Dangerous Drugs

Debate between Bob Stewart and Dan Poulter

Tuesday 12th September 2023 Commons Chamber

[Dr Poulter]

If the House divides this evening I will be voting against the measure for the further reasons I am about to outline.

I think it would be helpful to remind the Minister what the ACMD actually said with regard to legislation:

“Based on this harms assessment, the Psychoactive Substances Act 2016 remains the appropriate drug legislation to tackle supply of nitrous oxide for non-legitimate use. There is, however, a need for enforcement of the Psychoactive Substances Act 2016 to be supported by additional interventions designed to reduce health and social harms. Based on this harms assessment, nitrous oxide should not be subjected to control under the Misuse of Drugs Act 1971 for the following reasons”.

Those reasons have been drawn out to some extent during the debate, but they are neatly summarised by the ACMD in its recommendations to the Government in its report.

First,

“Level of health and social harms”,

which is relatively limited, and

“current evidence suggests that the health and social harms are not commensurate with control under the Misuse of Drugs Act 1971.”

Secondly,

“Proportionality of sanctions: the offences under the Misuse of Drugs Act 1971 would be disproportionate for the level of harm associated with nitrous oxide and could have significant unintended consequences.”

Thirdly,

“Impact on legitimate uses: control under the Misuse of Drugs Act 1971 could produce significant burdens for legitimate medical, industrial, commercial, and academic uses. The current scale and number of legitimate uses that stand to be affected is unknown but is estimated to be large.”

I think it is fairly clear that the Government did not carry out a proper impact assessment before bringing this measure to the House.

[Bob Stewart (Beckenham) (Con)]

I thank my good friend for allowing me to intervene. Does that mean that he thinks we should do nothing at all?

[Dr Poulter]

No, I do not think it means we should do nothing. I think that if we believe, as I think many of us do, that we should control the illegitimate supply of nitrous oxide, we should look at existing legislation, such as the Psychoactive Substances Act 2016, which was designed and taken through its stages by my right hon. Friend the Member for Hemel Hempstead (Sir Mike Penning). This point was discussed at some length during its passage. The focus was not on criminalising use and the potential users, but on controlling the supply: a clear distinction was drawn. The Minister may correct this view, but the ACMD made it clear in its report that better enforcement of that existing legislation to control illegitimate supply would be a much better and more proportionate way of dealing with the issue at hand, and the same was suggested more broadly in the evidence supplied to the ACMD while it was compiling its report.

So there is already a legitimate means of dealing with this, but unfortunately there is the potential for unintended consequences, and I was not reassured when the Minister said earlier that the Government would introduce another measure—which no one in the House has seen as yet—to ensure that there would be no such unintended consequences. If a Government are introducing two good pieces of legislation, they should introduce both of them together so that the House can consider them in the round. My concern is that primary legislation such as the Misuse of Drugs Act is tightly drawn, and unless it is amended, it is difficult to introduce another measure to sit beneath it and mitigate its provisions. I am therefore not reassured by the Minister’s comments, but in any event it is not good or effective government not to present the two measures at the same time so that we could consider the issues in the round.

Because I believe that there is already legislation in place which needs to be better enforced to deal with illegitimate supply, and because I do not believe that the Government have given adequate weight or consideration to the potential unintended consequences for legitimate users of nitrous oxide—which the Minister effectively admitted in his opening comments—I believe that the Government are in the wrong place at present, and that it would have been better to produce a proper impact assessment of the legitimate uses to sit alongside this measure before bringing it to the attention of the House. For all those reasons, I will vote against the order if it is put to a vote.

Veteran Suicide

Debate between Bob Stewart and Dan Poulter

Wednesday 3rd April 2019 Westminster Hall

[Dr Dan Poulter (Central Suffolk and North Ipswich) (Con)]

It is a pleasure to serve under your chairmanship, Sir Henry. I pay tribute to the hon. Member for Portsmouth South (Stephen Morgan) for securing this debate. I agree with much of what he said. He is right to say that, historically, there has been a disconnect between what the MOD and the NHS do in providing better care for veterans. When I was a Health Minister, I worked with the then Minister of State for Defence, my right hon. Friend the Member for Rayleigh and Wickford (Mr Francois), to improve mental health support, first aid training and other support and help available to armed services families. We also worked to support the MOD in better tracking veterans immediately after discharge from the services. I entirely agree with the point the hon. Gentleman made about one year not being enough.

To put the debate in context—it is important that we have the right evidence and data to support the making of informed decisions about veterans’ care—overall suicide rates for those serving in the armed forces are low, with the exception of males in the Army aged between 16 and 19. Evidence suggests that elevated suicide rates among 16 to 19-year-olds are related to issues such as Deepcut-type events and difficulties adjusting to life in the armed forces, as opposed to being deployment-related.

In the US, veteran suicide rates are definitely higher than population suicide rates, but just as in the UK, and perhaps surprisingly, they do not appear to be deployment-related, and there is much speculation as to why higher rates of suicide are experienced by US veterans, as compared with UK veterans.

[Bob Stewart]

Soldiers who are between 16 and 19 can deploy on operations only for two of those years. I totally understand that there will be other reasons involved, but soldiers cannot go on operations until they are 18 years old.

[Dr Poulter]

I defer to my hon. Friend’s considerable experience as a long-standing and distinguished soldier with a long-standing and distinguished record of service in our armed forces. I had the pleasure of serving in the NHS with a number of Ministry of Defence or armed forces doctors. I certainly know that they pay particular attention to these issues now, and the MOD has put a lot more into the training and support available to their doctors to better support veterans.

We have good data on suicide rates among Falklands veterans and veterans from the 1991 Gulf war. There is no evidence to suggest that the rates of suicide among that group of veterans are any higher than those in the rest of the armed forces; in fact, there is evidence that the rate of suicide among those groups is lower than expected population rates.

We do not have reliable evidence for the more recent Iraq and Afghan conflicts—the hon. Gentleman alluded to that in his remarks. There is a lot of anecdotal evidence and evidence emerging from coroners’ reports, but anecdote is not hard evidence. We need to work much harder on that to ensure that we have the hard evidence to make the right decisions.

In terms of gathering that hard data, the announcement by the Minister, my right hon. Friend the Member for Bournemouth East (Mr Ellwood), that the MOD has agreed to carry out definitive research by tagging all those who have served in Telic and Herrick is very much to be welcomed. That work is starting with defence statistics, but it is difficult to know how and when it will be completed—these days, it is challenging and bureaucratic to get data out of the Office for National Statistics, and that is hampered by general data protection regulation issues. However, the work that Professor Simon Wessely and his team at the Institute of Psychiatry, Psychology and Neuroscience are doing with the MOD will happen and should give us the answer. Hopefully it will build a strong evidence base for improving veterans’ care in future.

Finally, we need better to join up what happens when veterans leave the Army and register with the NHS. The current situation is not right, and we need to improve it. The MOD should compulsorily register veterans with civilian healthcare services when they are discharged from the armed services. To my knowledge, that does not happen, but it should happen routinely, because it would help serving men and women transition back into civilian life. It would also flag up to GPs that somebody is a veteran and has a serving record.

It is important that we get the data right. Anything that the Minister can do to help with the issues surrounding GDPR, make the ONS data more speedily available for population-based comparisons and support the work of Professor Simon Wessely and the IoPPN, would be greatly welcome.

Care Bill [Lords]

Debate between Bob Stewart and Dan Poulter

Tuesday 11th March 2014 Commons Chamber

[Dr Poulter]

I will give way to the former Secretary of State in one moment, but I would like to make some progress. I have been very generous in giving way.

The Government are grateful to Members for raising these important issues, but, regretfully, we cannot accept the amendment. The amendment makes two key changes. First, it gives commissioners of other trusts affected by the recommendations of an administrator at a foundation trust the power to define essential services at those trusts. That would be cumbersome and impractical and draw the focus away from the trust in administration and undermine the need for recommendations affecting other providers to be “necessary and consequential”, which is something that my right hon. Friend the Member for Sutton and Cheam believes in and raised in Committee.

Secondly, protecting essential services gives the administrator their focus for the trust in administration; it is a critical part of the process. Asking commissioners at other trusts to define their essential services would incorrectly indicate an equivalence in the administrator’s role between the failed trust and other successful providers.

Clause 119 recognises the need to give other commissioners a clear role and a proper say. It already extends the existing requirement on an administrator at a foundation trust to obtain the consent for their recommendations from each commissioner of the failing trust, and also from each commissioner of any affected trust. NHS England support must be sought in cases where not all commissioners agree.

Let me be absolutely clear. Under subsections (3), (4) and (6), the commissioners who are asked to agree and draft the final TSA report already include commissioners from affected trusts. It may be hard to spot that in the clause, as it amends existing legislation.

Clause 119 also requires the administrator to consult other affected commissioners. He or she must publish a summary of the consultation responses and take them properly into account when making final recommendations. The Secretary of State or Monitor will need to be satisfied that the administrator has carried out their administration duties properly, including showing proper regard for the statutory guidance.

Commissioners of other affected trusts will therefore have every opportunity to make their views known. However, I would like to thank my right hon. Friend the Member for Sutton and Cheam for bringing the matter to our attention. The Government agree that it is important for other local commissioners to be able to protect their essential services. We will update the guidance to make it clear that the agreement of commissioners to the TSA report should include their agreement that essential services have been protected at other trusts, as well as at the failing trust, so that all local commissioners have an equal say, with NHS England arbitrating in the event of disagreement. Furthermore, I would like to invite my right hon. Friend to chair a committee of MPs and peers to consider the draft guidance and ensure that his concerns are properly addressed before the regime is used.

[Bob Stewart]

My disquiet stems from the fact that when the TSA was put into South London Healthcare NHS Trust there was no mention that it would go beyond its borders and into Lewisham. I do not think that was very clever. That is what worries me about the Government’s plans.

[Dr Poulter]

The spirit of the previous Government’s legislation was to look at the wider health economy when a trust is in extremis and has reached the point at which it is failing patients, either because of its financial failure or the direct effect that has on the quality of patient care. There then needs to be a wider look at the whole health economy. I know the Princess Royal university hospital in my hon. Friend’s constituency very well. I also know Lewisham hospital very well, having done some of my medical training there. They cannot be seen in isolation from King’s college hospital, Woolwich, Sidcup and all the other hospitals in the area, because they look after patients in that part of London as part of an integrated health and care service. When a hospital fails in that way, it has to be looked at holistically. It is a power of last resort, to be used when a trust is in extremis, not a routine power, which is why we have the TSA process set up by the previous Government.

Oral Answers to Questions

Debate between Bob Stewart and Dan Poulter

Tuesday 16th July 2013 Commons Chamber

[Dr Poulter]

I am afraid that the Opposition are very confused about their figures. As I explained earlier, the £2.7 billion—or 20%—figure represents the savings that councils have made to meet demand, and real-terms spending next year is expected to go up. The point from the ADASS and other surveys is that integration works. This Government are investing in integration. According to the Dilnot report, it was the last Government who cut in real terms the amount of spending going to social care between 2005 and 2010—and the hon. Lady was a member of that Government.

[Bob Stewart (Beckenham) (Con)]

3. What steps he is taking to change negative perceptions of mental health issues.