National Mission on Drugs: annual report 2021 to 2022

2. Cross Cutting Priorities

2.1 Overview

There are six priorities which cut across all our work. This chapter outlines the progress made in 2021-22 for each priority and next steps in delivery.

2.2 Progress in 2021-22

2.2.1 Lived and living experience

Everyone has the right to participate in public life. This includes the right to meaningful participation in the design, implementation, and assessment of drug laws, policies, and practices, particularly by those directly affected.

We are committed to ensuring that the voices and rights of people with lived and living experience are at the centre of policy and decision making. In January 2022, the Minister for Drugs Policy announced the appointment of Professor Alan Miller to lead a National Collaborative which will develop and implement a human rights based approach (HRBA) and support SG in delivering this commitment. Dedicated funding of £0.5 million was provided for the establishment of the National Collaborative.

ADPs have been working to develop meaningful ways to involve people affected by substance use in decisions made locally and an additional £0.5 million was allocated to ADPs in 2021/22 to progress this work. These are sometimes called Lived and Living Experience Panels (LLEP) which serve to draw attention to the needs and issues within the locality to the respective ADP Strategic Group and help improve the quality of policy and services. For example, in Fife the LLEP was involved in the process of commissioning a recovery advocacy service from an initial funding bid to the Drug Deaths Taskforce (DDTF) to subsequent tendering and commissioning. Fife LLEP will be involved in the continued evaluation of this important provision.

LLE panels are being supported by Scottish Drugs Forum (SDF) to achieve improvements across the range of human rights indicators; support people to participate in the National Collaborative core group and provide access to SDFs learning and development.

Lived and living experience is also embedded in MAT standards with an experiential measure forming a key pillar of development and monitoring. The experiential work was developed during 2021/22 by a MAT Q (quality) team which itself includes lived experience representatives, and is delivered by Scottish Recovery Consortium (SRC).^[3]

The voices of families has also played an integral role in the development of the National Mission as highlighted in the Ask The Family report from Scottish Families Affected by Alcohol and Drugs (SFAD) published in March 2021.

2.2.2 Equalities and human rights

People affected by drugs and alcohol (including families, friends and support workers) often face many barriers to the recognition and realisation their human rights.

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 which the National Collaborative will implement.

The National Collaborative will 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. This will build on the MAT Standards which already reinforce the rights-based approach by ensuring individuals have choice in their treatment and are empowered to access the right support for them.

Effective implementation of the Human Rights Bill will require human rights capacity-building through training and development for people responsible for delivering services.

REACH Advocacy were awarded funding through the National Mission funds to deliver training on the Human Rights Based Approach in relation to the MAT Standards and an SQA Approved Advocacy Practice Award. Since 2020, they have delivered 49 workshops with 534 participants from frontline services. This included working with 16 ADP areas. They have also supported 46 people through the SQA Award.

2.2.3 Tackling stigma

Stigma can manifest in many ways and in many settings and stop people accessing the support they need. A stigma charter encouraging organisations to consider how we can work together, and individually, to create a stigma-free Scotland.

The right to health means that diverse treatment and recovery services, of sufficient quality, need to be available, affordable and accessible to all. It also means that people who use drugs should have equitable access to all other types of services.

In order to challenge the stigma and prejudice surrounding substance use, the Scottish Government facilitated a media campaign, between December 2021 and March 2022, over a number of outlets including: TV, radio, digital, and press outlets. Research was conducted pre and post-campaign to assess the campaign's effectiveness and the impact on public perceptions towards those who use drugs.

The campaign was found to be successful with an improvement in public attitudes. Specifically, agreement that people with experience of problematic substance use should receive help increased from 87% to 91%. Another example of a positive outcome is agreement that problematic substance use is a health condition increased from 62% to 75%.

The TV ad can be viewed here: YouTube

The DDTF developed a stigma charter that all organisations, including businesses and community groups, can use: Challenging drug and alcohol stigma | NHS inform

In 2022/23 we will be formally responding to the final DDTF report. This will include publication of a cross government programme of work and a stigma action plan.

2.2.4 Surveillance and monitoring

Accurate, relevant and timely data underpins an evidence-based approach. We are committed to evaluating, learning as we go and continuously improving.

In response to the COVID-19 pandemic, Public Health Scotland stepped up their surveillance around drug treatment and harms and this work has been continued and integrated into the COVID wider impacts dashboard^[4] and has been given additional funding to support the development of RADAR (Rapid Action Drug Alerts and Response), Scotland's drugs early warning system. Using innovative data collection and validation methods, RADAR assesses and validates information to allow for the rapid and targeted deployment of interventions and prevent and reduce the risk of drug-related harm.

Public Health Scotland have also been supported to develop other vital surveillance and data work including drug data quality support and the development of a new prevalence estimate for problem drug use in collaboration with the University of Bristol which will give us an essential understanding of the size and shape of Scotland's drug problem.

Throughout 2021/22 PHS has also been progressing a major programme of data linkage which will initially draw together health datasets to build a valuable understanding of the wider health and social care needs of people with drug problems. Early discussions have also taken place to explore the possibilities for further linkage with non-health datasets.

In addition, a team at Queen Elizabeth University Hospital in Glasgow have received funding to support a new hospital based toxicology surveillance study to better understand drug harms presenting in emergency departments.

In September 2021, Scottish Government published the first 'Suspected drug deaths in Scotland' report.^[5] This report is published quarterly and focusses on management information from Police Scotland to provide a timely indication of current trends in suspected drug deaths in Scotland. Statistics from National Records of Scotland are also presented for wider context.

2.2.5 Resilient and skilled workforce

A wide range of professions are involved in supporting people who use drugs and it is vital that services attract, retain and support their staff to have the right skills and knowledge. In 2021, the Scottish Government undertook robust research to fully understand prevailing workforce challenges.

This research – 'Scotland's Alcohol and Drugs Workforce: A Compendium of Mixed-Methods Research' detailed challenges in three key themes: recruitment; retention; and service design.

In relation to recruitment, the report found that whilst vacancy rates were high across health and social care; these were even more pronounced within the alcohol and drugs sector. In relation to retention a significant association was found between caseloads and sick days. Finally in relation to service design, the research highlighted that there currently exists wide geographical variation in the way services are designed and the type of services which are available in local areas.

The research was shared with a range of stakeholders and formed the basis of discussions on how to tackle these challenges – foundations for the working group are being taken forward in 2022 – to deliver immediate improvements at a pace commensurate with the ongoing public health emergency.

2.2.6 Psychologically informed

People struggling with drug problems have often experienced trauma and have co-occurring mental health challenges, therefore, a fundamental part of a recovery orientated system of care is psychosocial support and our MAT standards include a commitment to psychological support and trauma informed care.^[6] (See Outcomes 3 & 4)

The Scottish Government's ambition, shared with COSLA and many other partners, is for a trauma-informed and trauma-responsive workforce across Scotland,^[7] ensuring that services and care are delivered in ways that:

• are informed by people with lived experience
• recognises the importance of wellbeing in the workforce
• recognises where people are affected by trauma and adversity
• responds in ways that prevent further harm
• supports recovery
• can address inequalities and improve life chances

In 2021, a network of 'Trauma Champions' was also established, this includes senior leaders from across local authorities, health boards and key community planning partners who work collaboratively to influence change across local areas. The Trauma Champions network is supported by the Improvement Service.

The National Trauma Training Programme (NTTP) provides accessible, evidence-based trauma training resources developed by NES and informed by experts by experience, including a trauma-informed leaders component.

£3.2 million of NTTP funding was distributed to all local authorities in 2021/22 and 2022/23 to work with community planning partners to further progress trauma-informed services, systems and workforces.