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The Scottish Government is committed to evidence-based policy making. National Mission activity undertaken to date has been based on the evidence available and informed by people with lived and living experience, as well as the National Mission’s Clinical Advisory Group and National Mission Oversight Group.

For example, our approach to setting up the UK’s first Safer Drug Consumption Facility has been based on evidence from 300 existing safer drug consumption facilities already in operation around the world.

To ensure that our future strategic plans are evidence-based, they will be informed by the National Mission evaluation due to be published in 2026.

We will ensure that any new approaches to reducing deaths and harms is accompanied with evaluation as a matter of course, such as the Safer Drug Consumption Facility (The Thistle Service), which is due to open in the near future.

A full evaluation of the Thistle Service will be carried out, details of the evaluation package will be made available shortly but it will use a range of data to examine the impact of the facility on health, social, community, environmental, and economic outcomes.

Tackling alcohol related harm remains a priority for Scottish Government, and we are treating our policies to reduce alcohol and drug deaths as twin public health issues in Scotland.

We are working to ensure that people who experience harms as a result of alcohol use receive the same quality of care and support as people who experience harms as a result of drug use. We work closely with Alcohol and Drugs Partnerships and regularly monitor services through the annual ADP survey. The most recent one, reflecting activity for 2023-24, was published on 12 November 2024 and notes the following on data surveillance.

Almost all ADP areas reported having specific groups or structures in place at ADP level to inform surveillance and monitoring of drug harms or deaths. All but two (93%) of ADPs reported having a drug death review group and 77% reported having a drug trend monitoring group or early warning system.

Fewer ADPs reported groups relating to alcohol, with a quarter (27%) reporting having an alcohol death review group and 30% reporting having an alcohol harms group.

A third of ADPs reported having other structures in place for informing surveillance, which included multi-agency groups working on drug death prevention and action plan groups, wider public health monitoring which included drug and alcohol harms and sudden death groups whose remits include both drug death reviews and suicides reviews. Several ADPs indicated that alcohol harm and death review groups are currently in development.

It is our expectation that future Alcohol and Drug Partnership (ADP) funding letters will ask ADPs to undertake local alcohol death review. This message will also be reinforced in our National Specification for treatment of drug and alcohol misuse in Scotland, which is currently in development and will build on the recommendations of the forthcoming UK Clinical Guidelines for Alcohol Treatment.

A refreshed cross-government and cross-sectoral approach to population health - focused on prevention - is being progressed. Increasing healthy life expectancy and reducing health inequalities across Scotland remains a clear ambition for this Government. It is clear the reform of health and care services alone will not be enough to stem the current tide of population health decline in Scotland.

The Population Health Framework is being developed jointly by the Scottish Government & COSLA and in collaboration with Public Health Scotland, Directors of Public Health and key local, regional and national partners. The Framework will consider a broad range of population health drivers, including alcohol harm prevention. The Scottish Government continues to work with partners to identify what actions we, and they, can take to reduce inequalities and to improve the health of people in Scotland over the next decade.

The Scottish Government continues to take significant steps to tackle alcohol harm as a public health priority.

The National Mission focuses on actions and initiatives to address the harms associated with drugs, but these can and do support people affected by all substances including alcohol. For example, through an increase in residential rehabilitation places; initiatives to tackle the stigma and support the workforce and an increased understanding of the co-occurring nature of problem substance use and mental health issues.

This Government’s work to continue and increase the world leading Minimum Unit Pricing policy is an example of our approach to take concrete action to reduce alcohol harms. It is estimated that our world-leading policy has saved hundreds of lives, likely averted hundreds of alcohol-attributable hospital admissions and contributed to tackling health inequalities.

However, we have been clear that Minimum Unit Pricing is not a silver bullet – but one of the ways in which we are tackling alcohol harm including our investment in treatment and work to consider alcohol marketing restrictions.

The Scottish Government remains committed to progressing work on protecting children and young people from exposure to alcohol marketing. Public Health Scotland (PHS) are being commissioned to carry out a review of the evidence for the range of options that are available to the Scottish Government under devolved powers and will bring focused proposals forward should the evidence support it.

In 2019, Scotland committed to the ambitious goal of eliminating HCV as a public health concern five years ahead of the World Health Organization’s global target of 2030. Since then, we’ve seen considerable progress with major achievements across multiple indicators. Unfortunately the COVID-19 pandemic slowed the rate of progress, however we continue to work with NHS Boards and other services to press towards our shared goal of HCV elimination.

Public Health Scotland’s annual HCV surveillance report is scheduled for release on 3 December 2024 and we are working with PHS to assess our position against the indicators. We will provide an update on progress towards our elimination goal in due course.

As part of the reception process into prison, everyone has a consultation with an NHS healthcare professional within 24 hours of arrival, using a nationally agreed admission process.

Public Health Scotland (PHS) is currently in the process of updating its guidance on opt-out testing for blood-borne virus (BBV) in prisons with the intent to publish a revised document in the coming months. This updated guidance will recommend routine opt-out testing for new admissions and check and test for transfers between establishments. PHS is taking a cross-programme approach to opt out testing for BBV in prisons, and other justice settings, and works with Alcohol & Drug Partnerships, prisons, police custody and the national justice networks to ensure a coordinated approach.

In addition the Medication Assisted Treatment (MAT) standards include a requirement for opt-out testing in justice settings (including prisons) and PHS will gather intelligence on local policies and pathways for opt-out testing in prisons as part of an improvement approach to help implement the standards. The MAT programme will also publish a toolkit for the implementation of the MAT standards in justice settings and this will complement the BBV opt-out testing guidance.

The Scottish Government believes it is important to work with a wide range of clinical, lived experience and third sector representatives in developing chronic pain policies. This includes the Faculty for Pain Management (FPM) Our clinical lead for chronic pain policy has recently joined its committee and we sought input from the FPM in our stakeholder engagement in the summer of 2023.

The Scottish Government last had specific discussions with the FPM in 2020 to understand if there were any safety concerns around receiving chronic pain interventions, including steroid injections, and an individual’s immune response to COVID-19.

As part of the updated chronic pain implementation plan, we are working with Healthcare Improvement Scotland to deliver a national approach to specialist interventions, which may cover steroid injections, for chronic pain. This process will review effectiveness, safety, cost effectiveness, and incorporate the views of patients and clinicians.

The Scottish Government remains committed to progressing work on protecting children and young people from exposure to alcohol marketing. It was clear from our earlier public consultation that there was a wide range of views on alcohol marketing proposals, including uncertainty about the existing evidence base for many proposals.

Public Health Scotland (PHS) are being commissioned to carry out a review of the evidence for the range of options that are available to the Scottish Government under devolved powers. This will ensure that our work is evidence based and will deliver clear public health outcomes. We will consider PHS’ findings, and consider where the evidence supports further action or consultation on alcohol marketing restrictions.

If the evidence supports it, the Scottish Government will return with a further consultation on a range of targeted proposals. Ensuring public health policy is based on clear evidence is vital in delivering progress on alcohol harm and ensuring that the right balance is struck between improving population health and the potential impacts and effects on the economy, business and industry.

As the Cabinet Secretary set out to Parliament, Public Health Scotland (PHS) are being commissioned to carry out a review of the evidence for the range of options that are available to the Scottish Government under devolved powers. This important step will ensure that our work is evidence based and will deliver clear public health outcomes.

The final commission will be published in due course, and will set out the timelines for that review activity. The Scottish Government will consider PHS’ findings, and consider where the evidence supports further action or consultation on alcohol marketing restrictions. Once the evidence review is concluded the Scottish Government will consider any areas where evidence supports further consultation. No decisions have been taken yet on what these areas may be.

The Scottish Government is working with stakeholders on the review and development of various guidance to inform pain management services.

As outlined in the updated chronic pain implementation plan, the national clinical guidelines for Scotland (SIGN 136), and polypharmacy guidelines are currently being updated.

We are also working with Healthcare Improvement Scotland to deliver a national approach to specialist interventions for chronic pain and to consider the creation of national standards for chronic pain management.