NHS Reform: It’s Social Care Stupid!

 The current NHS crisis has spawned a flurry of proposed reforms to the National Health Service. They range from privatisation to the use of volunteers. However, most miss the point. The underlying problem facing the NHS across the UK is the failure to invest in social care.

The most obvious symptom of the NHS crisis is Accident and Emergency (A&E). Less than 68% of people were assessed, treated, admitted or discharged within the Scottish Government’s four-hour A&E target. More than 6,800 people spent more than 12 hours in A&E in October. While there is much in the Scottish Futures report to agree with, including patient-centred care, more volunteers doesn’t hack it. While the different NHS systems in the UK should cooperate, their emphasis on this is more political than practical. NHS Scotland is big enough to operate mainly on its own. More UK bureaucracy won't help.

The latest NHS Scotland delayed discharge statistics illustrate the need to focus on social care. A delayed discharge occurs when a hospital patient who is clinically ready for discharge from inpatient hospital care continues to occupy a hospital bed beyond the date they are ready for discharge. In October 2022, the average number of beds occupied per day due to delayed discharges was 1,898, the highest figure since the current guidance came into place in July 2016. To put this number in context, the Queen Elizabeth University Hospital in Glasgow has 1677 beds. So, delayed discharge is the equivalent of our largest hospital and then some. The chart below shows this is not a short-term blip.

There is also a human cost. In October 2022, there were 58,826 days spent in hospitals by people whose discharge was delayed. This is an increase of 17% compared with the number of delayed days in October 2021. No one wants to, or should, stay in a hospital any longer than they need to. This is on top of the financial cost, as hospital beds cost far more than social care provision.

The latest care inspectorate statistics showed that 60% of care services that employ nurses reported vacancies, creating a 16% vacancy rate. The staffing issues are not limited to social care. NHS district nurses play a crucial role in supporting people to return home from hospital. The vacancy rate for district nursing reached 16% last month. The Westminster Adult Social Committee has highlighted similar concerns in England.

The idea that more privatisation is the solution is risible. As Prem Sikka recently highlighted, social care companies are robbing the public purse, with profit margins of between 37% and 41.7%, and tax dodging is rife. This is the model that people like Karol Sikora want to expand! In addition, self-funding care home residents are now paying 40% more than publicly-funded residents, compared with 24% a decade ago.  

Sadly, the proposed National Care Service in Scotland will do nothing to challenge this, taking even more services from the public sector. Moreover, as the Scottish Parliament Finance Committee report highlighted, the costings of this over-centralised service are largely unknown. Still, we do know that it will divert much-needed resources from frontline services. Creating a National Care Service remains the right approach. However, its role should be to create a national framework, with services designed and delivered locally. Implementing organisational change of this magnitude will take a significant amount of time. In the meantime, we need to support the demoralised, tired, and financially stretched frontline staff who immediately need a break, decent pay and a vote of confidence. 

There has been a welcome initiative from former health ministers Alex Neil and Malcolm Chisholm to end zero-hours contracts. However, the response from Social Care Minister Kevin Stewart that companies bidding for government work are evaluated on their fair working practices "where it is relevant and proportionate to do so" - is not good enough.

Patients overwhelmingly access the NHS through GP services. However, patient surveys show this is becoming increasingly difficult despite GPs delivering more appointments (not all in person) than before the pandemic. Patient satisfaction is 12% down in the last year, with 10% saying it had become more difficult even to contact their GP practice. Some of the byzantine appointment systems don't help and put excessive pressure on reception staff, who take the brunt of patient dissatisfaction. 

This is primarily an issue for non-urgent treatment; charging better-off patients won’t help address this. While it may discourage some appointments, this short-term gain will result in long-term pain as conditions go undiagnosed, resulting in more severe conditions for the NHS to treat. The solution is recruiting more GPs and other health staff in primary care. GP numbers have fallen from 3,613 in 2019 to 3,494 in 2022. Scottish Government targets focus on headcount, which ignores the growing number of part-time staff. A BMA Scotland survey indicated that 75% are more likely to quit or reduce hours in the coming year due to ‘excessive workload’. Five years on, the deployment of multi-disciplinary teams has fallen short because of staffing shortages. 

Moving away from the expensive small-business model would also help in the longer term. Many more GPs, particularly younger staff, are coming to this view. For example, GPs at the Lothian LMC have recently said that the independent contractor model ‘is no longer fit for purpose.’

The NHS as an institution rightly attracts almost universal support, primarily because we all rely on it. That doesn't mean it is sacrosanct, and it is perfectly reasonable to debate reform. However, we must be wary of those who use reform as a trojan horse to promote their ideological agenda. The founding principles of an NHS free at the point of need, funded by general taxation, is the best way to organise healthcare. The NHS's main problem is the absence of adequately funded social care and primary care. That should be our focus right now. Anything else is a distraction.

Rebalancing the UK

 Big-picture reform may not be on everyone's list of priorities, but governments should be able to tackle big long-term projects while also addressing the immediate issues. Unfortunately, the short-termism of so many politicians has undermined the UK for far too long. In this context, we now have the long-awaited report of Gordon Brown's Commission on the UK's Future. 

The report starts with a persuasive case for change. The country was in crisis long before the pandemic and the economic consequences of Russia’s invasion of Ukraine. There are always excuses for not tackling the big issues, and successive governments have ducked them. Yes, we have an incompetent and ideologically driven government that has failed to deliver acceptable levels of investment, economic success and good-paying jobs. But, as the report says, the way our country is run is preventing us from making the changes we need for a better future.

Few could argue with the analysis in the paper of the challenges. These include the scourge of inequality, loss of trust in politics, and centralisation. Britain hasn’t taken back control as promised with Brexit – Westminster and Whitehall have. The same is true in Scotland by the Scottish Government. While there have been global factors, the UK has handled them less well, as this chart shows:

And while economic growth is not all we should be concerned about, at least on current definitions, our relative position has crashed.

This is particularly the case for workers. Pay and living standards for most people in Britain have not improved, and taxes have risen to pay for worse public services, making this a lost decade for British families. 

There are some broad solutions proposed to address these issues. Unsurprisingly, there is an emphasis on shared UK purpose and values while recognising that people in the nations of the UK feel morally and politically abandoned by the present UK government. So, the report argues that powers must be decentralised to the right place - in the nations, regions and communities. While there is more detail about local government in England, because this is devolved, many of the reforms proposed would also be welcomed in Scotland as an antidote to SNP centralisation. They reflect the arguments I made in a Reid Foundation paper a few years ago. My only exception is the obsession with directly elected Mayors. There is nothing democratic about centralising power in the hands of one person.

There are reforms proposed for Westminster, cleaning up the corruption that undermines trust in politics and Britain’s voice in the world. A long overdue plan to replace the House of Lords with a new second chamber of Parliament: an Assembly of the Nations and Regions. We should ignore the Lords who oppose this on spurious grounds, acting like Turkeys who don’t want to vote for Christmas. 

On Scottish devolution, the focus is on embedding the constitutional settlement, strengthening the Sewel Convention and introducing mechanisms to improve cooperation across the UK. While devolving powers is not the only way to enhance devolution, the principle of subsidiarity demands that powers be devolved to the lowest practical level. It is here that the report is weakest. Gordon's Treasury orthodoxy screams out of the pages, with the resistance to prudential borrowing powers that apply to local authorities but not the devolved administrations. New taxes can only be introduced by agreement with the UK government, which jars with the principles the paper claims to espouse. Today's STUC paper is much better on public finance issues.

On specific powers, devolving job centres is fine, but employment law is only to be shared. And what about drug policy and immigration? The Red Paper Collective has set out the case for devolving these powers clearly. Of course, all these should be exercised in cooperation when they can have implications for the rest of the UK. But the starting point is to recognise that not all parts of the UK have similar problems or require the same solutions. 

This report does offer a new approach that should appeal to the 40% of those living in Scotland who are not entrenched in either side of the national obsession. However, it could have been bolder in key areas, which also fall some way short of Scottish Labour’s policy positions on further devolution. Electoral reform is another issue that has been ducked, despite the recent UK conference decision.

Overall, we should thank Gordon Brown for embarking on this process because it takes someone of his stature to ensure this debate gets a hearing. While the report has weaknesses, the proposals would at least help rebalance the UK politically and economically.

From the national to the local

Yesterday, I was speaking at the book launch of 'A New Scotland: Building an Equal, Fair and Sustainable Society'. I have previously written about the themes in the book, which I picked up in my Afterword. These go beyond traditional economic thinking to include inequality, public services, and economic and political governance. While there is plenty of challenging analysis, there is also optimism that a better Scotland is possible.

My substantive contribution to the book was on local economics. There is plenty of commentary on macroeconomic policy in Scotland, not least within the confines of our interminable constitutional debate. However, there is far less analysis of how our over-centralised political and economic governance undermines the local economy. 

One of the issues I cover is the importance of ownership. This is a crucial issue with Community Wealth Building because local ownership is less likely to bolt when the cold economic winds blow. This week the Herald, in conjunction with The Ferret, ran a timely series of articles on ownership in Scotland. 

Their research looked at 23 major shopping centres in Glasgow, Edinburgh, Dundee, Aberdeen, Inverness, Perth, Stirling and Dunfermline, excluding retail parks. They found 18 involved ownership structures that made some use of companies registered to tax havens. In other words, more than three out of four of Scotland's largest city shopping centres are owned in or linked to tax havens. Tax dodging deprives governments of tax revenues, increases inequalities and undermines smaller and domestic businesses. As Paul Sweeney MSP said, “The levels of influence held by these multinational organisations is as unsustainable as it is unbelievable. For years, city centres and high streets have been left chasing their tails because large shopping centres have had carte-blanche to reconfigure the very fabric of our major cities.”

This isn’t just an issue for the retail sector. While the majority of cultural assets in Scotland’s cities remain in the hands of local councils and charities, others are not. These include venues such as the Edinburgh Playhouse, King Tut’s Wah Wah Hut, and Glasgow’s King’s Theatre, owned by global companies with links to offshore tax havens. In addition, cinemas and theatres are at risk of being taken over by tax haven-linked private equity companies.

The research also found that Scotland’s three largest airports and some major sea ports are linked to offshore entities and that a firm building Scotland’s digital infrastructure is ultimately owned by a private equity fund. One of the firms building broadband services across Scotland is backed by a state-owned Emirati company, which invested in an Israeli firm behind controversial spyware called Pegasus. The spyware is alleged to have been deployed by foreign governments against dissidents, journalists, diplomats and members of the clergy.

The Scottish Government has a welcome commitment to a 'wellbeing economy' and supports, in principle, Community Wealth Building. However, if this is to be more than just another glossy document full of ambition, it must be backed up by action. As IPPR Scotland puts it, “The Scottish Government has a stated ambition to create a ‘wellbeing economy’, built on inclusive growth and community wealth building. That needs to see wealth not just being created in our local economies but retained there, too.”

In the book, I highlight the local initiatives that could help to regenerate our town centres and High Streets. These include creating spaces for small businesses and cooperatives and 20-minute neighbourhoods that promote a circular economy. And most importantly, investing in the social infrastructure, like libraries and leisure facilities, which binds our communities together. All of these actions can be delivered under devolved powers. A better Scotland recognises that not all the solutions to our challenges can be dictated from the centre. They must be developed and organised from communities of interest and place because ownership matters.

Action on health inequalities

As the UK and Scottish Governments start the process towards another round of Austerity, we need to remember the impact this will have on health inequalities. Those in Scotland’s most deprived areas are 3.9 times more likely to die from an avoidable death than those in the least deprived areas. The leading causes of avoidable deaths were cancers, circulatory system diseases and alcohol and drug-related issues, and Covid-19. In addition, life expectancy in Scotland has been two years lower than in other UK countries for decades.

Mortality rates in higher-income countries have steadily improved for more than a century. However, these improvements started to stall after the last round of Austerity in 2012, actually increasing in the most deprived areas. In 2019, the UK ranked 24th in the OECD in life expectancy, behind all other English-speaking countries (except the US) and nearly all countries of Western Europe.

These trends were noticeable before the pandemic, which has exacerbated them, but there has been no return to pre-pandemic levels. As a GCPH/University of Glasgow report highlighted, ‘there has been a stalling of improvement overall, accompanied by increasing death rates among large sections of the population living in more socioeconomically deprived areas. This is hugely worrying. Put simply, we should not see such trends in a wealthy society such as the UK.’ Austerity is evidenced as making an important and substantial contribution to these trends.

While drug-related deaths, in Scotland in particular, are an important factor, they are not the sole or majority contributor to stalled mortality trends. Changes in rates can be observed even when drug-related deaths are excluded, and the increase in drug-related deaths is likely to have been partly caused by the same underlying factors associated with the overall mortality changes.

An independent review by the Health Foundation found large and sometimes widening health inequalities among children living in Scotland’s most and least deprived communities. They found that by 2016-18, infant mortality was 2.6 times higher for babies born to women in the most deprived areas compared to those of the least deprived, compared to a difference of 1.8 times in 2000-02. A key issue is obesity, which by 2019/20, was around 6% among the least deprived five-year-olds compared to roughly 13% in the most deprived. In 2001/2 there was no gap. This will not be resolved simply by targeting behaviours because there is no difference in physical activity by deprivation. There are differences in diet, and a healthy balanced diet is considerably more expensive calorie for calorie and therefore increasingly inaccessible to those on the lowest incomes.

Child poverty has long-term implications. People who experience deprivation as children are more likely to choose to do things that, although pleasurable in the short term, are unhealthy in the long run. This includes overeating, taking drugs, smoking cigarettes and gambling. This can help to explain why some people go on to become addicts while other people can avoid some of the more harmful effects of drugs and alcohol.

Politicians are failing to address the underlying causes of inequality. In Scotland, we have plenty of analysis but limited action. Audit Scotland recently reported that ‘the Scottish Government has not yet demonstrated a clear shift to preventing child poverty.’ Others, like Suella Braverman, seek to cover it up by focusing on immigration. Public anger at a lack of affordable housing and secure work, declining living standards and austerity has been redirected at the caricatured foreigner. Instead, we should be focusing on the economy and public services with actions such as those suggested in the GCPH report, including:

• Changing the economic structures that lead to immense wealth and income inequalities.

• Increase all benefits and tax credits in line with inflation every year, and put in place a one-off increase now to compensate for the loss of real income since 2010. Using devolved fiscal powers to top up reserved benefits and reverse UK cuts. Create new devolved benefits and increase existing benefits to support those in low-income households.

• Improve the availability of ‘good work’ by increasing in-work benefits, strengthening trade unions, minimising health and safety risks and increasing the statutory living wage to the Real Living Wage.

• Address tax evasion and avoidance and increase taxation of wealth, assets and corporate profits.

• Increase public sector funding for preventative services, and reinstate cuts in public services, particularly local government.

• Eliminate fuel poverty through action on housing insulation and heating and grow a social rented housing sector that is accessible, affordable and provides secure tenancies.

More than ten years ago, the visionary Christie Commission highlighted the impact of inequalities on the economy and our public services. They recommended more collaborative working, preventative spending, and building services around people and communities. Sadly, we see greater centralisation, silo working and little preventative spending. So, it was good to see the recent report of the Scottish Parliament’s Health Committee on health inequalities reference the report. What we now need is some focus on delivering its recommendations. Tackling health inequalities should be the priority of all governments.

 

I have always imagined that paradise will be a kind of library

 This is one of my favourite quotes about libraries, written by the Argentinian writer Jorge Luis Borges. It seems particularly appropriate during Libraries Week. Coincidentally, I contributed to a pan-European study this week on libraries, highlighting some of the challenges facing the public library service in Scotland and the UK.

I am very fortunate to own several thousand books in what I call my library and a frequent target for my wife's decluttering initiatives! However, it isn't a library. It is a collection of books, even if they are carefully organised and entered into a database. A public library is much more than a collection of books, more than a service; it is an integral part of the community. What I called in my Reid Foundation paper, Building Stronger Communities, social infrastructure.

Despite my 'significant' collection of books, I am a member of the British Library, the National Library of Scotland, the Mitchell Library in Glasgow, and arguably most importantly, my local library. I am not keen on the saying 'use it or lose it', although I understand the importance of demonstrating community support for public services. I always have a book on loan because even in my small local library, I can find a book that I wouldn't have bought, which stretches my thinking into new fields.

Under the Public Libraries Consolidation (Scotland) Act, as amended in schedule 21 of the Local Government (Scotland) Act 1973, local authorities in Scotland have a statutory duty to provide "adequate library facilities" for all residents in their area. The problem is that 'adequate' is not defined. I recall seeking counsel's opinion on a possible legal challenge some years ago, only to be told that the test could probably be met by one public library in the local authority area. There are some local acts on libraries, but they are no more substantial. Several local authorities have also outsourced their libraries to culture trusts, further blurring the statutory duty.

Like other local government services, libraries are under financial pressure. 83 public libraries have closed in Scotland since 2009/10, with spending cut by 30 per cent over the same period. This is despite yearly visitor numbers increasing by over 40 per cent. Many more libraries have cut their opening hours and reduced staff. Around 20% (700+) of all public libraries in the UK have no professional staff. They are spun as 'volunteer led', a euphemism for blackmailing communities into running libraries under the threat of closure. 

There has been a welcome move towards abolishing library book fines, although the data is limited. Glasgow Life has recently done this, arguing that it reflects a growing global movement to abolish late book fines, recognised as a barrier to participation, particularly for families from low-income households. A progressive move after they controversially closed several libraries, later reopened after great community campaigns.

The importance of professional staff is reflected in the wide range of services and activities in our libraries. It also provides an objective voice in selecting books and other resources. I am sure there would be no shortage of well-meaning middle-class people in my town who would be prepared to help run the library. However, they would have little idea of the wider community's needs. This is becoming a genuine concern in the USA as books are banned because some ideologue doesn't like the content. My experience as a UNISON official was that librarians made fearsome negotiators, always well prepared. A skill that even Donald Trump is discovering as he faces legal action for keeping files from US government librarians. I am also in awe of the work being done by "Crazy Ukrainian librarians" in the most difficult of circumstances.

The broader value of public libraries as a community resource is being recognised in the concept of 'warm banks' in response to the energy crisis. Librarians have always recognised this well before the current crisis. The consumer champion Martin Lewis has commissioned a best practice guide on this. A recent survey showed that 60% are actively considering participating in a "warm bank" scheme, offering heat and shelter to vulnerable people, as another way to help during the cost of living crisis.

In England, Baroness Elizabeth Sanderson has been appointed by the UK Government to help develop a new strategy to ensure public libraries provide the best possible service for their communities. There have been some understandably cynical responses to this initiative, but we will see. Almost one in five (18.6%) children in England between the ages of five and eight do not have access to books at home. Authors and publishers have urged the new prime minister to abolish "the last remaining tax on reading", and ensure schools have funding for author visits and invest in libraries.

So, please use Libraries Week to show your support for a vital public service. And challenge your elected representatives to strengthen the statutory duty, employ more library staff, invest in resources and keep our libraries open.

Governing With Purpose - a guide for charity trustees

 As someone who works with and serves on several third-sector boards, I have sometimes wondered why anyone does this. External criticism and internal squabbling are not unknown, and thanks are not always forthcoming. Moreover, when personal time has rarely been so squeezed, it isn't easy to get people to volunteer for this role, even if around a million people in the UK have risen to the challenge. Larger charities provide training when you become a trustee, but it can be limited for smaller ones, leaving the new trustee slightly overwhelmed.

In this context, a new book about governance in the charity sector should be welcomed. Brian Cavanagh, who has extensive experience in the public and third sectors, has written Governing with Purpose: How to lead a brilliant board – a guide for charity trustees. This is not a subject exactly brimming with previous publications. There are plenty of corporate governance books, but few focus on the charity sector.

Like Brian, I have seen examples of good governance and, sadly, some pretty poor ones. Charities have collapsed due to poor governance, and others grind on with little regard for their founding purpose. As many charities have become providers of services paid by the state, they sometimes lose their cutting edge as advocates for change, believing that they must acquiesce to government policy. It is not unheard of for a charity Chair or CEO to get a phone call from a Scottish Government minister after public criticism. As Jenny Starling said in an Open Democracy piece yesterday, 'Too fixated on doing ‘good’ and being polite, charities have stopped fighting for social justice.’

The book starts with first principles. What is good governance, and why it matters. Focusing on the big picture, vision, values and strategy rather than the minutiae of day-to-day operations. I have mentored a few senior staff in charities from other sectors, who have been surprised at the level of detail board members wanted to engage in. On the other hand, I have seen boards that nod through whatever is presented to them. Brian uses the concept of governing with purpose to suggest a different approach. He promotes the idea of governance as leadership, graphically portraying the interconnectedness as the governance square. 

This isn't just a theoretical concept. He goes on to give practical examples of how to develop good governance. The regulatory framework is not forgotten either. Something that could be stronger in Scotland. The chapter on strategy versus scrutiny is also helpful.

There are chapters on the roles of the Chair and CEO and the importance of the relationship between them. Again, in my experience, that can range between acquiescence and micro-management. I recently supported one charity when the Chair said, 'I could do her job better.' She might well have, but that was missing the point. This book has some good advice for both parties in this relationship and practical tips on how to Chair a meeting and related duties. Getting the board to focus on the 'why' of the charity is good advice.

The final section of the book is entitled ‘Re-imagining purpose’. As Brian puts it, ‘It includes bringing energy and dynamism to drive the charity forward. It is also about ensuring the ethos and purpose are not just words, but are put into practice, across the board and the rest of the charity.’ This includes stating uncomfortable truths, particularly when there needs to be alignment between what the organisation says it stands for and how it puts that into practice. The strength of trustees is that they can bring a diverse range of lived experience and expertise to the role. The final chapter in this section highlights the importance of recruitment, succession planning and board renewal. We can probably all think of the board member, or Chair, who has been there too long and recruits more people like them.

I found very little in this book that I disagreed with, and I tried! You might find some concepts a bit theoretical, but they are backed up with practical examples. Hopefully, it will spur some focus on governance in these difficult times for the sector. Unfortunately, I noticed the Scottish Government-backed 'Good Governance Award' had attracted very few takers.

For all the sage advice in this book, we should remember that being a trustee on a board should also be an enjoyable and rewarding experience. This book should help you achieve that goal and do some good on the way.

Tackling drug deaths - Scotland's national disgrace

Scotland's drug-related death statistics are a national disgrace. In 2021, 1,330 people in Scotland died due to a drug overdose. That was more than three times the rate of the rest of the UK and the highest in Europe. As the chart below shows, this isn't a new problem.

This month I was looking at drugs policy when drafting a response to Paul Sweeney MSP's proposal for a Drug Death Prevention Bill. This will enable the establishment of overdose prevention centres, including establishing a licensing framework for centres to prevent death due to drug overdose; and create a new body for the oversight of drug policy development and implementation to improve health by preventing and reducing drug use, harm and related death. He argues that preventable death due to drug overdose has become one of Scotland's major public health emergencies. Urgent practical action is required to address this health crisis, and this Bill is intended to be part of the solution, one contribution to a multi-faceted effort to tackle the problem.

Drug use is inextricably linked to poverty; it is not simply a 'lifestyle choice'. People living in the most deprived communities in Scotland are around 18 times more likely to experience problem drug use compared to people in the least deprived communities. As the Poverty Alliance argues, "That means redesigning our economy so that people are able to access decent work, and investing in our social security system and public services, so that people have the income they need to live in dignity and security."

The Scottish Drugs Death Taskforce has called for more resources to be spent fighting Scotland's drug-related deaths problem after calling current resource levels "woefully inadequate". Their report (21 July 2022) outlines ten key principles and 20 recommendations underpinned by 139 actions. These call for greater funding, efforts to tackle the stigma of drug addiction, and a higher degree of responsibility for drug-related deaths in both health boards and Scottish and UK governments. The report states, "The First Minister has publicly recognised that her government 'took their eye off the ball'. The question now is whether the government will provide targeted funding to enable services to deliver transformational change – not a return to the funding of the past, but an ambitious and radical commitment to making people's lives better."

While there is a case to review the UK Misuse of Drugs Act and for devolving the legislation, we must focus on what we can do in Scotland using devolved powers. As the former head of Scotland's drug deaths taskforce (Professor Catriona Morrison) has said, Scottish Government ministers should stop blaming Westminster legislation for the high number of people dying through drug misuse and focus on what can be done to address the problem. 

Scottish Government cuts in funding for Alcohol and Drug Partnerships in 2015 resulted from the pervasive stigma and the demonisation of people with a drug problem. Cutting  £15 million of funding for the most marginalised and vulnerable people in Scotland is a classic example of ignoring the benefits of preventative spending as recommended by the Christie Commission. Scotland's drug strategy should focus first on keeping people alive, but we also need to help not just to stabilise their drug use but get help with the wider aspects of people's lives.

Paul Sweeney's Bill is not a 'magic solution' but could help as part of a range of measures. Drug consumption facilities have been introduced in at least 14 countries across more than 130 sites. They provide a safe environment for the most vulnerable to use drugs under the supervision of trained professionals. A study in The Lancet shows fatal overdoses decreased in areas where overdose prevention centres were introduced alongside other beneficial outcomes, including reductions in self-reported high-risk injecting practices and increased engagement with drug treatment services. They may also help reduce drug use in public places.

This Bill will provide a necessary focus on the drug crisis that has sadly been missing in recent years. It also focuses on what we can do now, in Scotland, to address these issues - always recognising that the drugs crisis is part of wider inequalities in Scotland that also need to be tackled.