By ANGELA CONTANCE

Every life that is lost to drugs is as tragic as it is unacceptable. I offer my condolences to everyone who has felt such a loss, and I offer my determination to turn the tide of this public health emergency.

Families and people with life experience of drug and alcohol problems tell me that there must be a commitment to change and accountability at the very heart of our national mission, and at all levels from the front line to national leaders. I agree, which is why Public Health Scotland has published the comprehensive “National benchmarking report on implementation of the Medication Assisted Treatment (MAT) standards 2021/22”.

I will spend but little time on the areas in which progress has been made, welcome though that progress is. I want to make it clear to Parliament that the overall pace and scale of change is neither good enough nor quick enough.

The medication assisted treatment standards, which were published in May 2021, are designed to give clear criteria and principles to help care providers, and those who will benefit from services, to understand what must be on offer to support people in their MAT and in recovery. The standards should not just be considered as “nice to have”. My view is unequivocal—they must be delivered.

The standards are a demonstration of our commitment to a whole-system approach to care, and are fundamental to our rights-based approach in Scotland.

In recognition of the ambitious challenge that I set local areas through our national mission, we are providing more than £10 million per year in funding for local areas to implement the standards, and we established the MAT implementation support team to provide consistent support across the country. We are providing more practical and financial support than ever before.

The Public Health Scotland report gives us, for the first time, an area-by-area breakdown of where each alcohol and drug partnership is on implementing the standards, with particular in-depth focus on key standards 1 to 5. They are the standards on same-day treatment, informed choice of treatment, assertive outreach, harm reduction support alongside treatment, and making sure that treatment lasts for as long as people want it.

The report also summarises progress on MAT standards 6 to 10. Less data is available on those standards, which rely more on experiential feedback from people who are in services.

Of the 145 indicators; 26 have not been implemented, 25 have been implemented in full, and 94 are partially implemented. That shows that standards are being embedded and implemented on the ground, particularly in relation to informed choice, proactive identification of those who are at risk, harm reduction and keeping people in treatment. In many cases, the service standards are in place within an area, but are not consistent across the whole area for all people.

I am most concerned about the lack of progress against MAT standard 1. All the standards are crucially important and connected, but access to same-day treatment is life saving. In that regard, the Borders, where I visited recently, stands out as a beacon of what can be achieved, so my challenge to other areas is simple: “If the Borders can do it, why can’t you?”

The report includes eight detailed recommendations and some actions that are already being taken. As well as achieving implementation of the original standards themselves, we cannot stand still. The standards will also have to be developed to make them more bespoke for young people, for women and for custodial settings. The recommendations call for immediate improvement plans to set out how each local area will achieve full implementation. Those plans are being developed with ADPs and will be published in August.

I cannot stress enough how vital it is that ADPs fully implement the MAT standards—in particular, standard 1, which is on same-day treatment. We all want people to have the right to treatment, but that right will be for nothing if services are not in place. That is why I am, today, using powers of direction that are available to Scottish ministers under the Public Bodies (Joint Working) (Scotland) Act 2014 to compel local partners to implement the standards.

The ministerial direction has been issued to all health boards, integration authorities and local authorities. It spells out what must be achieved and the oversight arrangements that I am putting in place to hold local leaders to account for implementing the MAT standards fully. The Scottish Government, the Parliament and, most important, communities require a whole-system response across those three partners, and oversight of that will now be done through the following measures.

Improvement plans for implementing the standards will be required in all areas. We will require that they be signed by all chief executives and chief officers. The plans will be informed by the local assessments that are being published in August to supplement the benchmarking report.

The chief executives and chief officers will have shared and visible responsibility for delivering the MAT standards, and they will identify one senior leader to take responsibility for driving the necessary changes and reporting on progress. Most will be expected to deliver quarterly reports on progress. However, for areas that are of particular concern, where drug death rates are particularly high—today’s report shows that MAT standard 1, on same-day treatment, has not been delivered—those reports will be monthly.

The new oversight arrangements that I am putting in place will also strengthen accountability to communities, through the involvement of lived and living experience in the quarterly or monthly reporting that is now required. If necessary, we may also consider further powers to intervene through implementation of the national care service, which will introduce a more formal single framework of accountability. I will provide Parliament with regular updates on progress on implementation of the new arrangements and oversight of implementation.

I do not want to give the impression that no progress has been made. It is clear that some areas are on that journey, including East Ayrshire, South Ayrshire and North Ayrshire. In West Lothian, which I have visited, the Change Grow Live recovery service in Bathgate, which is part of the West Lothian Drug and Alcohol Service, offers same-day treatment, so it has implemented MAT standard 1. I know that that change has made a huge difference to the people who are being supported there. The challenge that lies ahead for West Lothian and other areas is to scale up the level of service across the whole council area.

ADPs and local partnerships are taking forward innovations to help to address drug deaths. One innovation that I know is of interest to Parliament is potential use of safer drug-consumption facilities. I have previously made it clear that we would support work to make such facilities available within the constraints and limits of the law on drugs, which is currently reserved.

Glasgow City Health and Social Care Partnership has been developing such a proposal for some time. It has engaged extensively, and I thank it for its work. Following detailed partnership working between the Scottish Government, the health and social care partnership, Police Scotland and the Crown Office and Procurator Fiscal Service, details of a new service specification have been developed and shared with the COPFS. The specification, which seeks to meet the parameters that were set out in the Lord Advocate’s statement on 3 November, will now be considered by the COPFS. If appropriate, it will then be referred to the Lord Advocate for consideration of any related statement of prosecution policy.

To improve services and embed standards, we need to have the necessary workforce in place. That is why the majority of the £10 million per year funding is targeted at recruiting more than 100 additional staff who will be able to offer services that meet the MAT standards. That increase in staffing is part of our national mission planning for further workforce recruitment and development. I intend to return to Parliament in the autumn to set out our plan to expand and upskill the workforce. Over this summer, we will draw on the experience of people who are at the heart of workforce policy, as part of the expert group, to help to develop and implement the necessary planning.

The standards are not optional extras; they are essential to getting more people into the protection of life-saving treatment more quickly. I pay tribute to local leaders, families, people with lived and living experience, and members of the voluntary sector, who have worked together to deliver demonstrable change on the ground, where it matters most. I thank the MAT standards implementation team for its continuing hands-on support, which it works alongside local areas to provide, and I thank Public Health Scotland for its vital report.

MAT standards are about delivering faster and more responsive services, but they are also about changing hearts and minds, and tackling stigma and discrimination. MAT standards are empowering people to demand the treatment that they deserve. There is no going back—we can now only go forward.

We all need to dig deep to do the hard miles ahead. All senior leaders within and outside Government must pick up the pace and deliver a public health response to this public health emergency, and they must do it now.