 Welcome to the first joint meeting in 2023 of the members of the criminal justice, the health, social care and sport and social justice and social security committees to consider the progress made in implementing the recommendations of the Scottish drug deaths task force report. We've got a selection of members from each committee with us, but we also have apologies from members that usually like to come in and join us on this meeting. We've got apologies from Miles Briggs, Faisal Childry and Sue Webber and Pauline McNeill is in the meeting but joining us online. So our first item is to decide whether to take item 3 in private or agreed. And so our next item is evidence session on reducing drug deaths in Scotland and tackling problem drug use. And our first panel of witnesses in front of us are welcome Kirsten Horsbro, the director of operations for the Scottish drugs forum. Karen Reynolds, the service manager of Renfisher alcohol and drug recovery service. Liz Nolan, deputy director of operations for Aberlawer and Justina Murray, the chief executive officer for Scottish families affected by alcohol and drugs. Welcome to you all. Thank you for coming in this morning. It would be really helpful if maybe I could go round everyone in the order in which I've introduced you. Just to get to start us off with an overview of what your organisation does for your clients and if you maybe could outline some of the particular issues that you want to draw our attention to as they go into recovery. So if I maybe, as I said, do it in the order in which I introduced you and go to Kirsten first of all. Thanks very much, thanks for the invite to attend today. So Scottish drugs forum is a national expertise in drugs policy and drugs related issues. We have a variety of different work programmes within the organisation on workforce development, training and policy areas and we have an addiction worker training programme and we do a lot of pure research and involve the voices of people with living experience of problematic drug use. I guess the main things that we would like to raise today are around implementation of things like medication assisted treatment standards, what sort of harm reduction interventions we don't currently have in Scotland at the moment that we should absolutely be focusing on and where we see some of the issues are in some of the things that we still need to really work on. Certainly over a thousand people dying of preventable deaths every year is a decrease than last year's or 2021 figures but is certainly by no means a success story. So things aren't moving quickly enough, there's a lot more we can be doing and certainly we have some thoughts around where we need to see improvements. I would actually like to press you on that and actually you mentioned that interventions that we aren't currently using could you expand on that for me? Certainly I think it's important to recognise that choice is the key thing here and that all approaches should be available for people. When we think about a drug deaths crisis we need to move quickly to provide interventions that are evidence based but we also need to create evidence. It's important that we have options available such as abstinence based residential rehab settings that is also an option and an approach that should be available but it's not a superior approach and harm reduction is critical as an intervention to address some of the issues that we are facing but bizarrely is often criticised or undermined in its approach. So medication assisted treatment standards are very welcome and certainly something that we should absolutely be focusing on and there have been improvements but it's too slow. We still hear from people with living experience that they're not getting access to the treatment that they need on the day that they present. We're still hearing of punitive practice, we're hearing of people for an example just in some recent work that we did people who have given a positive drug test for benzodiazepines or cocaine then having their methadone reduced in response to that so these punitive practices still exist and that's certainly something that we would like to raise. In terms of harm reduction approaches that we don't have it's been seven years since Glasgow made the compelling case for a safer drug consumption facility, something that we are still debating the pedantics of instead of just getting on and delivering it and dealing with any issues as they arise. These services are a place for connection and for being able to support people when their alternative is injecting maybe in a public place in somewhere that's undignified and hygienic. It's been made for that absolutely but it's bound up in this justice case or the constitutional wranglings around where the powers lie to actually. Yeah I mean we believe that that sort of facility can be introduced now regardless of any changes to the misuse of drugs act so which in itself is indefensible but certainly we would want to see them but we don't want to just see one either we should see them all across Scotland in places where people's alternative is injecting in somewhere that's unsafe and undignified and the other thing is drug checking services so there are delays currently to providing drug checking services that would give people autonomy and some more information to make informed choices about what substances they are actually using so there are a number of things that we don't currently have that we should absolutely be delivering more quickly and I think we'll look back on this time in years to come in this period and we need to be making bold brave substantial changes that will make real changes to the outcome of people's lives rather than looking back and regretting what we could have and should have done. Thank you that was very helpful. If I can go to Karen Reynolds now. Thank you very much for having me along today so I'm the service manager for an alcohol and drug recovery service and I think that there has been a fair level of criticism towards services and I know my colleague Kirsten has just spoke about there about you know punitive measures and the language that's used in services certainly within Renfrewshire and I'll talk about the Renfrewshire experience because I think that might resonate to a greater or lesser extent across the country about what we have experienced in Renfrewshire. We had already been going through a whole system review of treatment and care services and we then had an alcohol and drug commission both of which were very welcome but did highlight how much change needed to happen within services within Renfrewshire so we've had such a huge steep learning curve a steep how to climb but safe to say that we are making some significant progress in these areas we are trying to change the language that we use in terms of people that use our services so we don't want to look at that punitive measure in terms of withholding methadone or prescriptions we are encouraging our staff to look at using different terms in relation to it might not be safe to dispense your medication in this day because of a number of factors but at the centre of that is making sure that people that use our services actually see us as being a viable option for when they have a health issue in the same way as if they were to reach out to any other care group profession across the country when they have another health concern so there are great strides that are being making and taking place within the Renfrewshire context as I said I think resonates without across the country I think making best use of our digital capabilities and that's something that you know we are attempting to do just now but there are some challenges with that with our IT systems the number of systems that we need to record crucial information that actually will help you know plan and deliver services going forward we've put so many new initiatives that have just come up you know the Minister for Drug Policy came along and opened a recovery hub that's continuing in recovery changes lives entirely we've seen a real increase in terms of people that are attending that service hence the reason why we identified that gap but we are actually seeing the impact again having conversation cafes with strategic leaders to ensure that people with lived and living experience their voice is heard and not just heard and then ignored but actually they are part of the progress that we are making the planning and delivery what gap is it in your service that the hub is filling and what's it actually doing that wasn't done before so it's that it's that opportunity to move on from services what if people are moving through coming into a treatment and care service they shouldn't just be parked on to OST that should be a treatment option but it shouldn't be the final destination they should be looking at what else can they achieve in their lives it should be better than well as opposed to us putting a cap and a ceiling on where we think people should be so the continuing in recovery changes lives entirely circle as I would refer to it as is for people with lived and living experience for both mental health and addiction that can go along partake in a planned programme but more importantly that they plan that programme they look at opportunities of where they actually want to go in the future what is their recovery plan it's not something that we will do to them it's something that they have identified for themselves so we've a raft of partners that are involved in circle from ram H to advocacy to employment opportunities people coming in and training in terms of barista training there's a whole raft of things but it is an opportunity for people to come together that is not in an environment that is traditionally known as services it doesn't look or feel the same where they're free of stigma free of shame where their families can also access support and with a plan that they will eventually move on from services and take control of their own recovery thank you can I move on to Liz Nolan good morning again thank you for having us I work for Aberlour which many of you will know is Scotland's largest children's charity we currently work in 26 local authorities across Scotland and from our perspective we work with families in family support and outreach services community outreach and we've recently opened one of our first recent mother and child recovery houses in Dundee although we have had previous mother and child recovery houses in the past and we are fully supportive of the ambition to reduce drug deaths and it has been part of the bedrock of all of the work that we've done in Aberlour for decades I myself have worked for Aberlour for almost 19 years and at times I sometimes find myself repeating what I said 18 years ago about what needs to happen in the support of mothers children and families generally when it comes to to drug use what we believe and I think you'll have heard of speaking about this before as an organisation in order to succeed with this ambition we must truly respond to those with lived and living experiences and both of my colleagues have spoken about that we need to really understand the whole person we speak about that personalised support that personalised approach to addressing all of the issues that surround the drug deaths and that includes tackling poverty we know that numbers of those who die from drugs are disproportionately affected by poverty significant issues with mental health poor housing and we need an order to progress and to reach our ambition to support all of that and that whole person that whole family approach to support and that whole community and a whole systems approach and I think both of my colleagues have spoken about the pathways partnerships we need to ensure that we are part of all of the pathways to success and that the third sector the voluntary sector our ADP colleagues our statutory partners are working together on this and in order to progress with this we of course need to have resources available and we know that for many of those who are impacted by drug use there are differences in what provisions are available locally and if we want to achieve our ambition we need to make sure that services are available locally that there is choice our current residential rehabilitation home supports four mothers and their babies to come in we hear from mothers that actually that shouldn't be the last choice for them okay we need to ensure that residential rehabilitation is seen as a much earlier option for women they have to be given the choice to come in with their babies when their children to have that real wrap around nurturing care and support to allow them the time to find themselves and that's what we find for a lot of the mothers that we support is that actually we can address the substance use or you know whatever it is but actually underneath all of that there is real trauma that needs to be addressed it needs to have time another gap that we have found it in the services that are provided is that that many of the services that are provided are time limited it takes time to make relationships it takes time for trust to be built with the people that we serve and that doesn't always happen in 12 weeks and we do know that there are certain plans that are 12 weeks that are constrained by time we want it to be not limited to time we want it to be a recovery pathway that people can come back to so we have to allow for mistakes to be made we have to allow people the opportunity to come back to us time and time again if that's what's needed because for some that we hear time and time again from the women and the mothers that we support who have lost care of their babies that actually if only and that if only statement is made if only i had had the opportunity to if only a residential rehabilitation service had been available when i lost my baby if only and and and this is what we need to stop and i think being brave as part of Aberlour's mission and our you know what what we want and our strategy is we have to be brave and i would echo what christen said that we have to be brave we have to take risks one of the gaps that we have found in cow and grove is that actually referrals are coming into the service but there is still there is still a fear amongst professionals about allowing women to have their babies with them we are providing a nurturing safe environment where where mothers can be with their babies and we can work on and support them to address their trauma support them to address their drug use or their substance use but at the same time support them to find themselves and to actually learn to parent their babies and their children in a really safe nurturing environment but we only have one of those houses we are hoped to have another house if we truly and i keep saying that word want to achieve our ambition we have to make sure that that's available to all mothers who want to have their babies with them while they recover thank you Liz can i come to justina yes good morning so i work with Scottish families affected by alcohol and drugs and we support anybody who's concerned about somebody else's alcohol or drug use so we don't work directly with people using alcohol or drugs we support for example their parents the partners their siblings or adult children young adults in the family and pretty much every other relationship you can imagine so the work that we do with families is about really helping them first of all to have a voice and to find themselves again in a world where really everything has revolved around their loved one substance use everything that the family does revolves around that so a lot of the work we do with families is about helping them to understand the impact of the substance use in the family and look after themselves change some of the dynamics within the family around things like communication and boundary setting and really help families to recover even if their loved one doesn't recover themselves so the big barriers for us in terms of effecting change are really for me around implementation i think in scotland we're really really good at writing down what we want to do we've got from my point of view all the right things written down in legislation and strategies and policies but we don't implement what we say so so we're good at saying what we're going to do we're not so good at doing what we should be doing and there's not really any accountability in the system so we speak to families every day about their experiences of trying to support their loved ones and there are still significant failings within treatment care and support services is it a case of like it depends on where you are in the country there is definitely still a postcode lottery and i know people don't really like that phrase but again we've got good standards written down we've got the medication assisted treatment standards but you know everyday families are telling us stories about those not being upheld so we hear you know some stories i've heard this week you know somebody asking about rehab attending appointments with her son and the you know she was told the son wasn't wasn't ready wasn't showing enough commitment for rehab so she asked the worker could there be a checklist of what needed to be achieved before her son would be considered for rehab because he was already attending fellowship meetings he was doing drug tests and he was attending all of his appointments and the worker said oh it doesn't work like that somebody else attended their appointment and saw a poster about the medication assisted treatment standards and same day access to treatment and asked about this and they were told oh we're not doing that here and they said well actually i've just seen a poster in the waiting room and the next time they went back the poster had been removed so there's lots and lots of examples of where you know we know what we should be doing there's definitely some culture and attitudinal barriers getting in the way families find they're very judged and excluded and ignored by services and often blamed actually for their loved ones substance use in the first place so i think we need to do less writing and get more involved on the ground alongside services to really understand you know what is getting in the way for workers from doing what you know we all agree is is best practice and is evidence based practice okay thank you i'm going to bring you back in and i'm going to go to my colleagues Karen just in response to that i think that's a fair criticism of services in terms of that as justina said postcode lottery and i've certainly seen that coming into renfrewshire in 2019 having worked in Glasgow so it was a hop skip and a jump over the border if you like and there was a stark difference in terms of what was available i do believe that services and the staff working in these services are working extremely hard and they come at this from the right place what staff what we are seeing from the staff's perspective is in relation to being worried that they will make things worse that if somebody's on ost opiate substitute therapy and they're stable that by entering into residential rehab they will put them at risk and subsequent you know that risk could result in death so it's about the training of staff that's vitally important it's making sure that they understand why residential rehab should absolutely be on the table why it should be a choice why people should be asking about it and should understand what the process is in terms of entering into residential rehab we are not the judging jury on residential rehab we should be the gatekeepers but we need to make sure that people's expectations and that families are proportionate and that takes a lot of skill in order to do that so we welcome the opportunity to work alongside SFAD Scottish Recovery Consortium and the residential providers in fact we are going to be having a training event just in the future of a three-day training event making sure that workers understand what their roles and responsibilities are what that assessment process looks like but crucially on the third day making sure that our workers get a residential rehab experience now that's something that i know you spoke about you feel as if you say the same words over and over i certainly know that working in east end of Glasgow 20 years ago going along to a residential provider and having that experience of what does it feel like to be admitted to residential rehab we worry about the big things you know about their aftercare plan about the detox but actually sometimes what our services are worried about is who's going to be feeding my cat who's going to be paying the bills am i going to be able to have a cigarette when i go these are some of the barriers that sometimes what justina has just said though that you mentioned the word gatekeeper but it sounds as if that sounds quite a negative term that possibly people are closing the gate too firmly when actually the family and the person involved i apologize if that sounds negative in fact i felt that that was the opposite as in we should be opening the gates to say here are all of the opportunities that are available but people need to know about what is available justina has just said that across the country and it's not that pointing at your service necessarily the gatekeeping seems to be no we don't do it that way yeah i mean that's not available i mean but i think that will be an accurate observation of what's actually happening on the ground so we need to make sure that our staff are appropriately trained that they know they understand their own responsibility isn't to be you know you're going or you're not going it's actually about exploring the options and the possibilities and making sure that people understand what they're about to embark on and that their expectations are managed and that they understand that that is a choice that they absolutely should be advocating for okay thank you i've let you have a massive amount of time because it's upsetting out your stall but i can see my colleagues looking at me anything when can i get a go so can i can i hand over to Audrey that thanks very much convener and good morning panel and i'd like to ask some questions in an around through care support on leaving prison so you may be aware that recently the criminal justice committee has been considering the bail and release from custody bill that process is still on going and the bill seeks among other things to reduce our remand population and therefore our overall prison population in scotland and also aims to improve the release process from prison and with a particular focus around reintegration and as part of the submissions for today's meeting we received a case study from Aberlour around Sarah's story and the support that she's been receiving at Cowan Grove in Dundee and within that there is reference to her having spent a period of time in prison when she was abstinent but following that she went into a long period of instability and that sadly i'm sure not not unusual so the bail and release bill also places a duty on ministers to publish through care standards for both remand and sentenced prisoners so that the consistency around support is improved and we've spoken about the postcode lottery across scotland in particular so i wonder if i can come to you justina and then maybe kirsten just to ask in your view from your experience what should through care thinking about this as an opportunity to develop good law and robust through care provision what in your view should that look like and if i also can add to that in the context of perhaps women coming out of prison i'm really glad you came to me because my last job was in community justice i'm very passionate about this as well i think i'll return to what i said before about we've got to focus on implementation i would be surprised if there's anything written down in the new legislation coming forward which hasn't been written down somewhere before there is absolutely nothing getting in the way of good through care just now other than you know actual commitment and accountability so we have some really good national and local through care services i was involved in establishing the shine women's mentoring service in my previous role but you know there was never enough money put into it and there was you know there's sometimes a bit of professional cynicism from statutory services about what what the third sector can deliver but we know people need time as Liz was saying time to establish relationships with workers and you know time to you know reconnect with their families and with everything in the community so i would spend more time talking about how the new legislation is going to be implemented and where accountability is going to lie and i think it'll almost right itself if you speak to people who are on the ground thank you justina and kirsten thanks yeah just firstly to say before i go into that just to make sure that we're really cautious that we don't turn the drug deaths crisis into a strategy about how we get everyone drug free and i think it's important to make sure that we are focusing on all the options the broader picture is that we also criminalise and stigmatise people for experiencing drug problems when actually that's been emerged from often unimaginable trauma so the majority of people who are coming out of prison shouldn't have been probably in prison in the first place so there's an issue there in terms of how we decriminalise people who use drugs in the first place it's such a high risk period of time for people when they are released from prison so for overdose in particular we know in the first few weeks people are significantly more at risk of dying from a drug related death and often there are issues in terms of prescribing processes for people to leave in prison so to make sure that that community link up is there we talk about reintegrating people into society when actually a lot of the time people weren't fully integrated in the first place so it's so important that we connect up our services in the community in a much better way that we do for prison release i've got my backgrounds working in a drug treatment service and often we wouldn't know when people were released until they turned up looking for their prescription or they obviously had been released on a friday and that we hadn't been able to get their prescription to them on time resulting in people having periods over the weekend where they were without a medication that's potentially going to save their life so there are issues there definitely in terms of the communication and the linking up into community prescribing services as well as other types of approaches okay thanks i'll maybe just actually bring in Liz and and Karen just in particular given the new unit in Dundee and the way that it's supporting i'm very interested in the issue and issue around the challenges that women in particular face so would we bring Liz in on this i think your point about through care and after care i think we have to go to that through care it has to begin much much earlier in the process and we've actually taken account of that we had had a significant number of years working within quantum veils so we were very aware of those that that risk unrelease that that women primarily are those basically are released from prison would face so we've taken account of that when we've looked at the process of our residential rehabilitation service and actually we offer a pre and a post service and we provide outreach support to the to the mothers and their children once they leave us and that can be up to six months it can be up to a year and that's when i spoke earlier about that but we have to provide the process to return to come back if support is needed and it not seen as a failing and we have to provide it for as long as it's needed because you know everybody's recovery journey will take however long it takes and so that provision we made sure that when we were developing the services we spoke to mothers we spoke to to those with lived experience and living experience about what it was that would support them on their recovery journey and all spoke about that that pre support so that pre residential support and actually getting ready for residential rehabilitation was very very important residential support itself and then actually that that post support post residential support and that that was that reintegration into communities and i think kirsten's point about actually some of the families that we support were never integrated in that community in the first place and actually we have to support them to integrate and then to reintegrate so to speak and actually for many to return to the communities that they have come from isn't ideal either and we have to support them to integrate into new communities as well and we have to give them that option and the choices and for us it was making sure that that support provision post residential was there and it could work for as long as was needed so very much supportive of a through care and after care policy especially for coming out of prison but actually it has to step much much earlier and not just at the point of release or the point of somebody coming out of rehabilitation and that's certainly something that that was very evident in in the work of the committee that walking out of the door of the prison out the gate is too too late in terms of through care and after care cardin would you like to come in yeah just when you're saying that about how daunting it is walking out the gate i think everybody can appreciate how daunting it is i certainly felt that walking in here today it would be much easier if you had a link already established that when you leave whether it be residential rehabilitation or whether it be prison that you have a person that's there that you've met before that you were able to talk about what your worries and your fears were so that when you left you are you've got that established link and that's certainly you know one of the efforts that we are trying to focus on just now within Renfrewshire along with our colleagues in the Scottish Prison Service to make sure that those pathways are as robust as they can possibly be. It was happening to hear that the Scottish Prison Service were talking about a recovery cafe within that setting so that people get that experience and it doesn't feel that that's something that they just can't aspire to when they leave so it's about you know if they've been exposed to a recovery cafe within the Scottish Prison Service actually then talking about a recovery cafe in the community might not be such a big leap when they're actually discharged so i think it's really important to establish those relationships and i think as Liz already mentioned that does take time that doesn't happen overnight people need to you know have confidence and trust in those workers they are coming out to sometimes quite difficult situations the environment that they left in terms of housing you know their their benefits lots of different complex needs that need to be addressed while we've got an opportunity to talk about that in a different environment so that those links are established when they come out makes that transition much easier. Can I bring in Natalie, Natalie you have some questions. Thank you convener. I want to kind of focus around the whole family approach so obviously we've spoken this morning about the importance of families being involved in rehabilitation and support and we have that Scottish Government commitment towards the whole family approach. Can I just ask how your services are currently working to ensure that family are involved and in what ways this could be either improved or expanded given further support? I've got maybe some stuff but I'll bring some of you in first so could I maybe bring in Liz first? Our whole approach within Averlar is to work with the whole family. We know that it isn't just I think as Justina said the person that is using drugs that is affected you know that there is a much wider context to this so we provide individual support to mothers fathers but also to the children because their experiences you know many of the children that we work will have you know seen a parent die and actually it's the aftermath for a lot of these children and young people that we need to address subsequent to a parent's death but when we can and what we want as an organisation is to get in there much much earlier to be that wraparound with the family to provide that individualised support to each member of the family what we can't forget about is that there are often kinship care arrangements in place as well so actually you know there are grandparents and uncles we need to provide that support to the whole family and we need to tailor it to their needs you know as an organisation we very much believe and we do not go in with a preconceived idea of what support it is that we're going to provide to families it's very much based on building those relationships making the time and working with them around what it is that would actually provide them with the best means of support we cannot forget and I keep I've probably said it already about poverty about mental health we need to empower people we need to provide people with the mechanisms that they need to get out of situations as well and we can do quite a lot when it comes to family support and and really be there but for a lot of families they need that practical support when it comes to having enough money to feed their children having enough money to pay their bills and then actually they can start to concentrate on the recovery that traumatic experience and work around that work on their parenting for example and but we need to get the basics right first so it's about a whole family it's about working with everybody individually it's about working with communities it's about working with a whole system when we talk about systems we mean that actually all of the partners need to be involved we've heard several times over about one organisation will say this another organization will say that what we need is for all organizations to be saying the exact same thing to be respecting people to be understanding people understanding the real needs of people and then acting accordingly absolutely yeah i'm glad you mentioned children specifically because i wanted to ask what efforts are made to ensure that the views of children are taken into account because often children can feel very alone in these situations and have very unique and sort of specific thoughts on on what could help or what could what support they need or what support their parents needs to get out of this situation you also touched on poverty and other issues that impact on the ability to support people in this so around that whole family approach as well i would maybe ask if you could describe how those sort of issues poverty disadvantage poor physical mental health impact on the ability to deal with drug misuse and whether your organizations are taking any form of joined approach to try and sort of impact making impact on all these issues at once because i genuinely don't believe we're going to fix one thing without fixing the others and i'll maybe bring Karen in if you've got any yeah i think from a service perspective it would be fair to say that we've focused you know on individuals and missing that you know that whole family approach and certainly the alcohol drug commission and renfisher commissioned a whole family review and we've taken forward those you know we're working through those recommendations some of which we have implemented has been around you know making sure that families when the parent has been using substances are supported so we have a family support worker for example within the recovery hub circle who'll be looking at building those relationships not in that traditional service sense again but in an environment that's conducive to you know therapeutic work whereby that it might be a cooking club a cooking group a homework club so you can start to see you know hear the the experiences of those young people and how they felt when mum or dad were using substances and trying to work through some of that i think the youth and wellbeing service that again another initiative developed through the alcohol and drug commission actually that early intervention so before you know children have to come to the attention of statutory services or in fact need to use services themselves actually an environment that's in the lagoon centre so again another environment that's not traditional service service feel where they go in and talk about aspects that are relevant to them you know bullying cybers online cyber bullying low level anxiety alcohol and drug awareness so there are some steps that have been made i think we still have somewhere some steps that we need to take to address that in particular and i think that's some of the the recommendation certainly from that review that we're working through just now okay and sorry that that i'm just very conscious of the fact they've got a lot of members want to come in and we've got very limited time paul thank you convener and good morning to the panel and i suppose you know continuing the conversation we're having about the interventions and the programs and projects as well as that are run particularly in the third sector i'm particularly interested in sustainability and because i think there is clearly a focus in terms of funding and one of the key recommendations of the national mission is funding fit for that public health emergency but i wonder to my extent you know i'll come to lizz on this you know how do you ever learn feel sustainable how sustainable are you in terms of being able to continue services i know that in 2015 for example residential rehab services were withdrawn in the Glasgow area you know obviously there is a huge focus right now but we need to sustain that because i think the danger of course is projectitis which i think everyone would would recognise and i just wonder if you would comment on that so you're absolutely right we did have a service in Glasgow in 2015 and that closed and and we were very concerned about that at the time we would advocate for long-term funding i think what we have spoken about or what i've spoken about specifically is about that we need so we have families who are coming forward and asking for help we have to be able to provide that help and in order to do that we need services right across the country we need our statutory partners to be funded appropriately the third sector needs to be funded appropriately in order to sustain services i spoke about relationships in about time year on year funding isn't any good when it comes to building those relationships so we need to be and families need to know that actually services are there for the long term and for as long as they need it so we would be looking and we would seek always for that long-term funding that actually it's it's outcomes based so i mean when we're talking about funding we have to be able to evidence that we are meeting the needs of those that we serve and the people that we work for but we need it to be long term and otherwise you know we have services where we have had short term funding and by the time we've recruited and it's taken three months to recruit and then we've been able to provide six months worth of support we're actually having to stop referrals and stop taking referrals again and one of the points that i think was raised earlier was about you know when we have families that come forward and they're seeking supports there was a real fear from particularly the mothers that we work with that actually if they come forward and they ask for support that their babies will be removed and and we have to be able to respond to that and again that takes time we have to build up relationships and we have to build up trust and and that doesn't happen when we're not there for the long term because those relationships do take time so sustainability is something that i think you know we are all worried about we are all signed up and we all support the mission we all want to do what's right and what's best but in order to do that there needs to be funding made available and and i spoke about cow and grove that we have just opened one mother and child recovery house we are due to open another letter this year but they will be full pretty soon and and we will have other mothers and their babies who deserve to have those opportunities and in order to do that we need to have more of these small mother and child recovery houses local to where people need and available when people need them because we will we will have all of the families that and i think justina said about the poster so they wanted that support the poster got removed because that service wasn't wasn't there anymore if families come to us requesting support they want to recover right we have to have those services available and currently we don't and justina's point about it being a postcode lottery continues to this day we do not have equitable provision of services that are needed across scotland and that we have to do it and i wonder thank you that was a very helpful contribution but i wonder if Karen from the adp point of view now obviously we've seen a kind of a line of funding if you like being sustained but i wonder if the knock-on effect of local authority budgets and indeed those other areas of work that we often would see signposting to you know as those services decline is that a challenge yeah i think funding in itself is is a challenge you know how the funding is disseminated you know the length of the funding i would echo what was said in terms of that sustainability the most telling thing is when we speak to services and they say this is great will it be here in six months time so we are always juggling the managing of expectations i think in terms of residential rehab you know we have seen in a two-year period one person going into residential rehab to five within the last six months so people's expectations will increase they will demand and quite rightly so demand of our services and we need to be able to make sure that that's a consistent sustainable approach regardless of other pressures in terms of funding that the alcohol and drug recovery services third sector all the partners are funded appropriately sustained that we can expect that regardless of where you go in the country you would get the same service and it will be here in the six months time Pauline McNeill a similar theme i think Pauline is what you're wanting to look into yeah thank you convener yeah and thanks for your presentation it really is so informative yeah it's a follow-on from paulocain um so i mean reading through all the information that's been given you know the plan and the reform law reform is needed and we've got additional funding from the government 50 million a year what i'm interested in is what do the panel think about how wise that money is being spent or planned to be spent so i mean lots of priorities here i mean one of the key points for me is the manner by far the biggest cohort of people losing their lives and i just wondered if the panel think the money is being directed in the right way and can we see the money where is it being spent are you clear as the experts in the field if you like that the 50 million is being spent in the right places justina wants to come in straight off i mean i love being a third sector ceo but probably the most soul destroying part of my job is constantly chasing money as any third sector organisational but i would say around drug policy there's i would say there's not a lack of funding in the system but as you have maybe alluded there is a lack of transparency and you know funding i'd be the first to critique adps as Karen and others know but i think it's been really challenging for them to have lots and lots of demands thrown at them all of a sudden without necessarily having the time to build up their own adp capacity so you know we've got little pockets of money going for whole families we've got pockets of money going for mat standards you know pockets of money going for residential rehab and yet we're saying we need you to be looking at this as a holistic approach for whole families that's children and young people and adults and we need you to be looking at all kinds of different treatment pathways recognising you know it's about harm not use so we're not you know it doesn't matter if people are using alcohol and drugs it's about where there's harm that we need to invest in you know making sure we're putting the money so there's tremendous pressure to deliver very quickly without actually always taking the time to think through like where would this money best be spent and i would maybe say this because i work for a third sector organisation but you know it's been very difficult for the third sector in this scenario the vast majority of the funding is going to start the statutory sector and we've not really seen the the benefit of all of that investment yet so you know i think that would have been a different approach to think well what could the third sector deliver in this as well you know working in partnership as as we do every day let's get the adp perspective Karen i mean i think just what justina is saying there it has been difficult you know who would ever have thought that you know getting money would have been such a challenge but it has been because of the different funding streams the different eligibility criteria around that and we don't get the luxury of closing up shop in order to rearrange train the staff think about plan design evaluate whether or not that's working or not working so all of that has been a challenge just in terms of even trying to work alongside our third sector our colleagues that comes along with a commissioning process and you know how long the funding will be lasting for therefore do you go out to tender is that a direct award all of that's having to be taken into account and within a very short space of time when in actual fact again what we're trying to show the public is that these are sustainable services and these are viable options but in order to do that we do need time to plan and evaluate see what's working what's not working don't make the same mistakes i have to say that the the miss team the medication assisted information support team that peripathetic team being able to go around and you know help has got over any obstacles that we have but also been able to share what good practice has been happening nationally has been really useful and i would welcome you know that type of forum in the future because we don't want to keep we don't want to make mistakes that i've already somebody's trialled something out and it's not worked then why would we go down the same route again you know we could learn from that but also about sharing out good practice here's what we've done that could work in your area and here's how we overcome any obstacles pauline yeah thank you and convener this is what i really feel the committee needs your help to drill down on because what caron said there was where you said where would the money best be spent and it sounds to me like so if there isn't a shortage of money so to speak as justina said can you help the committee then because it doesn't seem to see it doesn't seem what you're saying that there's a clear picture of where the money should ideally be spent to get the results that you'd want and just a supplementary to that i mean there's been lots of pleas made about the importance of residential rehabilitation and connected services i mean is that an important starting point then to fix this first i'm i'm really struggling to understand then as a legislator or as a committee member what it is you would want to say to me as that you know to board we push angela constants then you know the results with the money that you see is there thank you was that direct that caron caron and justina thank you thank you i mean i think we have got clear plans for what needs to happen around alcohol and drugs you know there are strategies in place but what we've seen is funding still going out often on an annual basis even if it's indicative for future years you know the the goalpost often shift is where we're going through the year about what's supposed to be funded and i think you know carons also mentioned this the funding has gone you know largely through health boards to alcohol and drug partnerships to distribute we're then getting tangled up in all kinds of procurement and commissioning regulations around what could possibly go to the third sector for example so the third sector have largely had to compete for funding through the national drugs mission through cora funding and so on which is a competitive process whereas local alcohol and drug partnerships and local statutory services are gifted if you like their allocation so that's not a level playing field to start with but you know we do work in partnership across the sectors and that needs to continue but it's it's been you know difficult to to just keep reacting into these kind of shifting sands i suppose as as monies come come out the door okay caron then kirsten what's coming yeah i would again i would echo justina saying that it's good to hear that from the third sector and the dp perspective we're actually saying much of the same thing there are strategies in place people who are working in these services you know do have a real sense of what works and what doesn't work and who they need to work with in order to achieve better outcomes it's just the pace in which the funding is coming through it's the pace in which we need to change and i think that doesn't always chime for example with the recruitment process with a commissioning process you know about training staff and as i said before about bringing the public along with us you know they need to know that you know it looks great that everything is changing just now and they can maybe see pockets of that change but is it going to is it sustainable is it going to be here you know staff need to know that they're you know that if they're on temporary contracts you know they are also affected by you know the cost 11 they want to know that their employment is secured and that they then invest in that sector and we have been very fortunate in the in terms of the staff that you know do have a real interest people that come into this field is because they do want to make a difference we need to make sure that they are being well supported well trained that's people we love to experience as well we need to make sure that they're when they come into the sector that they're supported in a way that we've maybe not you know looking at the nhs absence management policy you know does how does that apply to people we love to experience when they come into a service so all of that takes time but i think there are clear strategies in place it just needs maybe a wee bit more planning and thought and that monitor and evaluation is really important kirsten can bring you in just very quickly to touch on the points that others have made as well we definitely see the workforce as being a major issue in terms of the delivery of all the things we want to deliver and touches on points that were made about small tests of change and that being quite frustrating to watch to see that that isn't sustainable there are major issues in recruitment into the sector and that's partly because of the reasons that cardin's also mentioning about the quality of the services that people are able to provide where there's their over capacity and they're not able to deliver the interventions that they want to be able to deliver so there needs to be huge investment into the workforce we've seen people being funded for posts but not being able to fill those posts because they have been short term so there's definitely a need for longevity of funding in terms of really bolstering the workforce to be able to deliver what it wants to deliver and also that we are properly financing all the interventions that i mentioned earlier that we don't currently have and that includes when we if we're truly wanting to achieve choice as well we've talked about heroin assisted treatment being available as a choice option but there's we need to massively invest in that across the country as well so that we are having availability of true choice for people in terms of lots of different types of service provision so that's something that we need to look at more investment for as well and i probably would disagree that there's plenty of money i think there will always be a need for additional investment into this sector because we don't people who are dying in mass numbers every year don't deserve mediocre responses in terms of this crisis and we need to absolutely invest everything that we possibly can to avoid these preventable deaths going forward thank you jillian mckay thanks convener i think on on this committee and many committees across the parliament we all agree that lived and living experience should be the heart at the heart of every service that we design but given the intensity of often being involved in these and the the long term nature of service service change and evaluation how can we ensure that that people with either lived experience in terms of what you're describing earlier justina about loved ones or those who have previous or current substance use issues actually engage in that meaningfully and in a way that doesn't cause further harm to themselves and i might come to justina first if that's okay yeah i mean i think we need to engage with people all of the time and we tend to sort of badge the sort of lived and living experience as a different thing but obviously we support families who are affected by someone else's alcohol or drug use you know we probably don't need to look out with this room to find people in that category there's lots and lots of people in scotland that are in that situation so it's not always about wearing a badge or standing on a platform and i think you know it's not that helpful to put in somebody like into an alcohol and drug partnership committee who's got you know lived experience and is in recovery if then actually people's day to day engagement at a service level is disrespectful and judgmental and stigmatising so you could say one might change the other but i think it's about us actually engaging with people in a human level all of the time and really respecting what they're bringing to the table for families they don't always have a lot of time you know they are pretty much run ragged trying to put one foot in front of the other they're not always going to have time to do consultation responses and join committees and groups so that's why we just as i say we need to just engage with people all of the time in a meaningful way and make sure that we're really capturing their experiences and responding to what they need so great points and of course family members and people with lived experience it's really important to hear their views but not at the expense of people who are currently experiencing drug problems and that's something that we at SDF really try hard to make sure is represented in all of these discussions so we have a great programme of work at the moment of introducing living experience engagement groups across the country and this is providing a space for people to come along on a weekly basis to air what is important to them that we can then feed back to adps and local providers for them we also are involved in a lot of peer research and it's essential that we're getting the views of people who are trying to access services or who've got current service experience and we've been doing a lot of that work in terms of capturing experiential data for the medication assisted treatment standards and that really gets to the reality of the situation unfortunately with some of the experiential data record and we are finding that it would be quite easy to fudge some of those experiences so it's absolutely crucial that we get the reality of the situation because ultimately and then that's how services will improve they won't improve by hearing um you know flowery stories about how how a particular part of the service is improved they'll improve by hearing the reality for everyone not just people who the service has been working for let's want to come in your question jaleen was just going to it's what justine has just said it's about relationships it's about understanding people it's about giving them time it's about being a flexible approach so some of the families that we would work with want to give their views individually or in groups we can set up forums and really supporting them because they are living their experience and sharing their experiences which is very personal to them it's also about understanding that that personal experience is their experience and not somebody else's so it's about ensuring that we get a broad range of experiences what we do hear from families is that they often tell their story and then they tell their story again and then they repeat that story to somebody else and what they don't get is feedback and they are not seeing I think justina spoke about this earlier on is that we repeat the stories we know what families want what they want to see is that put into action now and I think that question about where do we see the funding where should funding go we have to be brave we have to disinvest in what isn't working for families and really invest in what it is that supports families going forward and that will provide some sustainability for services going forward because we will be investing in what we know is actually working and providing positive outcomes for the families that we support but it is really important that if families tell their story that they are given feedback that they are listened to and that they feel that actually their voices count that's great thank you I want to come back to and touch on something that Karen has said earlier on about people's expectations and and sort of look at that from from the end of the end of that journey obviously we're looking in terms of the Parliament at reducing drug deaths as the as the aim of a lot of these pieces of work but I wondered from from your service users point of view what are the other measures of success that we should be that we should be looking at because the what is a success for for one of your service users might not be things that we are picking up on in different in different threads of our work so if there was something we're we're missing or a piece of success that we we should be measuring from your service users point of view what would that be who wants to come in so I'll give you live examples we have a particular service where it's an intensive perinatal service we work with women during that perinatal period so from conception to when a baby is one year old and we're currently working with 21 women we've worked with 21 women over the past two years 17 of those women have managed to to keep their babies with them 11 of the 21 women had previously lost their babies to the care system and the support that they are being provided with is that whole family support that flexible approach that relationship based that really getting in and about what's practically needed to support them with their substance use and with being a parent. Now many of the women that we support and the same in Cowangrove have had multiple babies removed from their care because of their drug use and that is an outcome so for 17 out of 21 women who without that service would have potentially lost their babies that's an outcome and that is practical support working with those women to reduce their drug use or to reduce the harm of their drug use and and to be able to keep their babies one particular woman I worked with her 17 years ago and she lost three of her babies and I met her a couple of weeks ago and her baby has come off the child protection register is six months old she is drug-free she is you know supporting other parents and she has a beautiful baby what she continues to need to do is to work through the trauma and the experiences of the loss of her babies and they are another gap right another gap in this provision is is those parents who have lost their babies we need to be mindful that they also need to continue to have support and they have been retraumatised time and time again and we need to remember that they also need significant amounts of support when we talk about a whole family support approach. I just quickly to say that you're right that outcomes are different for different people and rightly rightly so the most effective intervention for someone is the intervention that they want at that particular time and surely this is all about quality of life so are you healthy are you happy and the only person that can determine their quality of life is the person living that life so that's why it means so many different things for different people bring Karen in and then I'm going to have to go to Russell Julian. Yeah I think it just as my panel members have already said you know it's different for different people but I think we're in services we get caught up caught up in measuring how many people are in treatment how many people are on methadone how many people you know haven't into residential rehab actually our mobile harm reduction rapid response team so it's a mobile van that's about actually reaching people out of our service that potentially would never have come into our service and we need to start to monitor and evaluate that how many contacts that we actually have and do they result and people actually accessing treatment but somebody coming along to the mobile van and talking to somebody about potentially getting a dry blood spot test or picking up new needles or potentially thinking about you know that actually coming in and going on to a treatment is an option that for us would be a measurable outcome as well. Okay thank you Russell Finlay. Yeah thank you convener and good good morning panel um I want to just begin by apologising on behalf of my colleagues whoever who can't be here today she was keen to be here but she's got a clash with the education committee which also sits on and I think she's asked that going forward that whether this joint committee might potentially sit on another day so we'll see if that transpires now as often happens you come to these meetings with number of questions and then hear the evidence and the benefit or perhaps not the benefit of being last as you've got way more questions than you've got time to ask but I'd like to pick up on something that Kirsten referred to at the outset and that's the drugs consumption rooms issue I think you said something along the lines of a case had been made for these seven years ago in Glasgow yep and I think you also said that the quote was these can be introduced now as far as the sort of legal issues are concerned now the Scottish drugs task force of course called for these last july in their final report yet in in January of this year the justice committee which Audrey and myself are members of received a letter from the crown office which I have here and it essentially says that they are still in communication with Police Scotland about this now we know there was opposition to these from Police Scotland but I think what struck me when this arose at the justice committee was some surprise that they were still talking about it if there is no legal blockage and it's purely about practicalities I suppose my questions are do you understand why they're still frustrated or why they're still concerned about not being able to implement this do you think it will happen and if there's a long jam involved in the police in the crown is there something Scottish Government can do to to break that yeah so firstly Police Scotland actually have been supportive about the introduction of drug consumption rooms but want clear guidance about what their role is when they are established so I think that's an important distinction to make the discussions that I'm aware of that have been on-going have been to try and establish a service that both parties feel is acceptable under the current guidance from the misuse of drugs act and also what can be delivered within a Scottish context and we firmly believe that the Lord Advocate has a role in being able to provide these services and providing the necessary prosecution waivers if they are required for the service to operate I do think we will get them I do think we should have had them well before now and certainly you know we're not trying to reinvent the wheel here this is these are services that are over a hundred of these services exist all over the world they've been around since the 80s I've got a good evidence base I'm an absolutely we should be just getting on with it I think any of the questions that come out from the crown and the police can only be addressed once you start operating a service so that's what I mean about just get on with it deliver it there will undoubtedly be tweaks required to the service as it progresses but in the same way as when needle exchanges were first introduced there were issues around their first introduction of those and they have developed over time to become what they are now I mean one thing about this letter as well is there's no indication in that as to timescale there's no sense of urgency so going back to the original question can the Scottish Government or should the Scottish Government intervene here or what what would you suggest yeah I mean absolutely I think there is a need for to really press on this issue that the reason that there was the call for these facilities in the first place from Glasgow was because of the HIV epidemic there is still an ongoing issue with HIV and the Glasgow situation has been described as the most compelling case in Europe for a drug consumption facility so there is clearly a need and yeah absolutely there is a need to move on this fast and to get this introduced this year absolutely thank you and very quickly some of the evidence from from justina the written evidence was similar to what you you've said in fact perhaps stronger one quote that jumped out from me jumped out I mean was families repeatedly find there's no accountability in the system no one's accountable for repeated service and system failures and their concerns are just dismissed and that's on top of the implementation gap which I think is a very neat way of describing the difference between all these millions of words that are produced saying what we should be doing and what's actually happening and maybe this is a bit of a broad question but why is there this gap why is it about money is it about inflexibility what could be done to to improve that deliver and to be honest we don't really know but I think that's what we need to turn our focus on to whereas I think what we do normally is go oh we need another plan need another strategy we need another commission you know whereas I think what we need to do is really focus down what is happening on the ground that's getting in the way so you know families tell us about you know if they're even allowed to attend appointments with their loved one you know there is that sort of gatekeeping there's withholding of information there's a refusal to implement agreed standards there's no transparency and there's really just a lack of a treatment plan or pathway in services and if you compare it to other kind of chronic long-term health conditions like you know cancer or whatever you would involve the family in conversations you would have a plan you would have a pathway let's try this if it doesn't work we'll try that you know so I think it's we seem to have this disconnect in Scotland you know we we look at drug policy through a public health lens and we're very proud of that but actually the way we implement it is obviously still quite punitive and judgmental and so some of that kind of criminal justice lens is still lurking around and I think if we truly do want to take a public health approach it does mean you know just really shifting the culture and attitudes within services which we can see where there has been change you know as Karen and I were talking about before this morning's session you know services can change you know people can change the way they deliver deliver them and we need to give permission to workers to work in that different way you know I say often I don't need to phone my staff in the morning and say be nice to families today it's just what we do so what on earth would make somebody go to their work treat somebody in a disrespectful and judgmental way you know we need everybody to love their jobs and if they don't love their jobs we need to understand what is getting in the way what is getting in the way of that thank you very much thank you thank you so we have a few minutes left and I promised Audrey that if we did have a few minutes left she can come in and talk about drug law I suppose actually what I was going to cover really has been covered by Russell Finlay in terms of the fact that we still work within the context of 50-year-old misuse of drugs legislation which was perhaps fit for purpose back in 1971 but is is I think most people are agreed is is less relevant shall we say in particular in the context of Scotland where we are looking to develop a public health approach and one of the issues that I have always had is that a justice approach around drug use and possession is appropriate that that's up higher end of you like where it's more around supply and possession rather the context that we're speaking about is is possession and I failed to see the benefit of criminalising an individual who because of their circumstances that experience their environment is is living with a drug harm issue they wouldn't choose that their circumstances have taken them to that place so I suppose really it might be helpful to open up to the others obviously justina you've spoken about and Kirsten you've responded to the questions that Russell asked but I wonder if Liz and Karen might have any other comments to make around drug law in the context of what we're trying to achieve in Scotland so it may be Liz first then Karen I think I would fully support and agree with you that I think that the law is extremely outdated from our perspective what we have seen is whether there is criminalisation for possession of drugs we have in the past seen mothers imprisoned which has meant that actually their children have gone into care that lost that break of a family and the impact of that is significant and long-lasting so we would support our complete overhaul of the drugs law from 1971 I would echo that the same as my colleagues have already said that it is outdated in what we have said again if we make services viable options and not you know the we've heard from people who think that actually maybe being arrested and getting into prison is more attractive than actually attending services or living in the environments that they live in just now so we need to turn that on its head and make what's happening in communities the more attractive option but again yes absolutely the drug law has been outdated just in terms of I think what Mr Finlay had mentioned in terms of the scrutiny and the you know monitoring and evaluation of you know services I have to say having gone you know we're currently involved in making sure that we have all the evidence there to support that we are actually implementing the mat standards that's a level of scrutiny that I don't think has necessarily been there before but that's not an easy task you know there are three different strands of evidence that need to be submitted from process evidence numerical and experiential to say that we are meeting 10 mat standards the key now is to make sure that we maintain those standards and that we are evaluated on the benchmark that we've already set out thank you thank you I want to thank all four of you for your attendance this morning and for everything that you've said this month's been extremely helpful and actually very powerful as well so I'm going to suspend briefly to allow you to leave and then we're going to have the minister in front of us when she arrives thank you welcome back and welcome our second panel of witnesses this morning's meeting we've got Angela Constance minister for drugs policy or Landerheimer Mason the head of drugs policy division the Scottish Government and Maggie Page unit head for the national mission on drugs we're going to move straight to questions and not so much of a question more than an invitation from myself minister in terms of actually meeting the recommendations that were made by the task force could you give me an update on give us all an update on progress towards that yes of course thank you convener and good morning to colleagues I very much appreciate the opportunity to join you here this morning and would commend the three committees involved for joining forces and ensuring that there's joined up scrutiny of our national mission that aims to be joined up throughout every tier of government but in and around across government as well and members will be well aware that our work in response to the task force predates the publication of the vital and final recommendations from the task force so you know work in and around the implementations of mat standards precedes the task force final report work on for example our national naloxone program too and committee members will also be aware that in january we published a very full response to the task force and their 20 recommendations and their 139 action points and in january as well as having a debate in parliament that I also shared our response to the relevant committees and in and around the 139 action points as well so we've endeavoured to keep committees and parliaments fully informed of where we're at in terms of since january colleagues in the justice committee in particular will be following the bail and release bill that is of particular interest to me in drugs policy because of the for example ending friday liberations and liberations before a public holiday as well and all of that improvement in and around through care standards as well as you know how we use bail going forward as well and members will recall that just yesterday I gave an update to the government's response to the rapid review on how we have better joined up healthcare for people with co-occurring mental health and substance use conditions. I have been as you'd expect meeting with the transport minister in terms of working through some of the finer detail around the pilot for concessionary travel and we you know continue to be very focused on the implementation of mat standards committee I'll be well aware of the ministerial direction that's in place and the monthly and quarterly reporting that different areas are subject to and obviously I'll come back to Parliament in June to give another update on that and of course we continue to make progress with another pillar of the national mission which is in and around access and residential rehabilitation and there were figures published, monitoring report published by Public Health Scotland yesterday that shows that in the quarter of October to December last year we had the highest as yet of our number of staturally funded residential rehab placements at 228 which means over the lifetime of the national mission we have funded over 1100 residential rehabilitation placements but of course underlying all of this is our national mission reporting arrangements committee will be aware of the outcome framework that we are working to and also that every year we will publish an annual report as well and of course that was published last August and later on this year there'll be a further report. I don't know if you saw the previous panel so I'll assume that maybe you didn't but certainly some of the evidence from our stakeholders suggested that we still have a bit of a postcode lottery in terms of services and also in terms of MAT standards we heard from a couple of our panellists that you know often people aren't getting and families might not be getting the support that they think that they might be entitled to that are maybe contrary to what plans you've set out in terms of ministerial direction how do we how do we how do you bridge those gaps how do you respond to to the fact that maybe in some areas things aren't working in the way that you would expect so I mean this is fundamental to the work that I lead it is fundamental to both the approach we're taking with both MAT standards and residential rehabilitation and our work to improve support to families and that is about accountability and scrutiny at each and every level and the government we have to model that ourselves to demonstrate that we are accountable that we will engage constructively with any critique and you know performance reviews and that we expect that throughout the system as well so for me this is about the leap using each and every lever that we have available to us and some of this is about more regular reporting so we have that quarterly reporting for example over residential rehabilitation placements which details area by area where the placements are being are being funded and you can see a general improvement across the country and similarly with with MAT standards there are some areas that are subject to monthly reporting there are other areas that are subject to quarterly reporting and it's also about investment and for us following that investment very closely so we're doing a bit of a belt and braces approach so much more rigorous scrutiny and regular reporting but you know that is also you know coupled with additional investment but also a hands-on approach so my officials given the nature of this portfolio and regular engagement with each and every area and I you know spend a lot of my time you know directly engaging with families and local services but if I take for example the work of the miss team that's the MAT standards implementation supporting we really are being pretty hands-on with this that they need to implement and ensure that we have an acceptable standard of delivery irrespective where any individual or family resides notwithstanding that for some areas they will need to do things a little bit differently and in terms of our investment in family inclusive practice and the whole family approach you know so there's money that has been directed to ADPs but there's also money that went via Cora to you know third sector organisations so through our multi agency expert delivery group we're doing an order of how ADPs have utilised that uplift as well and we are currently you know working through that order. I imagine my colleagues might want to reference some of that in their line of questioning. Can I hand over to Audrey Nicolle? Thanks very much, convener, and good morning. Minister, you said just in your opening remarks you made reference to the bail and release bill that the criminal justice committee is currently considering and as you outlined one of the key parts of the bill is to improve the process of release from prison and I know that within the cross-government response to the task force report removing barriers to accessing services and treatment on release from prison is outlined in some detail within that. Within the bail and release bill there is a duty outlined on ministers to publish through care standards for both remand but also sentenced prisoners so that there's an improvement in the consistency of through care support. So I wonder in the context of drug harm and the work that you're doing in response to the task force report if you could perhaps just give some commentary around what those through care standards should look like in the context of as I say drug harm and the vulnerability in particular that individuals face at that release point where they've perhaps come from a period of abstinence but are vulnerable to perhaps coming back into an environment that places them at risk of harm from drug use. Yeah, and I think that's a very important question, Ms Nicolle. Obviously there are a range of colleagues across government that will have a direct interest in through care standards so you would well understand that while this may be primarily a matter for justice ministers there has to be an interest from housing ministers and other ministers that are focused on community services also. From my perspective one of the key issues is about aftercare so when people are released from custody it's a period of transition and any period of transition comes with risks and we know again you know from all the evidence that there can be for some people a heightened risk of overdose when they are released from prison so that's why our peer work that we're funding that will be extended at all prisons in and around Naloxone for example is so important. We've also and I perhaps should have mentioned this and that the general update is we have published on Monday our updated pathway from prison to rehab because I'm a big advocate of prison to rehab. Now rehab isn't for everyone but it should be there as an option for everyone for whom it's considered appropriate and there was further work we needed to do to ensure that both prison staff and people leaving custody were better prepared on what to expect when someone moves from a custodial set into prison but it's that continuity of connections with a community even if you've been removed from that community and that planning for someone's release should not be left to the last minute. It is an area that I have a great personal interest in bearing in mind I've been a prison social worker in three establishments and my last post prior to being elected to the Scottish Parliament was at the state hospital so as with all planning it needs to start early and it needs to start actually at the point when people start their sentences. Again going back to the criminal justice committee's evidence taking particularly around release from prison one of the challenges that we discussed was unplanned release from remand and the difficulty that that can create both for an individual where release hasn't been anticipated but nonetheless they walk out of court and how do we ensure that they are supported in maybe not necessarily the same way that release from a completed sentence how that looks but to ensure that that vulnerable point doesn't take them back into a problematic situation where services are not in place and key work support is not in place so I'd be interested in your views because it's something that the committee grappled with a little bit so yeah and I can well understand why committee has grappled with that because again unplanned discharges from court with little or no support is higher risk elevates risk and I suppose that the baseline approach is that we need to you know reform and change the whole system so that absolutely begs the question that you know bail should be used you know less sorry remand should be used less so that we can get better bail arrangements in place so that would help prevent those unplanned discharges from from court there are some there is some interesting work around the country there's a really interesting nursing team in Edinburgh that does some really crucial court work I met them some some time ago and again all of that is about continuity of treatment with people with substance use difficulties but absolutely so if we can prevent if we can reduce the number of unplanned discharges from court by reforming the use of bail where it's obviously where it's appropriate because public protection's always paramount and reduce you know the number of people who are on remand and then you know it this really has to be about you know every part of the system whether it's justice whether it's health whether it's social work actually being in a position to respond to needs much quicker and much and much swifter and it goes back to the importance of those through care standards thank you Natalie Dawn thank you convener good morning minister we've spoken about the importance of families being involved and rehabilitation and support so I would be grateful if the minister could outline obviously touched on this in the opening statement how the whole family approach is being developed who is or will be involved in its development and how organisations local organisations will be supported to act on this so where we need a cultural shift or a shift in mindset is the first and foremost we need to see families as partners they at the end of the day very often will know their loved one better than any service provider we need to ensure that individuals within families receive support for their needs and all of their needs as well as you know working to support you know the loved one in this instance affected by substance use so families have an expertise and we really need to be tapping into that and responding to that and listening to that and that was that the whole resin detra behind family inclusive practice that is at the heart of the whole family approach and the funding that we have attached to that that both via adps and both via the the Cora foundation and that amounts to six and a half million pounds per annum and there is continuity of that funding but this is where the audit is really important and while it might not make me universally popular you know asking for more information than ever before on what people are doing with Scottish Government funding I do think it is important in terms of improving consistency improving accountability I have accountability to to Parliament and obviously local services and local politicians have accountability to local communities as well so we're currently you know working through that audit but as well as bearing down and scrutinising what is happening and what isn't happening we are also through the multidisciplinary expert group really trying to provide practical hands-on support as well. Thank you. We know that families that are affected by substance misuse are often also dealing with other issues such as poverty, poor house and poor health and I think it's probably fair to say that recovery is much more difficult when we have these other issues present how does the minister see the whole family approach having a positive impact on these other areas? So this is why we shouldn't just look at the whole family approach in isolation it is why as part of our response to the task force that was a response from government collectively as a whole but also you know individually from you know the work that is being led by Shona Robison to tackle poverty and inequality the work to reform our justice system you know the investment in housing so it is important that we see all of these things connected and you know at the heart of the national mission is also ensuring that drug policy isn't seen in isolation because it's the social determinants of good health or the social determinants of poor health you know that ultimately you know need to be tackled and that's why through the cross-government approach we're not just making commitments for this year we're also making commitments for future years. Thank you very much and just one final question looking at drug related deaths among women so we know that these are increasing and evidence that we heard in our previous panel stated that women are at greater risk during the perinatal period partly because they're scared to seek help in case of consequences. Both the evidence submission from Aberlour and what we've heard this morning touched on mother and child recovery houses for example Cowing Grove and Dundee and the difference that this is made to women's lives and while this might not be appropriate for every woman where it is how do we ensure that services such as these are available for all pregnant women who could require them and on a wider note can I ask what more can be done to ensure a gender informed approach to tackling drug misuse. So if you look at our equalities framework there are six outcomes and there are six cross-cutting themes one of which is recognising equality and that is around the particular needs for women but it's also about how we better reach the black and minority ethnic community as well as the work that you've outlined by Aberlour and Phoenix Futures in terms of Harper House which I'll touch on in a second it's also really important to look at the work in terms of perinatal mental health work that both Mr Stewart and Claire Hockey are involved in and their substantial investment going into that work and you know a refresh in an update of how we support women with mental health issues and drug use and there's been much work done to change the health services both generic, universal and specific. I have to say that the work I had had the great pleasure of visiting the first of Aberlour's child and mother recovery houses in Dundee maybe just a month or so ago and it's quite an experience and it's part of our work to keep the promise because I know as a form of social worker the impact when families aren't kept together and we also know that while more men die in significant numbers than women but we have seen the rate of increase among women increased faster in recent years and in many ways that gap so maybe 10-15 years ago the ratio of deaths between men and women was wider and it's now narrower and at the heart of that there are many reasons for that as you suggest we take a gender informed approach but at the very heart of that is the trauma that women experience when they lose their children and the grief so we need to work harder to keep families and to keep mothers with their babies and the work that Aberlour will do they will open another children mother recovery house in the central belt I'm waiting on an update on that so I'm hoping that we will have more to say about that in the not too distant future but I think the work that Phoenix Futures are doing in Harper House is I think will be revolutionary as well and that's a national family service that's for mums and it's for dads and it's for children up to up to 11 as well so I take very seriously my obligations not just as a minister but as an MSP that we need to keep the promise and we families should not be partied due to lack of support and a lack of service and the evaluation that will take place in Harper House I think will inform us all for many years to come. Thank you very much convener and good morning minister. We had a discussion in the previous panel about safe consumption facilities and progress and we heard from a number of the stakeholders represented about the importance of that work and of pace on that work. Obviously we had communication at the beginning of the year from the crown agent which has said essentially there has been a back and forth if you like between Police Scotland and the Crown Office Procurator Fiscal Service. You had written to me minister on the 20th of February so about a month ago just setting out that there's no timescale because of the complexities involved but I think you said in that letter that through your discussions with the Crown Office and with Police Scotland essential progress has been made and parties understand the urgency so with a month hence from that I wonder if you'd be able to give an update in terms of those developments and indeed the urgency because I think it is critical that we see progress I think everyone in the committee wants to see that. I think we're all at one in this I mean the worldwide evidence about safe drug consumption facilities I don't need to repeat you know for this audience this morning I mean the evidence is a refutable they're not a silver bullet but they save lives and the scale of the challenge of Scotland is that we need all the solutions at our disposal there would have been an easier way to do this I'll happily answer questions on that if required but I made a commitment my party made a commitment that we would leave no stone unturned this isn't all in my gift so issues we have you know a operational independent police force the Lord Advocate in the Crown Office are independent and nobody here needs me to give a lecture on why that is but it is it is encouraging that when the proposal was submitted to the Crown Office that proposal went with the support of Police Scotland and the health and social care partnership in Glasgow it will be for the Crown Office and Procurator Fiscal Service to take matters forward and the Crown Office and Procurator Fiscal Service they are continuing to work well with Police Scotland and it is important that they continue that work and their work as committee will know is in and around and the policing of any facility should it be required because it is imperative that there is clarity on this in terms of both the public but also for for police officers so you know I have done everything I can up to this point like everybody else here I wait on the conclusion of those vital discussions between the Crown Office and the police and any decision that is forthcoming from the Lord Advocate and then obviously depending on that decision if you know whatever it is I will obviously have to respond in due in due course but I give you my absolute commitment anything I can do that's within my gift I will do it because these work safe drug consumption facilities work I appreciate what the minister has said and in terms of the progress that is being made but you know is there any sense of timescale around this I mean obviously we have changes about to come in in terms of Police Scotland's leadership as well which may be of concern around the leadership of the organisation so is there any clarity on when we might see a decision that you can then take forward as minister so I mean my sense and it's just my sense is that we are further away from the start of this journey and now closer to a conclusion now I appreciate that's perhaps not the specificity that Mr O'Kane and other colleagues would be looking for I think I would also say and I hope this is of some reassurance to committee that given the journey that the task force underwent you know the crime office was involved in that work Police Scotland were involved in that work and I think as a country and with all our different partners we have all come to a point where we understand you know what the evidence tells us the question remains ultimately and it's ultimately one for the Lord Advocate about what she can and can't do within her powers in and around statements of public prosecution policy and of course Justice Committee members will remember the statement that the Lord Advocate made to committee about the need for a very detailed specific proposition with community and Police Scotland buying and that's what we've worked towards I'm not the arbitrator or the judge of that work that lies with with someone else but whatever whatever the outcome of this journey you know I will always I will always look to to get the right solutions in place. I have further questions on data but I'm happy to defer at this stage of course. Can I bring in Pauline McNeill next and then I've got time at the end I'll bring you back in Pauline. Good morning minister the earlier panel which was really excellent was trying to sort of pinpoint for myself what are the sort of priorities for fixing or where the gaps are so a couple of things came out of that first is that there's an issue about recruitment and the funding of posts the implication being that some of the posts are temporary and therefore they're not getting the staff applying for posts that need and the second observation I had was that the whole funding process seems so bureaucratic it just seems to me that maybe simplifying it might be an important step forward I just wondered what you thought minister about those two points. So again these are very important pragmatic issues that Ms McNeill raises so in terms of recruitment and again we have monitored this very closely in and around the additional 10 million pounds that we've put into the implementation of mat standards and actually it's a very mixed picture so some areas have actually done very well in their recruitment and then there have been other areas that have struggled more with that. We have always provided continuity of funding you know because I have continuity in my budget and you know whether it's through the Cora foundation you know where people could apply for multi-year funds and some of that resource has been accessed by services as well as the third sector and you know we are given as much clarity and continuity to alcohol and drug partnerships and I understand well the point you're making about you know is there an argument for simplifying funding routes and we may well get to that point if we have a more simple whole systems approach but what I wrestle with is ensuring that money that has been earmarked and allocated for example to support families I need to know that that investment has went to families there is money that I have earmarked and allocated to improve access to residential rehabilitation and I want to know that that money has been spent on residential rehabilitation and aftercare so I'm not unsympathetic to that point about a more simplified process but I think the position I've arrived at is right now and the here and now to tackle a drug death crisis I have to follow the money and ensure that the resource gets to where it's more needed and I appreciate that that you know does require a level of monitoring and indeed it does require a level of bureaucracy to to scrutinise that and it may be that when we get to wider reforms perhaps in and around the support and functioning of alcohol drug partnerships and drug and alcohol services more and more collectively that would be in a position to change that but right now I am absolutely following the money and I ain't going to apologise for that. Thank you if I could just follow that up by asking specifically what progress exactly has been made on expanding residential services I mean I know it's one part of the picture but it's an important part are you able to tell the committee has there been an expansion of services and now or later are you able to say exactly what that amounts to thank you. Yes so in terms of increasing either existing or new services thus far I have allocated committed to an investment that comes to nearly 40 million pounds and that investment touches upon seven services services in Argyll and Bute Ayrshire in terms of heart per house Edinburgh in terms of the increase for the Lothian Edinburgh and alcohol abstinence programme there is the new child and mother house recovery house in Dundee and more recently we announced funding for the northeast where phoenix future will take forward a project to address the needs of the northeast and there's additional investment in Inverness for cross reach as well so in terms of new and existing services there's been seven very distinct investments in seven projects and that 38 million pounds will increase capacity by 40 percent so some of those increases and some of those new services are now I'm pleased to say on stream up and running and open where our investment thus far gets us to is around 600 beds we made a commitment to go from 425 to 650 beds the investment thus far is getting us to 600 and some of those beds are already on on stream but also as well as increasing capacity it's also about improving access because we wanted to ensure that where there was capacity within the existing system that that was being fully utilised because it was kind of post lockdown I mean this information goes back a couple of years now but not every establishment was at full capacity and that's why we directed funding to ADPs and across the country it was like five million pounds to say that funding is for residential rehabilitation and aftercare we should never forget aftercare you know this is a crucial part of that whole whole systems approach I hope I hope that's helpful there thank you thank you very much thank you Pauline Gillian Mackay thanks convener I just want to pick up on something a couple of things one thing that Natalie dom was touching on earlier on about the family approach and while I totally welcome that there may be various reasons why people don't have their immediate family involved in the recovery it may be that their immediate family are the source of the source of trauma they may be estranged for for various reasons does the minister have plans to to issue some some guidance around this to make sure that whatever that family setup it is whether it is a biological family setup or friends that someone treats his family ensures that that support network however it manifests is around that person is involved in their treatment so I mean in terms of the whole family approach in terms of mat standards there very much is that presumption of family involvement that that you know by and large is a good thing and of course individuals you know will have different circumstances where that may not be appropriate or it may not be what the individual in treatment or recovery desires but I think even in cases where you know perhaps for arguments sake a son doesn't want his mother fully informed there are actually ways and some residential establishments do this very well and if I take you know the work led by Dr McCartney in the LEAP project in Edinburgh they have a families group and what they do you know on a week by week basis is not you know necessarily going to the care of individual loved ones but they'll say this is the programme this is the shape of the programme this is what we're doing this week and this is what you might expect so there are always ways to you know engage and be helpful and support a family member even if there isn't you know explicit if consent has been withdrawn to to share kind of private you know medical information or whatever I do think so so it's Scottish families affected by alcohol and drugs they're also doing some work just now that's much more focused on models of care and service delivery and standards and and around that and I think that will be very important moving forward and as I indicated in my last update to on mat standards and you know we've got this journey really bearing down on people to get standards as they stand implemented but we do at some point need to come to the question about how mat standards involved so mat standards will need to be more explicit about treatment and around different substances and I think they could probably be more explicit around things like leadership and things like women you know how we better support women and and also how we work better with families because I think working with families is core it should be core to what we do in drug policy but it's also core to what we're doing in the early years it should be core to what we do in education it should be core you know to what we do in terms of housing support this isn't a nice extra it's got to be our core business and we've got to get the core and the foundations right no I absolutely appreciate that thank you minister the previous panel asked about contributing to service design and how we ensure that that is sustainable for anyone engaging of previously asked witnesses around the national care service how we do that because it is quite often an onerous and time intensive thing and often it's asking people to relive trauma as well so it's how we do that to make sure that we can take on that valuable experience and make sure that they can contribute in the fullness of the service design while not negatively impacting their their recovery or their wellbeing yeah so I've been around parliament and government a long time so when I came in to to this post I very much brought with me you know work that'd been done and then around social security experience panels how you build things from the ground up how you meaningfully engage lived and loving experience or indeed front line experience to help build a system or to build new services and again that needs to be core in drugs policy but it needs to be you know core business elsewhere as well because ultimately your services won't be as effective as they should be if they're not built with those who're going to use them or need them and that you know is you know sounds obvious but I think in many our systems you know historically and you think of the health healthcare system you know that these systems can be quite hierarchical there can be a bit of doctor knows best no disrespect to the clinicians out there so you know I think you know over the past you know can you five to ten years I think we've begun to see that shift in mindset and again you know this is also about cultural change as well so the work of the national collaborative at national level is really important in and around us but also is the work locally because again we're funding work to take place at a local level in terms of our expectations that every area needs to be engaging with lived and loving experience and that has to be about I mean it's a fundamental principle you know in and around your work we're doing to tackle stigma that those who are impacted by by by drugs and alcohol have an expertise and it's not just about listening to their voice they have a role to play in redesigning services and actually that makes sense for everybody I've got another question if we can come back to it at the end convener just to carry on 25 minutes lovely thank you on a slightly different topic and on behalf of behalf of Maggie Chapman one of my colleagues she was looking for an update on the implementation of the of the Dundee drugs commission and what what progress is is being made around recommendations brought forward by that group yeah so I mean that's an important point I mean obviously local partners are accountable for the implementation of both reports from the Dundee drugs commission and actually I think they have done it the Dundee's drugs commission have done an impressive amount of detailed work certainly in terms of my engagement with the local ADP and also crucially senior leaders in the iGB and the health board that there is a commitment to taking that forward and what would be most notable to me is that there has been attempts at a real reset of the relationship with the third sector I've not really spoken much about the third sector this morning but we really need you know not just in Dundee but elsewhere we need that leadership and meaningful partnership a bit more parity of esteem between statutory services in the third sector and I see some movement in Dundee in that regards but happy to provide further information to miss Chapman directly in and around that that's great thank you thank you jillian also finlay thank you very much convener good afternoon minister when's the last time you spoke with anyone from police scotland or the crown office in respect of drugs consumption rooms so there is ongoing engagement with my officials as you would expect I would have to go back and check when I had last spoke to police scotland I certainly have in the past had lots of engagement with the assistant chief constable Gary Ritchie who was very involved in the task force we can't recall when the last conversations were I suppose I have had many conversations with people over the piece in different formats certainly I had a lot of introductory meetings when I came into this post but given the independence of police scotland and the crown office much discussion is better at official to official level because the last thing I would want to do would be to derail any plans or any progress if it was perceived that I was interfering with the operational independence of police scotland and likewise with the crown office there's been a pilot scheme for heroin assisted treatment now it's costs in the region of four million pounds and understand that includes start-up costs now those who perhaps favour the rehabilitation route accept it's not an either or between that and and harm reduction however they point out that the cost of this pilot is something in the region of 17 times higher to treat someone that way with this particular programme then it would be for the typical cost of public sector rehabilitation how would you respond to to their concerns so first and foremost can I say just as a point of principle and I will talk about evaluation and you know monitoring of resources but first and foremost I don't hear many debates if any debates and discussions about the cost of treatment for other health conditions and it always seems to me that we have these more in-depth discussions or if I can put it like this concerns about the cost of treatment for people with drug and alcohol problems and for me we have to move beyond that because this is part of our problem that we have with stigma and the perception that sometimes exists in our society that some people are deserving and others less so and my starting point in all of this is the right treatment for the right person at the right time and different treatments do of course cost different amounts of money there is a difference between the cost of methadone to the cost of buvidol residential rehabilitation is considered expensive by some people and yes I think it is fair to say that heroin assisted treatment is an expensive treatment but my determination is to get the right treatment for the right person at the right time there will of course be an evaluation of the hat project that will be done by the University of Glasgow Caledonia and that will of course put all the facts in one place but heroin assisted treatment works for some people there is a international evidence base that for people who have very long histories in this case of heroin use in other substances where other treatment has not been successful it is an opportunity to stabilise people to have a discussion with them to engage with them about the types of other supports they need the evidence shows that it reduces the use of street drugs and if you like I have ever met with parents who have lost a child you will well understand that the priority is not necessarily the cost of a particular treatment but whether that treatment will work for it for a particular individual thank you I don't think there are concerns about the cost as such it's just working out the effectiveness of those treatments and the quite significantly higher cost to do to go down that route and that will be assessed in due course now it's been two years since the Scottish Government declared its national mission to respond to the needless death of thousands of people through drugs but today we've heard evidence from both Aberlawer about residential rehab still sometimes being a last resort or not being offered as quickly as it could be and also from Scottish families affected by alcohol and drugs who said that there's no one's accountable for repeated service and system failures now these are pretty stark assessments of the landscape and given it has been two years since the national mission it's quite a damning assessment as well what do you see in response to those criticisms? So firstly I mean in terms of the your point about the evidence around heroin assisted treatment you know in other countries heroin assisted treatment is used more frequently so for example in Switzerland there are about 8% of people with problem drug use that receive heroin assisted treatment and there are different models elsewhere that you know arguably you know are more cost effective we have a very kind of high threshold model and part of that is in relation to you know home office regulations but in terms of the national mission I have been absolutely crystal clear about residential rehabilitation it's not for everyone but under my stewardship we are going to invest £100 million in residential rehabilitation and aftercare and improving those pathways into access and residential rehabilitation and of course the statistics the evidence shows that more and more people are being publicly funded to access residential care and for me it's always been a balanced ticket we need to be serious about abstinence based recovery and the option of residential rehabilitation but we also need to be fearless about harm reduction and in terms of the actually really important point about accountability is I have never made an appearance in Parliament or an appearance to committee without talking about accountability it is probably the one thing that I have spoken most about in this role and I for one I never walk away from my own accountability and being open to scrutiny but we do need that accountability at each and every level and actually families and service users are right to point out where it is not working because we now have more information than ever before through our working residential rehab through our working mat standards actually about what is working and what isn't working and as we progress with the national mission we will sort what needs to be sorted in a similar theme last year the auditor general said that data around drug and alcohol is not good enough and there's a lack of transparency have improvements been made in that respect sorry could you repeat that yeah so Audit Scotland this time last year said that drug and alcohol data is not good enough and there's a lack of transparency transparency around how money is being spent which therefore means it's very hard to assess the effectiveness of how spending is used has that been improved has that lack of transparency been fixed or has it I believe it has because I actually think Audit Scotland made as they often do made a very important serious point that we do need transparency and of course of course the criticism is that you know we're then asking for lots of information that we're then publishing and then people complain about the resource that has to be attached to that and we've heard Ms McNeill you know fairly raised the point about you know bureaucracy in and around that but I accept I so for clarity Mr Russell I accepted that point made by Audit Scotland and I believe have demonstrated through the report in and around the national mission our annual report which is available for for people to read and the quarterly reporting around things such as publication of publicly funded residential rehabilitations so just to understand is quarterly spending on every project now published or is that the plan so um so there is what do you mean every single yeah government money going into these services is that going to be published so there is certainly publications around where the Cora foundation money is allocated to and that is publicly available I will double check as to how often that is there is a great deal of scrutiny on alcohol and drug partnerships which is much of which is published as well whether that's quarterly or whether it's through our annual report thank you very much I'm very grateful the minister and I had an exchange yesterday in the chamber around data and I know that the minister has agreed to write with further detail across the the wide spectrum of data but I suppose I'm particularly interested in the the spike in suspected drugs deaths in the last quarter which it which had kind of referenced yesterday but I think there is a sense from public health experts and experts in the field that this could be related to new drugs essentially arriving on the streets and the availability of those new drugs and I suppose it's data and surveillance in terms of understanding these new drugs and then understanding I suppose how to how to tackle the challenges that come with that and obviously naloxone is part of that as is as I say that surveillance and tracking of where these are coming from so I wonder to what extent the minister has officials are doing work in that space at the moment to just understand that yeah so and that this is where our support of the work that's led by public health scotland is really important as well so I know mr okayn is familiar with the radar work and that very much is about putting out alerts where there are reports of new or or novel substances and we do know sort of october to november that there was a spike and although in terms of suspected drug deaths you know overall they for 2022 they're down 16 percent but there was an increase in the last quarter of last year that quarter is the highest quarter since 2021 although the suspected drug deaths as a whole are the lowest they've been in five years and that particular quarter where there was a spike out of the last 24 quarters was was the ninth lowest but nonetheless I just you know right at the point I always make that you know that the remain too high so we won't know until you know the passage of time and you know we'll see we'll get more evidence when we get the annual report which is about confirmed deaths whether whether there's a relationship between the the the spike in deaths that we've seen in the last quarter of last year and the public health alert in terms of netizens now synthetic opioids worry me they worry me greatly and we have a problem of scotland in and around synthetic benzodiazepines but not so much in and around synthetic opioids and you only need to look at the experience in America and in Canada to know why I would be deeply concerned so some of the work so in terms of my engagement I attended the United Nations conference on narcotic drugs last last week that took place in in vienna can assure you that I didn't see any or little of of vienna but that was an opportunity to actually engage with countries where synthetic opioids is an issue because one of the things I wanted to understand more about was treatment opportunities what would we have to do differently and you know if we have an issue with synthetic opioids that would add to the case for safer drug consumption facilities but what the American experience thus far points to is that some of the treatments for opioids you know would continue to be effective there are some issues that you know need to be managed in terms of the introduction to treatment that can be clinically a little bit more harder but in terms of those international evidence-based treatments for opioid addiction that they you know can work in and around synthetic opioids so we're really really alert to that your question I think is really important in highlighting also the importance of drug testing as a really dynamic surveillance of what's going on so we heard in vienna last week a range of really impressive evidence from countries who have a very mature system of harm reduction where rather than depending say on post-mortem toxicology you know you're actually asking people what they have bought what they think it is you're able to give people information on what they actually have bought and crucially the information that or that the evidence that was presented to us showed very clearly that people adapted their behavior on the strength of the information they were given so people might not take the drugs they had based on what they were told they had crucially they might take less of it or they might take it in company with a friend to make sure that there wasn't a lot so unavailable for example so that's a real illustration of countries where harm reduction measures are really mature and embedded and how quickly they can respond to that kind of evidence thank you thank you I wanted to mention stigma in the national stigma action plan because this is one of the areas that we've been talking about things about this morning that are measurable you can get people to be accountable on but in terms of stigma and you minister has said many times stigma kills but you know stigma takes many many forms as in the development of this plan and the stigma charter is one thing but actually seeing how the actions of that are actually working in the ground not just in the agencies that deal with people with substance problems in terms of their treatment but in other agencies that they may come into contact with how are we going to make sure that stigma is tackled every service that people might come into contact with can I just say very briefly convener without trying to interfere with their management of committee just for the record that my officials met with the police on the 17th of january in relation to safe drug consumption facilities they met with the crown office on the 18th of january and they met with Glasgow on the 23rd of january I just wanted to put that on on the record so in terms of the stigma action plan so the charter was published in November and the stigma action plan was published as part of our response to the drug death task force in january and the principles about that is that yeah absolutely stigma kills and we need to tackle it that people who are impacted with drugs and alcohol need to be at the heart of shaping and informing services and also crucially we need to consider drug and alcohol problems first and foremost as a health condition but the purpose of the plan is to take the charter and to turn that into concrete actions and the vehicle for doing that will be around the accreditation scheme that will be developed it is important to say that we'll start with ourselves first in terms of Scottish government policies you know where are we inadvertently excluding people as opposed to you know proactively including them so I think there is a really important point to make about the government leading by example on this we have had considerable interests you know locally I mean people are beginning to approaches and you know ask more about the the action plan and you know how they could be involved in any accreditation scheme and there's a little bit of international interest in the work that we are pursuing in this area as well and can also say that the work of the national collaborative while some of their work is you know is very specific in and around the human rights bill but they will really amplify voices and part of their work will be you know the sharing and dissemination of best practice both in tackling stigma stigma but also taking that human rights based response just a final question have you seen any in the last couple of years since you've been in post have you seen any shift in terms of stigmatising language and approaches in the media or in politics as a result of these conversations that we've been having around it so I think it's fair to say we are on a journey and we're still at some distance to travel but the Scottish social attitudes survey has some quite interesting reading around people's response to you know a public health approach and you know the majority of people in that survey you know would say that they are not concerned about working next to someone with a drug or alcohol problem but when you ask a different question about living next door to someone with a drug or alcohol problem you get you get a different different answer so I think we are seeing a shift and we're beginning to see a shift and I appreciate some of this may appear anecdotal about people moving towards that public health approach and want to focus on what actually works in terms of getting people the help they need and getting people into treatment and recovery and of course I think that the zeitgeist in all of this is the lived experience community because they are visible proof one that recovery is possible and we also know whether it's from the Scottish social attitudes survey or other evidence that the thing that changes people's attitudes the most is actually contact with someone with lived or living experience. Thank you very much. I want to thank you and your officials for your time this morning that concludes the public part of our meeting today.