Dame Carol Black’s Independent Review of Drugs Report

Debate between Dan Carden and Tommy Sheppard

Wednesday 27th October 2021 Westminster Hall

[Dan Carden]

Absolutely. That is a valuable intervention, and it is good that we have a Health Minister responding to this debate, because it is a health response, joined up across Government, that this issue calls for.

Part two of the report goes on:

“Areas of the country with the highest rates of drug deaths or the poorest treatment services are the very same areas where the need to level up is greatest. These communities want to see urgent and effective action to tackle the violent drugs market, alongside purposeful efforts to rebuild treatment services and recovery support so that people can get the help they need.”

[Tommy Sheppard (Edinburgh East) (SNP)]

The hon. Gentleman is making an excellent speech, and I very much endorse and support the recommendations of Dame Carol Black’s review. However, I have heard her present these reports, and she has been very clear that the framework that she was given—the parameters that she was allowed to look at—deliberately excluded any review of the legislation that frames this whole matter. Given that this is a unique health pandemic—because the victims of it are liable to criminal prosecution if they seek help, and many who would seek to help them would be liable to criminal prosecution if they tried to do so—is it not time for the Government to begin a review of the Misuse of Drugs Act 1971, to ensure a more up-to-date legal framework to deal with these problems? Would that not assist in the implementation of Dame Carol Black’s recommendations?

[Dan Carden]

The hon. Member makes an important point, although it is one that I will not get drawn into today.

A month after part two was published, the Office for National Statistics confirmed that drug-related deaths had hit an all-time high in England and Wales—the highest number of deaths since records began. Drug deaths have risen 60% in the last decade. In 2020, 4,561 people lost their lives to drugs. Each life lost represents years of pain and suffering; each life lost leaves a family devasted and shattered irreversibly; each life lost is evidence of a missed treatment opportunity; and, most importantly for us today, it is important to accept that each life lost is a failure of policy, too.

I want to make special mention of the stigma that surrounds addiction. Someone who finds themselves dependent on a substance deserves the evidence-based health treatment and support that works, yet stereotyping and prejudice remain all too common in our approach to addiction. It was disappointing to see the Government’s response to the review referring to addiction as a “scourge on society”. The dehumanisation of people who become drug-dependent feeds into the stigma that we must eradicate, so we must steer the discussion, the policies and the treatment towards a compassionate and person-centred health response.

Last week I joined the Forward Trust at the launch of its “Taking action on addiction” campaign, which aims to improve public understanding of addiction as a erious, chronic mental health condition. The Duchess of Cambridge, patron of the Forward Trust, spoke there. I want to quote her at length:

“Addiction is not a choice. No one chooses to become an addict. But it can happen to any one of us. None of us are immune. Yet it’s all too rarely discussed as a serious mental health condition. And seldom do we take the time to uncover and fully understand its fundamental root causes.

“The journey towards addiction is often multi-layered and complex. But, by recognising what lies beneath addiction, we can help remove the taboo and shame that sadly surrounds it. As a society, we need to start from a position of compassion and empathy.”

As many as 80% of the public support more treatment and care for people struggling with addiction; less than 10% believe more punishment and condemnation would help. Intolerance, shaming, tougher punishments and denial will not rid society of addiction, because addiction is an illness. It is a matter of public health, and Dame Carol puts it best when she says,

“It must be recognised that addiction is a chronic mental health condition, and like diabetes, hypertension or rheumatoid arthritis, it will require long-term follow-up.”

Sadly, as things stand, I cannot think of another illness that causes so much harm to society, that is given so little, and the sufferers of which are treated with such contempt. It is the only illness in which blame is placed on the person suffering. Instead of blaming the individual for making bad choices, we need to ask why so many people are turning to substances in the first place.

Now to the prevention, treatment and recovery system as it stands: not fit for purpose, in urgent need of repair, years of austerity, continued disinvestment, fragmentation and a dire lack of accountability throughout. The Health and Social Care Act 2012 shifted addiction treatment out of the NHS mental health services on to local authorities, at the same time as their budgets were being slashed. On that matter, Dame Carol is clear:

“We recommend that funding for drug treatment be allocated to local authorities based on a needs assessment and then protected.”

We also urgently need to improve the situation for people suffering co-occurring mental ill health and drug or alcohol dependency. Too many people are being bounced between fragmented services and end up falling between the cracks. It is simply wrong that mental health services can require patients to reduce their alcohol or drug use, without providing the proper support to do so, before they can receive the treatment they need. Or that drug and alcohol services do not possess the competencies to support someone with significant mental health issues, thereby often leaving sufferers with no support whatsoever.

There must be a “no wrong door” policy. One young woman, whom I will call Jane, told me:

“It was as if I had to get more ill, drink and use more, until I got the right help and support. For 18 months, my mental health deteriorated. Mental health services couldn’t help me and addiction services struggled to support me because of my poor mental health. I was so frightened, I had to reach crisis point and rock bottom before I was able to be considered for residential treatment.”

Jane is now in recovery and leading a happy, healthy life, but she did not receive public funding. In fact, she was denied that. If it had not been for a chance meeting with Action On Addiction, which provided her with a bursary-funded bed, she would not be alive today. It should simply not fall to charities to catch the increasing numbers of people falling through the threadbare safety net. Access to treatment should not be about luck, only available to those who can afford it or those who live in a local authority that prioritises it.

Currently, the drugs treatment market operates in a similar way to that of adult social care. Providers are being squeezed and staff poorly paid. There is high turnover in the workforce and a depletion of skills. The number of medics, psychologists, nurses and social workers in the field is falling significantly.

It is time to repair that broken system and overhaul addiction treatment, and we have the road map for the future—the 32 recommendations of Dame Carol Black’s independent review of drugs. The scope of the recommendations is far-reaching and the solutions span many Government Departments, local government and other organisations.

Dame Carol’s review has pursued three main objectives: first, to increase the proportion of people misusing drugs who can access treatment and recovery support, including more young people, with earlier interventions to divert offenders away from the criminal justice system; secondly, to ensure that the treatment and recovery package offered is of high quality and includes evidence-based drug treatment, mental health and physical interventions, and employment and housing support; and thirdly, to reduce the demand for drugs and prevent problematic drug use, including use by vulnerable and minority groups and recreational drug users.

To achieve those objectives, significant changes need to be made in four areas: radical reform of leadership funding and commissioning; rebuilding of services; increased focus on prevention and early intervention; and improvements to research and how science informs policy, commissioning and practice. And the 32 recommendations cover a wide range of responsibilities.

The Government have already begun to set in motion some of the structural changes, which I welcome, and the policy commitments that will help to drive through the review’s recommendations. It is reassuring that Dame Carol herself will continue to act as an independent adviser to Government. However, the remaining recommendations are contingent on Government investment.

In January 2021, the Government announced £148 million of new money to cut crime and protect people from the harms caused by illegal drugs, which I also welcome, with £80 million of that money to be invested in treatment and recovery. That £148 million must be the first instalment of the £1.78 billion that Dame Carol has called for over the next five years and I hope that the Minister has come with hot-off-the-press Budget commitments. Dame Carol’s spending recommendation would restore addiction treatment to what it was before 2012. Although local authorities are well positioned to oversee services, drastic cuts to public health grants have led to cuts to addiction treatment services over many years. The Local Government Association has long argued that reductions to the councils’ public health grant, which is used to fund drug and alcohol prevention and treatment services, is a false economy, which will only compound acute pressures for criminal justice and NHS services further down the line.

I must stress to the Minister that if the Treasury is unable to find all the funding that the review calls for, the money it does find must not be thinly spread across the country. Instead, it should be targeted at those areas most in need, and efforts must be made at least to pilot the whole-systems approach that Dame Carol has called for. Small amounts of money given to each local authority will not bring about the long-term transformational change that the review demands.

There has simply never been the political will to act on prevention, treatment and recovery from drug and alcohol harm, but we have reached a crisis point, with record deaths, rising economic and social harms, and depleted treatment services. Dame Carol’s groundbreaking review, which was commissioned by this Government, is the moment for change, and the Government cannot meet their pledges to level up the deprived communities that they seek to represent, which are often found in the north, unless they recognise that. In the words of Dame Carol herself:

“The Government must either invest in tackling the problem or keep paying for the consequences.”