National Drugs Mission Oversight Group minutes: September 2022

Attendees and apologies

• David Strang, Chair, National Mission Oversight Group
• Angela Constance MSP, Minister for Drugs Policy, Scottish Government
• Dave Liddell, CEO, Scottish Drugs Forum
• Justina Murray, CEO, Scottish Families Affected by Alcohol and Drugs
• Jardine Simpson, CEO Scottish Recovery Consortium
• Emma Crawshaw, CEO, CREW
• Belinda Phipps, CEO, With You
• Rachel McGrath, Lived and Living Experience Representative
• Dr Susanna Galea-Singer, Royal College of Psychiatrists Committee member
• Laura Wilson, Policy and Practice Lead, Royal College of Pharmacists
• Eddie Follan, COSLA Representative
• Dr Sharon Stancliff, New York City Health Department
• Professor Thomas Kerr, Department of Medicine, University of British Columbia
• 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
• Chris Williams, Royal College of General Practitioners
• Sarah Peat, CREW
• Fiona Benton, SAMH
• Orlando Heijmer-Mason, Scottish Government
• Maggie Page, Scottish Government
• Morris Fraser, Scottish Government
• Sharon Mooney, Scottish Government

Apologies

• Catriona Morton, Royal College of GPs Deputy Chair
• Sandra Holmes, Lived and Living Experience Representative
• Dr Michel Kazatchine, World Health Organisation Regional Office for Europe
• James Docherty, Lived and Living Experience Representative
• Billy Watson, CEO, Scottish Association for Mental Health

Observers

• Alison Crocket, Scottish Government
• Alice Burling-Brown, Scottish Government
• Roz Currie, Scottish Government
• Paul Sutherland, Scottish Government
• Emma Wright, Scottish Government

Items and actions

Welcome and introductions

The new Chair, David Strang (DS) welcomed members and attendees to the second meeting of the National Mission Oversight Group. Apologies received.

DS welcomed members who could not attend first meeting and restated the purpose of the Oversight Group.

Board governance

The minute of the previous meeting on 30 June 2022 was approved.

The action tracker was reviewed, all actions were complete, noting actions 3 and 4, are ongoing.

A schedule of meetings for 2022/23 had been shared with the members of the Oversight Group.

SG update since last meeting

The Minister, who had chaired the first meeting of the National Mission Oversight Group thanked DS for taking on the chair duty of the group, stressing the importance of having a non-Government chair.

The Minister shared her updates from the summer, including an update on the DDTF response, the Annual Report and the publication of the NRS annual drug-related death stats. 

OHM provided a wider update on activities since the last meeting, the key areas included:

• upcoming quarterly publications for suspected drug deaths and waiting time referrals
• national mission plan was published on 9 August 2022 and the first annual report is scheduled for Autumn publication
• a cross government action plan is in progress to expand national mission
• the cost of living crisis
• drug deaths taskforce report, published in July 2022, and SG response
• residential rehabilitation
• harm reduction, including safer drug consumption facility proposal, most recent naloxone distribution publication and Heroin Assisted Treatment programme
• mental welfare commission scotland has resulted in 6 recommendations to improve care for co-occurring mental health and people who use drugs 
• a workforce delivery group been established to identify immediate issues and a full plan to follow
• national collaborative change team update and development of a Clinical Advisory Group to advise across the national mission

Discussion

The group discussed the volume of work happening, however felt that there was not a clear sense of how SG felt about how things were going, referencing MAT Standards implementation. 

The question was raised as to whether there were other areas, out with Glasgow, that were interested in HAT.

The group asked how does the work go towards progress and is there a risk assessment against this work. The Minister advised that SG are aware of what is happening and what isn’t happening and she would assess it as she knows SG are under the bonnet and the situation is deeply challenging.

Action: Secretariat to ensure that a written update is shared with the members of the National Mission Oversight Group, at least two days in advance of the meetings.

Context 

MP shared a short presentation on Drug related death statistics published since the last meeting including the NRS drug death report, the PHS National Drug Related Deaths database and quarterly suspected drug deaths. 

Discussion

The group discussed that there should be a caveat over the last two years of statistics as COVID could still be impacting these. National Drug Related Deaths database report is comprehensive with multiple factors, though unsure how much we can learned as the data is from 2018. 

The question was asked if there were any changes in the prescribing of drugs which may have caused an increase in the methadone statistics. MP advised that there were more people having take-home methadone rather than supervised methadone as a result of COVID which is a potential factor.  MP highlighted an evidence review exploring this issue published by SG in November 2021. 

MAT standards – deep dive

MF presented key points from the paper shared before the meeting on MAT Standards. These standards aim to improve treatment services – ensuring same-day access to treatment from a wider range of medication linked to primary care, mental health and advocacy for other services. The standards also include requirements to support people for longer in services which are trauma and psychologically-informed. The Minister provides parliamentary updates every 6 months with the next due in December 2022.

Discussion

The group discussed why the MAT Standards went down the ministerial route. The Minister said that in the face of public health emergency it was so important to ensure that all delivery partners were fully committed. Issuing a direction is not something Ministers take lightly but, in the circumstances, this path was necessary to sharpen focus on delivery.

DL advised that SDF had carried out a survey of 95 people and only 8 people got same day prescribing. Suggested that RAG system is flawed. He asked if data like this would be available as the MAT standards were being implemented for a cleared idea of how it is progressing.

It was agreed that the standards were very impressive and ahead of other countries. It was suggested that it would be useful to hear more about primary care and the wider NHS treatment services, as during COVID same day prescribing increased, and a wider range of volunteers supported in the delivery of prescriptions. 

Suggestions were made that there were a number of factors that could be holding back progress on the MAT standards. For example, some areas had not been able to provide documentary evidence of success but they believed they had in fact met the prescribing standard.

There was strong emphasis on the need to include the third sector as part of the way to improve services. The third sector can reach people quicker who are disengaged, or actively seek people to provide support. MF suggested that third sector was a significant touch point and one which the Group could consider in more detail at a future meeting.

Action: Officials to engage with LMc regarding third sector participation.

The Group reflected on issues in some local areas where there was a disconnect between statutory services and third sector services. Better connection was often achieved where these services were co-located where third sector and NHS services are not co-located. It was suggested that the Group could look into this in detail in future. 

Action: Secretariat to note suggested topic and follow up with Steering Group.

EF offered to support early discussions regarding implementation plans due at the end of September. 

Action: MF and EF to discuss how COSLA can support SG later in 2022.

Any other business and close

The Minister expressed her thanks to everyone for attending and stressed that SG is serious about getting this work done and taking on board the groups experiences and comments.

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.

The next meeting is scheduled to take place on 15 December 2022 at 3pm.