National Mission Oversight Group minutes: September 2024

Attendees and apologies

• David Strang, NMOG Chair
• Sally Amor, Lived and living experience representative
• Stephen McCulloch, With You
• ACC Paton, Police Scotland
• Andy McAuley, Glasgow Caledonian University
• Justina Murray, CEO of Scottish Families Affected by Alcohol and Drugs
• Chris Williams, Royal College of GPs Deputy Chair
• Hannah Carver, Stirling University
• Kirsten Horsburgh, CEO of Scottish Drugs Forum
• Laura Wilson, Royal Pharmaceutical Society
• Lorraine McGrath, CEO Simon Community
• Nichols Phin, Public Health Scotland
• Steph McCutcheon, Reach Recovery
• Maria Rossi, Public Health Scotland
• Chief Inspector Lesley Anne Docherty, Police Scotland
• Katy McLeod, Scottish Drugs Forum
• Fiona McQueen, Scottish Recovery Consortium

Also attended 

• Alison Byrne, Scottish Government
• Maggie Page, Scottish Government
• Morris Fraser, Scottish Government
• Chloe Poole, Scottish Government
• Georgie Alford, Scottish Government
• Anniek Sluiman, Scottish Government
• Chris McEwan, Scottish Government
• Rachael Sinclair, Scottish Government
• Lauren Ross, Scottish Government
• Paul Sutherland, Scottish Government
• Maria Rossi, Public Health Scotland
• Cheryl Glancy, Public Health Scotland
• Katy McLeod, Scottish Drugs Forum
• Samantha Stewart, Scottish Drugs Forum

Apologies

 

• Ms McKelvie, Minister for Drugs and Alcohol Policy
• Eddie Follan, COSLA
• Joanne McEwan, Police Scotland
• Paul Johnston, Public Health Scotland
• Susana Galea-Singer, Royal College of Psychiatrists
• Tracey McFall, Scottish Recovery Consortium
• Valerie White, Public Health Scotland
• Emma Crawshaw, CREW2000
• Iain Smith, Keegan Smith Law
• Sandra Holmes, Lived and living experience representative
• Billy Watson, Scottish Association for Mental Health
• Sarah Allen, With You

Secretariat

• Paul Sutherland, Scottish Government

 

 

Items and actions

Welcome and board governance

The Chair welcomed members and attendees to the tenth meeting of the National Mission Oversight Group (NMOG). Apologies were noted.

The Chair voiced the group's best wishes to the Minister who is on medical leave and then welcomed all attendees to address the room and introduce themselves.

The Chair reiterated the focus of today’s meeting focus would be to look at the NRS Drug Deaths Statistics for 2023, the PHS National Benchmarking Report on MAT Standards, the SDF Observational Peer Research report on MAT standard implementation and then finish with a Deep Dive on the Scottish Governments National Specification proposal. 

The minute of the previous meeting on 20 June 2024 was formally approved. EC provided an amendment to the full minute which was noted. The summary minute for the previous meeting has been published on the website.

SG update since last meeting 

The Chair handed to AB to provide the Scottish Government update.

AB addressed the recently published NRS Drug Deaths Statistics for 2023 stating that this was a time to pause and reflect and also that the Scottish Government is sorry is sorry for all of these tragic deaths.

• The new Programme Structure for the Drugs and Alcohol Policy Division.
• PHS National Benchmarking Report on MAT Standards.
• The establishment of three drug checking sites across Scotland.
• Progress on the Charter of Rights.

The Chair welcomed questions on the SG update from the group. 

Discussion 

Members welcomed the new Programme Plan and introduction of a new Delivery Board. The group discussed a potential evaluation of Planet Youth which is being expanded to more schools. 

NRS Drug Deaths Statistics for 2023, report published in August

RS gave a presentation to the group on the Drug Deaths Statistics for 2023 published by the National Records of Scotland in August 2024.

Key points from RS presentation were:

• 1,172 drug deaths registered in 2023. 
• Most of the increase was in males (up 16%).
• Second lowest number of drug misuse deaths since 2017. 
• People in the most deprived areas were over 15 times as likely to die from drugs than people in the least deprived areas.
• Opiates remain the most commonly implicated drugs but 
• Deaths involving cocaine are increasing and reached their highest ever level

Discussion

Points raised by Group members 

Members suggested that that while there has been large focus on nitazenes, xylazines and fentanyl, we need to deal with established drug types such as cocaine and gabapentin and explore what drives the regional variations on cocaine as shown in the NESI data.

The group discussed strategies for approaching cocaine use, acknowledging existing toolkits and the importance of human-centred approaches.

It was also voiced that we must be careful interpreting the figures where methadone is implicated. The figures cannot be taken to imply methadone doesn't work as a treatment approach due the limitations of what the data shows. For example,nothing is recorded to show if such cases involved people who were on or off prescription. 

National Benchmarking Report on MAT Standards (published by PHS 9 July).

Maria Rossi from PHS attended the meeting to give a presentation to the group on the National Benchmarking Report on MAT Standards (published by PHS 9 July).

Key points of the presentation were:

• This is the 3rd year that PHS have put together this report and this year it is showing promising results.
• In 2023/24, for MAT standards 1–5, 90% have been assessed as fully implemented (RAGB blue and green). This is an increase from 66% in 2022/23 and 17% in 2021/22.
• For MAT standards 6–10, 91% were assessed as RAGB provisional green (evidence that implementation is beginning). This is an improvement from 2022/23 when 45% were amber (evidence of partial implementation) and 12% had no evidence of implementation (RAGB red).
• MAT standards 1-5 have 3 years’ worth of data and MAT 6-10 have 2 years’ worth of data. 
• Aligning MAT Standards with a HRBA (human rights-based approach)

The next steps and challenges for MAT are:

• Polysubstance use & changing drug landscape
• Better outcome data especially around effectiveness and defining what success would look like
• Local ownership of continuous improvement 
• Alignment with HRBA – consistent with inclusion for all substances & settings 
• Implementation across Justice Settings

SDF Observational Peer Research report on MAT standard implementation

KM from Scottish Drugs Forum attended the meeting to present on the SDF Observational Peer Research report on MAT standard. 

Key points of the presentation were:

• While there are improvements in treatment, significant work remains, particularly in addressing inconsistent access to services, challenges within prison environments, and the ongoing stigma surrounding medication-assisted treatment (MAT).
• Gaps in support, particularly in psychosocial and mental health aspects, hinder effective MAT. Addressing the need for stronger relationships between providers and patients, as well as adapting to the unique needs of different populations (e.g., women, prisoners), is crucial.
• More comprehensive information for patients, families, and staff is needed to optimize treatment outcomes, along with addressing staff burnout and barriers to implementing individual MAT standards (such as shared care, advocacy, and trauma-informed care).

Discussion – National Benchmarking Report on MAT Standard and SDF Observational Peer Research report on MAT standard implementation

The chair welcomed comments and discussion on MR and KM’s presentations.

Points raised by Group members

Members raised concerns about the low visibility of MAT Standards, noting that service users, especially homeless individuals, are often unaware of their rights to these standards. Some services may not fully inform users about MAT, which limits their ability to advocate for themselves. Additionally, challenges related to staff retention, resource limitations, and gaps in staff knowledge were highlighted as significant barriers to effectively delivering MAT. 

Members discussed how the implementation of the 10 MAT Standards has evolved over the last three years, with noticeable variability between different Alcohol and Drug Partnerships (ADPs) in how they apply the standards and capture related data. 

It was also suggested that more support is needed for families and individuals hesitant to engage with NHS services due to concerns about potential repercussions, such as offering alternative contact methods like email or chat functions.

Members voiced that the narrative surrounding Buvidal prescriptions, which are often viewed as progress, despite this not always being the case. Similarly, methadone doses are sometimes stigmatized, with dosage changes wrongly perceived as either progress or regression, which is a dangerous and misleading approach

Members also expressed concern about the lack of scrutiny around Buvidal compared to other medications like methadone. Members also raised similar concerns around cocaine use, particularly its role in suicides, stating that it requires greater focus and scrutiny, as its increasing prevalence presents significant risks.

Deep Dive - National Specification. 

CM from the Scottish Government attended the meeting to present on the Nation Specification work being carried out. 

Key points of the presentation were:

• The National Specification and proposed Overarching Guidance to follow are part of our response to the recommendations made in the Drug Deaths Taskforce report 
• The purpose of the National Specification is to provide clarity on the range of support options which should be available in local areas. 
• This will help local services to set out future strategic plans to deliver on their commitment to reduce harms, alcohol, and drug deaths and to improve the lives of those impacted by alcohol and drugs within a ROSC as per the definition in the Quality Principles. 
• The National Specification links closely with the overarching aim of the National Mission to improve lives and reduce deaths - by developing treatment and recovery services, help services to deliver on their duty to provide the highest quality of healthcare and be inclusive of the voices and experiences of people, and their families, in recovery.

Discussion: Deep Dive - National Specification

The chair welcomed comments and discussion on CM’s presentation.

Points raised by Group members

Members raised some concerns regarding system orientated like language (such as, patient, drugs misuse etc) and suggested moving away from this language. The group emphasised the need for more flexible, and person-centred approaches that take account of person’s individual circumstances.

It was highlighted that the National Specification should avoid labelling or medicalising addiction and should recognize other contributing factors. Members also noted that the specification does not feel significantly different from the MAT Standards. There was a suggestion to consult with those with lived experience (LLE) to ensure that the framework reflects what people actually want.

Members inquired whether the National Specification would be implemented across all NHS services and local authorities, as this could help standardise local thresholds. However, it was acknowledged that this would likely lead to an increased demand for resources, which would be critical to itssuccess. It was also noted that there is already existing material that could be used to inform the development of the National Specification.

AOB and Clos

The Chair thanked attendees for attending the meeting.

The Chair reminded attendees that, should they have any items they would like to add to the agenda for future meetings, they should let the steering group know.

The next meeting is scheduled to take place on Thursday 12 December 2024 in St Andrew’s House, Edinburgh. The proposed focus will be determined at the Steering Group meeting on 3rd October.