National Drugs Mission Implementation Group minutes: December 2021

Attendees and apologies

Group members:

• Angela Constance MSP (Chair), Minister for Drugs Policy
• Maree Todd MSP, Minister for Public Health, Women’s Health and Sport
• Ben Macpherson MSP, Minister for Social Security and Local Government 
• Vicky Irons, Dundee Integration Joint Board Chief Officer
• Annemargaret Black, Stirling and Clackmannan Integration Join Board Chief Officer
• Gillian Ferguson, Glasgow ADP Co-ordinator
• Vered Hopkins, Dundee ADP Co-ordinator
• Dave Liddell, CEO Scottish Drugs Forum
• Jardine Simpson, CEO Scottish Recovery Consortium
• Sandra Holmes, Families Lived Experience Representative
• Rachel McGrath, Lived and Living Experience Representative
• Dr Chris Williams, Royal College of GPs 
• Prof Marion Bain, Deputy Chief Medical Officer
• Alex McMahon, Chief Nursing Officer

Attendees:

• Dr David McCartney, Chair of the Residential Rehabilitation Working Group
• Fiona Duncan, Chair of The Promise

Apologies:

• Keith Brown MSP, Cabinet Secretary for Justice
• Kevin Stewart MSP, Minister for Mental Wellbeing and Social Care
• Shona Robison MSP, Cabinet Secretary for Social Justice, Housing and Local Government
• Justina Murray, CEO Scottish Families Affected by Alcohol and Drugs
• Susanna Galea-Singer, Royal College of Psychiatrists 

Observers:

• Aime Jaffray, Drugs Policy Division
• Martin Shanahan, Drugs Policy Division
• Sharon Mooney, Drugs Policy Division
• Nick Smith, Drugs Policy Division
• Karis Deacon, Drugs Policy Division
• Cara McSherry, Drugs Policy Division
• Michael Kellet, Population Health Directorate
• David Milne, Public Service Reform Policy
• Sheree McAlpine, The Promise

Items and actions

Welcome and introductions

The Chair welcomed members and attendees to the third meeting of the Implementation Group. Apologies received and nominated deputies  were listed.

The minutes and actions of the previous meeting were agreed. 

The Chair provided the Group with an update on the quarterly suspected drug death figures which were announced on 14 December 2021. 
while there has been a small decrease in the numbers of suspected drug deaths in comparison with the same period last year, these numbers remain far too high
our focus remains on doing everything possible to turn the tide on this emergency, by ensuring that people are given the right treatment, when they need it

Update on Residential Rehabilitation and the recent publications on the pathways into, through and out of Residential Rehabilitation (paper 2)

Dr David McCartney presented an update on the work that the Residential Rehabilitation Working Group has done on pathways and how the Implementation Group can support this work. The key points were:

• the evidential basis for Residential Rehabilitation is much stronger than people believe, and it is one of the longest established forms of treatment for alcohol and drug problems
• the Working Group has worked with the Scottish Government to publish  a set of papers on Residential Rehabilitation Pathways, including a Guide to Good Practice which informs stakeholders including commissioners, referrers, providers, practitioners and individuals and families contemplating rehab
• while this work has been generally well received, there has been some resistance across the sector and the support of the Implementation Group may help in challenging these views
• the most common arguments against Residential Rehabilitation including the cost, lack of demand and the danger of overdoses after the fact due to a loss of tolerance often turn out to be myths
• if we accept the non-linear course of recovery journeys, we need different types of intervention to be complimentary to each other, rather than in opposition. Joined up Recovery oriented Systems of Care (ROSCs) would allow us to mitigate some of these risks which are present particularly in the transition periods into and out of Residential Rehabilitation

In discussion, the following points were made:

• the Chair highlighted to the Group the letter (paper 3) which was drafted in support of the pathways publications, explaining that the intention is for members to sign this and circulate it, as we cannot publish information and just assume it will reach the correct audiences. Action: Members to circulate this letter around their organisations and networks, and feedback to the Group on how they can utilise this, and other methods, to spread awareness of the work that has been done on pathways and ensure this is developed across the sector
• Gillian Ferguson commented that that ADPs would welcome a framework around the various Residential Rehabilitation services and costs
• Vered Hopkins explained that a key point of focus needs to be on what happens when people return to the community from Residential Rehabilitation, and would welcome more work with local areas on this to ensure that there is a well prepared, long term pathway available. She also noted that a gendered approach needs to be considered
• Dr McCartney commented that the Working Group are heading in the direction of creating a set of standards which would support clinicians in making assessments for Residential Rehabilitation. This, as well as a 5 year plan for embedding aftercare support are both on their agenda for consolidating this work
• Sandra Holmes highlighted the positive impact that the LEAP programme has had on her life, with a focus on the important role that aftercare played in her daughters recovery. She commented that every area in Scotland should have a LEAP programme in place
• the Chair summed up the discussion by commenting that part of the Scottish Government’s National Mission is to create a whole system of care with both opportunity and choice. 
• action: IG Secretariat to issue the letter in support of the publications on Residential Rehabilitation pathways to members     

Presentation on the work the Scottish Government has done with the Promise

Fiona Duncan gave a presentation on the work that has been done by The Promise     and the Scottish Government to galvanize the wider public sector. The key points     were:

• the Independent care review, unlike previous reviews, relied on children and families who were experienced in the care community to ensure that The Promise made would meet their needs as well as the system’s
• to Keep The Promise, we need to build a system that ensures that all kids grow up loved, safe and respected, so that they can reach their full potential
• while The Promise have been unable to access data that would give an understanding of how many drug related deaths are care experienced people, anecdotal data suggests that this is around 1/3. The data that is available shows that care experienced children are twice as likely to use drugs at the age of 16
• a collaborative cross-portfolio environment is required as a variety of different policy teams are working to support the same families, and policy coherence could help in making a real difference to their lives
• there are 100 organisations looking at the system of care in Scotland, with 39 of them asking for data. The Promise is doing work on data capture, with an intention to gather the right data, that will allow for genuine change to be made

In discussion, the following points were made:

• the Chair commented that the work that has been done by The Promise encapsulates how you knit together meaningful collaboration so that the work is lead and informed by the voices that matter the most
• Dr Chris Williams offered to support The Promise in obtaining data around General Practice. Action: Chris Williams and Fiona Duncan to have a separate discussion around datasets for drug related deaths and care experience from GP systems
• Vered Hopkins highlighted that the highest risk in terms of drug related deaths is at the point of transition from children to adult services, noting that a detailed case review written in Dundee is due to be shared
• Fiona Duncan commented on the benefits of such case reviews, but explained that practice often swings in that area, but doesn’t swing across Scotland – highlighting the need to join the dots. 
• Dave Liddell described the training that the Scottish Drugs Forum (SDF) has provided on county lines/sexual sexploitation particularly at this transition point. Suggested that part of the problem is a lack of trust in social services
• Gillian Ferguson asked if Fiona could provide information on how The Promise sequenced and prioritised the vast volume of work it has to undertake. Action: Fiona Duncan to provide some information to the Group on the work that has been done by The Promise on sequencing and prioritising projects – for the Group to consider how this can help us in planning for the National Mission
• Jardine Simpson commented on the difficulties in engaging with both local and national systems
• Fiona Duncan explained that The Promise created a Design School, which every organisation they work with wanted to be part of. This was a means of anchoring The Promise in the system both locally and nationally
• the Chair commented that there should be a deep discussion between Fiona and Scottish Government officials to make sure that The Promise and the National Mission are working together to join up the dots. Action: IG secretariat to explore options for a work to be done between The Promise and SG officials around the ways in which the National Mission ties in with the work of The Promise – and what actions can be brought to the Group in the future
• the Chair explained that she had recently answered a parliamentary question on drug related deaths in care experienced people, but noted that there was clear issues around this data being shared across the sector. Action: IG Secretariat to explore ways in which data sharing can be improved across the sector to ensure that data on the link between drug related deaths and care experience is reported accurately

Delivering services through COVID-19 restrictions

The Chair introduced a discussion on what the Group can do to limit the impact of COVID-19 restrictions on service users. The key points were:

• we know from previous lockdowns that the potential disruption to mental health services, the availability of prescribing and face to face drug services can cause a spike in drug related deaths
• we have learned from the herculean efforts of services to protect service users during these times, and with the cases of Omicron in Scotland rising exponentially, we need to do everything we can to continue access to the right support

In discussion, the following points were made:

• Sandra Holmes highlighted that the festive break is often the most worrying time for families, particularly due to the lack of a crisis team to turn to over Christmas and New year. Sandra also commented on the lack of support for volunteer workers within the sector
• the Chair commented that she is keen for the government to tackle the risks of loneliness that come with the holiday period, and are worsened by the pandemic
• Annemargaret Black commented that it would be helpful for Health and Social Care Partnerships to have a national guidance to avoid a variation in approaches. Action: Officials to consider putting together national guidance for Health and Social Care Partnerships and Health Boards to ensure a joined up approach is taken as the COVID-19 situation develops
• Jardine Simpson explained that a Christmas Support map has already been published and these have been re-issued to recovery organisations. Jardine noted that at times where the system response is to retract and shut down, Lived and Living Experience Organisations recall, and everyone should take some time to consider the immense contribution that these organisations make to the sector
• Michael Kellet highlighted that the continuity of drug and alcohol services were identified as a priority within a letter that was issued to NHS Chief Executives earlier this month. Michael commented that from the discussions he has had thus far, he does not believe there is any appetite to let this slip
• Alex McMahon thanked Sandra for her comments and stated that John Burns has set up a national response group which will oversee the contingency and resilience required to ensure this remains a priority throughout future restrictions. Action: Michael Kellet and Alex McMahon to continue monitoring the impact of COVID-19 restrictions on the provision of drug services, to ensure that face to face services and prescribing continue as close to normal as possible

Any other business and date of next meeting

The Chair invited any other business, there was none.

The Chair concluded the meeting and advised that the next meeting will take place on 16 March 2022 at 10:00.