Thomas Jefferson said, a well-informed electorate is a prerequisite for democracy. The following program is part of the series, Influencers and Media Makers. A number of years ago, CCTV sat down with some of Vermont's most influential voices in media, news, and information access to understand their perspectives about the role of media in democracy and how their decisions shape the way we as Vermonters receive information. Much has changed since our first interviews. The people, the technology and social media, the political landscape, and so much more. Fast forward 20 or so years, and in collaboration with Leadership Champlain, we are revisiting the topic with a focus on what has changed, gaps and challenges across geographic, language, and socioeconomic boundaries. The conversations you will hear with today's gatekeepers provide important, varied, and insightful context to the media in Vermont today. Welcome to our segment on the involving role of media and the necessity of an unfettered press for a healthy democracy. How do you respond to that generally in your role as reporting for VPR and in Vermont? Yeah, obviously I'm a big fan of freedom of the press, press access to things, but in terms of the role media plays in democracy, I think disseminating information is one of the kind of higher points of things that we do, you know, emergency situations, right? Like the COVID-19 pandemic is a great example. In the early days, I was doing a lot of, you know, what is the health advisories? What does the health department say? What does the governor say? What are the things that people need to know in order to make decisions so they can stay safe? That's like one certain area, particularly I think in broadcast media that is very common because it's so immediate. But one of the other sides, which is when I'm probably more passionate about, which is the idea of holding government and public officials and large institutions to account institutions that have a lot of power and sway in people's lives and being able to scrutinize actions that they do to make sure that they're behaving and performing in a way that's responsible and helpful to the public. So the sort of, you know, education information side of things but also the accountability side are very important. I like the accountability side in my work, but, you know, the information is important too. Absolutely. And getting into the role of democracy, how does VPR play a hand in helping people make voting decisions? Yeah, I'll use the 2020 election as just kind of a case study because, as you remember with the pandemic, there was all the vote by mail and sort of early election or early voting. And so we wanted to make sure that people had all the information they needed to know how to vote by mail, how to do that so that, you know, correctly and also sort of explain how it works, why it's safe, why they should trust that their vote is counted and try to sort of push back on a lot of the misinformation that was coming out around that time. And that was, and as a statewide news organization, we have a great responsibility in doing that as well because we can reach, you know, every part of the state, every corner of the state and that's a big responsibility and so trying to make sure people not just know who the candidates are, I mean, there's that side of it as well but I think making sure people understand how they can actually participate in helping foster that participation is an important civic role that media organizations have. And knowing that there is a tumultuous national political environment, how does VPR balance covering that versus state and local issues in your role? Yeah, the, you know, thankfully we're a statewide news organization so the way we think about national news kind of is how does national filter to the state level. You know, sometimes shows that we have like Vermont tradition, maybe we'll take something that's happening nationally and invite people to have a conversation about it and that can be a really powerful way for people to sort of talk about things that are happening on a larger scale but really like our reporting is focused on things that are happening here in Vermont. And that isn't to say that there aren't divisive things that happen in the state but I think for me being able to focus more on what's happening here helps kind of stay a little bit out of that prey and really trying to stick to rigorous like back based reporting and not getting too drawn into just having stories that are just kind of, I don't know, fights for the sake of fights I guess but things that I think are useful for people to know about like I said before about how their government works or how people make decisions and that have power. Great. Yeah, so building on that how does local media address those issues of partisanship, bias, ideology and propaganda when they do permeate into the local issues? Yeah, I think the biggest thing is to be back based, to be led by facts and to not get to and to not kind of fall into the both sidesism sort of thing like where if you have one perspective you have to have the opposite perspective and sort of dividing everything into black and white issues. There's also, I mean there's a lot of gray and nuance and complexity but I think in terms of some of the things that we're really challenged by right now as a country and a world there's not really like a both sides to those issues. Climate change I think is an example where you saw in the last decade or so it went from news organizations always having a person who believes in climate change and someone who thinks climate change isn't real and sort of putting those two sides up to each other like it was a debate. Whereas now news organizations say climate change is real and they don't give weight to the people who are denying climate change in the same way because all the facts and the science says that human cause climate change is leading is going to lead to some pretty catastrophic changes here and instead of, and it's you know to our detriment to say that people that say that's not happening is true and that's a hard thing for news organizations especially in the US to do since there's this idea that we have to be objective and down the middle and that's just not necessarily the case in a lot of these bigger stories like climate change I think is really one of the big examples from the past where you saw news organizations shift the way they talk about climate change because of following the facts. Yeah. Was this an institutional change at VPR that was communicated in any way or implemented in any way or was this just kind of the wider media following some kind of trend? You know I'm trying to think of what conversations we had at VPR I mean we have a dedicated climate reporter right now you know I think generally in my time in the seven years I've been reporting like a lot of news organizations were starting to kind of shift towards more of that approach not just locally but nationally that you know that climate change you know is real it's happening and we need to not so much cover a debate over the science but you know say the science is here and here's what is going to happen if we don't do anything about it so I think there's a kind of a confluence of both conversations locally and then the broader national and international media as well. Interesting to see that interplay there. Yeah there was something else that we kind of picked up on a side conversation that we wanted to include as we before we move on. I don't know that I recall I think Pete you had some points but you can certainly, okay. Okay great. And the audio is good just before we move on. Okay great. So in making some of these decisions what do you choose to highlight in a political report and how are those choices influenced? Do you follow competition or popular trends? Not only in how you report or exactly what you're reporting in Vermont. Probably not the best reporter to ask about that because I'm not I don't know that I'm the most competitive reporter I don't I think a lot of the competition in journalism is a little bit like internally created like we are creating competition to compete with other news outlets and often the only people that really care about that who gets a story first are other journalists and I don't know that that's the most healthy thing for democracy to be driven by trying to out scoop some other people. So I would rather work with other reporters especially in Vermont which is a smaller state we have a very I think robust media ecosystem for such a small state but that also you know it's not huge and you know instead of having a bunch of this you know reporters devoting time to covering the same press conferences where we're all going to write the same story wouldn't it be better to share some of those resources and have one or two people covering that sharing that story which is the same story we're all going to write and then people can focus on many other things that are going uncovered. You know there's a criticism right that journalism that the media doesn't that we miss stories and that's certainly true and part of that is because there's a tendency to all cover the same things because you're trying to compete with everybody and so you you miss things because you we don't have infinite resources so I'm very interested in trying to use the resources we have to cover more and to cover better and cover more in depth and to do longer more investigative stories or even just more nuanced and detailed stories about where we're living to help people not just make informed decisions about voting but to feel more confident I mean not necessarily confident but to just know the place they're in better and know when things are good and also know when things are not good. Interesting, yeah. Would you say that BPR has a certain subscriber base that you're looking for stories that would better suit your audience or are you trying to remain in those other ways as objective when it comes to selecting those stories? Like what do you mean in terms of trying to find new audiences I guess? Yeah, I wonder, you know, BPR often has a bit of a bias against BPR as a news organization for being kind of particular in the way that stories are shared and who they're shared for sometimes a more academic kind of experience and so yeah, I wonder if those are the types of stories that BPR seeks out or if that's just a nature of Vermont and the whole or if there are other ways that BPR is looking at branching out to other ways of reporting and other audiences? Yeah, I mean, that's something that we're talking about a lot. Something I've thought about, you know, a lot of things are focused on more of an academic, white, educated audience and to truly reflect the state as a lot more, it is more diverse, you know, racially, economically, socially, politically than what the traditional public radio listener might be. And so I think we're trying to figure out how best to do that. When I think about it, it's probably, you know, slowing down a little bit and spending a little bit more time building trust within some of the communities that maybe don't trust a place like BPR as much. You know, younger audiences, you know, more racially diverse audiences, different levels of economic status as well. How do you sort of get to know what are the issues they care about and what actually want to know about is that you have to spend time with them and yet they have to trust you and they have to feel some sense of being reflected in the work and not just sort of being... It's almost like this idea of telling a story as opposed to telling a story like at them or about them. And that's a, I think, often journalism rewards sort of people just sort of parachuting in and dropping in, even though I think, you know, as a local organization we don't do that as much. You know, the New York Times does that a lot and we're like, oh, we don't do that as a BPR or state organization, but like we do end up doing that sometimes. And so how can we change our ways to do that less? I'm still trying to figure that out. I think slowing down a little bit and spending some time and trying to get to know people and have them building trust with them. But those are all kind of like squishy things. It's hard to know if we're doing them yet. Yeah, I agree. I think on a local scale it is a little easier to follow those changes, but they do happen rapidly. And that really segues into our section on the news, desert and access. And we define that as a community, either rural or urban, with limited access to the sort of credible and comprehensive news and information that feeds democracy at the grassroots level. But a lot of the media makers we've interviewed through this series really define it very differently. Sometimes it's that geographic news desert landscape or sometimes it's a matter of the socioeconomic status of whoever might be engaging in media or seeking media. Sometimes it's generational. So I just wonder how you define a news desert in Vermont and what kind of desert areas you see all across the strata. I like that idea that news deserts it's not just a place where maybe there's not a newspaper, but is there not media that is serving a particular community's needs? I think you could say there are geographic areas of the state that don't have as much coverage as they used to. I mean, I think there are newspapers in southern Vermont, there are newspapers in the northeast kingdom, but there are areas there that aren't covered as rigorously. Those newspapers are smaller. We don't cover them as well as others do. There's not necessarily a good media organization that speaks to younger Vermonters maybe in the news. There's not really one that looks at maybe racial or gender issues in the same way or in those are all could be, you could say news deserts. Are we really speaking to the issues that all of these different folks might have or the kind of different ways that you could sort of cut up the demographics of Vermont? Do you need a news organization for all of those things or do the news organizations that we have have to think better and do better about speaking to those folks as in Vermont? Maybe it's a little bit of both of those things I think but I think you have to be deliberate and try to be better about that as a news organization. I think for VPR and Vermont PBS as we're merged now, we have a large platform across radio, across television and online and I think we have a big responsibility and how do we how do we help fill in some of those news deserts and become a place for more people in Vermont to get information and have access to media. I mean it's the technology issue too. We don't have broadband across most of the state so you can't be a totally digital platform necessarily. There's still a need for maybe print or radio at the very least because a lot of people still have radios so the technology is like a whole other side too. Absolutely. Yeah, it's always changing too. And let's see Yeah, what is Vermont PBS and VPR's responsibility in expanding access to diverse audiences? Was that a lot of the reason behind that merger and how are you attempting to do that? I think that is one of the things that folks at the organization really want to prioritize and are prioritizing in the kind of mission of the organization. How we do that is a good question. Like I said earlier I'm still figuring that out. I think we're all figuring that out. I think trying to be more present in the community in different places not going to the same kinds of events maybe that we always went to for trying to talk with different community leaders in different places that maybe we haven't spent as much time it's I think a slow process but I think you sort of have to start with inviting people in maybe there are opportunities I think to work with and partner with other organizations that have greater experience and trust in communities where maybe we don't to help create things or host discussions or events or concerts. I think events are one way that we're looking at it that's not necessarily but that could lead to more stories and I think it's sort of I'm maybe like switching gears here but it's not just about for me as a journalist like I don't want to just be covering like bad things that happen in a like if about this one I like written about you know like the Northeast Kingdom I write about the EB-5 scandal a lot and that's not the only thing that happens in Orleans County and I sometimes feel like I need to write about more than just the hole in the middle of downtown Newport or the embezzlement of millions of dollars like that's the only association a lot of people might have with with Newport because of these stories and you know that's like of interest to a statewide audience but it doesn't necessarily get to the hole the breadth and depth of a place and so you know maybe working and being more present in the state will open us up to maybe being a little bit more holistic in the way we're telling stories in Vermont. Yeah see now we have another definition of a news desert only reporting the negativity for sure that's great and in that work of partnering and reaching out to other organizations to try to fill some of those gaps are you aware of those demographics you're not reaching you mentioned younger audiences and how does social media play a role in filling those gaps I think social media could could play a role don't really know what that is exactly I think with social media you have to really be intentional and like make things for that medium like what works on the radio is not going to work on tiktok what works on tiktok isn't necessarily going to work on the radio and to I think attract an audience in social media you have to understand what media works for that platform and you actually have to be making things that are designed to work on that place and I think I think that's an area we could go into to maybe get to younger audiences but I think we need to be intentional and actually make things for that platform instead of just trying to repackage what we're already doing for that place it won't work otherwise and it will come across as inauthentic and that's like not a great look at all I don't think yeah is it difficult to be authentic on social media given how that can also be a pretty divisive place and how does VPR navigate that I think we think about it a lot as well I think we're changing the way we think about it or trying to or rethinking it but I think I've often thought of social media as a way to promote work and direct people back to my work so if I write a story I might tweet it to try to get people to read that story but like is using it to direct traffic to the website really the best use of it or if people are already on a platform like Instagram or TikTok maybe instead of trying to kick them to our website like create something that exists there that can tell them that story since they're already on that platform if that makes sense right instead of trying to redirect traffic you already have their attention here what is something they can consume to frankly to get the story that we're trying to tell right like if I have a story that can translate and kind of be repackaged for Instagram in a way that people get information that they need that's really good and they don't need to read that on the website if they can still get something out of like an Instagram post I think you need to have like dedicated people that are doing that and the way you're authentic is by like creating stuff for that place not as a way to try to get people somewhere else yeah it's interesting because we've spoken to some media makers who talked about how challenging that profit model is of using social media when it's really that platform that's generating a lot of their own revenue from your content and so that seems to have really affected the social media that we do consume and folks who use it for a news outlet yeah anything else you want to highlight as a challenge in that or or positives from social media um you know I think social media is you know it's one well there are many different social media right so they're all they're all one they're all their own thing and twitter is not my favorite place in the world I don't like to spend a ton of time on that I think it kind of amplifies issues that and divisiveness but there could be some good things there as well and you know but I think the intentionality of using it yeah in your role as someone who's participating in the freedom of press and for this organization how do you respond to wider media attacks on democracy or on the process of the elections and some wider global issues that seem to be undermining freedom of press yeah it's I mean if I had an answer to that right I probably would uh I don't know maybe I would write a book or something or do speeches but I think that um I think one of the things we can do maybe it's in a small way it's like we just don't have a lot of media literacy here like being able in this country and you know it should be something taught in like high school civics is like how to sort of dissect where the information is coming from because you know what you're getting from one cable news channel might not actually be all that like fact based out in any way shape or form and might be undermining democracy in some ways and being able to sort of try to recognize the biases that are present in media in all forms of media not just you know cable news but in newspapers you know in the New York Times and The Walking Tomb Post and all these are being able to sort of read critically and see critically um I think that might help a little bit it's not the only thing that's going to solve this problem because like you do have sort of uh you know outlets that are saying things that are eroding democracy and democratic norms and spreading misinformation but you know I think people need to it's not just enough for news organizations to be fact checking those news organizations which is one thing we can do like you know during the 2020 elections saying like the vote in Vermont was safe and secure like here are all the things that we know we've we've like looked at through the information we've been able to get from the Secretary of State's website and like here's why we know that that your vote counted and why these things are are true it's like that fact checking is important but like the other side is like you need to people need to be able to think critically about what they're actually consuming and not just like take it all at face value and but I don't know then sometimes people like well what if you what you're telling me right now is the lie and like being critical of that which that's sort of I think a little trying to find the right word for that that's like sort of a what about ism what about ism right like so I think I also think like you know news is entertainment or like kind of cable news this is I think one of the places where a lot of this gets information is permeated through like 24-hour news cycles sort of it's all about trying to attract people and hold them to get advertisers and make money and if that's your motive then you're going to that's going to be the bias is going to be towards sensationalized things even if they're not true and that's just not healthy and that's not good so I don't know maybe remove the profit motive from that sort of stuff but that's that's a whole yeah it's a whole different model of economics that maybe is not the most reasonable way to fix things yeah and vpr does and Vermont Public Television fills that role of that non-profit type of model and the transparency that you provide in your organization that isn't as clear but should be when there's an advertisement running between segments yes so again and let's see yeah do you see any bright spots or opportunities in facing these challenges ahead as we try to come together as a nation even after some of these tragedies I think kind of for the media world that I exist here in Vermont and I think I'd like to see less competition between the outlets we have and more collaboration trying to find ways to work together to tell more stories about more places and people and things in Vermont as opposed to just trying to compete over the same sort of rote stories I think that's how we can really make a difference and help shore up against some of these attacks of democracy that are coming so we shouldn't be fighting among ourselves we should try to work together a little bit more great yeah certainly a message we've been able to carry through this conversation so thank you for contributing your thoughts on these really important topics I think that's it if you like this and want to see more watch the rest of the series thank you for watching and please vote


Welcome everyone to the Health, Social Care and Sport Committee's fourth meeting of 2021. Apologies for this morning's meeting that has been received from Evelyn Tweed, and I would like to welcome Mary McNair, who is attending this morning's meeting in Evelyn's absence. Our first agenda item this morning is to invite Mary McNair to declare any relevant interest to the committee. Good morning, convener. I confirm that I am an elected member of Weston Barger Quick Council, and up until June of this year I was a part-time social care worker. Thank you. Our second item today is to consider whether to take item 4 in private, to consider the evidence heard on the minister's session 6 priorities. Our members agreed. We agreed. Thank you. Now on to our third item today, and that is to take evidence from the minister for drugs policy on her priorities for session 6. I welcome Angela Constance, the minister for drugs policy, and I remotely should be joined by her officials, Michael Crook, the head of the drugs death team, drugs policy division and Modis Fraser, the head of delivery and support unit for the drugs policy division of the Scottish Government. Minister, I believe that you have a brief opening statement. I do indeed, convener, and I am very grateful to the committee this morning for the opportunity to provide evidence on my priorities going forward over the next five years. The loss of life from drug-related deaths is as heart-breaking as it is unacceptable. I once again offer my condolences to all those who have lost a loved one, and my continuing commitment to do everything possible during this parliamentary session and beyond to turn the tide on drug-related deaths. This morning, the Scottish Government published the first quarterly reports on suspected drug deaths. This first report focuses on management information from Police Scotland and covers the first two quarters of 2021, the first six months of our national mission. Although the report is not a replacement for the drug-related death national statistics published annually by National Records of Scotland on the confirmed drug deaths, as the information is official statistics based on death registration records supplemented by the information from the Crown Office and forensic pathologists, nonetheless, the information on suspected drug deaths will help services to respond to what is needed more quickly and will help Parliament monitor progress. It provides a barometer of drug death trends over time. We can very cautiously take some encouragement from what appears to be a slightly lower figure of suspected drug deaths than for the same period last year. However, I want to stress that there is a long way to go here and whether suspected drug-related deaths or actual drug-related deaths remain too high in Scotland today. My priorities start with getting more people into protective treatment and recovery on the back of our commitment to an additional investment of £250 million, including £100 million for residential rehabilitation over this parliamentary term. Information from quarterly reporting will allow me to set a treatment target for 2022, which is one of my main priorities. Implementing the Medicational Assisted Treatment Standards by April 2022 is a key priority. Those standards set out what people should expect and can demand from services, in particular same-day treatment and access to a wider range of Medicational Assisted Treatment options. That is part of our overall approach to making people's rights a reality. However, the options being offered to people must also include access to residential rehabilitation, which is clearly a priority for us all. We recognise that, in polydrug use deaths, the number of cases involving methadone and benzodiazepine has risen. We need to understand how that is happening and be able to offer safer alternatives, for example, such as buvidol and new treatment to reduce overdose cases. The role of prescribers, including GPs, will be absolutely crucial in all this. In October, the advisory committee on the misuse of drugs will have its first meeting in Scotland, and there will be a four nations drugs meeting in Belfast later that month. I will be using this opportunity to continue to press the UK Government on the evidence for drug checking facilities and safe consumption rooms, while pursuing further action via our own devolved powers. I will continue to prioritise people with lived and living experience through local panels and a national collaborative. That already plays a vital role in service design and delivery across Scotland, but my priority will be ensuring that everyone's rights to the highest standard of healthcare is made a reality. We will also continue to strengthen the links across portfolios. Our mission is linked to other vital work to improve mental health, to address poverty and inequality, to ensure that we are keeping the promise to our children, to build resilience through education and prevention, and to bring public health approaches to our justice system. Another priority will be to develop and upscale women-specific services. I announced that Phoenix Future has been successful in principle in a bid to establish a new national specialist family service. That facility will be the first of what I hope will be many new residential rehabilitation facilities, and I will be setting out milestones for further growth over the next five years to Parliament shortly. I will continue to prioritise the use of naloxone. Services have made great strides, but I want to see more. We launched a national naloxone campaign last month, which has already significantly increased demand through our third sector partners. I am also encouraging community pharmacists to be more active in the use of naloxone too. In November, we will launch a campaign to tackle stigma, which is still for many people a barrier to access in life-saving services. I am also making it a priority to see alcohol and drug services feature in the proposed national care service. It is a real opportunity to consider how we can better support some of Scotland's most marginalised and vulnerable people. In conclusion, convener, I am very conscious that it is not possible to cover everything in detail or every priority over the next parliamentary term and the time that we have available, but I hope that this summary is helpful to the committee and is very much the start of a conversation that we will have over the years. I will continue to update Parliament regularly. That has been very helpful. A number of things in there that the colleagues are going to come in and ask you more detail on. I was wanting to open up by asking you for reflections on what you have been in post for about nine months now. You have outlined some of your strategies and priorities over the nine months. Given that you have got a hinterland and a lot of experience in a lot of the related areas that have an impact on drug use in Scotland, what is your assessment of how we have got to this place? What are you prepared to consider in the bounds of what we can do in Scotland, but perhaps pushing the boundaries of what we need to do in Scotland? For me, convener, it is always about following the evidence and what works and listening to people who are most affected by drug deaths in our communities, and that is people with lived experience, but also people with living experience. In terms of encapsulating where we are and why Scotland is our challenge, it is so acute and severe. I have my own views on that and I know that in the past there have been many discussions about culture, about patterns of drug use and about concentrated levels of priority. I always distill our challenge in Scotland into three areas. We have a higher proportion of people who use drugs. That is quite an existential question as to why that is and there is much research into that. We need to recognise that. We have a higher proportion of our people who use drugs and, therefore, we have proportionally more people with problem drug use. The rate of drug use in Scotland is about double that in England south of the border. The other issue is about benzodiazepines. Elisabeth benzodiazepines is an issue across the UK, but it is more acute in Scotland and, again, the facts would show that. Since 2009 in Scotland there has been a 450 per cent increase in the implication of benzodiazepines and drug deaths, by comparison south of the border it is 53 per cent. Again, to be frank, and this is at the heart of the matter, we do not have enough of our people in treatment. That is that the core of my assessment is that we do not have enough of our people in treatment. We know that treatment is protective and what we need to do is to get that culture of change, that culture of compassion in our services so that people can access services easier, that services can be more fit of foot in terms of following people up and people should have informed choices about their services and treatment too. We have made other progress around other preventable deaths. We must consider drug deaths as not just tragic but also preventable. While the scale of the challenge is massive, we can and we must turn this around. There are a couple of things in there that I want to pick up on specifically. You were saying that we do not have enough people in treatment. Is there two parts to that? It is getting access to getting hold of people and giving them the pathways to get treatment and it is having enough capacity in treatment as well. Straying into that area of what is reserved and what is to devolved. The drug consumption facilities, is it fair to say that they are more than just a facility to have safe use of drugs or a pathway as well to getting people into treatment? Where do you see GPs in that? People might not actually be in treatment but most people are registered for the GP so that is an early intervention pathway for people as well. How do you see those things matching up and helping people to get into treatment? What we know in terms of emergency interventions, harm reduction interventions such as safe consumption rooms and the heroin assisted treatment project in Glasgow, that not only helps to reach people where they are at any particular time and helps to reduce the risks that they face at that time but it is part of a longer conversation, a longer journey that can help people to connect with other services. That may be connecting with primary care, it may be connecting with services in and around bloodborne viruses, it may be helping people with the practicalities of addressing other issues in their life whether it is problems with more personal care, housing or perhaps even some of the underlying causes. The importance of harm reduction and all the evidence would show that it is about meeting people where they are now and working with them through the good times and the bad, sticking with them in whatever they choose their onward journey to be. In terms of your distillation convener, we need to increase the capacity of services and that will involve workforce planning, for example. There is lots of baseline information that we do not have, so we need to update our workers and the process of updating work around prevalence about baseline information, about the number of people in treatment and that will help us make progress with things such as our target to treatment. It is clear that people in this committee will know the issues that are reserved and the issues that are devolved, but the challenge for us is leaving no stone unturned that whatever our powers are, whatever resources we have at our disposal, we make all the vital connections and take every opportunity to implement evidence-based practice. Sandesh, why don't you ask a supplementary question on what I've just raised there? If it could be short, please, then I'll move on to Gillian Mackay. My question is just pressing a little bit more on what Gillian asked specifically about why you feel that GP is what their role is going forward. That is a really important question, Mr Gillian. I know that you're a former GP, and I often talk about our life-saving work being connected to the work to improve people's lives. You and I may take for granted the role of primary care in our own lives, and I know that there are many GP practices that are at the front line of our communities and that are already doing great work to support people and their families struggling with drug use. What we find across Scotland is that there is a different picture between how services are organised, so in some areas of Scotland, GPs can offer more services to people affected with drug use, and other areas, the pathways and the routes point more towards specialist services. Regional variation is, of course, fine as long as it is working, but in terms of taking a public health approach, there is an absolutely core role for GPs in all of that. It's part of my job to engage with clinicians from all backgrounds, whether they're psychiatrists, whether they're GPs, whether it's specialist addiction services. That connection is my final point, convener, of the importance between harm reduction and immediate access to treatment for a drug problem with primary care is made in standard 7 in the new medication assisted treatment standards, in that people should have the choice that, in terms of that connection between their treatment and primary care. A lot of Scotland's drugs deaths involve more than one substance, and drug death figures show a continued upward trend in cocaine being implicated as a cause of death. The Scottish Drugs Forum has warned that efforts to get more people into treatment must take account of the needs of people using cocaine, as well as those using depressant drugs. Minister, could you outline how you will ensure that drug treatment services serve the needs of people using cocaine and those who use a number of substances? That's a really important point that Ms Mackay makes. At the core of that, this is about person-centred care. Where we get into real complexity, we have to watch that, while there are different treatments, medication assisted treatments, that are geared towards opioid dependency and opioid substitution therapy and methadone and buvidol, we have to watch that we don't have services that are siloed. The number of people who die from where cocaine is the only implicated drug is comparatively small—it's about 16 deaths—so what we're looking at here is cocaine in the context of polydrug misuse. That's a much more complex picture. We have to take that down to the individual. Services have to be about engaging with individuals as individuals, first and foremost, and working out what support and help they need. The point about cocaine is important because we have seen a 23 per cent increase in the implication of cocaine and drug-related deaths. There's a lot of information about the increase in purity, but there's also the lowering of price. We must also think about our approach with services, which is that cocaine use features more among younger people. I'm generalising a bit here, but opioid use tends to be people over 25, where there's a rise in cocaine use among younger people. Some services, depending on the age of the person, will need to be age appropriate. There's a different pattern of drug use among young people, so there's no easy answers, but we need to be thinking about whole packages of care and support and get underneath the skin of why people use drugs and particular substances. I will go remotely to Mary McNair, who has questions on prevention and early intervention. You will agree that the reason for addiction is a complex and a massive ascisee. We will never address the problem without joint working across all disciplines. Is the Government doing enough to fund the effect of integrated working to cover health, social work, housing and training and employment? Ms McNair is absolutely right to make those vital connections. That is why we have a national mission in the first place. We need to be taking that helicopter whole systems approach. Its core is early intervention and prevention. That is about our work in terms of poverty. That is our work with young people in our health system and in our education system. We probably know much more about what works with young people now than we did 20 years ago. In the context of curriculum for excellence, we know that young people respond better to approaches that are about upskilling them, about increasing their personal resilience, self-esteem, confidence, obviously diversion, activity and opportunities within communities. The point about housing is very well made. There is a massive investment planned in increasing the supply of affordable housing over the lifetime of this Parliament with some very stretching goals of 110,000 houses by 2032. All of that work must connect with GERFECT and keeping the promise. There are some examples within my own division in terms of the drugs policy division about our investment with families and supporting family inclusive approaches. There are particular funds that are for work with families and children but it is absolutely vital that drugs policy is connected with every aspect of Government policy. Can I pick up on one of the things that you said about families? You mentioned the services for women. I was watching your evidence session from the committee in the last session in March. You picked up on some of the historical difficulties that I have for women who have caring responsibilities and families getting access to treatment. Can you give me more information on how you have moved on that and what interventions you are putting in place to help more women with families to get the treatment that they need? We know that there is often a great fear among women in terms of reaching out for help and disclosing the level of their drug use, particularly if they have children. That is one reason why we are investing in whole family approaches and family inclusive practice. You may recall that, when I made the statement to Parliament on 3 August, we made an announcement about a substantial investment in an organisation called Phoenix Future. That is about establishing a national residential family service for the whole of Scotland. That announcement outlined that, subject to various approvals and consultation within the communities, the facility would be able to accommodate up to 20 families. Both mums and dads who have children between birth and 11 years of age need to think about services on a national level, and we need to think about them on a more regional basis. That is one example of a step forward. There will be other work and announcements in due course. In terms of the funding that we have channeled through alcohol and drug partnerships, there is a specific allocation of £3.5 million for local ADPs to be investing in whole family approaches. We need to be supporting families as a collective unit, but we also need to be supporting individuals within families in their own right. We will be publishing a framework on what family inclusive practice should look and feel like on the ground. We are making progress in this area. Of course, I will keep committee informed. That is really helpful. Annie Wells wants to come in with a supplementary on this. Thank you, convener. Good morning, minister. Thank you very much for attending. I have just been thrown through the latest statistics. The police division with the greatest number of suspected drug deaths was greater Glasgow at 187. That was followed by Lanarkshire with 67, Edinburgh City 64 and Tayside 64. Is there any specific work taking place in those divisions to see what the issue is here and how we can help and support those people? Thank you, Ms Wells, for that question. In terms of the information that was published this morning on suspected drug deaths, you are quite correct to point out that the information is in the context of police divisions. It is suspected that drug deaths are on the basis of the inquiries that are made by the attending police officer at the time. What that information won't tell us is things like the use of substances that are potentially involved. We get that level of detail from the annual report on confirmed cases. A lot of what we take in Glasgow, for example, a few weeks ago, I went out to visit the Glasgow overdose response team. That is a service that is looking to quickly follow people up who have survived a near fatal overdose. What we know from looking at successive annual reports is that more than half of our people who die have a history of overdose. When people survive a near fatal overdose, we really need services to kick in quickly. There are a range of projects that are funded through some of the community funds, new funds that will open the local alcohol and drug partnership, and some of the drug death task force projects that are specific to Glasgow. We have information that is available, convener, on a more regional basis in terms of specific services and specific projects or specific tests of change. It might be helpful if I can pull some of that together and share with the committee, because I know that there is a broad selection of MSPs here from across the country that you will be very interested to look at that in detail. It would be really helpful. I come to Paul Cain quickly on this. Thank you, convener, and good morning, minister. I think that just to follow up that point, because I think that we all understand the importance of further understanding when someone perhaps overdoses and they are treated, or they attend hospital, and understanding the information and patterns around that. I am just keen to understand in terms of reporting what we can further do to have further data on that, because the hospital admission information does not cover, for example, A&E attendances, or when people are treated by the Scottish Ambulance Service. I am just asking the minister for her thoughts on how we can get more data in terms of where people are treated and making sure that we follow up with them. I am absolutely committed to getting more information and more data that will help us to improve our services and to improve our offering and to really tie in that every step of our national mission is based on evidence and what we know are the issues in Scotland. In terms of that, Mr Cain, your question seems to be about how we link information and link data. In general terms, the annual report gives us some rich information about substances. That information is also available local authority by local authority and is also available month by month. The issue about being able to understand more about other health problems in the context of drug use and involvement with other services is really important, because some of that information we have, so we know things like information about drug-related admissions to accident emergency or psychiatric admissions, but there is a bit of a time lag in that information. Some of the work that we are doing with Public Health Scotland is about how we can get that type of detailed information more quickly. We can gather quite a lot of information that tells us the circumstances around people's tragic deaths. I suggest that we need to know more about people's lives, and while part of that connects with their lived and living experience strategy and engagement with services locally, there is data around that as well that tells us more about the lives people lead that will help us to shape services. We also need more of that data to have quality indicators that will underpin our treatment target. Along with that, I am keen for us to explore the link between social inequalities and deprivation in poverty. It is really important to have some understanding of the commitment from yourself and the Government to make use of all the powers that we have, to make sure that we tackle childhood poverty, housing issues and employment opportunities for people. I wonder if you could give us a little bit of feedback on your thoughts on those issues. It is a really good point, and I reiterate that often, but it absolutely is about connecting the emergency life-saving work with the work that improves life chances. The statistics speak for themselves. We know that people in the poorest communities are 18 times more likely to suffer a drug-related death than those people in the least deprived communities. It is important to stress that drug-related deaths and drug use are an issue across all of Scotland, in that the drug-related deaths in the highlands are the lowest drug-related deaths in Scotland, but it is still higher than the drug-related deaths in the north-east of England. I hope that there is some context that this is an all-Scotland problem, but there is no doubt about it that the increase in drug-related deaths is being driven by an increase in the poorest people in their communities dying. There is absolutely no doubt about that. Therefore, the work on child poverty, for example, is absolutely crucial. We know that there is a £23 million tackling child poverty fund and a cross-government child poverty action plan. Colleagues here will be well aware of the plans in and around the Scottish child payment. However, that work has to connect with drug policy work and the bigger Government approach, where £2 billion of our resources are invested in low-income families. Around half of that is much more focused on households with children, so £2 billion investment is in endeavours to alleviate pressures on low-income households, and there is a proportion of that for households with children. It is connected with the economy, the fair work agenda and all of the things that you could talk in detail about, as well as the work in adverse childhood experiences and trauma. ACs have a huge link to people's living environment. The move on to talk about other issues around drug policy, particularly around the progress and priorities in the... I believe that Gillian Mackay has got some questions in this area. On treatment, when people leave residential rehabilitation, they are at increased risk of overdoses. Their tolerance to drugs will have lowered by the period of abstinence. It is important that we recognise that people do not leave rehab cured and that they often need on-going treatment and support. How will the Government ensure that residential rehab services are well integrated with other health and care services and that follow-up support is provided to those when they leave rehab? Absolutely. In terms of our commitment to increase the capacity in the reach and improve access to residential rehab, that is very much in the context of aftercare as well. We have to recognise that this can be a chronic condition. It should be of no surprise to anyone involved in providing drug services that sometimes people relapse. Progress in life is rarely linear and this shouldn't be about people running out of chances. We should be given people as many chances as they need to get on to the road to recovery. The work that we are doing with local services and that integration with aftercare is crucially important. We also need to think about rehabilitation within a community context as well as a residential context. We know that times of transition, leaving residential rehab is a time where risk can be elevated, so people must have that wraparound person-centred support that meets their needs. It also applies to people leaving prison. It applies to other changes where people might be moving or leaving services. Our work on investments and around outreach are particularly important in that area. Also, when people disengage from services, we need to be far better at following that up to. Particularly around access picking up earlier on the issues around access to rehab, as well as there has been a greater discussion about residential rehab and how that interacts with the rest of the mix of treatment options. Many people might be afraid to lose their tenancy if they enter rehab. They might have caring responsibilities, as the convener pointed to earlier on. For people who have unplanned discharges from treatment and things and integrating the naloxone carrying for the police and hopefully for the wider public, how do you see the integration across various aspects of Government in supporting people in their tenancies and encouraging more people to take up carrying the naloxone, so that it is something that can be used to support particularly those people who find themselves in a period of homelessness, as many people with drug and alcohol addiction do? Yes. There is a lot in that question, convener, but the member is quite right to be making all of those connections. The point about access, for example, into residential rehabilitation is important. The work that is being undertaken by the residential rehab development working group is about developing clearer pathways, because pathways vary across the country. I am on record saying that sometimes pathways into residential rehab are as clear as mud, and that is not right, and it is not acceptable. There is also an issue about access into community services. If I compare, there can be many barriers. You have to do this, you have to be on this level of treatment, you have to be absent or whatever, so sometimes we need to be thinking about what are the barriers to getting people into treatment. In terms of residential rehab, which is an abstinence-based model, there are obviously certain expectations around people's personal commitment and detox and lowering substances to facilitate that. However, it is a fair point to point that there are perhaps too many barriers to access in other services. One of the early actions that I took was a result of information that Shelter had provided with me. There is a bit of confusion around housing benefit rules, and of course, if you know anything about housing benefit, there is a minutiae of detail times often to be unraveled. There were different things happening in different local authority areas in terms of applying rules. What I was not going to put up with is people having to choose between keeping their tenancy and going into residential rehab. There are funds allocated and available to address that while we sort out the complexities around regulation or whatever. That is just one example of where we can invest resources, because we are just not putting up with that. We sort it out, but we are just not putting up with that and we cannot have that choice. I have always been a big fan of housing first and other housing models that are not putting up other barriers that we take people as they are. The priority is to get people into a house, into a home and then we will work out the rest, whether it is people's drug use or their health problems or other issues. I have certainly spoken about parents and mothers in particular with care and responsibilities, so I will not repeat that. The issue about naloxone is really important because it helps save lives. It buys some time for emergency services and it temporarily reverses the impact of a nopioid overdose. It is safe and easy to use. The work of the previous Lord Advocate, as a result of the pandemic, he issued guidance that enabled us to widen the distribution of naloxone into third sector settings. I have to give a shout-out to Scottish families affected by alcohol and drugs. It is a result of people going to the international naloxone campaign and people going to the Stop the Deaths website. They have had over 460 people applying for these kits. They provide a click and deliver service. Families who have a loved one at risk can have naloxone at hand. Nearly over two thirds of ambulance technicians are trained in naloxone to give out the take-home kits to people who they come across. It is also important for those who are distributing naloxone and non-drug services that they are also making those connections and helping to support people and refer people to drug services. I apologise for the length of that reply, convener, but I hope that I have managed to at least outline some of the very important connections. You mentioned that ambulance services have naloxone and that families can apply to it, but where are the police in this with their policy on it? Are they carrying naloxone? There are three areas in Scotland where the police are carrying naloxone. That is in the east end of Glasgow, Falkirk and Dundee. That pilot has been successful and naloxone has been used 40 times by the police. There is a review period that we have now entered into. We want to have a discussion with justice colleagues about how that programme could be extended. It is important that statutory services play their part and that helps us to communicate with the wider communities and the wider population that there is a tool that can be used to help to prevent people from dying while help has been called. We need to prevent people from having an overdose in the first place. We have certainly covered that extensively in the session, but naloxone is one part of the jigsaw. There are other parts of the jigsaw that are about preventing people from getting into crisis in the first place. Other parts of the jigsaw are what happens when people survive and overdose and how we connect them with support services. Thank you, convener. I will pick up on what convener is saying about naloxone. The front-line workers that are now testing the pilot, ambulance crews and the front-line police officers and even families that are being trained to use naloxone, what is the perception of how that is being received? Is it being positive for all the front-line workers who are engaging in the naloxone testing? That is certainly my understanding. If I take the police, for example, there is a very high proportion of police officers who have, after they have undertaken the training, what will carry naloxone. When you speak to families, as I do, and I am sure that many members around here do, they will give many examples of how naloxone has saved the life of a loved one. When you speak to people of lived and living experience, they will talk about the range of services that have helped them on their journey. The key challenge for us now is to widen that distribution and for it not to retract. The Scottish Government is participating in a four nations consultation about permanently widening the distribution of naloxone and naloxone, although safe to use is a controlled drug. The Lord Advocate, as a result of the pandemic, was able to use his discretion to give confidence to widen the distribution to non-drug services, services where people are homeless for example. We now need the changes that the Lord Advocate made in Scotland as a result of the pandemic to be permanently made. There is a UK-wide consultation, a four nations consultation, and we are participating in that. There were concerns about some of the language that was used in the consultation and the scope of the consultation. Nonetheless, the Scottish Government has participated in that consultation because we want to see a permanent change to the arrangements that are made to widen the distribution of naloxone. Prior to summer recess, we had a debate on many of those issues and quite a consensual debate around the medication-assisted treatment standards and the need for the strong implementation of those. I am keen to hear from the ministers on an update on our progress towards that, having set the date of April 2022 as a target. Is there a follow-up to that, if I can? How will that progress be reported? I think that the minister made a commitment in terms of coming to Parliament, six monthly, to report to us on that standard, so that you can address those points. Mat standards are important in terms of laying a foundation for change. Implementation and embedding of the new mat standards are really important to further progress building on that, particularly around widening access to treatment, for example, and helping us to integrate further addiction and mental health services in making all those links with primary care that we discussed earlier. For the first time, we have published the mat standards and there is a financial resource in terms of implementation. £4 million for this financial year was allocated to that. I suppose that the nub of Mr Cain's question is that we have the mat standard implementation support team. What they are doing is looking at the reported progress from different areas, testing that progress and engaging with local areas about what support they need. I was very keen that we had missed because the scale of the challenge to implement mat is significant because we are moving away from a three-week waiting-time target, which is what our system operates around, to turn in a ship that will provide, for example, mat standard 1, which is about same-day prescribing. There is a lot of work to do, so progress has been made. It needs to be a whole area of progress. A range of other matters will keep Parliament informed. The other point to recognise is that we are absolutely serious about the target of April 2022, but the support does not just stop then, so that quality improvement and quality assurance and support role by the missed team, which is part of a three-year programme, continues. What we cannot do is get it embedded, get it over the line and then go, job done. We will have to really keep on it. The target is absolutely April next year, but we will continue in that monitoring and supportive role. We have some very clear asks from particular local authority areas that we are seeking to deliver on in terms of resources and help as quickly as possible. In light to that, if I can minister on alcohol and drug partnerships in terms of the role that they play, a very localised role in the relationship that they have to their IJB. In the context of the consultation on the national care service, there is discussion around whether ADP should sit as part of a more national service delivery and whether they should remain more local. I am keen to understand your view on that and where you think that it can be most effective. The national care service is the biggest reform in the NHS since 1948. You will have heard Mr Stewart talk about this often. It is an immensely complex and challenging task to build a national care service and deliver it over the lifetime of this Parliament. However, my view is also a very significant and exciting proposition. It is at a very fundamental level how we care for people and how we value those who care for people. Bear in mind that people with drug-related difficulties are among the most marginalised, unexcluded and stigmatised in our communities. It is important that we ask that question about what benefits are there for drug and alcohol services being part of the biggest change in our national health service in over 70 years. Some of the synergies in terms of what we are trying to do to improve services have a strong connection with work in a national care service, about person-centred care, about informed choice, not just caring and treating folk but helping folk to live their lives. It is really important, and I feel strongly about that, that questions on drug and alcohol services should be part of that consultation. What we need to test and explore as part of that consultation are the opportunities via the national care service to improve accountability, to improve governance and to improve the status of drug and alcohol work. I know that, certainly, some people involved in delivering and working in services do not just feel that it is the people who serve that are stigmatised. I think that they sometimes feel that they are a bit forgotten and that the service is somewhat stigmatised. I do very much believe it about accountability at every level. I have an interest in a focus on governance, so I can assure you of that. The challenge in terms of alcohol and drug partnerships is that partnership needs to be at a local level and sometimes at a very local level, if we are going to reach into those communities that are most deprived and most disadvantaged. That is the kind of issues that we are testing now. The national care service is about a rights-based approach, and that fits with what we are trying to achieve in terms of improving drug and alcohol services. However, it is in the consultation, and there are some quite deep and fundamental issues that we need to test out. With your indulgence, convener, I would agree with much of what the minister said, certainly in terms of the need for local connections and accountability and improving the status of those services. I think that it will be interesting to see the views, certainly, of people within the consultation. I wonder if I can ask about alcohol and drug partnership reporting in the here and now. Government had previously committed to providing information from ADPs in terms of the spending by IJBs, both in 2016-17 and 2017-18. I think that the last time we had figures on that, and that was going to be a baseline for future reporting. There has not been any further information since that time. As part of the intelligence for us to understand what is working on a local level and where spend is going, it would be helpful to have further information. I wonder if the minister would say something on that, and what other intelligence can we garner from ADPs that will help us to map some of that and to meet those standards? In terms of alcohol and drug partnerships, it is fair to say that we are making a bigger ask of them. It is part of the quid pro quo for the bigger investment in funding that is being made. We have heard an uplift this year of £13.5 billion from the national mission fund. We have been very specific about the proportions of that to be spent on family and child services, residential rehabilitation and aftercare and other front-line services. We have also agreed a framework in and around governance with COSLA. I will speak with COSLA to see whether that might be information that might be of interest to the committee. That is about forward planning. It is not just about writing an annual report on what has been done. It is about undertaking more work to assess local need, to evaluate what you are doing. There is some external validation built into that, and it is about forward planning what you are going to be doing over the next year. Again, we are supporting ADPs in and around how to do that. There are also some agreements that we came to COSLA about the role of chief finance officers and integrated joint boards and their role in all of that. There is also the role of service level agreements between the alcohol and drug partnership and the people who they commission services with. I am cognisant of the role of alcohol and drug partnerships vis-à-vis integrated joint boards, too. On your fundamental question about understanding the total spend, it is very clear for the Government to articulate in the drugs policy division how much we are spending and what on. There is obviously budget information on what we are spending on drug and alcohol services overall in all our budget documentations. However, when you are looking at what local government put in from their funds and then what additional funds come from the IGB or NHS, I appreciate that the picture becomes far more complex. I understand the committee's interests in that. It would indeed be beneficial to know the size of the total investment. It is a question that I am interested in, too. I hope that some of the work that we are undertaking in the Government might help with that. However, it might be helpful when I next meet Councillor Corry from COSLA that I discuss it with him, because I know that you have expressed an interest in this over a number of years. I will discuss it with Councillor Corry from COSLA, the health and social care spokesperson, about building on the new governance arrangements that we have agreed for the hearing and how we might begin to shed light on that. That information should be available at a local level, but we will try to unravel it. I do not think that we will necessarily unravel it quickly, convener, if I can just, for the sake of my officials, add to that, because they are engaged in increasing capacity in residential rehab, implementing math standards and a whole host of other work. However, I will give you an undertaking to at least explore this with COSLA. We have questions from David Torrance. Thank you, convener, and good morning, minister. As far back as 2017, there was a public petition raised on the harms of prescription drugs, and the short working life group took us up and made its recommendations in March this year. Also, in January, the First Minister announced a national mission to reverse the deaths from prescription drugs. Minister, what progress has been made on the dependency around prescription drugs? There are two really important strands to this. The committee will appreciate that the focus of my work on reducing drug-related deaths is primarily, although not exclusively, focused on illicit drug use. Colleagues in public health will be more focused on doing more work in and around how we reduce dependency on prescribed drugs. That is also of interest to me, because we do know—I am not telling you something that you do not know—that people can and do become addicted to prescribed drugs. Some of the work that was undertaken by the short life working group, there was a consultation on those recommendations. Health colleagues are implementing an action plan in and around that, and some of that is about prescribing guidance. It is about assessing, monitoring and recording. It is a slightly side issue. I know that when I met the Royal Pharmaceutical Society, it is very interested in how it could work with Government to implement a tool that better records the amount of over-the-counter medications that people are buying, because that is also an issue for some people. The prescribing guidance around prescribed drugs is complementary to the prescribing guidance in and around illicit benzodiazepine use. The issue for the drugs policy division is to connect the work to reduce dependency and use of illegal illicit benzodiazepines that are in our community. That is not unconnected to the work around prescribed benzodiazepines, for example. There is a range of work that we are doing to tackle the issue around street valium. Some of it is devolved, some of it is reserved, but I will stop there, convener. Somebody may want to pick up the benzodiazepine issue later. Emma, do you want to come in on this issue or tackling stigma? Yes. I will bring you in now on that. It is a very complex issue and there are lots of strands that are being worked upon. One of the ones that I was interested in in previous questions in chamber was tackling stigma. We know that the Scottish Drugs Task Force, in collaboration with other partners, has an actual strategy for addressing stigmatisation among people, communities and families. For me, especially in a rural area, it is an issue as well. Are you able to tell us a little bit about how important it is to tackle stigma so that the media is using the correct images or the better images and areas where even healthcare professionals are not working in direct services with alcohol and drugs users? People like me, when I worked in the recovery room, had a better understanding of the use of stigmatising language. Stigma is a huge barrier to people's access and treatment. It is an issue that has a huge impact on people's wellbeing and on how people are treated in services and in the community, and we, as parliamentarians, have a role to play in that, as well as the media and services and the wider public sector workforce. Some of that work around a trauma-informed workforce is really important in that regard. Ms Harper is the issue about the charter, the lived experience representatives and engagement with other lived experience groups that have developed a stigma, an anti-stigma charter. The purpose of that charter is that it can be used by different organisations, different services, but it is adapted as well. I would describe the charter as it is quite core in terms of its purpose, but it can be adapted to other services. The national naloxone campaign, part of that is about stigma, that these are lives that we can and must save. It is about engaging the wider population about what they can do to help to save lives as part of the national mission. Later on in this year, we will report back to Parliament about a national stigma campaign. A very quick question this time. People who use drugs may be subject to multiple stigmas, not just that related to their drug use such as homelessness, that relating to the mental health and for some HIV status. How will the Government ensure that the multiple stigmas are tackled within the systems that people who use drugs use, not just their drug use and the stigma surrounding that? You are again quite correct to be making all those connections. It is important that strategies and approaches complement each other and connect with each other as well. There is also a lot to learn from other campaigns and approaches as well. I am going to bring Annie Wells in. Annie, I believe that you have some questions around residential rehab that you want to put to the minister. Yes, I do. The Scottish Government's residential rehab mapping report stated that the Government funded only 13 per cent of residential rehab places in Scotland in 2019-20. Promises have been put forward regarding funding and places, but can the minister tell me how many extra residential rehab beds will be available by the end of this year? What we know from that information is that 13 per cent of beds that were accessed in that timeframe came from alcohol and drug partnerships funding. There was also publicly funded places from housing benefit and social security. People would be accessing private funding and charitable funding as well. On the first calendar quarter of this year, you might recall that we published information on how emergency funding was used. In January to March, we quickly initiated £5 million out the door. £3 million of that went to ADPs. Some of that money was for a separate improvement fund that people could apply for. There was also a grassroots fund. On how ADPs allocated that money, we published that so that is available. We are currently gathering further information from ADPs and again we will make that available. On current capacity, we published earlier this year that overall the 20 facilities in Scotland were operating about two thirds of capacity. We know that there is capacity there to be utilised. I have given a commitment to return to Parliament with our milestones over the next five years about how to improve access. As Ms Wells rightly points out, what extent will we improve capacity over the next five years? We will come to Parliament with much more of the detail on that. I have repeatedly spoken about the right to recovery bill, which will be getting late before Parliament in the next couple of weeks. We have worked with front-line organisations to say that the bill is the right thing to do. Will the minister be willing to back the bill when it comes forward once she has seen the content? I am keen to look at the bill in detail. It needs to be published before I can give it full consideration. If Ms Wells purses a member's bill, there is a well trodden path about the requirements on the member to consult and engage and convince others of their proposition. There is a well trodden path in terms of what considerations Governments give to the bill. I think that I have a track record of always giving members a fair hearing. I will look at that on its merits. I have never ruled out the need for further legislation, but I will want to test whether the bill will do what it claims to do. There is a process in and around legislation. I do not want that to hold us back from doing things now. I will want to see how any bill actually helps us with the integration of services. I have outlined some of my rationale about why I wanted alcohol and drug services to be part of the national care service consultation. Obviously, the Government will bring forward a bill on establishing a national care service. The consultation, development and responses will help for them if and how drug and alcohol services are or are not part of that. I think that there is a strong argument for national commissioning of residential rehabilitation. I can say more about that if people wish. We also have a commitment as a Government further down the track in terms of human rights implementing international treaties. How do we make human rights real in people's lives and communities? I think that is a very broad issue. That will also inform my thinking about my response to any bill that is brought forward. It is also important—I apologise for the time that I am taking, convener—that we have made a commitment to a national collaborative. A national collaborative is about how those with lift and living experience plug into the national mission. A collaborative is not something that you do to people. It is about enabling the wider lived and lived experience community to have their say and respond to a whole range of issues. In short, we will look at the detail of the bill when it comes. I want to check in with Mithi McNaire. Mithi, you wanted to come in on a question around the inequalities aspect of things. Before we move on to our next theme around Covid-19, can I say if Mithi still wants to ask that question? I wanted to take the minister briefly back to the impact of the deprivation. We have long been aware for a long time that the link between deprivation and drugs. I worry really that we will study the fact that more avoidable deaths are occurring. How do we get the balance right between the risk of analysing that link and getting meaningful data that helps us to respond to the main reasons of it? I will not repeat what I said to Mr O'Kane about the purpose of more data and what we are doing to acquire more meaningful information. Let me assure Mithi McNaire that the purpose of the work that I am leading within the Government is to turn words into actions. In terms of the link between deprivation and drug deaths, I refer back to some of the answers that I gave to Mithi McNaire about the additional funding and action in the things such as the child poverty action plan, the child poverty annual report, tracking work, the fair work agenda, the work that has been done in and around social security, the work that we are doing in early years, the massive expansion of early years for our youngest citizens, the work to reduce the attainment gap. All of that is absolutely connected. At its core, it is about addressing the impacts of deprivation on every aspect of people's lives. Thank you. I am going to move on to talking about the impact of Covid-19 in questions from Stephanie Callaghan. Thank you, convener. Morning minister. I wanted to ask you, just thinking about Covid, clearly it hasn't hit everybody equally and people have struggled to access treatment and access support. What I am really interested in is what kind of specific changes to approaching treatment during Covid has actually had a positive impact and how do we maximise the benefits of that going forward and making sure that we are taking that learning forward with us and using it to support and help people? I think that one example would be Buvadol, which was introduced into the prison estate during the pandemic. Buvadol is a long act in Buprenorphine that can be administered by a weekly or monthly injection, so it doesn't require a daily dosage. There was very positive evaluation around the use of Buvadol in prisons in that it won't suit everybody. I think that it's important to stress with any treatment that it won't meet the needs of everyone. It had some benefits in terms of clarity of thought, not tying people to daily dispensing. It is also rarely associated with overdose, as it has a protective factor in and around how opioids attach to brain receptors. It's a bit like a blocker if you take an opioid on top of your Buvadol, you don't get the effects of it or the high from it. I was very keen that, having looked at the results of Buvadol in some of our prison estate, how can we introduce that to the community? How can we widen access to treatment? That's why there's a £4 million investment in this financial year to widen choice to people, and that includes Buvadol. Obviously, that widening choice of treatment is a change in practice that occurred in response to the pandemic, but it's one that we want to continue and implement further in the community of already spoken about our work. Around the lock zone and how that distribution was widened over the pandemic and we don't want to detract from that. Can I bring in Mary McNair on this particular theme in Covid-19? Mary? Oh, I thought you were finished. Mary, I'll stop you there because I didn't realise that Stephanie was wanting to ask a supplementary, so Stephanie, carry on. Sorry, convener, my apologies. Again, just thinking about the impact of Covid, we've all realised the way that isolation and the connections to our families and how important they are for us to stay healthy mentally, but not everybody has that support. I'm wondering as well, you spoke about the promise earlier on and that talks about how those relationships and that trust that you build with other people going forward, not just with families but with organisations that provide support, really helps to sustain progress. My question is round about how we can actually sustain that progress. As people are coming through addiction and starting to move on with their lives, we'll hit struggles at some point in time. How do we make sure that they're able to connect back in and get the support that they need just as they move forward? Tackling social isolation is also a public health issue. Members may be aware that a few years back that the Government introduced tackling isolation and loneliness strategies, and there's a range of investments and funds around that. In terms of tackling drug-related deaths, I have to point to the lived experience and the recovery community, because much of what they do is based on their own real-life experience and the expertise that they bring to the community. Mobilising the lived experience community can help to reach people that services might struggle to reach. That relationship aspect of support is crucially important, and things such as the peer navigator system, such as the violence against medics against violence, have been strong proponents of within our prison system and our hospital system. A lot of the peer navigators from organisations such as Adenabeth 2 are about making people with lived experience contact with people when they come into police custody. All of that is about making those connections and building a relationship with people. Supporting them and helping them in their onward journey, as well as referring them to services potentially too. Covid-19 has had an active impact on many in our society, and I'm very concerned about its impact on the private communities and how this may be tumble-charged when the UK Government removes the £20 universal credit uplift later on this month. Has Covid-19 made it more difficult for people in the private communities to access drug services, and is there a concern that the welfare changes will make that challenge much more? There were, of course, great challenges people access and services during lockdown. I do have to say that the work of the lived experience community was particularly helpful and particularly imaginative. The Government worked with organisations such as the Scottish Recovery Consortium on guidance about how to continue to have meetings, whether that was online or in parts, in open-air settings or over the phone. I know that, for example, the recovery community in Glasgow did amazing work throughout the pandemic. There are other smaller organisations such as Recovery Enterprise Scotland, which are based in East Ayrshire. We are under an enormous strain during the pandemic, as a smaller organisation. That is why some of the new funds that I introduced are particularly geared at smaller, more local grassroots organisations so that they can have a fund that they can access funding that can help them with their work in their community. We have worked hard to make that funding as easy as possible to access. There is no doubt about it that so-called welfare reforms have an impact on the lives of the poorest. I suppose that the frustration for many of us around this table is that there is an increasing investment in the Scottish child payment, which will lift tens of thousands of children out of poverty. However, we have seen a cut that the temporary increase in the universal credit of £20 will be taken away from people when we are still not out of Covid and we are far, far away from recovery both socially and economically. Are there any positive responses as a reaction to Covid that we would want to keep post-pandemic? I think that I have outlined those discussions with previous members. Miss McNair's connection is not that good, so in terms of our work around Buvadol, our work around Naloxone, I have mentioned some of the work around prison to rehab. There was a £1.9 million investment in that. The work and the contribution made by the lived experience and recovery community throughout the pandemic should remind us well about the value of meaningfully engaging with and not just paying lip service to the recovery community in those with lived and living experience. That is why we want to take that work further forward with our work on a national collaborative. A couple of members want to ask questions about funding. That will be the last theme that we touched on. I thank the minister for the huge amount of information that she has given us already. I bring in Emma Harper. All of the discussion that we have had this morning, minister, obviously requires financial input. I am aware that the Scottish Government has committed to increasing funding. There was £5 million at the remainder of the last financial year and then there was an allocation of an additional £50 million funding each year. That will be a total of £250 million over the next Parliament, which will support further investment in a range of community-based interventions, including primary prevention and expansion of residential rehabilitation, which she has covered a wee bit of already. I am interested, minister, if she is able to support the breakdown of how the funding is allocated and for the alcohol and drug partnerships to be spending that money and then reporting back on how that will be assessed and evaluated, for instance. In terms of the £5 million, which was an additional resource that was released at the last quarter of the last financial year, but the first calendar quarter of this year, £3 million of that went to alcohol and drug partnerships. As I mentioned earlier, we published the returns on how that was invested. There was also £1 million put into a grassroots fund and £1 million put into a service improvement fund. At the turn of the financial year, after March 18, I announced four new funds totaling £18 million. Those are multi-year funds that I hastened to add. Those four new funds opened in May, so there is a £5 million recovery fund, there is a £5 million service improvement fund, there is a £5 million local fund, again geared towards grassroots organisations, and there is a £3 million family and children's fund. Those are available via Cora for all non-profit organisations to apply for. We have worked really hard to make the application process accessible and quick. To date, we have funded an excess of around 50 projects through that. When you add in other funds in terms of the work that, for example, the task force is done, we have funded more than 80 specific projects. On what we will invest this year in residential rehab, that will be around £13.5 million. That will come from ADPs, the recovery fund and other sources of funding in Government. When I come back to Parliament, I will outline in more detail the profile of that funding, because we have a commitment of £100 million in residential rehab and aftercare over five years. In terms of £50 million for this year, there is also a £13.5 million specific uplift to ADPs that I have mentioned. There is around £14 million that is going on, such as £3 million for outreach, £3 million for non-fatal overdose, £4 million for widening the distribution of buvidal and £4 million to implement the MAT standard. I hope that that gives you an overview. There is a little bit of resource going on research, but there is also a resource set aside for the national stigma campaigns and our living experience strategy work in terms of establishing the national collaborative. Thank you for breaking all the finances down. I know that a lot has been made of residential rehab and the costing of that is just scanning BBC articles. Castle Craig has mentioned that it is £2,500 a week for one person, but there is obviously a variety of residential approaches. I know that the number of residential beds has increased in Scotland. We are now at £418 when it was £365 previously. That is a bit of good news. I am looking at the whole broadness of the residential rehabilitation and the variety of costings of that. I am looking at the work that the Scottish Government is doing to look at the best-tailored person-centred approach for each person. You have talked about families and Phoenix futures. My question is about assessing all of the pathways for funding. Will it be something that you will be able to come back and report to us in chamber or at committee in the future about how all of that is working? In terms of residential rehab, the average cost per placement is around £17,000. In some areas, it is greater. There is also a variation in terms of the length of placement. This is something that the residential developer working group has looked at in detail. I do not necessarily want to be prescriptive about the length of stay in residential care. Care needs to be person-centred and there needs to be a flexibility in services. We need to recognise that residential rehab, as well as the link with Aftercare that Ms Mackay spoke of, has a link with detoxification services. Some residential rehabilitation units have in-house detox, and some do not. It is important that we are always thinking about the journey that people will take and the services and opportunities and the care that they need on that journey. Post-residential recovery is what needs to be continued after somebody does a stay in a residential place. That is part of the funding. A set of outreaches is another thing that is active. It is about lots of strands to try to support people through this whole process. Third sector charities are really important as part of any funding model that we consider. In short, we need to stick with people. There is an important role for us to reform and change how our statutory, NHS or local government services work in terms of how they meet the needs of people and their families that are struggling with issues in and around drugs. However, there is a valuable role for the third sector, so we have taken that Belt and Braces approach so, as well as increasing investment to ADPs. Many of whom will enter into the agreements with the third sector. There are four funds that I have outlined earlier in the £18 million multi-year fund that is available for third sector organisations to access. The role of the third sector, along with our public services and the lived and living experience community, is all vitally important. Those are the three strands of partnership—the lived and living experience community, the third sector and the statutory services. I have a number of questions. I am a practicing GP at the moment, so I am still working. I have a question about the standards of the medication assisted treatment. Number seven, all people have the option of match-shared with primary care. Could I ask you to define primary care? Primary care is multidisciplinary. That is often led by general practitioners, but primary care is located within our communities. It is often the first port of call that is supported by nursing staff. There are efforts to connect GP practices such as the work in and around depend practices with the voluntary sector and welfare advice. I am sure that perhaps my health colleagues and colleagues in public health may well have a more technical definition of description, but that would be how I see general practices. With number seven in particular, having the option to have match-shared with primary care, could you explain that in a little bit more detail? Would that mean that the patient would be with an organisation and that would count as primary care? Or would it have to be with the GP that they have the option for? A lot would depend on what the nature of the care they are receiving. If we are talking specifically about medication assisted treatment, that needs to be delivered by someone who is qualified to prescribe. However, the important thing about the medication assisted treatment standard is that it also makes connections with other aspects of treatment in terms of what is collectively known as psychosocial treatment and work to help people to address past trauma. A lot would depend on the type of care that we are talking about and the type of care that is available within a local practice. On number seven, a person who is qualified to prescribe medication, certainly at the moment, all GPs do not do that. Most probably do not. Is that something that you would like to see happen more? Practice varies. In the Lothians, for example, my understanding from NHS Lothian is that the majority of GPs are involved or could be involved in prescribing medication assisted treatment to their patients. In other parts of the country, the practice has been that people have been referred to more specialists, more centralised addiction services and an example of that would be in Tayside. As well as supporting GP practices in the resources and the range of services and support that they need to serve our communities, we also have to recognise that there are vital connections for patients here with who are receiving medication assisted treatment and their primary care needs. I know from my engagement with GPs that weighing aside the issue of who prescribes a medication assisted treatment, I think that every GP that I have encountered also said that they could do more at a community level with, for example, the physical needs and physical care that people who live with drug use experience will often have other health issues that can be addressed by accessing primary care. I certainly would look after my patients' needs, but it was more specifically about who does the prescriptions of the medication and would there be increased funding given to general practice? The funding arrangements for general practice sit with the Cabinet Secretary for Health and I can assure you that he engages very well and very often with the GP community and the whole host of issues that flow from the GP contract. I have opportunities with the additional resources that we have to reduce drug-related deaths. That is not prescriptive about what I have not said for a minute, all that money goes to ADPs or all that money goes to the third sector. It is about investing in services and approaches, where the evidence shows that lives can be saved. I was very heartened to hear that you said that you have a focus on governance. With that in mind, how will you be assessing the 10 standards that you have got out? I have a focus on governance and implementation. I think that I answered that question when Mr Rackane asked me the very same question, or paraphrased the very same question, that, as well as providing practical support through the Medication and Assisted Treatment implementation support team, known as MIST, to get those 10 standards embedded by next April, that their work also covered at least a three-year period that is about quality improvement and quality assurance? I think that I said to Mr Rackane that the last thing that we wanted to do was to put all that additional investment in time, resource and support to get those standards embedded and then to sit back and relax, because we cannot sit back and relax, we need to keep on this. I did listen to the answer that you gave to Mr Rackane, but I suppose more specifically is how, what measures are going to be in place for this? In terms of the quality insurance and the quality improvement that will underpin the on-going work of the MIST team, when I introduce a target for treatment, which will be at the turn of the year, there will be indicators underlying that treatment target that relates to more qualitative information that will be informed by our experience of implementing MAT standards. When you introduce this target, what happens if you do not achieve it? That will be for others to decide. My focus is not on my own future, I have been around Parliament and I have been around Government before, I had a life before I was a parliamentarian and my focus is on just getting the work done. Right, so I want to thank the minister for the time that she spent this morning, and in particular for the update, but also for the offers of specific information on services around the country. I think that that would be really helpful for us, because obviously we are looking at our work programme for the next next year, so that information would be helpful. I thank the minister and her officials for joining us this morning. At its next meeting on 21 September, the committee will host two round-table discussions with key stakeholders to explore session 6 priorities in relation to public health and NHS policy respectively. That concludes the public part of our meeting today.