National Mission Oversight Group minutes: December 2024

Attendees and apologies

 

• David Strang, NMOG Chair
• Sally Amor, Lived and living experience representative
• Stephen McCulloch, With You
• Justina Murray,CEO of Scottish Families Affected by Alcohol and Drugs
• Chris Williams, Royal College of GPs Deputy Chair
• Kirsten Horsburgh, CEO of Scottish Drugs Forum
• Laura Wilson, Royal Pharmaceutical Society
• Lorraine McGrath, CEO Simon Community
• Steph McCutcheon, Scottish Government
• Eddie Follan, COSLA
• Joanne McEwan, Police Scotland
• Emma Crawshaw, CREW2000
• Iain Smith, Keegan Smith Law

Also attended    

• Laura Zeballos, Scottish Government
• Maggie Page, Scottish Government
• Alison Crocket, Scottish Government
• Chloe Poole, Scottish Government
• Georgie Alford, Scottish Government
• Ray Buist, Audit Scotland
• Jillian Matthew, Audit Scotland
• Benjamin McElwee, Healthcare Improvement Scotland
• Chanpreet Blayney, Healthcare Improvement Scotland
• Rachel King, Healthcare Improvement Scotland
• Diane Hekerem, Healthcare Improvement Scotland
• Julia Martineau, Dundee Health & Social Care Partnership

Apologies

    Ms McKelvie, Minister for Drugs and Alcohol Policy

• Susana Galea-Singer, Royal College of Psychiatrists
• Tracey McFall, Scottish Recovery Consortium
• Valerie White, Public Health Scotland
• ACC Paton, Police Scotland
• Andy McAuley, Glasgow Caledonian University
• Hannah Carver, Stirling University
• Lorraine McGrath, CEO Simon Community
• Nichols Phin, Public Health Scotland
• Sandra Holmes, Lived and living experience representative
• Billy Watson, Scottish Association for Mental Health
• Paul Johnston, Public Health Scotland

Secretariat

• Paul Sutherland, Scottish Government

Items and actions

Welcome and board governance

The Chair welcomed members and attendees to the eleventh meeting of the National Mission Oversight Group (NMOG). Apologies were noted.

The Chair reiterated the meeting would focus on the Alcohol and Drug Services Report published by Audit Scotland on 31st October 2024, MAT7 implementation and GP engagement and MAT9, including the implementation of the new mental health protocol.

The minute of the previous meeting on 19 September 2024 was formally approved. The summary minute for the previous meeting has been published on the website.

The Chair introduced new Deputy Director of the Drugs Policy Division, Laura Zeballos, to the group.

SG update since last meeting 

The Chair handed to LZ to provide the Scottish Government update since last meeting.

LZ highlighted the achievements since the last meeting of the NMOG in September 2024, highlights included: 

• The launch of the Charter of Rights on 11th December, 
• The Cabinet Secretary having attended the Cross-Committee on Tackling Drug Deaths and Drug Harm on 14th November, 
• Audit Scotland having published their updated report on Alcohol and Drug services, and the Scottish Government having provided a formal response to accept the recommendations. 

LZ updated on the progress of the Delivery Group and advised that ‘Meeting zero’ will take place on 14th January 2025. LZ also advised the group that, we will be publishing the National Drugs and Alcohol Workforce Capability Framework and the prisoner healthcare HEAT map in March 2025.

LZ updated the group regarding the delays in opening the safer drug consumption facility, mainly as a result of final commissioning activities and water testing. She noted that we are hopeful that the site will open in early 2025.

Discussion 

Members raised concerns that Scottish Government may not be flagging up areas of work where there are concerns or we are lacking progress. It was highlighted that there has been a lack of recent reporting on progress made for stigma. 

Members were assured that stigma remains a priority and as a cross-cutting theme, does not just sit as one stream of work. Scottish Government agreed to add a section to future updates on areas of work that may require the attention of the group.

Presentation - Alcohol and drug services report published by Audit Scotland on 31 October 2024 

Jillian Matthew and Ray Buist gave a presentation to the group on the alcohol and drug services report that was published by Audit Scotland on 31st October 2024. 

The full report was shared with the group in advance of the meeting. 

Key points from Audit Scotland presentation were:

• The audit looked at how effectively Scotland’s alcohol and drug services are delivering the Scottish Government’s strategies:
• How well are current leadership and accountability arrangements supporting the effective delivery of the Scottish Government’s drug and alcohol strategies?
• How responsive are drug and alcohol services to the needs of people using services and is this evidenced in outcomes and performance data?
• How effective are the funding arrangements for drug and alcohol services for achieving objectives in national strategies, and what is the balance of investment across different types of services?

Key messages

• The number of people dying in Scotland because of alcohol or drug use remains high compared with the rest of the UK and Europe, despite funding more than doubling over the last ten years. Balance of focus has shifted from alcohol harm to drug harm.
• Progress has been slow in implementing some key national strategies, including those set out in the Scottish Government's workforce action plan and stigma action plan.
• Significant barriers to accessing treatment remain, such as stigma and waiting times, and better joined up working is needed to provide person-centred services to help people access and stay in treatment. Services focus on those at highest risk with limited focus on prevention.
• The alcohol and drug workforce are key to supporting people but is under immense strain. The focus on treating high numbers of people in crisis means there are limited opportunities to plan for the long term and invest in prevention.
• People with lived and living experience are increasingly involved in shaping services, but this varies across ADPs and there is limited involvement in strategic planning.
• The Scottish Government has yet to undertake an evaluation of the costs and effectiveness of alcohol and drug services to determine if they are delivering value for money.

Recommendations

• Work with key stakeholders to increase focus and funding on alcohol-related harm whilst continuing to tackle drug-related harm.
• Develop a transition plan for the ongoing funding and sustainability of alcohol and drug services after the National Mission ends in 2026.
• Clarify accountability of alcohol and drug service providers and other statutory services that are collectively responsible for improving outcomes for people experiencing alcohol and drug harm.
• Set out ambitious but realistic timescales for delivering key national strategies and putting in place robust and proportionate monitoring and reporting.
• Invest in developing and implementing more preventative approaches in collaboration with partners in the public and third sectors.

Presentation - Scottish Government response to Audit Scotland Report   

Maggie Page (Unit Head, Drugs Strategy Unit) spoke briefly on the Scottish Governments response to the Audit Scotland reports and the work that has already been carried out.

A paper outlining the Scottish Governments response was also circulated with the group prior to the meeting.

Key messages from this were:

• We are working closely to develop UK-wide clinical guidelines for alcohol treatment services by the end of 2024, putting the clinical response to alcohol problems on a more equal footing with drugs.  
• The National Mission has set strong foundations across Scotland, and we are now supporting partners in their long-term strategic planning to maintain and build on those foundations.  
• Public Health Scotland and Healthcare Improvement Scotland are working together and with us to support and build Alcohol and Drugs Partnership leadership across Scotland.
• As we enter the delivery intensification phase of the National Mission, we will implement a new strategic Delivery Group, with chief executives from our key delivery partners.  

Discussion - Alcohol and drug services report published by Audit Scotland on 31 October 2024

Members suggested that we should provide a separate adolescent service for children and younger people aged between 18-25. It was also highlighted that despite the report showing an overall drop in access to services, some services have seen a 250% increase in referrals. Interest was expressed by some members in the other barriers experienced in engaging with services as there has been an increase in presentations by homeless people. 

Concerns were raised that services are still focusing on opiates and should now start looking at stimulants and alcohol instead and also that the whole system is designed around opioid use and is neglecting other drug related harms. 

It was noted that the levels of data ADP’s are required to capture is unsustainable. It suggested to the group that the next couple of years could see huge role for AI technology to play a part in improving reporting burdens in the healthcare sector.

Presentation on MAT7 – All people have the option of MAT shared with Primary Care

Chris Williams, deputy chair of the Royal College of General Practitioners delivered a talk to the group on MAT7, with a particular focus on GP engagement in its delivery. 

Key points of the presentation were:

• GP’s are well placed in their local communities to facilitate the delivery of MAT7. GP’s can advocate for patients and can develop current and continuity care as they have multidisciplinary team.
• There may be a need to change the dynamics of MAT7 to avoid over medicalising. 
• The structure of GP surgeries mean that the appointment systems can cause difficulties for potential services user. 
• Currently the Chief Medical Officer is conducting research on the demographic of people that they should be seeing. These are people that, for easily demonstrable reasons (stigma, homeless, in and out of prison), the system doesn’t treat well.
• Enhanced services are one way to deliver the contact measures required for people from disadvantaged backgrounds. This would not just be GP but for any other type of care provider. However, it could mean GP’s and other staff members are taken away from core practice needs and there is not enough money and resources for this to happen.
• There may be a difficulty in upskilling GP’s and practice staff alongside their existing surgery pressures and there are questions to ask around current knowledge and confidence gap. 
• The RCGP offers a 2-part certificated course on the Management of Problem Drug Use. Part 1 of the course is inexpensive and is a good way to get into and sense check what is already being done within surgeries. Part 2 of the course is more specialised and is more aimed at GP’s.

Discussion –MAT7 presentation delivered in item sixThe chair welcomed comments and discussion on CW’s presentation.

Members shared their experience of working collaboratively with GP colleagues and also confirmed that post-GP care will fall under enhanced GP services which could affect MAT delivery.  Concerns were raised that GP’s are already so stretched and cannot agree to taking on anymore. It was also suggested to the group that pharmacists be involved in providing enhanced services to allow an additional level of triangulation (with GP’s/ further care). This could be supported by putting pharmacy staff through the certificated course on the Management of Problem Drug Use (part 1) to make an impact and also become a core service 

One member voiced that they are seeing patients with more complex needs and are finding that some GP surgeries vary on accepting these patients due to workloads and risk. It was also suggested that an important strand of the enhanced service is choice, i.e. people choosing where they receive their prescription from. One member shared their positive experience of having a good working relationship with a local GP and the benefits of shared information and feedback and suggested this could be used as an implementation model. Another member expressed positivity for when family members are referred to by a GP and we should explore ways to make sure more GP’s know about that they can do this. 

Presentation on MAT9 - All people with co-occurring drug use and mental health difficulties can receive mental health care at the point of MAT delivery  

Benjamin McElwee, Rachel King, Diana Hekerem and Chanpreet Blayney of (Health Improvement Scotland) attended the meeting to deliver a presentation to the group MAT9 and the work being undertaken to deliver the new protocol.

Presentation will be shared with group after the meeting. Papers supporting the presentation were shared in advance of the meeting. 

Key points of the presentation were to outline the recommendations from the Rapid Review of Co-Occurring Substance Use and Mental Health Conditions in Scotland:

• Each area to have an agreed protocol in relation to the operational interfaces between mental health services and substance use services owned and monitored by a responsible individual at a senior management level, with clear oversight of both service areas
• The risk of harm and death are increased in the context of polysubstance use, stigma and exclusion
• Prevention, harm reduction and treatment interventions should be adapted to respond to the high prevalence of cocaine and benzodiazepine involvement in drug harms.
• What the protocol covers:
• To align activity and priorities with strategies and change occurring within the health care system
• To develop more joined up approaches in relation to assessment, understanding needs and access to services roles and responsibilities across services and hoe communication should be used to ensure seamless care.
• To create strong leadership that supports ongoing implementation and improvements across services, and a collaborative and enabling culture is fostered.
• To ensure that processes and changes are embedded and sustained through the development of positive relationships across services and a strong, skilled workforce.
• To develop an accountable governance structure focused on learning with robust oversight and auditing, that included governance systems and processes which are people-led and promote shared decision making.

Discussion: MAT9 - All people with co-occurring drug use and mental health difficulties can receive mental health care at the point of MAT deliver

The chair welcomed comments and discussion on the MAT9 presentation and asked how this new protocol is being received and enquired if there has been any reluctance to implement this given the time/ resource constraints. It was advised that they are keen for this to be looked upon as a self-assessment tool rather than a further reporting tool.

Members stated that this has been about for a long time and that it will be good to see results. Concerns were raised that there is some unintentional language used that could create system stigma. 

It was flagged that front line police officers need something tangible to signpost individuals to services and care. 

Any other business and close 

The Chair thanked attendees for attending the meeting.

The Chair reminded attendees that, should they have any items they would like to add to the agenda for future meetings, they should let the steering group know.

The next meeting is scheduled to take place on Thursday 13 March 2025 in St Andrew’s House, Edinburgh. The proposed