Homeless Network Scotland is pleased to provide a response to the proposed Right to Addiction Recovery (Scotland) Members’ Bill lodged by the Scottish Conservatives and drafted with activists and advisors, including people with experience of addiction. Our response has been informed by a briefing and consultation event attended by over 50 organisations from different sectors and with various roles. The information slides from our consultation event are available here [pdf].
Which of the following best expresses your view of the proposed Bill?
This response is based on feedback we received at our Right to Recovery Bill event with 50 Homeless Network Scotland members on 14 December. Attendees included frontline organisations and people with lived experience. Answers we have provided against each question present a summary of the views noted at the event.
Attendees were generally very supportive of a new bill being developed that will focus on people’s rights to treatment and recovery and provide them with more choice and control, thereby (according to international evidence) increasing the likelihood of successful treatment. People with lived experience told us that they have previously felt they had limited choice and control over the treatments they were offered and would also value more options including those used in addressing trauma e.g. hypnosis, acupuncture and physiotherapy.
The bill needs to be in line with the Scottish Government’s current drug strategy to ensure effective delivery and positive impact. Some amendments may be needed to ensure this is the case and this must be very carefully considered.
Do you think legislation is required, or are there other ways in which the proposed Bill’s aims could be achieved more effectively? Please explain the reasons for your response.
Legislation would help ensure everyone will be treated fairly across Scotland. Attendees were clear that the Bill has the opportunity to re-dress current inconsistencies in availability of different treatment and rehabilitation options.
Another benefit to enshrining the aspect of choice and control in legislation is that it make the system and response more equitable. Not everybody will be in the same place or benefit from the same response, and finding a way to reflect this in legislation is important.
How do you think the right to treatment established in the Bill would be most effectively implemented and enforced? Tick all options that apply.
Duty on Health Boards
Duty on Integration Joint Boards (IJB’s)
Other (For example Local Authorities – please specify below).
Clear leadership from Scottish Ministers would help encourage other organisations to support and deliver the legislation. It is essential however that this is not seen as solely an NHS issue, the public sector as a whole should be involved as the social issues being addressed by this bill cut across all sectors. The bill should clearly set out what is expected of which sectors and how they will be expected to work collaboratively to ensure person-centred care is provided. The future role of a National Care Service in relation to a rights-based framework for addiction treatment options should also be considered.
Importantly, taking a collective responsibility for a ‘no wrong door’ approach to accessing treatment options. This means working across current silos – for example, homelessness, addictions, criminal justice, mental health – so that people can get the best outcome, regardless of their experience of existing service use. People need to be aware not just that they have a right to treatment, but also aware of what options are available so that they can exercise choice and control to access the best option for them and their family.
Which of the following best expresses your view of allowing those suffering from addiction to choose a preferred treatment option, and for them to receive that option unless deemed harmful by a medical professional?
Having choice and control is the best approach with the best chance of success. The individual and the service provider both need to have access to the correct information about what treatment is available and provide support to the individual so that they can make an informed choice about what is best for them at that time. People can only access their rights if they know what rights they have.
This would mean a new approach on training and include more focus on treatments to support trauma. People with lived experience also suggest that the methods for treatment should be expanded.
We know from evidence across several sectors that people engage with and buy in to responses and solutions better when they feel that they are involved in the decision making and they have more positive outcomes when they have more control over decisions (including treatment decisions) that impact on them.
Which of the following best expresses your view of requiring the Scottish Government to establish a national funding scheme?
Taking into account all those likely to be affected (including public sector bodies, businesses and individuals etc), is the proposed Bill likely to lead to:
some increase in costs
Implementation of a right to treatment should lead to increased numbers of people taking up treatment options, which would lead to an increase in the costs attached. However, there are a significant number of other costs that must be fully considered (e.g. primary and secondary health care, justice and welfare costs) which could significantly decrease once people are accessing treatment that works for them. There could in the longer term be significant savings as a result of this bill.
Properly reviewing the costs attached to the bill, including those it reduces – primary and secondary – will be important so that it can be implemented effectively, ensuring funding is available for delivery. Cost benefit analysis should be undertaken as part of the implementation plan and subsequent evaluation for the bill.
What overall impact is the proposed Bill likely to have on equality, taking account of the following protected characteristics (under the Equality Act 2010): age, disability, gender re-assignment, marriage and civil partnership, pregnancy and maternity, race, religion or belief, sex, sexual orientation?
Development and implementation of the bill has the potential to ensure everyone has the same rights to the treatment that is right for them and ensure people have ownership of their own lives. People should have the opportunity to challenge decisions on their treatment plan. However, development of the bill needs to be informed by an in-depth understanding of robust evidence on equality to sure that delivery of the bill avoids exacerbating current inequalities.
The bill could also help gain a better understanding of what recovery looks like and requires across different groups and characteristics.
In terms of assessing the proposed Bill’s potential impact on sustainable development, you may wish to consider how it relates to the following principles:
- living within environmental limits
- ensuring a strong, healthy and just society
- achieving a sustainable economy
- promoting effective, participative systems of governance
- ensuring policy is developed on the basis of strong scientific evidence.
With these principles in mind, do you consider that the Bill can be delivered sustainably?
As noted above, thorough cost benefit analysis will be required to inform the development of the bill from a sustainable perspective economically. In addition, better community-led treatments as a result of this bill could help more people access and sustain employment.
Do you have any other additional comments or suggestions on the proposed Bill (which have not already been covered in any of your responses to earlier questions)?
There are opportunities for this bill to bring a better approach to working with families, including them in decisions about treatment options and harnessing the informal advocacy role they often provide. This may also earn services a better understanding of the person as a whole, the security of their housing, the environment they are living in and the impact on any children or young people in the household.
In summary, we support a rights-based framework to underpin access to all addiction treatment options, including recovery. We believe access to new rights, and clear information about those rights, can better ensure people have choice, control and advocacy where required. Having cross party support to move forward on a legal framework will be essential.