National Drugs Mission Implementation Group minutes: June 2021

Attendees and apologies

Group members:

• Angela Constance MSP (Chair), Minister for Drugs Policy
• Kevin Stewart MSP, Minister for Mental Wellbeing and Social Care
• Maree Todd MSP, Minister for Public Health, Women’s Health and Sport
• Vicky Irons, Dundee Integration Joint Board Chief Officer
• Annemargaret Black, Stirling and Clackmannan Integration Joint Board Chief Officer
• Gillian Ferguson, Glasgow ADP Co-ordinator
• Vared Hopkins, Dundee ADP Co-ordinator
• Dave Liddell, CEO Scottish Drugs Forum
• Justina Murray, CEO Scottish Families Affected by Alcohol and Drugs
• Jardine Simpson, CEO Scottish Recovery Consortium
• Sandra Holmes, lived and living experience representative
• Michael Kehoe, Royal College of Psychiatrists Committee member
• Chris Williams, Royal College of GPs Joint Chair
• David Caesar, Interim Deputy Chief Medical Officer
• Amanda Croft, Chief Nursing Officer 

Attendees:

• Ash Denham MSP, Minister for Community Safety (on behalf of Keith Brown)
• Duncan McCormick, Medication Assisted Treatment Standards Implementation Support Group (MIST)
• Tracey Clusker, Medication Assisted Treatment Standards Implementation Support Group (MIST)
• Elinor Dickie, Medication Assisted Treatment Standards Implementation Support Group (MIST)
• Sharon Mooney, Scottish Government Drugs Policy Division and Medication Assisted Treatment Standards Implementation Support Group (MIST)
• Fiona Robertson, Scottish Government Drugs Policy Division
• Aime Jaffray, Scottish Government Drugs Policy Division 
• Diane McLafferty, Scottish Government Drugs Policy Division
• Graham Thomson, Scottish Government Police Division
• Laura Farquhar, Scottish Government Mental Health Division
• Kim Gallacher, Scottish Government Mental Health Division
• David Kerr, Scottish Government Health Improvement Division 
• Amy Kirkpatrick, Scottish Government Health Improvement Division

Apologies:

• Keith Brown MSP, Cabinet Secretary for Justice
• Shona Robison MSP, Cabinet Secretary for Social Justice, Housing and Local Government
• Martin Coyle, lived and living experience representative

Items and actions

Introduction

The Chair welcomed members and attendees to the first meeting of the Implementation group. Initially meetings are to be hosted virtually via Teams due to Covid-19 with a view to meeting in person once restrictions allow. The implementation group is a forum for turning words into action and ensuring we make the necessary changes happen in Scotland to save and improve lives.

The Chair invited members to introduce themselves.

Terms of reference

Members were invited to discuss the draft terms of reference which had been circulated (paper 1). 

In discussion, the following points were made:

• Annemargaret Black commented that it could be helpful to include some information on the cultural context we are working in and the root causes of problem drug use. The Chair advised that other groups supported by the Scottish Government, such as the Drugs Deaths Taskforce, will analyse the evidence to make recommendations including on the root causes of problem drug use and that this group is to focus on the implementation of recommendations
• Dave Liddell requested that medication-assisted treatment standards (MAT standards) be explicitly referred to and also to include issues around the accountability of Alcohol and Drug Partnerships (ADPs) within the group’s remit
• Jardine Simpson highlighted that the terms of reference should include lived and living experience as a source of expertise who should inform policy and practice

Action:

• Secretariat to review comments on terms of reference and circulate a finalised document 

Implementation of MAT Standards 

The Chair introduced the recently published MAT standards (paper 2) and acknowledged that while not a silver bullet, they had the potential to be a cornerstone in the mission to reduce drug related deaths and improve lives. The Chair reiterated the Scottish Government’s commitment to implementing the standards by April 2022. This is to be supported by significant financial resource, as well as support from the MAT standards implementation support team (MIST).

Duncan McCormick delivered a presentation on the plans for implementation and the support that is available (paper 3). The presentation covered:

• the purpose and structure of the MIST team
• we know what works when it comes to MAT, but currently coverage of MAT is only 35% in Scotland. The MAT standards represent policy and guidance being translated into action
• to deliver the MAT standards will require support and a shift in culture and so MIST are using a Quality Improvement approach
• the diffusion of innovation will require a push before it becomes business as usual and this is where resources, support and leadership (including from the Implementation Group) is vital

Tracey Clusker discussed the various levels of support available to local areas from the MIST team and shared some examples of good work that is already ongoing to share innovation and learning between different areas. 

The Chair thanked Duncan and Tracey for their presentation and invited discusson from the Group. Points discussed were:

• the standards were welcomed and it was remarked that they are comprehensive and, if implemented, should result in quality improvement. There was acknowledgement of the engagement that had been done during the development of the standards
• implementation would be challenging and that inclusion will be vital to successful implementation. There may be concerns about standards filtering down to the front line, and there may be issues around interpretation. For example, ‘recovery’ may have different meanings to different people. It was highlighted that the right treatment for the individual is key
• research from Scottish Drugs Forum’s peer research group which found that only eight people from a group of 95 were able to access help on the same day. There is some reflection on current practice required and a mystery shopping service could assist with this. Qualitative information will be important in evaluating the standards, both on how people who use services feel and staff
• there should be particular consideration given to the needs of women, and women with children who face particular challenges when accessing treatment
• there are also risks around workforce, such as burnout, recruitment and retention which could impact on the implementation of the standards. There is a risk around workforce capacity despite financial resources
• it is important that there are specific staff, the MIST team, to support implementation especially on issues that will be challenging to local areas universally such as information governance. Planning will be crucial to successful implementation. Early progress on standards 1 and 2 should be prioritised
• there was a discussion on the availability of services outside of core hours, and a lack of crisis interventions
• the standards are not solely about opiod harm, but that further research on benzodiazapines and stimulants will be important
• leadership at all levels will be necessary to successful implementation, and everyone should be fully committed to supporting implementation
• there was discussion on the importance of utlilising the experience of people with lived and living experience, and how we can ensure we are working in partnership
• the Chair reiterated the clear commitment that MAT is to be implemented by April 2022 and should be moved on at pace with regular milestones. Progress to be reported at future group meetings

Actions:  

• Dave Liddell to share research on MAT standards with the Group
• MIST Team to engage with Vared Hopkins on support for women and with SDF, SRC and SFAD on utilising lived and living experience
• Secretariat to ensure updates on MAT implementation are included on future agendas

Implementation Group forward look

The Chair invited suggestions for agenda items for future meetings. Suggestions were:

• cocaine and benzodiazapines to be a key item in an early meeting
• women and women’s health
• understanding how different sectors interface for people who use drugs
• workforce
• primary care and mental health services 
• prevalance 

Action:

• Secretariat to schedule a forward look for meetings and distribute with group

Any other business and date of next meeting

The Chair concluded the meeting and advised that minutes and details of the next meeting would be distributed in due course.