Drug Treatment Services

Debate between Jeff Smith and Lord Hanson of Flint

Tuesday 16th July 2019 Westminster Hall

[Jeff Smith]

I agree with the hon. Gentleman; not for nothing is the UK labelled the drug-death capital of Europe. That should worry us across the UK.

The second theme that emerged from the reports is the real worry about the future of services after 2020 if the ring-fenced public health grant for local authorities ends and funding moves to general local authority funding. A report by the Select Committee on Health and Social Care showed that public health budgets have been cut every year since 2013, with alcohol and drug treatment services facing the biggest cuts. Councils have reduced spending on adult drug misuse by an average of 27% since 2015-16, and almost one in five local authorities have cut budgets by 50% or more since then.

The highest cuts have been disproportionately concentrated in areas with high rates of drug-related deaths, according to the Camurus report. More than half of the directors of public health surveyed believe that the removal of ring-fenced public health grants will result in further cuts. Service providers are struggling to maintain their current offer, and have even less capacity to make additional outreach efforts that are needed, such as offering proactive early prevention measures or engaging under-represented groups and communities who come less into contact with available services.

I wish I had more time to talk about hepatitis C, which is a really important issue. Stuart Smith, the head of community services at the Hepatitis C Trust, said:

“I walk into many drug services around the country and it’s chaos. They’re being asked to do so much with so little resource. I’m not sure how many of them can even feasibly have it on their priority list to discuss hepatitis C with clients.”

Hepatitis C is a very harmful condition but it can be prevented and cured if we have the resources to do so.

This is another story of austerity hitting the services that are most needed by the most vulnerable in society, but—this is the third theme that emerges from the sector responses—it is also a story of false economies. Spending on the recovery and reintegration of people who struggle with drug and alcohol dependency is one of the smartest spend-to-save investments that a Government can make. Strong evidence suggests that properly funded drug treatment services help to drive reductions in drug deaths, crime, and rates of blood- borne viruses. Research that the Government themselves commissioned concluded that drug treatment can “substantially reduce” the social costs associated with drug misuse and dependence, with an estimated cost-benefit ratio of 2.5:1. Depending on the breadth of the definition of “social costs”, that ratio could be calculated far more favourably and take into account factors such as lower crime, fewer health problems, less benefit dependency, lower social services spending and so on. Public Health England estimates that for every £1 invested in drug treatment services, there is a £4 social return.

Drug treatment and harm reduction services are cost-effective and offer good value for money, so this is a classic example of funding reductions in one part of the public services leading to spending increases in another. To quote Ron Hogg, police and crime commissioner for Durham and Darlington, who in my view is one of our most progressive PCCs:

“As PCC, I have concerns regarding the future allocation of public health funding in Durham, via the Public Health Grant, and the knock-on effect for policing. I am fearful that I will face the triple whammy of a reduction in police funding, a further reduction due to changes in the funding formula, and the consequences of a decrease in public health funding. The consequences of these changes are likely to include a significant increase in crime in County Durham and Darlington.”

We know that half of acquisitive crime in the UK is directly related to drug dependency.

[David Hanson (Delyn) (Lab)]

I am grateful that my hon. Friend has raised the issue of crime. Is he aware that crime prevention orders and drug and alcohol treatment orders attached to sentences have fallen? Drug treatment orders have fallen from 8,734 in 2014 to 4,889 in 2018, and alcohol treatment orders have also halved. People are not getting drug treatment orders as part of their sentence in the community, which leads to the same threats that my hon. Friend describes.

[Jeff Smith]

I thank my right hon. Friend for making that important point. Durham constabulary’s Checkpoint scheme, through which low and medium-level offenders with drug dependency are diverted into treatment rather than the criminal justice system, has reduced arrests by 11% and convictions by 9.7%, and has made a positive contribution in relation to participants’ drug use, physical and mental health, finances, accommodation status and relationships. There are benefits right across society when we send people into help and treatment, rather than into custody.

A number of stakeholders have identified that the lack of resources not only puts a strain on current treatments and activities, but stifles innovation in new ideas and treatments. That leads me to another key point, which is on our wider approach to drug treatment and policy. There are measures that we can take to reduce deaths and that would lead to less demand on drug treatment services, but the Government are either not encouraging or not permitting them. The most obvious is what many call drug consumption rooms, although I prefer the term overdose prevention centres, which are aimed at those with severe addictions. People will take their drugs—they have them in their possession, so they will inject them, and there is no way that we can stop them doing that—but rather than being left to inject their drugs in a bedsit or back alley, alone with an increased risk of overdose, they can go to one of the centres, where a nurse is on hand; they can use in a sterile clinical space with medical supervision, and naloxone on hand to reverse any overdose.

There are two great benefits to the centres. First, they save lives: no one dies of an overdose in such facilities. Secondly, they also have services for addicts to engage with. It might be the first time that addicts have come into contact with services, so they could be encouraged into other treatment options. At least 100 drug consumption rooms operate in at least 66 cities around the world, in 10 countries. In a number of European countries, such as in Spain, Germany and the Netherlands, supervised drug consumption has become an integrated part of services offered within drug treatment systems.

Police and crime commissioners and health professionals have been assessing the value of piloting such facilities in various areas, but the Government position is to block the pilots. Furthermore, the Government are unwilling to revisit the legislative framework, and so are insistent that we cannot make provision for the centres. However, according to the European Monitoring Centre for Drugs and Drug Addiction last year:

“There is no evidence to suggest that the availability of safer injecting facilities increases drug use or frequency of injecting”.

Equally:

“These services facilitate rather than delay treatment entry and do not result in higher rates of local drug-related crime.”

Drug consumption rooms, overdose prevention centres or whatever we want to call them simply make sense, and it is very regrettable that the Government will not allow them to become part of our treatment landscape.

On the subject of innovative models of service delivery, I mention the Checkpoint scheme in Durham.