National Drugs Mission Oversight Group minutes: December 2022

Attendees and apologies

• David Strang, Chair, National Mission Oversight Group
• Angela Constance MSP, Minister for Drugs Policy, Scottish Government
• Jardine Simpson, CEO, Scottish Recovery Consortium
• Emma Crawshaw, CEO, CREW
• Belinda Phipps, CEO, With You
• James Docherty, Lived and Living Experience Representative
• Sandra Holmes, Lived and Living Experience Representative
• Dr Susanna Galea-Singer, Royal College of Psychiatrists committee member
• Eddie Follan, COSLA Representative, Convention of Scottish Local Authorities
• Dr Sharon Stancliff, New York City Health Department
• Professor Tessa Parkes, Director for the Salvation Army Centre for Addiction Services and Research, University of Stirling
• Dr Andrew McAuley, School of Life Sciences, Glasgow Caledonian University and Health Protection Scotland
• Lorraine McGrath, CEO, Simon Community
• Fiona Benton, SAMH
• Kirsten Horsburgh, Scottish Drugs Forum
• Chris Williams, Royal College of GPs
• Orlando Heijmer-Mason, Scottish Government
• Maggie Page, Scottish Government
• Dr David McCartney, Chair of Residential Rehabilitation Development Working Group and Clinical Lead, NHS Lothian LEAP

Apologies

• Laura Wilson, Policy and Practice Lead, Royal College of Pharmacists
• Justina Murray, CEO, Scottish Families Affected by Alcohol and Drugs
• Dr Michel Kazatchkine, World Health Organisation Regional Office for Europe
• Dave Liddell, CEO, Scottish Drugs Forum
• Billy Watson, CEO, SAMH
• Rachel McGrath, Lived and Living Experience Representative
• Professor Thomas Kerr, Department of Medicine, University of British Columbia
• Catriona Morton, Deputy Chair, Royal College of GPs

Observers

• Alice Burling-Brown, Scottish Government
• Lee-Ann Wilson, Scottish Government
• Emma Wright, Scottish Government
• Deanna Francis, Scottish Government
• Kelly McLeary, Scottish Government
• Aurora Malinauskaite, Scottish Government
• Anniek Sluiman, Scottish Government

Items and actions

Welcome and introductions

The Chair welcomed members and attendees to the third meeting of the National Mission Oversight Group, thanking all for accommodating the date change.  Apologies received.

Chair reiterated the purpose of the National Mission and the Oversight Group role is to challenge, provide scrutiny, challenge and advice to Scottish Government (SG).

Board governance

The minute of the previous meeting on 22 September 2022 was approved.

Proposal to publish a summary minute within one month of the meeting to minimise time lapse between the meeting and publication of the minutes.      

The actions tracker has been revised to include advice from the group. An update will be provided in advance of future meetings. Actions and advice summary was reviewed, noting action 3 from meeting 2 will be revisited at a future date.

SG update since last meeting

OHM referenced paper provided in advance of the meeting, highlighting preference to discuss and take any questions and summarised content. The key areas included:

• achievements since the last meeting
• actions for the coming months
• areas of focus until April 2023

Discussion

The group asked for clarification on Safer Drug Consumption Facilities (SDCF) in the update paper. 

Minister outlined that whilst individual members have raised concerns in Parliament, the majority view in Scottish Parliament in favour of SDCF. 

Minister and SG will continue to engage with UK Government, though in the short to medium term will focus on what is possible within powers and legal framework. Unable to speak on behalf of Crown Office of Lord Advocate, final decision is pending conclusion.

Taskforce response progression

MP shared a short presentation on Drug Deaths Taskforce Response. The report is due to be published in January 2023 and will have three sections:

• cross government action plan
• taskforce response
• national stigma action plan

The report will include an appendix which will provide a direct summary response to all 139 actions in the Drugs Deaths Taskforce final report.

Discussion

Group feedback included that Scottish Recovery Consortium (SRC) are included in the Workforce Expert Development Group (WEDG) and if the Taskforce response will include a financial resourcing commitment.

Minister confirmed that SG are currently going through the pre-budget process and financial resources will be included in the report. The budget is expected to be published week commencing 12th December 2022.

Residential rehabilitation – deep dive

DMcC and MP presented key points from the paper shared before the meeting on Residential Rehabilitation (RR) that covered the following areas:

• residential rehabilitation background and working group recommendations
• key achievements 
• governance and oversight 
• monitoring and evaluation  
• future focus and challenges

RR called for in various capacities, including alcohol, from various sources and opinions are not always positive. Drivers for change come from multiple sources including political, press, lived experience/families, advocacy groups and drug deaths agenda. Noted that FM/Minister recognised the need to have as many tools as possible to tackle drug deaths in Scotland.

Discussion

Group discussion included SS asking of the approach to medications and if individuals were mandated to attend RR in Scotland, which they are not.

Generally, the intention of Residential Rehabilitation is for abstinent recovery and it was noted that the biggest cohort was alcohol recovery with relapse prevention medication available. If an individual opts to leave treatment early, there should be access to methadone or buprenorphine and community appointments for follow up. Rehab provision is focussed on those who want to achieve abstinence and is not mandated, however courts have capacity to introduce treatment order, though this is voluntary.

BP described experience of organisation having less drop outs due to better preparation and recovery services remaining in contact with the person whilst in treatment. Multi-disciplinary teams are the better option, though noted this varies by location. Agreement that this is the best approach to ensure decisions being made were clear.

Long term journeys and value based care from a GP perspective was highlighted by CW, and that National Care Service (NCS) legislation on information sharing would help demonstrate in the longer term. DMc observed that there are interesting projects in development and local rehab benefits the community by working with people.

Aftercare and how decisions are made when allocating places as those who as individual’s experiencing homelessness described by LMc. These individuals are often not known to multi-disciplinary teams and if they can access RR, discharged to B&B or hostel accommodation. Dual diagnosis and complex trauma are often masked by substance use which is the biggest factor for the Simon Community. DMc outlined that there is variation in aftercare, however, the RRDWG Pathways sub-group is exploring recovery housing to scope recommendations for SG. Agree that aftercare needs to be clearly understood, defined expectations and delivered over a longer period of time.

Approach to stabilisation units and how this is being approached was highlighted by KH. Some residential rehab providers require that the person needs to be abstinent of have significantly reduced usage before entry to RR. DMc reflected that this can pose a risk and where there is little rehab support, it would be best to redirect the individual in these cases. This will form part of the principles RRDWG are developing. Minister added that stabilisation has been identified as a gap in treatment services and this will be addressed at the start of the new year.

SGS posed if there were any thoughts on how to link better with Mental Health whilst in treatment for patients with dual diagnosis. DMc provided context on trauma approaches and that vast majority of services highlighted that staff are trained, though reassured, there is always scope for improvement. Trauma often disclosed for the first time in RR. Wide variation in terms of multi-disciplinary teams though the Service Directory will look to match people to the right treatment for them.

JD provided own experience and commented that access to RR is not that complex – provide people with what they are asking for and the autonomy to make own decisions - there will always be a chance of relapse and discussions are veering in a different direction when discussing efficacy of rehab. DMc agreed and referenced SRC/SG research results showing the same themes.

AMc provided context on research perspective and the papers published in the last 12-18 months have been helpful and observed this is the biggest investment seen for RR. An opportunity to learn was apparent due to the gaps in mortality studies and understanding of the impact of the investment on mortality. DMc agreed that there is little in Scotland on this area though there is a paper scheduled for publication in 2023 on general outcomes though will be based on a small sample. Research into this would be helpful. Additional commentary from DMc included exploring what happens if the risks are accepted and mitigated for people discharged from rehab and normalise relapse as part of the process. 

SS highlighted concerns in RR with access to medication and the increase in stigma. Experience in New York has been that detox units had switch to stabilisation where people were admitted for approximately 5 days to move from “street” drugs to OST. However, there is no accommodation to place people after the stay. Experience of providing Naloxone training to residents resulted in a life being saved within two weeks.

Minister reflected on discussions and comments from the group agreeing with JD and simplicity in approaching access to RR, this is why publishing pathways to access treatment were necessary to make the process as simple as possible and reiterated that £100m investment was always for RR and aftercare. Publishing quarterly reports ensures areas are held accountable noting that research highlighted those who would benefit the most are those who often find it the hardest to access. Agreed that LEAP is an excellent example of what can be achieved though options with partners in the third sector and other, such as Phoenix Futures, need to be considered to provide service diversity. 

Chair queried the capacity and need. 650 beds and 1000 placements and how short are we currently. DMc confirmed parameters set by SG, confirmed by MP that financial modelling was undertaken to set the ambitious targets. DMc advised that some areas report no demand, while others, demand exceeds supply of beds though the specifics are difficult to answer. SGS added that some studies indicated for every 100 people, 10 are likely to need RR with some studies applying safe assumptions to estimate.

AS echoed MP comments and added that measuring is required, though PHS are undertaking an evaluation of RR and there are different levels of population that can be measured, though this information can be shared with the group when progress made.

Chair invited the group and DMc to highlight an additional questions, comments or feedback. DMc added perspective on detox in that is should not be offered on its own as it is a procedure, not treatment and reiterated exploration of mitigating risks and how best to take that approach.

Any other business and close 

The Minister expressed her thanks to everyone for attending and for providing detailed discussions. We are looking forward to the challenge next year and for the group to continue to hold SG to account. 

The Chair reminded attendees that should they have any items that they would like to add to the agenda for the next meeting, they should let the steering group know in advance of their next meeting on 2 March 2023.

The next meeting is scheduled to take place on 23 March 2023 at 3pm.