Reflections on moving sector

Stephen Wishart is the Improvement Advisor for Medication Assisted Treatment (MAT) standards at Healthcare Improvement Scotland. Stephen recently joined Healthcare Improvement Scotland, before this he worked as a Senior Development Worker within housing and homeless charity Shelter Scotland.

Stephen now helps support the health, social care, third sector, voluntary, and justice systems by providing improvement support to the implementation of the Medication Assisted Treatment (MAT) Standards.


Before coming to Healthcare Improvement Scotland, I had worked for third sector organisations within the housing and homelessness sector. The last eight years of which was within a rights-based context where advocating for people to ensure their legal housing rights were upheld became a passion and where many of the client base are those who also find themselves caught in chaotic drug and/or alcohol use.

Working within that sector, day-to-day, allows you to build an insight into the issues that people may face and often this can revolve around two main observations:

  1. It’s a system that is complex and slow;


  1. It is difficult to navigate, engage in and find a solution within – especially without advocacy or support.

Although the homeless system can be difficult for anyone there is an added layer of challenges for those who are homeless and in addiction, with many also struggling with poor physical and mental health. This results in a “perfect storm” and an overly complex system requiring constant and often recurring navigation.

Housing is the basis of stability and security for every individual or household, and this can often be more apparent for those without permanent accommodation. Within an addiction and treatment context, realistically, how can anybody be expected to start a recovery journey when they have nowhere safe to sleep at night? For many, the first step into homelessness accommodation can be an introduction or re-introduction into a social circle that involves chaotic substance use. Even with the best desire to maintain any form of recovery it can soon be eroded due to the environment they are placed in alone and this cannot continue to be the “norm”.

Pockets of excellent collaboration exist across statutory and third sector services, but we need to improve and build upon this to enable a comprehensive, integrated and responsive system. In doing this, we would be able to effectively address people’s needs regarding the broad range of risks and harms they experience, so to solve one issue, we must look to solve them all and, for me, this is where working to support the implementation of the MAT Standards comes in. It was a chance for me to utilise my experience and expertise to improve the current system of care, but from the perspective of the work I have done till now.

Lived experience

Despite how different housing, drug, and alcohol, sectors may appear, one thing for me that must be in place is the involvement of those with experience of the issue, past and present, to build a service that works for them.

If we co-design services in this way, we can assure ourselves that we understand the complexity of addiction and not allow decision makers to believe that “they know best”. Equally, it is also important to acknowledge that placing people with experience at the front of design and implementation of services does not mean we minimise the value of professional experience – so it is important to listen to each other in a genuine way. Working together is essential to ensure everyone is heard and understood and enables us to identify solutions that will have a greater impact than what would have been achieved by each of us on our own.

We need to think differently to produce better solutions, as repeating any of the same mistakes of the past will only achieve the same results – a form of insanity. People want to be trusted that what they are saying would help them in their recovery journey with the added clinical expertise of their caregiver.

People and communities want change and are willing to stand up and make a difference, what we need to do is build a platform for this to happen.

Working together

Ensuring that we build a fairer system that allows people to have access to the medication and/or support needed to treat any addiction needs, including access to services that support good health and wellbeing, is a necessity to address the current drug and alcohol crisis.

Building sustainable solutions is down to all of us; statutory and third sector, people with lived and living experience and communities and we need to ensure that we leave a legacy that works for those whose voices are rarely heard. 

My challenge

I am under no illusion the difference between my previous role and the role I am in now. I have come from a service whose role is to advocate for the rights of individuals and families, the demand for which continues to grow, to then come to a role where I can help do that “from the inside”. This change will not be without its challenges, and it will certainly need a different approach from me – but I know I can never lose sight of why I am doing it, to create a system that works for the most marginalised people in our society, in our communities.

Your challenge

What can you do in your daily practice that will ensure that everybody’s views are heard, reflected upon and used to co-design a system that offers better integrated care that is person-centred?

Stephen Wishart, Healthcare Improvement Scotland

Stephen Wishart, Healthcare Improvement Scotland