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28/11/17 14:30

Statement on alcohol and drug treatment strategy

Minister for Public Health and Sport Aileen Campbell

28 November 2017

Thank you Presiding Officer.

Next year marks the 10th anniversary of the Road to Recovery. It signalled a landmark change in the way Scotland deals with problem drug use, setting out a new vision in which all drug treatment and support services are based on the principle, and hope of, recovery.

During those ten years, much has been achieved. We have an impressive and growing recovery network in Scotland. This has proven invaluable in promoting a civic and cultural shift in attitudes towards problem drug use. Within treatment services we’ve also seen a shift in attitudes through the introduction of recovery orientated systems of care.

We have implemented innovative harm reduction measures such as the world’s first take home naloxone programme.

We have also established ambitious waiting times targets for access to alcohol and drugs treatment.

This all comes against the backdrop of almost a decade of record investment – since 2008, we have invested £689 million to tackle problem alcohol and drug use.

The main principles behind the Road to Recovery, that had cross party support, still remain relevant.  However, 10 years on, we must be alert to the changing nature of Scotland’s drug problem and how we respond to new and emerging challenges.

Our understanding of the underlying causes of addiction and substance use have developed, aided by an ever growing evidence and research base. There’s a greater understanding of the effects of deprivation, poverty and adverse childhood experiences in driving the reasons so many in our communities turn to drugs and/ or alcohol as a way of escaping the painful trauma and experiences.

That’s why, Presiding Officer, my intention is to bring forward a combined alcohol and drugs treatment strategy in spring next year.

Whilst there are clear differences between the two; the root causes and the fundamental culture of the responses by services have too much in common to be kept apart.

The legal status of alcohol means there is much that is different in policy terms around availability and accessibility. Indeed, the UK Supreme Court judgment on minimum unit pricing for alcohol is an example of the different levers we have at our disposal in terms of preventative interventions. The Supreme Court judgment marks a landmark moment in our ambition to turn around Scotland’s troubled relationship with alcohol.

I therefore still plan to bring forward a refreshed alcohol strategy that sets out my plans for preventative action in early 2018.   

Turning to treatment and recovery support, the focus of our efforts must be on improving the experience for patients and their families. 

With rising drug and alcohol deaths, evidence of the devastating consequences of problematic substance misuse can clearly be seen across Scotland. These substances are significant contributors to the early deaths or excess mortality that we see in Scotland. We know from the work of NHS Health Scotland, the Scottish Drugs Forum and Glasgow Centre for Population Health that that generation was made, in part, more vulnerable by the social and economic decision-making of the 70s and 80s.

Those impacted are now reaching an age where multiple social and health issues are meeting years of problem substance misuse with devastating consequences.

However, I fully recognise the importance of resources for treatment and that is why the £20 million per annum announced as part of our new Programme for Government is crucial for this refresh.

Presiding Officer, that represents £60 million additional funding over the life of this parliament to help deliver improved services, delivered with the person at its heart, not the addiction, and to enable a greater consistency of quality service across Scotland.  It will also support Alcohol and Drug Partnerships and services across Scotland as we instil the principles of the “Seek Keep and Treat” work, which I will mention more on shortly.

Our refreshed strategy and the resources behind it, must be innovative in approach, guided by evidence of what works, but also informed by those with experience.  Whether that’s practitioner or patient, to stand any chance of delivering the impacts we seek, it must be authentic and be empowering of the people seeking to make improvement.

The growing demands placed on health services by ageing drug and alcohol users in particular demands services re-align to appropriately and collaboratively link into other areas including mental health and primary care.  This will remove some of the current stresses placed on the system by emergency and unplanned hospital admissions.

We must continue our approach of Recovery Oriented Systems of Care.  Recovery must prevail as the mainstay of our policy – with care centred around the person connecting into work on homelessness, employability, mental health and family support.

This refreshed approach must be viewed as providing an opportunity to enable support to reach out to those who are most vulnerable, but who cannot access the sustained help they need for both health and wider social issues.

This is vital because we know being in treatment offers protection against a drug related death.  There is a strong sense this is also true for alcohol but I want to ensure the evidence base is robust. That is why I have asked Scottish Health Action on Alcohol Problems – SHAAP – to lead work to enhance our understanding between the circumstances and contributory factors of alcohol related deaths.  This work will develop actions to further develop the evidence base on alcohol death prevention and treatment services.

Presiding officer, we know that the cohort most at risk and vulnerable to this are often furthest away from services.  That is why the refresh will develop our ‘seek keep and treat’ philosophy to services.

We must actively seek out this hard to engage cohort whether it be through assertive outreach, advocacy, or new innovative approaches.

We know retention amongst this cohort can be improved. Much is already being done to ensure service quality, but there is clearly a need to consider whether the range of services on offer can keep more people in treatment by responding to their care needs in a way that addresses all aspects of their well-being.

And finally, we also know that it is imperative to appropriately treat people, by providing that person centred care and support alongside social and clinical intervention. Increasing evidence points to factors such as social isolation and stigma as major barriers to continued engagement

Seek, Keep and Treat will be the guiding principle for additional investment to secure change.  I expect to see services being redesigned to be more active in identifying those who are disengaged from treatment.  People should only be discharged for the right reasons, and appropriately supported as they move on their treatment journey. And we will seek to measure levels of retention and treatment outcomes that are consistent with this approach.

We must consider ways in which services can provide the wide ranging support that will keep people engaged. This must include an acceptance that some individuals will not be ready to immediately embark upon a journey of recovery or abstinence; an acceptance that some will stumble and relapse, numerous times in some cases; and agreement that this must not preclude them from receiving high quality support and treatment when they return.

Earlier today I met with Alcohol and Drug Partnerships and Health and Social Care Partnerships, to begin to give shape to this shift that is cognisant that these services, currently face high demand and pressure.  That is why the resources I outlined earlier are important to enable a move to invest in models that work.

Transformation will take time, commitment and energy – it will also require our health and social care systems to assess its current practice, reflect on its effectiveness, be innovative, and be open to change if evidence points to a need to improve.   

The recent efforts to introduce a Safer Consumption Facility in Glasgow is an example of how ambitious and innovative responses are being generated at the frontline. Where we see stigma challenged and a huge public health problem responded to in a way that meets the needs of that population. The law does not currently allow that facility to proceed but we must not let that be the final word on the matter. I have written to my UK counterpart to ask for discussions on how this Parliament obtains the powers to allow us to meet a significant public health challenge.

Treatment can no longer just be clinical, but must also address some of the deep rooted social and economic circumstances that people face. It is therefore fundamental that we better join the dots between Health and Social Care Partnersips and Alcohol and Drug Partnerships and ensure provision of addiction services, according to robust local needs assessment, is a priority set out in their respective delivery plans. 

This will require cross portfolio, cross cutting, and cross discipline working.  It will require my Ministerial colleagues and I across housing, mental health, justice, and employability to align our work, and collaborate. 

I also aim to engage thoroughly with those with lived and living experience of addiction, families, and those at the front line who dedicate their lives to doing what they can to support and help those with addictions.  This strategy must be based on strong evidence and research, but must also be authentic and relevant to all those who interact with it.  It must be focused and must drive the improvements we so desperately want to see.  But we should also not lose sight of the improvements that have been made and a need to continue with the good work that has been impactful.

Presiding Officer, there are no quick solutions here – lives are complex, can be chaotic, and can have suffered great trauma. The issues we see in an aging and vulnerable population are long-standing and deep-rooted. Developing a refreshed approach to responding will be challenging.  But it is a challenge that I will not shy away from.  The individuals, families and communities that can be devastated by addiction should expect no less.

Just as parties united 10 years ago to back an approach to substance misuse, so too do I intend to work with colleagues across the parliamentary divide and bring back to this chamber a refreshed strategy in spring of next year.