership of the plan in their area. Our dedicated workforce needs to be supported to provide the best possible care and I am pleased that NHS Education for Scotland has already begun responding to those recommendations. That includes widening access to training on substance use to staff in mental health services and we will also work closely with local areas to ensure that staff are equipped with the knowledge, confidence and skills to support people with co-occurring conditions. As well as ensuring that staff have the appropriate skills, we know that we need to do more to tackle stigma and provide trauma informed care and we will draw on existing activities such as the stigma action plan, the national trauma training programme and wider workforce initiatives to drive forward change across both services. By the end of this year, we will move into phase 2 implementation to support local areas to implement an effective protocol Health Improvement Scotland will provide strategic change management to support and act as a centre of excellence sharing best practice and facilitating learning across Scotland. We will agree individual milestones with local areas to implement the protocol based on their current status. It is important to note that we will not be overly prescriptive areas that will be able to adapt the protocol to their local circumstances. However, my expectation is that all people with co-occurring conditions should be able to access high quality care regardless of their locality. That is why it is so important that people with lived and living experience are closely involved in the adaption and implementation of the protocol. I will ask all areas to ensure that people who use services and their families are able to meaningfully contribute to this process. We cannot hope to improve services unless we listen to people who want to help. Indeed, we will not truly know if we have succeeded unless we are hearing that change is happening on the ground. Given the close links of this work to the wider match standards, we will align the timelines for that work. We expect all areas to be rated as green for the implementation of match standard 9 by April 2025 at the latest. Of course, we expect that many areas will achieve this much quicker and we will set ambitious but achievable timelines for each area as we move into phase 2. By the end of this phase, all service users should feel like they are being listened to, treated with respect and receiving support in a way that makes sense to them. Moving forward now to April 2025, the final phase of the plan is about sustaining the change. Health Improvement Scotland will continue to support local areas in this phase to ensure that service users continue to feel an improvement in the care that they receive. In addition to our work with local areas, we are taking forward national recommendations. We will commission an alcohol-specific rapid review as suggested by the mental health and substance use rapid review and will undertake exploration of an annual needs assessment and areas for further research. Presiding Officer, I have set out our plan to deliver better care for people with co-occurring mental health and substance use conditions. We will report on our progress through the national mission report and I will of course keep Parliament updated. I want to end this statement today by sharing a quote that articulates how important it is that we get this right. This comes from a person with living experience who spoke to the Mental Welfare Commission and he said, people with co-existing mental health conditions and substance use problems can and do recover. I have seen broken people with mental health issues and addictions achieve this. People who are now in full-time employment, living life and are out there helping others. I sincerely believe that we will hear more testimonies like this if we can deliver on this vision that I have set out today. 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 and I would be grateful if all members who wish to ask a question could press their request-to-speak buttons now. I call Sue Webber. In 2021, 1,245 people lost their life due to alcohol. 1,330 died due to drug misuse. With suspected drug deaths increasing by 26 per cent over the last quarter, progress on this vital issue is heading in the wrong direction. This statement perfectly encapsulates the SNP's current strategy. We have the drugs deaths, task force report changing lives, the mental welfare commission report ending the exclusion. We have match standards that should have been implemented in April 2022 and now we have these new gold standards and protocols. I have no confidence that the statement today will change anything on the ground. I will quote from the minister because she said, as important as the nuts and bolts of delivery are, we know that protocol is not enough. It must lead to change on the ground. Services are not meeting the needs of people who have both or either mental ill health and problems with substance use. The minister promised to fully implement the match standards by April 2022. Match standard 9, which states that all people with co-occurring drug use and mental health difficulties can receive mental health care at the point of match delivery, has now been pushed back to April 2025 at the latest. Favour slogan is, you keep dying, you keep talking, we keep dying. April 2025 is two years away. Minister, how can we stand here once again discussing another report and another set of protocols with person-centred care when people still can't access the services that they need for their mental health or substance issues right now? I have always sought to lead, for example, by demonstrating my accountability to this Parliament and to the people of Scotland. The plan that I have set out today, which is essentially about joining up healthcare, ensuring that people with co-occurring conditions get the right treatment at the right time, bringing forward how we will get absolute clarity about who leads when on the ground so that our people are no longer bounced between services or indeed fallen between two stools. The importance of this statement today is that it is about bringing to Parliament showing that we are diligently building a better system and that we are bringing the detail of delivery to Parliament, because this is not about the headlines, this is about the hard graft. Ms Webber rightly pointed to the tragedy, not just of drug-related deaths but also to alcohol-related deaths. Part of my work now is to expand and develop on specific alcohol treatment, notwithstanding the synergy that the national mission brings, for example, in and around residential rehab placements, which figures published today demonstrate that we have the highest quarter of statutory-funded residential rehab placements than ever before. Demonstrating that we are indeed reaching out and providing care to people with substance use issues. I would say in terms of the suspected drug death information that shows that for the last calendar year there is a 16 per cent reduction. We have also seen figures published today that demonstrate the impact of minimum unit pricing on alcohol deaths. I would of course acknowledge that there was indeed a spike in suspected deaths in the last quarter of that last year, and that is why I reported to Parliament the work that is happening in and around public health alerts and what we are doing to combat our concerns in and around synthetic opioids. Thank you, Presiding Officer, and I thank the Minister for Advanced Sight of her statement and begin by offering condoms to anyone who has lost a loved one to drugs here in Scotland. Perhaps especially this week it is worse taking a moment to stop and assess the progress of this Scottish Government in getting to grips with this public health emergency, which was declared over three years ago. Tragedily, the statistics do tell a sobering story. Scotland has recorded 2,269 confirmed drug-related deaths, and last week learned that there were 1,000 suspected drugs deaths last year, including a significant spike in the last quarter. It is also concerning that there have been delays and at times a seeming lack of urgency match standards implementations, for instance, promised, and then delayed. Indeed, we have known about the correlation between mental health and substance misuse for many years, but by the Minister's own admission in the statement, work to deal with this has not always been clear or, indeed, I would say quick enough. I have two questions for the Minister. Firstly, on the timescales, the Minister states that implementation will start by the end of this year. Can she make a guarantee to Parliament that that will happen? As she knows too well, she is already addressing this public health emergency. Secondly, it strikes me that the big thing missing from the statement was data, which was a key recommendation in the rapid review. Indeed, in last week's suspected spike in drugs deaths it clearly demonstrates that there is a problem in knowing exactly where the issues are and how we should tackle them and, indeed, how action is working. What will the minister do to get data right? Minister. In terms of publishing data, this Government is gathering and publishing more information, more data than ever before because we are determined to lead by example about accountability because we need accountability at every layer of government, accountability at a national but also a local level. I can point to the suspected drug deaths stats, information that we started publishing every quarter. Of course, the radar work, the rapid action drug alerts and response work are early warnings. There is work that we are doing in and around data linkage so that we get better information more timely, not just about how people die, but about the lives that they lead and where and how we can intervene more effectively. There is also other work in and around pilot projects about toxicology testing and emergency departments. I am happy to write to Mr O'Kane about some of the more nuanced detail of all that. In terms of the timelines, let me be clear that phase 1 will be completed between May and December this year phase 2 in terms of implementation. That work will be between January 2024 and April 2025. In terms of how we sustain that going forward as well between 25 and 26. There is a range of activities and perhaps it may be better that I write to Mr O'Kane in terms of almost month by month in terms of what action I expect between April and November this year. Emma Harper, to be followed by Sandesh Gulhane. The minister has been working with me to address stigma, particularly for all those working in health and social care, not just in the alcohol and drug services. I thank the minister for a letter to me yesterday setting out that NES are working to incorporate substance stigma across all their learning modules. However, will she agree with me that we absolutely must do all we can to tackle stigma if we are going to enable successful recovery and that all the media has a key role to play here as well? Minister. Ms Harper is quite correct to point to the importance of tackling stigma. We all have a role in that whether as politicians, whether in terms of how matters are reported in the media, how services are provided, this is where trauma informed approaches are so important as well. I think anything that is a barrier to treatment has to be removed and we have to kick stigma into touch. Sandesh Gulhane, to be followed by everyone tweet. A survey last year found that 90 per cent of GPs had experienced difficulties in referring patients to both mental health services and addiction services, including when the patient presented in crisis, something that I've experienced myself as a GP just this year. GPs also reported that people with these issues are often turned away from these services with GPs having to re-refer them. Does the minister think that it's acceptable that people with these issues are being turned away with GPs being left to pick up the pieces? Minister. To be a candid exciting officer, no, that is not acceptable and part of this improvement plan is to give absolute clarity about who leads when. Mr Gulhane may well have read our rapid review, our findings of that rapid review and I'm sure he's also looked at the mental welfare commission report as well where it talks about the four quadrants of care, which is an extremely helpful guide that can hopefully move people on from inane debates about who should be leading and who should be supporting. Mr Gulhane may also be interested as well as those people who are interested in data, that in terms of data, which was recommendation 2, in the rapid review, is that we will also evaluate referrals that have been rejected because that is also about us boring down into the detail and ensuring that every part of the system is getting this right. To ask the minister how she intends to ensure that those in rural areas have sufficient access to mental health support. Good question. It is important to recognise that, while aspects of our response and our action plan to this rapid review may seem quite specific, but it is important to recognise that this improvement plan sits in the context of the wider national mission and indeed the wider work that my colleague Kevin Stewart takes forward. I hope in the statement today that I have demonstrated that we are clear about the level of expectation that has to be met in every part of the country, notwithstanding that whether it comes to this rapid review and implementing it or whether it is match standards that there is some flexibility for rural areas who either need additional support or additional support in terms of overcoming some of the rural barriers. We need to be followed by Audrey Nicholl. The minister knows that substance use is often a form of self-medication for underlying mental health disorder and trauma, yet the recent budget accounted for £290 million for mental health for the coming financial year, which is merely a reversal of the £38 million cut during the emergency budget review. That effect of freeze will have a direct impact on services and risks, increasing the likelihood of people using substances to self-medicate in the absence of professional help. So, whilst today's announcements are welcome, does the minister or not accept that the Government could prevent this harm in the first place by going to the root cause of the problem and increasing the mental health budget in line with the 10 per cent commitment of overall NHS expenditure previously committed? Minister. That is investing and reforming services like never before. It is important to remember that there are always debates about the absolute quantum of services but it is crucial to at least acknowledge that the mental health budget has more than doubled since 2020-21. We also have an additional investment through the national mission to save and improve lives of £250 million over the lifetime of this department when Audit Scotland acknowledged last year that that was a significant real-terms increase. Notwithstanding the importance of investment it is also what we do with that money and ensuring it gets to where it is needed most. Audry Nicoll to be followed by Alex Cole-Hamilton. Thank you, Presiding Officer. Can the minister outline the action being taken to ensure all mental health and substance use staff are trained on how to effectively assess and manage co-occurring mental health conditions and substance misuse disorders? Minister. This is where the work of NHS Education Scotland is imperative. It is important that we expand on the training opportunities available to both mental health and substance use staff, often about the impact of other co-occurring conditions. This work has already started as I outlined in the statement and I made a commitment to Parliament the last time I was on my feet in and around mat standards that we would be coming back to outline to Parliament where we would go with our workforce support strategy. Audry Nicoll-Hamilton to be followed by Stuart McMillan. Thank you very much, Presiding Officer. I also welcome the recommendations made by the Mental Welfare Commission in their report. The link between substance use and mental ill health is well documented and has been well debated in this chamber. The report offers a welcome road map into how we might address that. The minister is well aware that substance use is not limited to those who have attained majority and those who can just access adult services. Children and young people will take substances in this country too and will have mental ill health as a result of that. Can I ask about the interplay between the recommendations in this report and the ecosystem in our child and adolescent mental health services? That's an absolutely excellent question. We know from the latest quarterly figures, Presiding Officer, that more than 5,500 children and young people have began treatment within the CAMHS system. That is the highest number ever. It's an increase of 11 per cent. We also have to acknowledge that young people use substances differently and tend to use different substances. We also know that there's an importance of prevention because we know from people with lived experience that they often started their drug usage very early in life. So services really need to meet the needs of young people. There needs to be service specifications and standards and that is what we are currently co-producing crucially with young people because we have to be informed by the views and opinions of young people about what will meet best, where and when. Stuart McMillan, to be followed by Gillian Mackay. Thank you, Presiding Officer. I'd like to remind the chamber of my register of interests as the vice-chair of moving on, Inverclyde. The minister has ensured that many third sector organisations have received funding to assist their activities and help people with addictions. Will this continue with regard to mental health organisations and vital partnership working opportunities that they may wish to pursue? In terms of the national mission to save and improve lives and to reduce drug deaths, we have very clearly taken a belt and braces approach. We have increased funding to statutory services to alcohol drugs partnerships but we have also funded around 200 projects thus far via funds that we had provided to the Cora Foundation. I also know that there is a synergy of that with the work that Mr Stewart has undertaken in that 1,800 awards from the £36 million community and mental health and wellbeing fund has also been made. The Government values the crucial role of our voluntary third sector organisations. Gillian Mackay, to be followed by Tess White. Thank you, Presiding Officer. We know that as well as poor mental health being the driver for addiction, addiction can also be the catalyst for a deterioration in many's mental health. How can we ensure that people receive support in the appropriate way to address this interaction holistically whichever way round the conditions occur and how can we ensure that the full treatment pathway from diagnosis to pharmacy is stigma free? Minister. Presiding Officer, I refer Mr Mackay to what I mentioned earlier to Sandish Gulhane about the four quadrants of care. This was a tool that is highly recommended and supported not just by our own rapid review undertaken by clinicians but also by the mental welfare commission. We have just got to cut through some of these old debates that have persisted for long and weary. We have to have very clear protocols, leadership and accountability that takes forward who leads when and which service supports. I hope that the plan that we have brought forward today will help to cut through some of this. Tess White, to be followed by Ruth McGuire. Thank you, Presiding Officer. It was announced earlier today that John Wiley, chair of the Dundee alcohol and drug partnership, is standing down at the end of March. That's just four months after his appointment in November 2022. As the minister says, a joined up approach requires leadership and it requires leadership nationally and locally. We're now facing another potential tender process for an independent chair with interim measures in the meantime. What support will the Scottish Government provide to the ADP and local partners to ensure momentum isn't lost on the response to Dundee's horrific drugs death record? Minister. Presiding Officer, I appreciate Ms White raising that issue and I was very sorry to hear that the independent chair of the ADP had stood down. My understanding is that that is for personal reasons but can I give her the absolute insurance that both I and my officials will be lazing and reaching out to the local service to ensure that interim arrangements are put in place and that another chair, another appropriate chair is found as soon as possible. It's a fair point that she raises. Ruth McGuire, to be followed by Michael Marra. Can the minister provide an update on steps being taken to alleviate demand on both our acute hospitals and on our emergency mental health services caused by alcohol use disorders? Presiding Officer, on your chamber has noted the information that was published today by Public Health Scotland and the University of Glasgow on the reduction in alcohol deaths as a result of minimum unit pricing but also reduction in hospital admissions that could be around 400 a year. The point that she makes is an important one because the whole resondectra of getting people into the right treatment at the right time is first and foremost to save lives but the information that we publish regularly about hospital admissions demonstrates the constant need to intervene earlier, quicker, faster, better. Michael Marra, to be followed by Stephen Kerr. Thank you, Presiding Officer. To follow on from Tess White's question regarding the departure of the chair of the ADP in Dundee, there are real concerns in the community about the last chair, not this one, but the last chair departed with clear indications of frustration at the lack of ability to drive and deliver change. Now just months on we're in the same position again. The minister has confidence that the ADP can deliver change under the current model and what can we do to make sure that there is a long-term sustained leadership in Dundee where those problems are so ingrained? Minister. I understand fully Mr Marra's frustration in this regard in terms of the specifics around the current chair resigned for personal reasons. I can't add any more than to what I said to Miss White. Let me make a more generic point. I am absolutely focused ensuring that all ADPs and including the one in Dundee get the right support. The issue that we often forget in this chamber because sometimes we are very critical, rightly so, at times of alcohol and drug partnerships where the issue lies with senior leadership. That may be senior leadership at this level within the Scottish Government but one of the things that we need to do as we embark upon this journey of reforming alcohol and drug partnerships and services is we need to ensure that leadership at that IJB and health board level absolutely steps up to the plate at times ADPs are left to hang out to dry when the problem lies elsewhere and that, Mr Marra, I can assure you is not lost in me. Stephen Kerr I think that the minister is right to highlight the importance of leadership and that's why my question is very simple all three candidates for the leadership of the SNP have stated their support from my friend Douglas Ross's bill the right to recovery bill and so will the minister take this opportunity to express her personal support for the legal provisions contained in that bill? Minister Let me start by assuring Mr Kerr that whether I'm in the front or the back benches I will always seek to serve my country, my constituents and those people who have touched my heart who are impacted most by drug and alcohol deaths so perhaps unlike him I'm not all that one worried about what next week may or may not bring what I would say in terms of the right to recovery bill I haven't heard any candidate make any remarks that are out of sync with what I have currently said or repeatedly to this Parliament that we are all united in ensuring that people can hear their rights and can claim their rights I look forward to seeing the detail of Mr Ross's bill when it is brought forward it will get a fair and very sympathetic hearing but meantime this Government will continue with her work around the human rights bill which is about ensuring that people can know and claim their rights in practice and of course I would point him which at its core is about holding all of our feet to the fire and making rights real in this country That concludes the ministerial statement The next item of business is a debate on motion 8291 in the name of Shirley-Anne Somerville on expansion of vocational and technical qualifications in Scotland's secondary schools I'll just allow a moment or two for members to change seats