 The next item of business is a statement by Angela Constance on actions to increase access, choice and support through drug services in Scotland. The minister will take questions at the end of her statement and therefore there should be no interventions or interruptions. I call on Angela Constance's minister around 10 minutes, please. Sorry, minister. Have you got your card in? You're not going to make me shout, are you? Minister, 10 minutes from now. Thank you, Presiding Officer. The loss of life in Scotland from drug-related deaths is still as heartbreaking as it is unacceptable. I offer my condolences to all those who have lost a loved one. My focus continues to be on doing everything possible to turn the tide on drug deaths. Two weeks ago, I updated Parliament on the progress that we are making on building capacity and improving access to residential rehabilitation. Today, I am going to focus on the other main pillar of the national mission, medication-assisted treatment standards. This morning, I had hoped to visit services in Cercodi specifically to hear about the experience there on setting up same-day treatment and other match standards. Sadly, that visit could not go ahead today because of Omicron. From my visits to other areas where same-day treatment is already in place, I have seen and heard about the difference that it has made for people. Introducing the match standards quickly has improved lives. First, I would like to say a few words about the quarterly figures published today on suspected drug deaths. While those indicate that there may have been a slightly fewer suspected deaths over the first three quarters of 2021 than there were for the same period in 2020, as I said to the chamber in September when the first quarterly report was published, the figures remain high and there is still a long, long way to go. That report is on estimated drug deaths from Police Scotland. It is the second report published this year that covers July to September. While that report on suspected drug deaths cannot be used to make accurate predictions about the status of the annual report for 2021, which will be about confirmed cases, it helps services respond more quickly to what is needed and will help Parliament monitor progress. In that vein, I can also announce today that I have approved investment of more than £1.1 million over three years and a range of measures to further help monitor progress. Surveillance projects will be developed on a new problem drug use prevalence estimate, a hospital-based toxicology study and improvements to the national drug-related death database. All of those projects will improve our real-time understanding of harms to enable faster and better responses. We know that treatment is protective and my priorities start with getting more people into protective treatment on the back of our commitment to an additional investment of £250 million over the five years of this mission. One of the most significant things that we are doing to achieve this is implementing the medication assisted treatment standards produced by the drug deaths task force in May 2021, and I am grateful to them for that work. Embedding them across Scotland by April 2022 is a key priority to give people access, choice and support through drug services. The match standards set out what people should expect and can demand of services. In June, Parliament agreed that I should provide regular updates in progress. The first thing that I would like to report on is the launch of our stigma strategy last week. Stigma is a barrier to services for many people, a barrier to the services that people have a right to, whether that is residential recovery or to match. They need to tackle stigma that is laced through the match standards, so that important campaign aims to get everyone to think about and talk about problem drug use in a much less judgmental way as a first step towards ending stigma. I can also report that I have now met with chairs, chief executives and chief officers across the country to get their assurances and commitments to have the standards embedded in a way that will make a real difference to the services that people can access from day one. With the support of our national implementation team, based in Public Health Scotland, we have helped all authorities to assess their readiness, to identify where they need extra support and to produce project specification documents that are now being signed off by integration authority chief officers. I can also report that good progress has been made in turning services around to improve access, choice and support. To help with that, we will provide around £6 million for this year to ensure that all standards are fully embedded by April 2022. I have committed to providing over £10 million per year for the next four years to ensure that the standards are continuously improving. I would like to highlight some of the key things that funding this year will help achieve. In Fife, we will provide £300,000 per year to help to set up a benzodiazepine-specific treatment service. That new service will directly address the growing risk of Benzos contributing to drug deaths and other areas that we will be able to learn from. In Dundee, we are providing £600,000 per year to get more people into treatment through primary care. That is one of a suite of new approaches being taken in Dundee, signalling a change in its service model, as recommended by the Dundee Drugs Commission. Those examples of new approaches have been made possible by the additional funding that has come with the national mission. As I said to the health, social care and sports committee in September, everyone is focused on getting match standards properly embedded by April 2022, but the work does not stop there. Over the life of the national mission, we want to see services improving continuously and that this improvement is then sustained for people who need help and support. As you would expect, there will be tough challenges ahead. The implementation team and local services have identified some issues that have to be resolved. There were workforce challenges across health and care even before Covid. There are still some areas that rely on very medicalised models of care, even when there is support available from other disciplines and from third sector partners. We know that there will be particular challenges facing services in rural areas, distances to services for same-day treatment, for example. To overcome those challenges, we are supporting local areas to share best practice on solutions. We are also asking local services to adapt their care models to be less reliant on traditional medical models of care, to empower local third sector groups to do what they do best, providing flexible local alternatives at pace. We are also encouraging local areas to adapt their primary care models to get more GP practices and community pharmacies involved in the care for people with problem drug use. That is the sort of flexibility that will be required to make the MAT standards sustainable. What that will mean is that people will not have to wait days or even weeks to access MAT. Same-day treatment will become the norm. There will also be a wider choice of MAT available with people having more choice of dosage and long-acting buprenorphine being made more widely available than it has been before. There will be better assertive outreach and anticipatory care in place to help people at high risk, either to start or to continue on MAT. Everyone in treatment will be given support to remain in treatment for as long as they need. That is particularly important through transitions, transitions from rehabilitation from hospital and from prison. Services will be psychologically informed and help people to grow social networks. Primary care and mental healthcare will be available alongside MAT. All care will be trauma informed. Advocacy and support for housing, welfare and income needs will also be available from MAT services. In my next six-month report to Parliament on MATs in June 2022, I will be able to report on how authorities have moved beyond embedding the standards to improving on them. The implementation team will be working with services in March and April next year to gather evidence that the standards are all embedded. That evidence will be made available. It will be more than just proof that all the necessary processes and structures set out in the MAT standards are in place. We have already begun training locally to gather evidence of progress from people using the services. Authorities will be relying on the experiential evidence to help to show what has improved and to help to make further sustainable improvements across the life of the national mission. No one should underestimate the scale of the challenge that I have set for integration authorities and alcohol and drug partnerships to embed the MAT standards by April 2022. I certainly do not. However, those standards will help to make people's rights real. I can report that we have already made good progress towards that. With that progress, we can improve and save lives as part of the national mission by increasing access, choice and support for people through drug services. Thank you very much indeed, minister. The minister will now take questions on the issues raised in her statement. I intend to allow around 20 minutes, after which we will need to move on to the next item of business. As ever, if members wish to ask a question, could they please press the request-to-speak button so that I place an R in the chat function, and I call on Sue Webber. I draw the chamber's attention to my register of interests as a member of the Edinburgh alcohol and drug partnership. Six months ago, when Scotland's shocking drug death statistics for 2020 were first released, Nicola Sturgeon promised to get a grip on the crisis and pledged an additional £250 million to tackle the drug deaths emergency over the next five years. Last week's budget announced that there would be £147.6 million to address the twin public health emergencies of drug deaths and the harms from alcohol, including £61 million specifically to address the national tragedy of drug deaths as part of our commitment to invest £250 million over the lifetime of this Parliament. However, the same figure was £145.3 million in 2021-22's budget. If we were to adjust the budget for inflation, that means that services are in fact facing a real-terms cut of about £2.5 million. The First Minister pledged to get it right and provide funding. So where is the additional £250 million that was promised? If I can start on a positive note, it is very useful for me to know that Ms Webber is a member of the Edinburgh alcohol and drugs project. I hope that that will be a useful source of information for both of us going forward. With respect to the budget, I suggest that the member has been perhaps a little mischievous. The First Minister made a very clear commitment at the start of this year for an additional £250 million in addition to core alcohol and drug budgets. That is reflected in the budget. It was a key manifesto commitment of this Government, which we are following through. I can assure Ms Webber that I am ensuring that every penny of that additional £250 million will be put to maximum use to both save and to improve lives. The Conservatives are, of course, more than welcome to pitch up to Parliament and argue for an extra £1 million or £2 million. However, I have pitched up to this Parliament with the full support of the First Minister and, crucially, the finance secretary and brought to Parliament £255 million. £5 million at the very start of this calendar year in terms of emergency funding and that crucial £250 million over the lifetime of the national mission. We are delivering on our promises to invest and reform services, and I can assure Ms Webber that every penny of that will be put to good use. Today's recorded suspected drugs death figures are a sobering reminder of why we have the statement here today. I hope that the reported decrease does mark the start of real improvement, but the fact remains that the long-term trend is still moving upward and progress has been too slow. The update today is welcome and the minister claims that good progress is being made, but will the minister be publishing any data or supporting documents for the progress that she has described? It would be instructive, for example, to know how many ADPs are achieving that standard one on the same day prescribing. Can I also ask what progress has been made with addressing the high fatality rate that is linked to street benzos? When, in August, the Benzodiazepine working group issued interim clinical guidance, the report from the Scottish Drugs Task Force today talks about a consensus meeting and then a conference. Although I welcome the specific treatment announcement that has been made for 5 today, in 2019, 70 per cent of fatalities were linked to street benzos. If we are serious about addressing fatalities, the work here must be a priority. Finally, the Government must press ahead with safe consumption rooms as part of a package. I know that there are barriers, but I do not accept their insurmountable and I can ask when the Government will bring forward a proposal on that issue. Ms Baker is quite correct to reflect on the sobering reminder of the suspected drug-related death statistics that were published today. Although they show a small decrease for the first three quarters of this year compared to last year, we have to report those facts as facts and that there is some care that needs to be taken and drawn too many conclusions from those statistics. She is quite correct that those statistics have to be treated with care because the bottom line is that drug deaths in this country remain far too high. On the data that we will be publishing, I am obviously briefed regularly by my officials. The position is ever-changing with progress being made week in, week out. As I outlined in my statement, what we will do is gather the evidence and interrogate that evidence roundabout either prior or at the next six-monthly statement, the progress report that I make to Parliament. We will publish more information so that members can see area by area standard by standard. I also say to Ms Baker—this is an open invitation to other MSPs—that, if they want to come and engage about progress in any particular area, I am happy to do that. We are delving in to the detail and scrutinising the delivery of match standards in all 30 alcohol and drug partnership areas. The point about benzos is really important. There are plans for a consensus roundtable discussion at the start of the year. That is an area that is quite hotly debated amongst clinicians. I am keen that we build a consensus on that. We are also in discussions with the UK Government around legislative opportunities in and around prohibiting the sale and use of pill prices. On safer drug consumption facilities, we are pursuing two options. We continue to engage with the UK Government about our detailed and delicate work on what we can do within our own powers continues, and, like Ms Baker, I am absolutely determined. I am conscious from earlier statements on the issue that there is a lot of interest around the chamber and a lot of detail that the minister can provide, but I would be grateful given the number of colleagues that want to get in to have succinct questions and answers. I am pleased from now on to Gillian Martin to be followed by Craig Hoy. Problem alcohol and drug use does not just affect the person seeking treatment, but the family of the person, particularly dependent children. I would like to ask how the minister is ensuring those who are parents get appropriate treatment choices that take their caring responsibilities into consideration. The minister mentions stigma. Of course, the fear of repercussions and stigma for parents with alcohol and drug problems may prevent them from coming forward for treatment, so I will be interested in a little more detail on how that has been addressed. I will attempt to brief the issue of stigma that Ms Martin has highlighted is of particular importance to overcoming barriers to supporting women to achieve the necessary access to the necessary services that they need. Ms Martin will be familiar with the work that we have undertaken with respect to residential rehabilitation and filling the gaps and services there, with respect to women and children. On Wednesday, last week, I launched the framework to improve holistic family support. It did that at the Beacons in Blantyre, and this is about the importance of family-friendly services. However, the framework is also backed up with funds totaling £6.5 million, and the Drugs Death Task Force recently published a report on women and drug-related deaths, making out a range of recommendations on developing services, collaboration, sharing information and workforce training. Those will be taken forward as part of the implementation of that standard. Between 2006 and 2007 and 2015 and 2016, Cacain was the main drug of between 5 and 8 per cent of all drug users, but that figure rose to 21 per cent in the most recent data released in March. As part of the national conversation on drugs, what would the minister's message be to those regular Cacain users, many of whom believe that their use is simply recreational and who would never therefore think of seeking out help, support or treatment? Mr Hoy is quite correct to point to the growing implication of cocaine use in drug-related deaths. It is a matter that I am paying particularly close attention to. I have been discussing with a range of services, including the alcohol and drug partnership in my own local area of West Lothian, where there are particular concerns about young men using cocaine on a regular basis and the particular harms that that is associated with in terms of debt, financial pressures and their mental health. There are treatment options around cocaine use. It is imperative that people come forward to seek help in that regard. There is a need in terms of cocaine use to have very person-centred approaches and, quite often, to employ more motivational approaches to help people to identify the problems that cocaine is causing in their lives and to work out person-specific plans to help to overcome that. To ask the minister what the Scottish Government is taking to improve drug services in rural areas, where there is often less choice of services. In particular, how third sector organisations, such as the Shed Project in my constituency, are being enabled to continue and expand on the vital work that they do to support people, including those who are struggling with addiction? Local initiatives such as the Shed Project in his constituency, which provides drop-in services tailored for people with alcohol or drug-related problems, is absolutely vital to the delivery of services in rural areas. There are specific challenges for rural areas just because of the geography and distances that are travelled. Nonetheless, I am clear that MAT standards have to be delivered in all parts of Scotland, although the solutions for rural areas may need to be more innovative and flexible. That is why the MAT implementation support team is working with a range of rural services to share best practice, and it is also working hard to find solutions to those unique challenges. That has also been supported with additional financial resource, which this year was initially identified for £4 million, but has now increased to £6 million. I have no doubt that the minister agrees that it is important to have the community on site with maximum consultation on all aspects of drugs policy. I know that this was raised with her before, when North Asia Council, community councils and the local community found out about the national drugs facility that is intended for solcoats in the media. Going forward, could she outline what she thinks she can do to ensure that there is maximum consultation? Can she provide an update on what is happening in relation to the solcoats facility so that that can be shared with the community? I imagine that Ms Clark is aware that this particular question is covered comprehensively in my last statement to Parliament. I have a responsibility to lead a national mission. There were gaps identified in services available to women and families. We sought to address that. I have, of course, engaged with some local councillors in the area, also the local constituency member, Mr Gibson, and I assure the chamber that Phoenix Futures has a great track record in working with communities, and they have a great track record in saving lives and improving lives. We can see that in the project, the very similar project that they have run in Sheffield for the past 25 years. Can the minister outline whether health boards will be encouraged to carry out their own local consultations to ensure that our services are increased? That surely is progressing away that best meets the needs and the circumstances of our local service users. Two points that I would like to raise, Presiding Officer, is that with an additional £0.5 million this year and for the life of the national mission to increase and improve their engagement with people with lived and living experience of drug use, and, as part of our specific work on the implementation of MAC standards, as I referred to in my statement, we are recruiting local people so that we can be really both bear down on the detail of good qualitative evidence from those who matter most, and that is about people who are trying to access services or people who are in services. There is investment in peer-to-peer research in that regard, which is particularly important. I thank the minister for her detailed work. The big question is whether it is enough to meet the enormous challenge that is built up with the highest drug death rate in Europe. There has been a significant increase, as I am sure the minister knows, in the number of deaths of homeless people with drug misuse as a major factor. What has she learned from those deaths and what plan does the minister have to improve stabilisation services? I am very appreciative to Mr Rennie for those questions, because the point about stabilisation services is very important. It relates to the concerns that we have around alcohol, benzodiazepines and whether we are talking about detoxification or stabilising people who are in chaos or in crisis. That often needs to be done in supervised environments with the correct medical and clinical support. We have received a report from the Drugs Deaths Task Force on making recommendations on stabilisation services. I have been to visit a few stabilisation services, and we are taking that forward. Of the points that he raises around the correlation between homelessness and drug deaths, I think that the bottom line for me is that we do not have enough people in treatment. That is on us, and that is why the core of our national mission to save and to improve lives is to get more people into treatment. That means that we have to work harder to prevent people from becoming homeless in the first place, but we have to work harder to reach people who are perhaps further away from services. Mr Rennie is quite correct to point to the scale of the challenge, but we can make a difference. Those deaths are avoidable and preventable. There is evidence around the world about what we need to do. We have three and a half minutes and four speakers. As briefly as possible, Stuart McMillan is to be followed by Gillian Mackay. Can the minister provide an assurance that abstinence-based rehabilitation centres, operated via religious organisations, will also qualify for funding to help to provide increased choice for people seeking assistance? Faith-based residential services are included in the scope of residential rehab funding. Obviously, in terms of transparency and accountability, there needs to be clarity about how faith informs the model of care, and we would expect all providers to be equal opportunity providers. I value the role of the faith communities in service provision. I also think that there is a role for faith communities in winning hearts and minds. Gillian Mackay, to be followed by Brian Whittle. The minister mentioned the interaction between stigma and medical-assisted treatment in her statement. I appreciate the detail of the stigma strategy that is probably too much to go into here, but in practical terms, I could ask what work is under way to directly engage with those who would benefit from medical-assisted treatment, and particularly those who may suffer from multiple stigma. I can point to the fact that, in terms of the media campaign that was aimed at tackling stigma, it was carefully developed over a not-inconsiderable period of time with people with lived and living experience. As we go forward with the national mission, I think that there is more to do to address the stigma that people in the workforce feel, and there is more to do to address the stigma that families and communities are adversely affected by too. The minister initially rightly focuses on preventing death in the most acute drug addiction cases, but I also need to prevent people from falling into that position in the first place. Does the minister agree that we need to co-ordinate our resources, use that data to deploy them in the most effective manner, including greater integration between statutory and third sector services, and that we should be aware of my view on funding the third sector effectively? I hope that Mr Whittle is well aware of my view that we absolutely have to have a acute focus on prevention and education, and that I hope that he is aware of my views of the value and the role and the potential of the third sector in this country. That is why there have been funds of £11 million announced this year. I welcome the minister's announcement this afternoon, and she will know that the Criminal Justice Committee has been taking evidence on the challenges faced by people previously accessing drug services and who are now in prison. In our recent pre-budget scrutiny work, committee members recommended, among other things, investment in recovery cafés in prisons. Can I ask the minister to what extent the action that she has outlined today will support the on-going work by the Scottish Prison Service to respond more effectively to prisoners with her drug dependency, and will there be the injection of funds in the recovery cafés that the committee asked for? Again, I point to the funds that are available to the third sector in this regard. I have visited recovery cafés most recently at Perth prison. I have recently met the Addiewell Recovery Café at the recent annual recovery walk. The MAT implementation support team is very focused on working with the national prison care network to ensure that access to MAT is not compromised and that people within prison have the same access to MAT standards. I am very much in support of recovery cafés. We fund organisations such as the Scottish Recovery Consortium and Cisco, sustainable interventions support and change outside to carry recovery work in prisons, and they bring that lived experience from local recovery communities into prisons to provide things like peer mentoring support, and they are very valuable indeed. Thank you very much and apologies to Monica Lennon for not being able to call that. I apologise to the chamber. I admitted to revending the chamber of my declaration of interest as a member—a board member—of moving on in required, which is not a faith-based organisation. Thank you, Mr McMillan. That is now on the record. We will be at short pause as the front benches change.