National Collaborative: Call for Nominations papers

• National Collaborative roadmap
• annex A
• annex B
• annex C

This proposed Roadmap follows broad consultation and its implementation will empower those affected by problem substance use to participate in the design, delivery and evaluation of all forms of drugs and alcohol support services.

Its human rights-based approach will enable everyone to enjoy the right to the highest attainable standard of physical and mental health and other related human rights to be included in the forthcoming Human Rights Bill.

National Collaborative roadmap to July 2022

Vision

Drug and alcohol deaths in Scotland are both a national public health emergency and an urgent human rights issue.

Everyone has the right to the highest attainable standard of physical and mental health. Despite this, people affected by drugs and alcohol (including families, friends and support workers) often face many barriers to the recognition and realisation of this and other human rights.

The right to health means that different kinds of drug and alcohol treatment and recovery services need to be available, affordable and acceptable to all, and be of sufficient quality. The right to health also applies in a wider context and means that drug users have a right to equitable access to services that are available to others.

The right to health is not only about healthcare but also includes the right to positive determinants of good health. This means that the many and varied causes of problem substance use, not least poverty, need to be understood and urgent steps taken to try to prevent people from developing problem substance use.

People affected by problem substance use need to be meaningfully involved and have the right to participate in shaping the design and delivery of services. Such engagement is a key part of a human rights-based approach to policy and service delivery. This reflects the fact that unless full consideration is given to people’s experience of human rights in their everyday lives, and particularly of those who most often experience denial of their rights, then policy and implementation will not be as effective as it needs to be.

Human dignity and rights need to underpin all services that people affected by problem substance use need. This will help bring about the necessary shift in power and culture.

It will help to increase the hope, resilience and confidence of those people seeking to access drugs services and will help to reduce stigma, increase empathy and improve the abilities of those people working to provide improved services.

The National Collaborative VISION is to integrate human rights into drug and alcohol policy development, implementation, monitoring, and evaluation leading to better outcomes for people affected by problem substance use.

Talking about taking a human rights based approach to drugs is not new. The National Collaborative aims to further develop and practically apply what is set out in ‘Rights, Respect, Recovery’ (2018) and the learning from elements of the National Mission which have taken a rights-based approach. Annex A sets out how the National Collaborative links to what has come before.

There are a number of wider factors and potential changes affecting the drug and alcohol sector which mean that there is a real opportunity for the National Collaborative to make a difference now.

• the Human Rights Bill will give effect to a range of internationally recognised human rights in Scots law. This means that people will be able to claim and enforce these rights in different ways, including in a Scottish court. It also means organisations that provide services, such as drug and alcohol services, will need to adapt to ensure they are meeting their obligations to honour these rights in their service provision
• the National Care Service aims to improve the quality and consistency of social care support in Scotland, including for people with addiction. It aims to change the way care is delivered, moving towards a person centred approach with stronger national oversight and accountability

Purpose

The purpose of the National Collaborative (referred to as ‘NC’) is twofold:

• to empower people affected by problem substance use to enable their voices – and, critically, their rights - to be acted upon in policy and decision-making concerning the design, delivery and regulation of drug and alcohol services at a national level
• to set out how the rights to be included in the forthcoming Human Rights Bill can be effectively implemented to improve the lives of people affected by problem substance use

Approach

The NC will develop and apply a human rights-based approach. This approach places people and their human dignity and rights at the centre of all policy and decision-making.

According to the Scottish Human Rights Commission, “A human rights based approach empowers people to know and claim their rights. It increases the ability of organisations, public bodies and businesses to fulfil their human rights obligations. It also creates solid accountability so people can seek remedies when their rights are violated.'

Since the late 1990s, United Nations (UN) General Assembly resolutions have acknowledged that ‘countering the world drug problem’ must be carried out ‘in full conformity’ with ‘all human rights and fundamental freedoms’. The reality, however, has not always lived up to this important commitment. There remains a lack of clarity as to what human rights law requires of states in the context of drug and alcohol laws, policies, and practices.

The recently published International Guidelines on Human Rights and Drug Policy do now however provide a comprehensive set of international legal standards to support the practical development of a human rights based approach.

The NC will apply the FAIR Model of a human rights-based approach.

The FAIR Model follows the process indicated below:

The action plan will be shaped by the application of the human rights-based United Nations (UN) PANEL Principles of Participation, Accountability, Non-discrimination, Empowerment and Legality.

• participation: people have a right to be involved in decisions that affect their rights. Participation must be active, accessible and meaningful
• accountability: there should be monitoring of how people’s rights are being affected, as well as remedies when things go wrong
• non-discrimination: all forms of discrimination must be prohibited, prevented and eliminated. People who face the biggest barriers to realising their rights should be prioritised
• empowerment: everyone should understand their rights, and be fully supported to take part in developing policy and practices which affect their lives
• legality: approaches should be grounded in the legal rights that are set out in domestic and international laws

Identification: action plan

The action plan will include:

• a Charter of Rights
• an Implementation Framework
• a Monitoring and Evaluation Framework

The Charter of Rights of people with or affected by problem substance use will be co-designed through interactions between people with experience of problem substance use, service providers and government and will practically apply the rights within the Human Rights Bill to this context.

The Charter of Rights will directly support people with or affected by problem substance use to know and understand their rights in accessing drug and alcohol services. It will also give service providers and government a tool to support the continuous improvements of the availability, affordability, accessibility and quality of such services.

An Implementation Framework will set out how to ensure the everyday effective implementation of the Charter rights and make them real.

This Implementation Framework is likely to include the development of models of practice, standards, workforce development, independent advocacy and complaints procedure, monitoring and reporting and access to a legal remedy if all else fails.

The Implementation Framework will also aim to develop best practice for effective participation of people with experience of problem substance use in the design and delivery of drug and alcohol services at a local level. This will support the ongoing efforts to establish Lived and Living Experience Panels to feed into each Alcohol and Drug Partnership.

To be able to measure real improvements on the ground the Action Plan will include a Monitoring and Evaluation plan. This will involve the development of human rights-based indicators co-designed with people affected by problem substance use.

Implementation

The NC will take an inclusive approach by respecting everybody’s views and experiences and ensuring nobody is left behind. It will act independently at all times from the government and challenge it whenever necessary.

There are already many groups of people with lived and living experience doing really valuable work. The NC aims to bring more coherence, support the further development of sharing of good practice and amplify this at a national level.

There will be several ways for people to actively participate in the National Collaborative process both at a national level and feeding in through local groups. Below is a summary of the various routes for being involved. The point of contact for the SG support team is NationalCollaborative@gov.scot. There are Role Specifications available on the group page.

These multiple forms of participation are a starting point and will be subject to ongoing evaluation and improvement as the process unfolds.

Role	Purpose
Critical friend	To guide the NC on its journey. People in this network will be able to offer external insight to work, often reviewing projects and offering candid feedback that may be uncomfortable or difficult to hear.
Research participant	To ensure the NC is shaped by the views, voices and experiences of people whose rights are affected in practice (“rights holders”)
Member of an ADP LLE Panel	To inform prioritisation, planning, implementation and monitoring of services. This includes responding to National Collaborative developments and guidance to develop innovative local approaches.
Member of a Reference Group	To input into the NC in a more informal way. These groups might have a more specific focus and will either be existing groups e.g. SFAD Family Reference Group or groups which are identified as underrepresented on the Change Team. We are open to there being multiple reference groups to advise at different stages. Ones we already have in mind are: Families Forum ADP Liaison Group Health Professional Liaison Group International Liaison Group
Coordination and Communities Team	To guide and support people taking part in co-design, i.e. the Change Team. The Coordination & Communities Team will convene workshops, run training, support networks and connect to the community. It will also provide leadership on ongoing initiatives and projects that seek to mobilise communities of people affected by substance use. Membership may include organisations delivering services, Nationally Commissioned Organisations (NCOs), organisations employing a Human Rights Based Approach, organisations involved in advocacy or peer research.
Change Team	To co-design an Action Plan for the National Collaborative which will include a Charter of Rights for people affected by problem substance use, as well as an Implementation Framework and Monitoring and Evaluation Framework. The Change Team will consist of 15-20 people, including rights holders (people with experience of problem substance use), duty bearers and rights defenders. The Change Team will meet every four to six weeks and individuals are expected to be in this role for a period of two years.

 

The NC will also aim to be transparent and accountable on its roadmap with regular updates on progress. There are five provisional phases of the National Collaborative process or journey.

Milestones

• publication of roadmap for National Collaborative
• report with analysis of Change Team workshops and interactions
• publication of action plan
• evaluation report monitoring progress against the objectives and outcomes of the National Collaborative (annually thereafter)

Annex A: National Context

Drugs policy

Since 2013, drug-related deaths (DRDs) in Scotland have risen sharply, and Scotland currently has the highest rate of DRDs of the four nations across the UK and in Europe.

In November 2018, the Scottish Government published its strategy “Rights, Respect and Recovery” which supported a rights-based approach to problem drug and alcohol use. In January 2021 the First Minister announced a new National Mission to reduce drug related deaths and harms, supported by £250 million additional funding over five years. Among the main focuses of the National Mission is ensuring that the voices of people with lived and living experience are heard and acted upon in decision-making to promote a human rights based approach.

Many elements of the National Mission already advocate for a rights-based approach. For example the MAT Standards- which were developed with people affected by problem substance use- are about “ensuring individuals have choice in their treatment and are empowered to access the right support for where they are in their recovery journey”.

In addition to this, people from across the sector have made significant progress in highlighting the human rights implications for people affected by problem substance use. The drug and alcohol field in Scotland has many initiatives which are led by people affected by substance use with family support groups, recovery communities, networks of activist drug users and peer navigators and mentors all playing their part.

Some of the additional funding to Alcohol and Drug Partnerships was allocated to develop more meaningful ways for people affected by problem substance use to participate in local decision making. In some areas, this is working well and there are examples of where people with experience have had the chance to advise and influence the design of a service or a strategy. Despite this, these approaches are not yet consistently applied across the country and we heard from many ADP areas that there is a need to develop and share emerging good practice to enable more meaningful participation.

Annex B: Key findings from feedback on the first draft of the Roadmap

Introduction

Since the draft roadmap for the National Collaborative was shared in mid-April, Professor Miller and the SG policy team have had meetings to seek feedback and advice to help shape the roadmap. This included meetings with Nationally Commissioned Organisations (NCOs) and other 3rd sector organisations, Alcohol and Drug Partnerships and groups of people with experience of problem substance use. We also worked with partners to host Community Conversations to hear from a broader range of voices and shared an online survey so that people could provide anonymous feedback and advice.

The primary objective of this second round of consultation and engagement was to seek support for the principles and approach proposed. All partners and groups that we spoke to committed to participating in the implementation of the roadmap subject to further discussions on the specific roles, responsibilities and expectations of that involvement. Other objectives of the engagement were to test out early thinking on the National Collaborative and get direct feedback on how this could be improved. There was a range of responses to this, some stakeholders were cautiously optimistic about the potential for the National Collaborative to be a “gamechanger” in the sector whilst others expressed understandable uncertainty about how it would lead to real change on the ground.

In terms of the positives, people liked the structure of the FAIR model (Facts, Analysis, Identification and Review) and the fact that there were different ways to engage in the National Collaborative process (although these could be clearer.) Many stakeholders were keen to encourage their networks to get involved and some agreed to host “Community Conversations”.

What is clear from the meetings with people with experience of problem substance use is that the National Collaborative is yet to prove itself and must continue to demonstrate how it is responding to feedback and advice. As one stakeholder said it, the National Collaborative roadmap offered a “glimmer of hope but it’s fragile.” Below is a summary of the feedback and it has supported the further development of the Roadmap.

Key finding: there needs to be a comprehensive package of support for people to get involved in the National Collaborative

Supporting advice:

• the NC need to equip people with knowledge and understanding before seeking their advice
• people (especially families) participating in the NC may be coming with very live issues and grievances
• there may be accessibility issues with mailing list updates and draft roadmaps being shared via emails
• sometimes, due to self-stigma, people need to be persuaded that their views matter. One way to do this is by remunerating people for their time in the same way that you’d expect a professional advisor to be paid
• concessionary travel is an issue and some areas have more flexible interpretation of the policy

Key finding: the recruitment process needs to be as inclusive as possible

Supporting evidence:

• things are too “top down” and people with experience should help to decide who participates in the NC
• if there’s going to be clinicians, social workers etc. on the Change Team then this risks limiting the number of people with lived and living experience who actually get a say. The distribution of roles within the NC needs to be carefully considered
• 15 people involved in the Change Team will never represent the vast range of experiences of people throughout Scotland. The NC should not ask participants to represent a cohort of people but instead to advise government based on their own individual experiences
• there is a risk that some voices dominate at the expense of people who are most at risk of having their rights breached. These are people still engaging in services or people who are not getting any kind of support

Key finding: The roadmap needs to demonstrate how the National Collaborative builds on what has come before

Supporting evidence:

• there is a risk that the NC is perceived as yet another SG model to take things back to square one when ’Rights, Respect, Recovery’, ROSCs, MAT Standards haven’t been implemented yet. The roadmap needs to articulate how the National Collaborative is in line with these strategies e.g. the Charter of Rights needs to link to or make reference to the MAT Standards
• the roadmap needs to say more about how the NC will interact with approaches being implemented in local areas e.g. ADP LLE panels
• there is already lots of evidence out there on what’s not working, the NC needs to build on this
• the plan should make reference to previous asks from communities in relation to the exclusion of addictions from the Equalities Act and concessionary travel

Key finding: The roadmap needs to focus on action, implementation and accountability

Supporting evidence:

• the Quality principles got stuck in limbo because they weren’t backed up by implementation. By contrast, the Care Inspectorate Standards for adult health and social care provide enforceable standards.
• the roadmap needs to be really explicit about the role of ADPs
• ADPs are likely to be supportive of the NC but buy-in from big hitters such as NHS and HSCPs might be more difficult to secure. However this is essential if the NC is going to drive change. SG letters to Chief Executives can be used as levers by the ADP
• having a strong communications campaign (digital and non-digital) will be important to ensure transparency and accountability
• the roadmap needs to articulate how the NC will link to workforce development. What difference will a Human Rights Based Approach make if there aren’t any additional facilities or staff?
• there needs to be concrete proposals that make it easy for national groups/ bodies/ government to engage with local activists rather than expecting local activists to come to them

Key finding: the roadmap should adjust its language and terminology to be more inclusive

Supporting evidence:

• the roadmap needs to be explicit on whether alcohol is being included or not within the vision
• the distinction between living and lived experience are not always helpful as people have different views on the separation
• the ‘Core Group’ could be perceived as exclusive and like it’s the only way to be involved in the NC in a meaningful way. This is why we have moved towards calling that group the ‘Change Team’
• there needs to be options for people who might not want to or can’t participate in the Change Team

Annex C: glossary of key terms and acronyms

In almost all of the feedback we received on the first draft of the Roadmap people challenged the language and terminology used. In this version we have tried to remove ambiguities and be clear on what we mean so that everybody feels able to contribute to progressing with the implementation of the roadmap. In doing so, we acknowledge that we are using terminology that may be seen as imperfect. People affected by drugs and alcohol may have a language to express their own experiences which is meaningful to them and this is to be acknowledged and accepted by all. The National Collaborative wants to facilitate a constructive discussion and build consensus through the language of human rights.

Experience of problem substance use