Seòmar agus comataidhean

I thank Mr Sweeney for his long-standing interest in, and campaigning on, the issue. I will defer to Maggie Page on the detail to ensure that I do not speak out of turn. NHS Scotland Assure is involved, and there have been delays in ensuring that the facility can be operational.

I would very much welcome that interaction. Again, I go back to Ms McNair’s questions on interaction with UK ministers at a minister-to-minister level. Those conversations have not happened, but I would very much welcome them, and I believe that the relevant health and social care partnership—without wanting to speak for it—would welcome them, too.

With regard to the learning from the facility, I expect that a great number of people will have an interest in looking at the success, or otherwise, of the pilot. In Scotland, we have to contend with a specific, and greater, issue with drug-related deaths. The recent statistics show that there has been a rise in the prevalence of drug-related deaths elsewhere in the UK, but it is not on the same scale that we are seeing in Scotland. I do not wish to diminish in any way the challenge that we have in Scotland, but I believe that there is, and there should be, a wider interest in the success, or otherwise, of the pilot at Hunter Street.

I met the new Secretary of State for Health and Social Care, Wes Streeting, pretty early in his tenure, and we are due to meet again soon. However, the issues that we are discussing were not covered in our ministerial discussion.

I will bring in Richard Foggo to talk about interactions that officials have had, but I think that it is safe to say that there is greater recognition from the new UK Government of the importance of taking a harm reduction, public health approach to tackling the issue of reducing drug and alcohol-related deaths. I am hopeful that we will have a constructive relationship on that basis to allow us to see progress on some of the areas that we are discussing. Those areas will include the safer consumption facility and the drug-checking facility, which the convener asked about, but I hope that the interaction of those things with reserved legislation will be open for discussion, too.

I know that there is interest in other areas; Edinburgh is looking closely at such facilities, too. The scheme is a pilot, so we are starting from a smaller place. If it is successful, we can, based on the test-and-learn process, build it up from there.

If it is successful, I expect that we will consider wider participation in addition to the facilities in Aberdeen, Dundee and Glasgow. Those cities have particular challenges, but the issue is facing all communities across Scotland.

I will be honest. I do not know why 1,000 was set as the target, and whether that is the right measure of—I do not think that “success” is the right word, but I think that Ms Wells understands where I am coming from. That target predates my involvement, so I do not know why it is 1,000.

What we can demonstrate is the clear progress that is being made on the availability of residential rehab. Audit Scotland recognised that in its report, to go back to Ms Dowey’s line of questioning.

We need to demonstrate that we are making progress across all areas. We are reducing stigma, thereby giving people the opportunity to access support and breaking down the barriers to that support, as well giving their families the opportunity to receive support. The progress that has been made in access to residential rehabilitation beds is a sign of that progress.

Again, as I say, I honestly do not know the reason behind 1,000 being the target, and it will be for us all to judge whether that is the right measure. The important thing is that demonstrable progress is being made in availability and in the capacity of the system, and that is clear.

I expect that that will form part of the audit work on bed availability that Maggie Page referred to. If we have further detail at local authority or health board level once that work is complete, we will certainly seek to provide that to the committees.

I will come back to the first point that Ms McNeill made, and then I will address her second point, on the gendered aspect. I will bring Maggie Page in on both questions, too.

On the first point, constituents have come to me who are in exactly the situation that Ms McNeill has outlined. They believe that residential rehab is right for them, but clinical decisions have been made that make that more challenging.

That touches on some of the work that we are seeking to do to provide clarity and ensure that guidance is in place with regard to people who present with both mental health and substance dependency issues at the same time. I am clear that we must support people to tackle both issues concurrently, as they drive one another—the substance dependency drives the mental health issues, and vice versa. We need to be clear on that, and I certainly believe that we need to support people in both aspects. I would be happy to return to Ms McNeill’s points in that regard.

On the gendered aspect of this issue, Ms McNeill is absolutely right. The figures are clear on the level of drug deaths among men, and indeed on the prevalence of poverty and the correlation between people living in poverty and the impact of that in terms of substance abuse. I will bring in Maggie Page to talk about this, but we have been developing work on how we target men to ensure that they understand what support is available.

Again, that brings us back to the landscape of destigmatisation, which is so important when it comes to men’s interaction with health services. Mr Sweeney and I are currently participating in Movember, because we need to promote greater awareness among, and provide a greater level of comfort for, people with regard to the need to interact with health services, regardless of how uncomfortable it might be to talk about health. Over the past couple of weeks, Chris Hoy has demonstrated the importance of doing that when it comes to prostate cancer, and it is just as important in this area with regard to the drivers of drug dependency among men and the mental health aspects in that respect.

I will bring in Maggie Page to talk about the specific action that we have been taking in that area and the work that is developing there.

I would be very interested in hearing more about the direct experience that you have been able to pick up. I presume that that will come through in the report, but if there is anything that the practitioners in Broadford would be able to feed straight in, I would be keen for us to look at that as part of our reform and improvement work. We are keen to look at how we can blur the lines of health boards and ensure that we maximise the operational capacity through better working arrangements for our staff.

However, I am cognisant of the fact that, although such an arrangement might work for many people, there are others who would prefer to have a fixed-point contract that involves working in a fixed-point place. Therefore, we would need to handle that carefully, but I would be very interested in hearing more about the experience that you picked up in Broadford.

That is a major concern for me. Since coming into post, one of the areas that I have had the greatest concern about is the rise in agency and locum costs. In some areas, that cost is unavoidable, and we need to invest to ensure service continuation. However, I want to take a longer-term approach, and I hope that some of the reform discussion that we will have later this month and, going into the rest of the year, the reform and improvement work can focus on how we make sure that we have the culture and management structures in place that allow greater flexibility for workforce so that we are attracting and retaining staff.

We have a number of areas of intervention including bursaries and golden hellos to try to attract people to rural and island areas in particular on a sustainable basis, so that we can avoid the need for locum and agency cover. That cost increase over recent years is a major concern for me and one that I wish to tackle.

It increasingly sounds as though the session on Skye was incredibly productive, and I am ever more regretful that I was not a part of it so that I could hear directly from the colleagues that Ms Mackay refers to.

We are in a situation where we do not have the luxury—although I do not think that it is a luxury, actually—of being siloed; we cannot afford that. We need to use the capacity that is available, regardless of where it comes from. There must be much greater collaboration between public sector agencies. The integration agenda is about much greater collaboration between our health and social care partnerships, or IJBs, and our statutory partners, as well as the community and the voluntary sector. As Ms Mackay rightly said, that sector often provides services that statutory providers cannot provide to the same level of funding. We have to see much greater collaboration there.

We must also utilise the expertise and innovation that are coming through from the private sector. If we can harness that, we have an opportunity to stay true to the principles of the NHS being publicly owned and free at the point of need and delivery. We need to harness some of the products that are being delivered by the academic and private sector to free up clinical capacity for the care that clinicians and health service staff give. We have an opportunity to take forward much greater collaboration, if we can, to continue to improve and reform our health service for the better.