Drugs deaths: National Mission Clinical Advisory Group minutes - September 2023

Attendees and apologies

Attendees and apologies

Attendees    

• John Harden, Co-Chair,  Deputy National Clinical Director
• Catherine Totten, AHP Professional Advisor Mental Health, Scottish Government
• Professor David Lowe, Clinical Director Health Innovation (Scot Gov) and Consultant Emergency Medicine NHS GGC
• Roy Robertson, Professor of Addiction Medicine at the University of Edinburgh and Retired General Practitioner
• Adrian MacKenzie, MAT Standards Clinical Lead, Healthcare Improvement Scotland
• Chanpreet Blayney, Consultant Psychiatrist at NHS Greater Glasgow and Clyde
• Susanna Galea-Singer, Clinical Lead and Consultant Psychiatrist/Chair of the Education Committee/Co-Chair Faculty of Addictions Psychiatry
• Sarah Donaldson, Specialist Pharmacist in Substance Use, NHS Tayside
• Duncan McCormick, Consultant in Public Health Medicine at Public Health Scotland
• Isabel Traynor, Consultant Clinical Psychologist/Head of NHS Fife Addictions Psychological Therapies Service (APTS) and Lead Psychologists in Addiction Services Scotland (LPASS) representative
• Kirsty Nelson Parish Nurse, Queen's Nurse
• Dr Ryan McHenry, Clinical Research Fellow & Registrar in Emergency, Pre-Hospital and Retrieval Medicine
• Tara Shivaji, Consultant in Public Health Medicine, Public Health Scotland
• Trina Ritchie, Lead Clinician, Greater Glasgow and Clyde Alcohol and Drug Recovery  Services
• Duncan Hill, Specialist Pharmacist in Substance Misuse , NHS Lanarkshire
• Tracey Clusker, Nurse Consultant, Public Health Scotland/ NHS Lothian
• Darren Fullarton, Associate Nurse Director and is the Lead Nurse with North Ayrshire Health and Social Care Partnership
• Dr John Paul Loughery, Vice President Royal College Emergency Medication
• Mark Richards, Associate Chief Nursing Officer and Executive Nurse Director
• Saket Priyadarshi, Associate Medical Director and Senior Medical Officer - Glasgow Alcohol and Drugs Recovery Services
• Sarah Donaldson, Specialist Pharmacist in Substance Use
• Mandy Ramsay, Head of Clinical and Care Governance, Turning Point Scotland

Apologies     

• Marion Bain, Co-Chair – Deputy Chief Medical Officer
• Hazel Torrance, Head of Forensic Toxicology Service, Scottish Police Authority

Also in attendance

• Mark Kelly, Chair of Workforce Expert Delivery Group
• Joshua Bird, Scottish Government
• Joshua Campbell, Scottish Government
• Alice Burling-Brown, Scottish Government
• Alison Crocket, Scottish Government
• Kirsty Wood, Scottish Government
• Maggie Page, Scottish Government
• Maisie Bennett, Scottish Government
• Morris Fraser, Scottish Government
• Paul Sutherland, Scottish Government

Items and actions

Welcome and Introduction

The Chair welcomed members, attendees to the second meeting of the National Mission Clinical Advisory Group. 

Board Governance

The minute of the first meeting on 28 June 2023 was approved.

Members were advised that a membership list as well as previous meeting minutes have now been published online on the Scottish Government website.

Members were advised that this meeting is being recorded for transcription purposes for the summary minutes and all recordings will be deleted.

Presentation: Drug Related Deaths Figures for 2022

Joshua Bird gave a presentation on Drug Related Deaths Figures for 2022 and shares slides.

Workforce Expert Delivery Group Presentation

Presentation by Mark Kelly (Chair of Workforce Expert Delivery Group) and Joshua Campbell (Workforce Team, Scottish Government)

Q &A/ Discussion Session led by Chanpreet Blayney, (Consultant Psychiatrist at Health Improvement Scotland) and Saket Priyadarshi, (Associate Medical Director and Senior Medical Officer - Glasgow Alcohol and Drugs Recovery Services).

Questions put to the Clinical Advisory Group:

• in your experience is there a way in which services could be designed more efficiently?
• is there anything which could be done at a national level to support local services reform? What steps would be required to achieve this? Who would need to be involved in delivery of this action?/Discussion
• how might we develop the role of non-medical prescribers?

Discussion -  key themes 

Understanding the workforce

• a benefit of Core Service Specifications is to define what’s services do and don’t do., this can help to define workforce paths and different roles and responsibilities within addiction services
• we need to gain and understanding of who the wider workforce is, across the wider services and also the core Workforce
• we have to implement shared protocols and look at the design and delivery of different services and implement quality standards and peer support
• a way to support integration of services would be to explore having all the services available on the same site and allow service users to see different agencies in the one consultation. Having drug and alcohol services joined would benefit service users but also will educate the workforce to see both sides and gain experience through discussions with colleagues and peers either through training or informal chats
• we  must recognise different roles and responsibilities people have and ensure any training is appropriate to them and not some mandatory exercise
• core, nationally agreed service specifications could be important. To define what services should do, shouldn't do and interface with other services too, such as Mental Health
• in line with MAT 6 & 10 there has been workforce training needs scoping in relation to psychosocial interventions, most areas also have workforce development plans and implementation frameworks developed
• services and service models vary considerably between boards and should be looking for a more consistent approach across the country. There will be a need for geographic variations e.g. urban/rural

Training 

• Work on Digital Prescribing has been developed and it is now at the point of delivery. There are still some hurdles to implementing this change, like legal changes that must be made for the requirement of wet signatures of prescriptions. This could now allow us look at ways to further transform and train the workforce . This could be by changing the restrictions of who can prescribe and allow others, for example, pharmacists or nurses to prescribe
• we need to offer enhanced training for people coming into the service. An example would be conversations cafes with medical students, this could encourage recruitment and signpost different training available
• we should also be encouraging staff to practice to the highest levels of what they can deliver. Services need to be built on what patients need and their journey
• there needs to be more training for all medical and social science professions to provide better awareness and understanding. This should be at both undergraduate and postgraduate levels and needs to be more consistent at all academic establishments and courses
• Royal College of Physicians are planning a training day in 2024 to look at the educational gaps and needs of undergraduates and postgraduates and all sectors
• NHS Education for Scotland  are working on developing new materials but this is mainly post graduate and there will be a need to deliver more at the undergraduate level, syllabuses and content may be vary but all professionals and individuals will come in to contact with people with dependence issues therefore students will be more aware as they qualify to work in the area and with patients
• AHP education and workforce review will also look at needs of undergraduates as well as existing workforce and maybe an opportunity to influence any gaps

Data sharing

• we have to create a true integration of services and look to find ways to address red tape issues with data sharing and this should also extend to recognition of an individual’s qualifications from another organisation
• this should be done through implementing a good governance framework and national specification
• new ways of working is being called for as is increased training but we need to be mindful that this isn’t just Health and Social Care but extends across whole Scottish workforce
• one of the (many) barriers to sharing between the NHS and third sector relates to the requirements for people having appropriate Information Governance training. Larger organisations may be well resourced in this sense and smaller organisations may not be. So this would be a useful consideration in terms of wider workforce competencies and (if a national platform available), a way of standardising what training people can access

Service design

• there is a need for national consistency and also to understand local variations
• partnership working at every level is essential 
• more of a holistic approach with trauma informed care at the heart of all service design and delivery
• pathway development across the sector will help efficiency and identify duplication  
• one of the gaps, particularly for alcohol is the lack of intelligence available  to inform any demand and capacity assessment at a local level.

Focus of next meeting

Agreed that December meeting should focus on Benzodiazepines: Clinical advice on guidance for the treatment of harmful or illicit benzodiazepine use

 For consideration

• should we include polydrug, stimulant use and Gabapentinoids in this topic?

For March 2024: Two items under consideration : 

• laboratory and infrastructure challenges: looking at post mortem testing 
• heroin assisted treatment: evaluation of the Glasgow project  

Any other business and close 

The next meeting is scheduled to take place 5 December 2023 at 2pm to 3:30 pm.

Subsequent meetings as follows: 

• Wednesday 13th March 2024 1pm to 3pm*
• Wednesday 19th June 2024 1pm to 3pm*
• Wednesday 18th September 2024 1pm to 3pm*
• Wednesday 11th December 2024 1pm to 3pm*

* These meetings will be held in-person at St Andrews House in Edinburgh.