NHS Recovery Plan: annual progress update

National Mission to tackle drug-related deaths

Scotland continues to have one of the highest reported drug death rates in Europe. In 2021, Scotland recorded 1,330 drug misuse deaths, the second highest on record. We recognise that the level of drug deaths remains unacceptably high, and are leading a National Mission to reduce deaths and save lives, supported by an additional £250m of investment by the end of the parliament.

Steps we have taken

We have published a National Drugs Mission Plan which sets out our approach to achieve our outcomes, which were developed in collaboration with stakeholders, including people with lived and living experience: preventing people from developing problem drug use; reducing harms from the consumption of drugs; getting more people into high quality treatment and recovery services; addressing the needs multiple and complex needs of people with drug problems and supporting families and communities affected by problem drug use.

In August last year, we launched the ‘How to Save a Life’ campaign and encouraged the public to go to the Stop The Deaths website to learn how to recognise the signs of a drug overdose, receive training in the use of the life-saving medication naloxone and get a free naloxone kit. A total of 28,852 Take-Home Naloxone (THN) kits were supplied in financial year 2021/22, the highest annual total since the beginning of the National Naloxone Programme.

Box 7: Residential Recovery by Aberlour

Children’s charity Aberlour will receive a grant of more than £5.5 million over this parliamentary term to develop two Mother and Child Residential Recovery Houses. The houses are designed to enable children of women with problematic substance use to stay with their mothers during their recovery. Aberlour’s approach to rehabilitation aims to deliver positive outcomes for women and their children. Problematic substance use affects not only the individual but those around them, including family members and friends. Keeping mothers and their children together can enhance the effectiveness of treatment and lessen any harmful impact on children

The first house developed in partnership with Hillcrest Homes will open in Dundee in Autumn 2022. The second house located in Central Scotland will open in 2023. Each house will support four women and their children at any one time.

Source: Mother and Child Recovery Houses – Aberlour

We are investing in services and approaches based on the evidence of what works. This includes working with every locality in Scotland to embed the Medication Assisted Treatment (MAT) Standards, to enable the consistent delivery of safe, accessible, high-quality drug treatment everywhere in Scotland, and rolling out the provision of long-lasting buprenorphine to provide a greater choice of opioid substitution treatment as part of those standards.

Because people need to be able to choose the right form of treatment for them, we have also committed to investing in the expansion of residential rehabilitation by building capacity and expand pathways into, through and out of treatment – and ensuring this is available for everyone who wants it. We are committed to increasing the number of statutory funded placements by 300% in Residential Rehabilitation by 2026 so that at least 1,000 people are publically funded for their placement.

Our framework for holistic family approaches and family inclusive practice sets out principles of how we can improve support for families affected by drug and alcohol use by taking a whole family approach, and we are supporting this with investment totalling £6.5 million per year over the life of the parliament.

Steps we are taking

We know that Safer Drug Consumption Facilities have been shown to prevent fatal overdoses and encourage people to access longer-term help. An initial proposal, within the existing legal framework, has been shared with the Crown Office and Procurator Fiscal Service for consideration. In the event of a positive outcome to work currently being carried out by partners, we will quickly move to establish a Safer Drug Consumption Facility in Glasgow.

Heroin Assisted Treatment is an Enhanced Drug Treatment Service (EDTS) which involves the provision of a heroin substitute to people with longstanding problem substance use under supervised conditions and has been shown to reduce the use of street drugs and increase the likelihood of individuals remaining in treatment. Glasgow opened the first EDTS service in Scotland in November 2019 which is the subject of a large scale evaluation supported by the Scottish Government Chief Scientist Office (CSO) and Glasgow Caledonian University. We committed to supporting further HAT services across the country and continue to work with local areas to explore this.

We are supporting the development of models of care at a national level to deliver drug treatment within primary care. The models of care will support the implementation of MAT Standard 7 (All people have the option of MAT shared with Primary Care). This will be supported by work to increase the number of GP practices that deliver integrated drug treatment services.

In March 2022 we announced a target that by 2024 there will be at least 32,000 people in community-based Opioid Substitution Therapy in Scotland, an increase of 9%. We are also exploring the utility and safety of benzodiazepine prescribing among people receiving OST in Scotland, and a full report is expected in Autumn 2022.

We know that people with substance use problems often face barriers to receiving help for their co-occurring mental health conditions. We are therefore piloting improved arrangements for people with co-occurring substance use and mental health problems. In summer 2021 we commissioned Healthcare Improvement Scotland (HIS) to take forward an ambitious programme to test new approaches to integrating substance use and mental health services in local areas. This work aimed to improve the quality of care, increase access to treatment and ultimately improve overall health outcomes for people with substance use and mental health problems. A separate rapid review into substance use and mental health services which will report in autumn 2022.

Steps we will take

The National Collaborative for Lived and Living experience, chaired by Prof Alan Miller, will lead a process to empower people affected by problem substance use, to enable their voices – and, critically, their rights – to shape policy and decision-making concerning the design, delivery and regulation of drug and alcohol services at a national level; and to set out how the rights can be included in the forthcoming Human Rights Bill to improve the lives of people affected by problem substance use.

Stigma kills people, and we will publish an Anti-Stigma Plan that sets out the role we can all play in ending the exclusion that people who use drugs in Scotland experience on a daily basis. Because addressing this public health emergency goes well beyond improving treatment options, we will also publish a cross-government action plan on tacking the broader inequalities experienced by people who use drugs.

Finally, our recently published National Drugs Mission Plan sets out our approach to achieve our aim and vision through the articulation of outcomes which focus on preventing people from developing problem drug use; reducing harms from the consumption of drugs; getting more people into high quality treatment and recovery services; addressing the multiple and complex needs of people with drug problems and supporting families and communities affected by problem drug use.

These outcomes, alongside six cross-cutting priorities, have been developed in collaboration with stakeholders, including representatives with lived experience. They reflect both the complexity of the challenge we face and the opportunities that a whole-system, whole-Scotland ‘National Mission’ approach will afford.

We recognise that the level of drug-misuse deaths remains unacceptable. Whilst there is so much more work to do, every life saved means one less family grieving and we remain determined to use this halt in the upward trend of recent years as a platform for real change.

Next Steps

This Recovery Plan update shows the progress we are making towards our long term plan to ensure the NHS and social care systems of Scotland recover from the unprecedented impact of the Covid-19 pandemic. We are committed to doing this through a planned programme of investment and reform.

We know that more work needs to be done, more investment needs to be made, and more reforms enacted.

But this NHS Recovery Plan is a solid foundation for our improved health service. Our health and social care system has already, despite the pressures it faces, responded to its ambition with passion, agility, skill and dedication.

At the heart of this response has been the incredible efforts of our workforce, who continue to provide the public with exceptional and compassionate care. They continue to provide this care in a variety of settings whilst also developing and implementing innovations which will pave the way for a more sustainable system, to better face both current and future pressures.

We have challenges before us. They include protecting the most vulnerable this coming winter, to continue to act in the face of the continuing threat of Covid-19, to maximise capacity in the system, to continue to care for the health and wellbeing of our staff, and to ensure that people get access to the right care, in the right place, at the right time. We will do whatever is needed to ensure this happens.

We will continue to work tirelessly to deliver the ambitions set out in this Plan, and will provide a further update of our progress in a year’s time.