National Health Service: Workforce Race Equality Standard

Lord Patel of Bradford Excerpts

Wednesday 24th February 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, I shall give the House a few figures. Some 22% of all staff in the NHS are from BME or minority ethnic backgrounds, 28% of all doctors and 40% of hospital doctors. Yet only 3% of medical directors are from BME backgrounds and 7% are in senior management roles. We have two chief executives and six chairmen from BME backgrounds out of 250 trusts. So the performance across the NHS is, as the noble Baroness has mentioned, absolutely terrible and we have to take some serious action to change it. The noble Baroness has given one example but I think that there are many others. The NHS workforce race equality standard is a new initiative which, by introducing some transparency into the health service, will improve matters.

[Lord Patel of Bradford (Lab)]

My Lords, I congratulate the noble Lord because I know that, as chair of the WRES committee, he is very committed to this issue. But does he agree that the targets set will be incredibly difficult to meet in the space of a couple of years? It will mean making changes to tackle the huge inequality that has existed in the NHS for a number of years. I suggest that one way of achieving this is to ask CQC inspectors, when they carry out their inspections, to target specifically the WRES and look for action plans that show improvement year on year. If the improvement is not there, no trust should be getting a “good” on the CQC’s well-led domain without addressing this specific issue.

[Lord Prior of Brampton]

My Lords, the whole purpose of the WRES is to shine a light on the performance of each trust in the country. The CQC will be including it in its well-led domain from March of this year and has already begun to incorporate it into its inspection processes. As the noble Lord knows, in Bradford where he is the chairman of a trust, we have a huge amount of progress to make.

Drugs

Lord Patel of Bradford Excerpts

Thursday 4th February 2016 Grand Committee

Asked by

[Lord Patel of Bradford]

To ask Her Majesty’s Government what is their response to the Office for National Statistics’ report on deaths related to drug poisoning in England and Wales in 2014.

[Lord Patel of Bradford (Lab)]

My Lords, I am grateful to have the opportunity to raise the important issue of deaths related to drug poisoning. I thank the noble Baroness, Lady Walmsley, and my noble friend Lord Hunt for speaking on this today. The Office for National Statistics report on deaths related to drug poisoning highlights a number of concerns which I have been raising in questions and debates in this House for some time. I cannot begin to cover all these issues today. Suffice it to say that I have grave concerns that the Government’s drugs policy may have contributed to the increase in drug-related deaths in England. I am aware that this is a serious assertion and I hope the Minister will take my concerns with the sincerity with which they are meant.

Heroin is involved in more fatal overdoses than any other illegal drug. The most common form of treatment for dependence on heroin is opioid substitution therapy. Under this treatment, the street heroin to which a person has become addicted is replaced by a pharmaceutical substitute, usually methadone. The evidence is clear that this treatment can halve a patient’s risk of death for as long as they remain in treatment but, because relapse is common, the patient’s risk of death increases significantly when treatment ends. So the longer a patient remains in treatment, the better their chances of staying alive. However, rather than being evidence-based, I strongly suggest that the 2010 drug strategy reflects the Government’s concerns that there were too many people on methadone for too long—a point vigorously reinforced by the Work and Pensions Secretary, lain Duncan Smith, who said that he felt too many people were “parked on methadone”. Therefore the Government introduced a payment-by-results system to incentivise service providers to encourage drug users to more quickly complete treatment and achieve abstinence.

What is wrong, you may ask, with encouraging more drug users to become abstinent more quickly? Surely that is a good thing. However, UK and international evidence clearly shows that there are major risks in pressuring drug users to withdraw from treatment. The Government’s own Advisory Council on the Misuse of Drugs stated that there was strong evidence that time-limiting opioid substitution therapy would increase the rate of overdose death. Of course I understand that the Government’s decision-making must include public opinion and there is a fear of being seen as soft on drugs—there has been from every Government who have been in power. However, I know from working with drug users myself for many years that the first treatment a drug user receives must be about stabilising the chaos in their lives, and abstinence should be about providing the right range of treatment options at the right time. The evidence shows that heroin addiction is a long-lived condition, averaging around 10 years, so drug users must be ready to achieve abstinence, because if they relapse after they have left treatment they are at a high risk of fatal overdose, since their tolerance to heroin is obviously greatly reduced.

What has been the result of the Government’s approach? On a positive note, between 2011 and 2012 an estimated 8.9% of adults used an illegal drug. This is the lowest level of drug use since figures were first collected in 1996. The number of people who completed drug treatment, free of dependence, is at record levels. However, perversely, in 2014 there were 3,346 drug-poisoning deaths in England and Wales, the highest number since records began in 1993. Deaths involving heroin increased by almost two-thirds between 2012 and 2014, from 579 to 952.

More worryingly, Public Health England’s own network—the National Intelligence Network on the health harms associated with drug use, which exchanges intelligence on blood-borne viruses, new and emerging trends in drug use and drug-related deaths—reported in December 2015 that the number of drug-related deaths is increasing, and that the rate of increase is probably accelerating. Amphetamine and cocaine deaths have also been increasing in recent years. However, the network’s analysis showed that treatment is protective against drug-misuse deaths.

I have cited a number of facts and figures, but let me put a human face on this and highlight some wider impacts. A number of local areas have conducted their own drug-related death reviews. Some have found an increase in female drug-related deaths, some individuals are parents, some people were released from prison and needed further support and treatment. In fact, in 2010 I produced a national report reviewing drug treatment in prisons and highlighted the importance of ensuring good continuing care for vulnerable people leaving prison to prevent relapses and drug-related deaths.

More people had complex health issues involving repeated presentations to hospital wards and A&E departments. Some have mental problems requiring treatment and repeated admission to mental health wards. They have a dual diagnosis of substance misuse and mental ill health. Only last week, as the Minister will know, we heard that the number of deaths annually among mental health patients in England rose by 21% over the past three years, from 1,412 to 1,713. The number of those killing themselves or trying to do so has also increased, by 26%, from 595 in 2012-13 to 751 in 2014-15. I wonder how many of those people had a dual diagnosis.

In light of this, will the Minister agree to see if an investigation can be set up to look into the causes of the drug-related deaths and the mental health deaths, and to see how many had a dual diagnosis? I understand that an update of the UK clinical guidelines on drug misuse and dependence is expected this year. In fact, I thought it was going to be published by February. These are essential guidelines for all clinicians who provide pharmacological interventions for drug misusers as part of their drug-treatment programme. This is a positive move, but I strongly suggest that it is also time that the Government carried out not just an annual review but, more importantly, a full impact assessment of the current drug strategy. Will the Minister therefore agree to ask the relevant government department that a risk and impact assessment of the current drug strategies be carried out, ensuring that an evidence-based approach be developed that tackles the failures and weaknesses of the current strategy, including, obviously, reducing drug-related deaths; training, employment and housing for drug users; integrating prison and community services; and, as I have already mentioned, the important issue of provision of dual diagnosis?

Finally, we know that there is a major funding issue within the NHS, and this is having an impact on services that work for these vulnerable people. Drug and alcohol treatment are no longer part of the protected NHS spend, but will have to compete for resources in the much harsher local government public health environment, which is likely to result in a reduction in services. In fact, I have seen a reduction in services in many environments already.

As for mental health, suicides among people in touch with crisis resolution home treatment teams, which are there to support people in crisis to stay in their own homes rather than being admitted to hospital, have increased significantly. It has been reported that these teams have lost their funding and have been disbanded or merged into community teams. So their specialist function has been lost, at a time of increasing demand. We also know that the number of specialist mental health nurses has fallen by more than 10% in the past five years.

In conclusion, I ask the Minister to say in his reply what steps are being taken to tackle the lack of funding for drug misuse and mental health services, which deal with some of the most vulnerable people in our communities, particularly those with a dual diagnosis of drug misuse and mental health problems. Because I have the time, I shall also make one other point. I understood that the evaluation of the payment-by-results pilot studies was to be published either last year or early this year. Can the Minister update me on when publication will happen? I look forward to hearing from other noble Lords, and to the Minister’s response.

Health: Parity of Esteem

Lord Patel of Bradford Excerpts

Tuesday 20th October 2015 Lords Chamber

[Lord Prior of Brampton]

I look forward to reading the report; perhaps the noble Lord would like to send me a copy. I cannot comment specifically on mindfulness, but there is no doubt that talking therapies are having a big impact. The evidence shows that some 45%, perhaps up to 50%, of people who have been introduced to IAPT talking therapies—CBT, psychotherapy and the like—have experienced considerable improvements.

[Lord Patel of Bradford (Lab)]

My Lords, my understanding was that, in an effort to ensure parity of esteem between physical and mental health, clinical commissioning groups were directed to increase spending on mental health in line with the increase in their 2015-16 budgets. What evidence and assurances can the Minister give that that has taken place?

[Lord Prior of Brampton]

NHS England is committed to ensuring that every CCG in the land increases its spending on mental health. The general allocation to CCGs was 3.7%, and the CCGs’ commitment to spending 4.6% of their allocation on mental health will hold NHS England to account for achieving that.

Mental Health Services

Lord Patel of Bradford Excerpts

Monday 19th October 2015 Lords Chamber

Asked by

[Lord Patel of Bradford]

To ask Her Majesty’s Government how they will improve mental health services, as outlined during Prime Minister’s Questions on 16 September (HC Deb, col 1039).

[The Parliamentary Under-Secretary of State, Department of Health (Lord Prior of Brampton)]

My Lords, the Government are committed to putting mental health on a par with physical health. We invested more than £120 million to introduce the first waiting times standards for mental health services from April 2015. We have expanded access to psychological therapies. Our crisis care concordat has ensured that we have halved the number of cases of people going through a mental health crisis being held in police cells.

[Lord Patel of Bradford (Lab)]

The Minister gave three significant areas of development. First, on the investment to introduce the first waiting times standards for mental health services from April 2015, will the Minister say what the results of the waiting times standards have been in the first quarter, from April to June? Secondly, he mentioned the expansion of IAPT services, but as I understand it there is no ring-fencing for IAPT services. What evidence and assurance can the Minister provide that these services are being provided across the country, especially for children and young people?

Finally, the Minister mentioned the excellent crisis care concordat, which says that we have halved the number of people in crisis being held in a police station. He will be aware that just this June the CQC report said that people in mental health crises, even those who are suicidal, are not getting the care that they need in emergency situations. What assurances and steps are the Government taking to deliver care to those people in an emergency situation?

[Lord Prior of Brampton]

My Lords, very briefly on those three points, we will have the waiting time results for IAPT tomorrow. I will publish them in the Library and write to the noble Lord. On the ring-fencing point, the IAPT part of the £150 million extra spending on CAMHS is not ring-fenced, but the £150 million is in total. We will wait to see the results on how effective the IAPT spending is before we come to a final decision on how much should be spent on IAPT and on other parts of the care budget. On the noble Lord’s third point, the CQC published its report, Right Here, Right Now, some six months ago. It found that things were getting better, but there was still far too much variation. By using that report and encouraging local crisis care concordat teams, we hope to address that variation.

Primary Care: Targets

Lord Patel of Bradford Excerpts

Tuesday 13th October 2015 Lords Chamber

[Lord Prior of Brampton]

The noble Baroness makes a very good point. There is plenty of evidence to suggest that where general practices employ clinical pharmacists, it relieves GPs of a considerable burden. Interestingly, the NHS Alliance produced a report last week called Making Time In General Practice. It identified that up to one in six patients seen by GPs could in fact be seen by someone from a broader skill mix within general practice, so what the noble Baroness says makes a lot of sense.

[Lord Patel of Bradford (Lab)]

My Lords, while one may applaud the intention of the 24/7 NHS service, does the Minister agree that the Government are potentially raising public expectations that are just not going to be achievable, given the deficit of nearly £1 billion that we have seen in the first quarter of this year alone?

[Lord Prior of Brampton]

My Lords, the deficit in the first quarter is indeed a matter of huge concern—I am not going to pretend otherwise—but the Government are wholly committed to seven-day services both within hospitals and in general practice. We are committed to investing £10 billion extra in the NHS over the next five years, and ensuring that we have enough GPs and enough support for them is a key priority.

Police: Ambulance Support

Lord Patel of Bradford Excerpts

Thursday 16th July 2015 Lords Chamber

[Lord Prior of Brampton]

The noble Lord raises a very important point. Apart from being an extra drain on the resources of the police, it can often exacerbate a mental health problem if someone who is already very distressed ends up being transported in a police vehicle. Under the mental health concordat, to which all ambulance services are signed up, they are committed to reducing the number of times that people detained under the Mental Health Act are transported in police vehicles. We will monitor performance against that very carefully.

[Lord Patel of Bradford (Lab)]

My Lords, the Mental Health Act code of practice clearly says that people with mental health problems should not be transported by police vehicles. In the Midlands the ambulance service transports roughly 75% of people with mental health problems—that is reasonably good but not acceptable—while in Lancashire the figure is as low as 5% and in London it is 30%. Have the Government made any assessment of this, given what the Home Secretary said about police cells being completely inappropriate places of safety for people with mental health problems? Police vehicles should not, wherever possible, transport mental patients.

[Lord Prior of Brampton]

The noble Lord is right: it is quite wrong for people to be detained under Section 136 in police cells. It is also wrong that people suffering from severe mental health problems are transported in police vehicles. I am not aware of the figures that he gave for the West Midlands in comparison with other parts of the country but I will look at them very carefully.

Prisons: Mental Health

Lord Patel of Bradford Excerpts

Wednesday 24th June 2015 Lords Chamber

Asked by

[Lord Patel of Bradford]

To ask Her Majesty’s Government what steps they are taking to achieve parity of esteem between mental health and physical health in prisons.

[The Parliamentary Under-Secretary of State, Department of Health (Lord Prior of Brampton) (Con)]

My Lords, achieving parity of esteem between mental health and physical health in prisons is a government priority. Following the 2009 review by the noble Lord, Lord Bradley, we ensured that prisoners can access equivalent health services to people in the community. The Government’s mandate to NHS England has objectives to achieve parity of esteem, including in health and justice settings, and to develop better offender healthcare that is integrated between custody and community, including developing liaison and diversion services.

[Lord Patel of Bradford (Lab)]

I thank the Minister for that Answer. I am sure he will be aware that a great deal of effort has been made to improve data accuracy and the quality of recording of mental health diagnosis in NHS trusts, including new coding standards, all as part of preparation for a national payment tariff for mental health, similar to those for people in hospitals with physical health conditions. Can the Minister describe, first, how this will be implemented in the prison setting? Secondly, what support will his department be giving to implement the standards for prison mental health services, which the Royal College of Psychiatrists published recently due to, as it said, the lack of a national blueprint for mental health services for people in the criminal justice system?

[Lord Prior of Brampton]

I thank the noble Lord for his two questions. On the first, about coding, it is very important that we get the tariff right and that it does not become just another measure of activity but that outcome is built into that tariff. Paul Farmer, the chief executive of Mind, is preparing a report for NHS England, which will include proposals for the tariff and payment systems. That will include health in prisons as well as outside prisons.

The second question was about the standards issued recently by the Royal College of Psychiatrists. The noble Lord, Lord Bradley, in his foreword to The Bradley Report Five Years On, referred to the importance of having a national blueprint, which of course is now possible given that NHS England is the commissioner of specialist services throughout the country. I will also draw those standards to the attention of Paul Lelliott, the chief inspector of mental health within the CQC. I am sure that the CQC will wish to incorporate those standards into its inspection regime

Mental Health Services: Young People

Lord Patel of Bradford Excerpts

Tuesday 23rd June 2015 Lords Chamber

[Lord Prior of Brampton]

I thank the noble Lord for that question. He is right that, out of a class of 30 children, three are probably suffering from diagnosable mental health problems. The Government are commissioning a prevalence survey to establish more precisely what that number is. There is a feeling that it will be increasing with the use of social media and more bullying in schools. I agree with the noble Lord that we must make it easier to access talking therapies in particular and the Government have plans to do that.

[Lord Patel of Bradford (Lab)]

My Lords, will the Minister assure the House that children and young people with serious mental health problems are not treated on adult psychiatric wards, alongside fairly dangerous adults, that they can access appropriate child mental health services, and that they do not have to travel hundreds of miles across the country to do so?

[Lord Prior of Brampton]

The Government have committed to spending £150 million over the next five years on children who are suffering from eating disorders. This may partly answer the noble Lord’s question. They have also now committed to spending £1.25 billion over the next five years to develop mental health services for children and young adults. That is against a background of our current spending of about £700 million, so we are talking about doubling the spend. Doubling the spend does not mean doubling the benefit and output, but the noble Lord can be assured that it is an absolute priority of this Government to tackle mental health problems right where they start: when people are young.

Health: Human Papilloma Virus

Lord Patel of Bradford Excerpts

Tuesday 20th January 2015 Lords Chamber

Asked by

[Lord Patel of Bradford]

To ask Her Majesty’s Government what action they are taking to include all adolescent boys in the national vaccination programme for human papilloma virus.

[Lord Patel of Bradford (Lab)]

My Lords, I am most grateful for the opportunity to discuss the very important issue of whether adolescent boys as well as girls should be included in the national vaccination programme for HPV—human papilloma virus. I thank all noble Lords who will be speaking in this short but important debate, and express my gratitude to Peter Baker, former chief executive of the Men’s Health Forum and the current campaign director of HPV Action, for all his expert advice and guidance.

This debate is particularly timely because the Joint Committee on Vaccination and Immunisation—JCVI—is currently looking at whether the national HPV vaccination programme should include boys. I have a particular interest in the outcome through my role as chair of the All-Party Parliamentary Group on Men’s Health. Some two years ago, the all-party group held a meeting jointly with the All-Party Group on Sexual and Reproductive Health in the UK. The chair of that group, my noble friend Lady Gould of Potternewton, and I heard evidence from two distinguished speakers—Professor Margaret Stanley from Cambridge University and Mr Peter Greenhouse, a consultant in sexual health from Bristol—which absolutely opened my eyes to the avoidable risks to the health of men caused by HPV infection.

I realised that HPV is not just a problem for women. It does not cause just cervical cancer but other cancers in women and a wide range of cancers in men as well. We know that HPV can cause, in men and women, cancers in the head and neck, as well as anal cancer. In women it can cause vaginal and vulval cancer, and in men penile cancer. In fact, worldwide HPV is understood to cause 5% of all cancers and is thought to be behind the steep rise in oral cancers in the past 20 years.

Unfortunately, HPV is a very common and easily acquired sexually transmitted infection. The majority of people—probably over 80%—will be infected with HPV at some stage in their lives. The good news is that most people’s bodies clear the virus naturally and it causes no lasting damage. But in others it can persist, especially if they have weakened immune systems, and can lead to potentially life-threatening problems. HPV is not just a cause of cancer; it is also responsible for genital warts and a very unpleasant but fortunately much rarer condition called RRP—recurrent respiratory papillomatosis. This can cause serious breathing problems and is very difficult to treat.

Thirty-six organisations have come together as HPV Action to make the case for gender-neutral vaccination; in other words, protecting both males and females from the consequences of HPV infection. These 36 organisations are major names in the fields of cancer, sexual health, men’s health, oral health and public health; in fact, one of them is the Royal Society for Public Health, of which I happen to be a vice-president. HPV Action has informed me that some 2,000 cases of cancer in men are caused each year in the UK by HPV. Around 48,000 men also develop genital warts as a result of HPV infection, and about 600 men and boys live with RRP. This is a huge burden for the individuals affected and their families, and a significant issue for the NHS, which has to find the resources to treat and care for them.

It seems patently unfair that we exclude boys from a vaccination programme that can easily prevent a wide range of diseases, including several types of cancer. This makes no sense on the grounds of equity or public health. I also wonder if it might even be unlawful to exclude boys from this programme under our current equality legislation. I would be very interested to hear from the Minister whether this is the case and whether an equality impact assessment has been undertaken on this issue.

With regard to the JCVI’s timescale for a decision on adolescent boys, in 2014 it stated that it would be in a position to make a recommendation later this year. Unfortunately, in the past few weeks we have heard that the JCVI will not be taking a view until early 2017. Given the facts and figures that I have just presented, this delay is totally unacceptable. I ask the Minister to meet the JCVI urgently to discuss how the decision-making process can be accelerated. Any continued delay is causing many, many more people to suffer avoidable ill health. In fact, I believe that the case for vaccinating boys is already proven and that Ministers should make a decision now to vaccinate boys as soon as possible.

Of course, as always, there are arguments put forward that seek to justify excluding boys. I will briefly address a couple of these. First, it has been argued that the current vaccination programme for girls is so good that it protects males as well. It is true that the programme reaches over 80% of girls; 80% is the level at which the population as a whole is believed to be well protected. The UK HPV vaccination programme is without doubt one of the best programmes in the world for girls. But it is not perfect. There are some areas, notably in London, where vaccination rates in girls are well below 80%. The latest data for Enfield, for example, show that just 67% of girls received all the doses they needed. A recent study by University College London also found that girls from black or other ethnic minority backgrounds were less likely to have been vaccinated than girls from white or Asian ethnic backgrounds. These shortfalls leave large numbers of unvaccinated girls and women at risk of contracting HPV and limit the efficacy of the wider vaccination programme.

Evidence from Denmark clearly shows that while HPV vaccination for girls is reducing the incidence of genital warts in girls, it is not reducing the incidence of warts in boys. This suggests very strongly that boys are continuing to be infected with HPV, either by unvaccinated Danish girls or by girls from countries without a vaccination programme. Men in the UK, as in Denmark, do not conveniently have sexual contact just with women brought up in their own country. It is also the case that not all men have sexual contact with women of their own age group. For those men who have partners who are older than the first female cohort to receive the vaccination, the risk of HPV infection and disease will remain.

Secondly, there are some who believe that the problem with not vaccinating males is largely confined to those who have sex not only with women but also—or instead—with men. It is true that men who have sex with men are, in general, more seriously affected by HPV. Rates of anal cancer in this group have risen sharply in recent years, and anal cancer rates are even higher in men who have sex with men who are HIV positive. It has been suggested that the solution to this problem could be to offer HPV vaccinations to men who have sex with men, on attendance at a GUM clinic. Indeed, this step was recently recommended by the JCVI. In my view, and in the view of HPV Action and other experts, this is a useful but certainly nowhere near a sufficient response. It might be of some help to individuals who receive the vaccine, but it is not an effective solution for all men, or indeed for all men who have sex with men.

That is because we know that people generally become infected with HPV very soon after their first sexual experiences. That is why it is best to vaccinate before a person begins sexual activity. It is also best because the body’s immune response is greater if the vaccine is administered before the age of 16. But if we wait until men who have sex with men turn up at GUM clinics, they are likely already to have had sex with one or more sexual partners. There is lots of evidence to prove that the median age of men approaching GUM clinics is their late 20s and early 30s.

As we cannot practically or ethically identify and vaccinate the 12 and 13 year-old boys who will in their adult lives go on to have sexual activity with other men, the only effective way to protect men who have sex with men is to vaccinate all boys. This would, of course, also protect all other men and increase the level of protection for unvaccinated girls, especially in those areas where, as I have just mentioned, vaccination rates are below 80%.

The proposal to vaccinate all boys has far-reaching support. In fact, it is now hard to find anyone in the field of public health in the UK who does not support gender-neutral vaccination. Significantly, other countries are already vaccinating their boys. Australia, several Canadian provinces and Austria have already introduced gender-neutral vaccination programmes, and the United States is recommending vaccination for both sexes.

I want briefly to mention the issue of cost. HPV Action estimates that the additional cost of extending the HPV vaccination programme to boys in the UK would be in the region of £20 million to £22 million. This relatively small cost has to be set against the economic impact of HPV-related disease. In England, the cost of treating genital warts alone is estimated to be more than £52 million a year. The cost of treating RRP has been estimated at £4 million a year and there are the costs of treating a rising number of HPV-related cancers.

I serve as chairman of Bradford Teaching Hospitals NHS Foundation Trust, so noble Lords will appreciate that I am very interested in health interventions that are cost-effective, as this one clearly would be. But, ultimately, any decision about whether to vaccinate boys should not be made solely on a financial basis, although that is very clear cut. I believe that public health, equity and, above all, the human costs of HPV-related disease for both sexes must be the primary considerations. I would be grateful if the Minister could assure the House that the Government will act quickly to vaccinate both boys and girls in the UK.

Alcohol-related Disease

Lord Patel of Bradford Excerpts

Wednesday 17th December 2014 Lords Chamber

[Earl Howe]

My noble friend is right. I am afraid that the figures for hospital admissions over the past 12 years make gloomy reading. Admissions relating to alcohol-related illness have more than doubled. We welcome the recent falls in alcohol consumption that we are witnessing, and the falls in alcohol-related deaths, but we should not be complacent—and we are not. Harms such as liver disease, as well as social impacts such as crime and domestic violence linked to alcohol, remain much too high, and Public Health England is giving priority to alcohol issues from this year, particularly through support to local authorities.

[Lord Patel of Bradford (Lab)]

My Lords, on the point the noble Earl made earlier about Public Health England and dissemination of funds to local authorities, he will remember that that before Public Health England was set up, £800 million that was ring-fenced for drug use and drug treatment was given to the new body to disseminate to local authorities. Can he say how much of that funding is now diverted from the essential treatment that drug users need to people misusing alcohol, thus probably raising drug-related deaths, acquisitive crime and drug use generally across the country?

[Earl Howe]

The noble Lord was kind enough to give me prior notice of that question just before we came in. I have taken advice on it, and the advice I have received is that there is no wholesale evidence of a shift of funding from drug treatment to alcohol treatment. There may be the odd example of that, but I can tell the noble Lord that Public Health England is monitoring this issue in local areas, to make sure that that shift does not take place in a disproportionate way in relation to the need in those areas.