Drug Deaths Taskforce response: cross government approach

11. National specification

Taskforce Recommendation: The Scottish Government should develop a National Specification outlining the key parts of the treatment and recovery system that should be available in every local area, ensuring it also delivers on the principles of quality, choice, access and parity of treatment with other health conditions.

The Scottish Government sets out requirements for the treatment and recovery system in annual funding letters to local services. However, we agree that a National Specification for those services would help set these requirements out more clearly. This would also provide more accountability, particularly for those with lived and living experience and their families who will be able to see clearly what they can expect to be available in the treatment and recovery system.

We are working with partners to scope out the components of a Specification for further development and consultation. This process will need to involve a range of local and national partners and most important amongst those will be people with experience of using the services and their families.

The Scottish Government has already taken action to improve key components of the treatment and recovery system through the MAT Standards, the new Treatment Target, the requirement to increase accessibility to residential rehabilitation and through work with Scotland Excel on developing a national approach to commissioning residential drug and alcohol services.

The development and implementation of MAT Standards is a good example of how specified services deliver on the principles of quality, choice, and access.

We are undertaking work with Scotland Excel with the main objective being to provide a more effective and efficient mechanism for referral and procurement of residential services which will lead to delivering better health and wellbeing outcomes for people. Alongside this, essential standards will guarantee quality of care and evidence-based practice in residential rehabilitation.

The research phase of this work has commenced and Scotland Excel is investigating how national commissioning arrangements may be able to help improve access, capacity and standards of services available to people who require residential services, including detox and stabilisation, and to set out options for development of a national approach.

The research includes questionnaires to existing and potential service providers and to ADPs and partner commissioning organisations and provide options for consideration by Scottish Government.

In implementing the MAT Standards, by April 2023, each local area will have a documented procedure and pathway to identify and follow-up people who have just experienced a near-fatal overdose (NFO). The standard requires that the process includes the Scottish Ambulance Service, Police Scotland and SPS in the pathway.

There are good examples of NFO pathways in place across Scotland, some of them involving peers at key stages to better work with individuals and get them the support they require. The use of peers in these situations, such as in Clackmannanshire where peer recovery workers are embedded in justice settings to identify individuals in the justice system needing support, can be key. This will be prioritised in the work being undertaken to ensure that high quality pathways are in place across the country.

There is a clear need for a more coherent stabilisation service and the Taskforce has suggested that this should be brought together with detox, residential rehabilitation and crisis accommodation. The Scottish Government will continue to support existing stabilisation programmes and will explore the options for a national fund for establishing and expanding stabilisation and crisis services. Recognising the work already in place in Glasgow with Turning Point Scotland, we will be focusing attention first in our cities but our aim is to achieve national coverage linked in to all other existing services.

We are committing £5 million per year to develop stabilisation and crisis care services. £3 million will be made available through ADPs to develop and implement stabilisation services and work towards aligning crisis, stabilisation, detox and rehabilitation to reflect the full range of recovery pathways required for people. An additional £2 million will be available for a rapid capacity fund to allow stabilisation and crisis services to scale up and improve their facilities.

As part of our wider harm reduction work, the Scottish Government will continue to prioritise the availability and distribution of naloxone. The Taskforce suggested 15 actions around naloxone, demonstrating the importance and priority attached to this life-saving medicine. We agree with all of these actions and many of them are already in progress. This includes working with Community Pharmacy Scotland to ensure that all community pharmacies have naloxone available in case of emergency. In addition, and following the work done to make naloxone more widely available during the COVID-19 pandemic, Scottish Government officials are engaged with both COPFS and colleagues in the UK Office for Health Improvement and Disparities to ensure that those changes remain in place, and, if possible, new legislation is introduced at a UK level to make them permanent.

The actions relating to the establishment of a National Naloxone Coordinator will be addressed alongside proposals, from an existing working group examining the current monitoring of naloxone distribution, to establish a new national naloxone group to oversee the various different strands of naloxone work underway across Scotland.