Hansard

I thank the committee for inviting us. I am sure that all the guests who are round the table will agree that one deficit on the matter in Scotland has been the lack of opportunity for balanced public debate. We are all grateful for the opportunity to debate the issues and say our piece.It would be easy for me to dive into the faults, but I will spend about 30 seconds talking about the origins of why we are where we are and about some good features of our treatment services. We should remember that our system was founded 30 years ago in response to an emergency. That emergency was the emergence of heroin and the threat of the blood-borne virus, HIV, and AIDS. It is therefore easy to understand why we have taken a robust, criminal-justice-based, muscular approach to drugs—the enforcement approach. I suggest that, 30 years on, it is perhaps time that we stepped back and considered that, although that might have been right in the past, it might not be right for the future. There is much that is right and good about drug treatment and rehabilitation in Scotland. A lot of money—tens or hundreds of millions of pounds—has been spent over the past 10 years, as Neil McKeganey said. There has been a lot of innovation and good practice in drug and rehabilitation services throughout Scotland. We have an excellent team of dedicated people. They are not working for the money or the fame, but because they are dedicated to the cause. Let us not forget that. Over the years, tens of thousands of people have been given a good professional service with compassion and professionalism. That said, there is no doubt that, although many of the components of an integrated system are there, there is a complete lack of cohesion and synergy, which detracts considerably from the efficiency of the system. The effectiveness of treatment and rehab in Scotland is not so much like a postcode lottery as like a local authority lottery. The levels of funding are very different in different parts of Scotland. Some rural areas, which we do not often think about or talk about, have particularly tenuous funding arrangements. No matter how much money there is in certain local authority areas, the complex and convoluted streams through which the funding is delivered present a major problem. For example, in the City of Edinburgh, 10 discrete funding streams go into dealing with drugs, with a couple more for alcohol. Those present will understand how difficult it is to run a business based on that kind of chaotic funding arrangement. We really need to sort that out. It is not always about a lack of money, although there is a lack of money in some places; it is more about how the money is delivered, who has control of it and the performance outcomes that are demanded of it. We also lack a common system of performance management, single shared assessment and integrated care. It may seem ridiculous to say that in Scotland in the 21st century, but that is the fact of the matter. We speak about co-morbidity and complex needs, but we still treat drugs, alcohol, mental health, housing problems and family issues separately. We fund them separately, and different local authorities deal with them differently. There is a lack of choice, and that lies behind the methadone problem that Neil McKeganey was speaking about. There is a role for methadone, and we know what it is. The point is not about methadone itself, but about what should go with it. What supports its use as part of a recovery plan, not a maintenance plan? As Neil McKeganey said, we have a problem in prisons. I see the drug-dependent prison population as providing a golden opportunity, and literally a captive audience, which we do not make enough of. We wish a pragmatic, not moralistic, approach to the issue to be taken over the coming years. We should view drug treatment and rehabilitation as health issues, with an element of choice and supported by a range of services. We need to engage volunteers and self-help groups a lot more than we do. We need decent access to treatment rather than a local authority lottery. Last but not least, we need integrated services and a more cohesive pattern of funding. We need to judge treatments on their outcomes. That should be done in a way that is compassionate and humane, but also intelligent—we should not simply use a five-bar gate approach.I wish to end my remarks on a positive note. Literally as we speak, a review is being carried out of alcohol and drug action teams. It is a stocktaking exercise, which is being held throughout Scotland. It is a robust inspection. We have been through it ourselves, and I can tell those present that it is robust. We very much hope that the review will take on some of the issues that are raised today and that it will deliver a plan for the future.