Drugs

Diana Johnson Excerpts

Thursday 6th June 2013 Westminster Hall

[Diana Johnson (Kingston upon Hull North) (Lab)]

I welcome you to the Chair, Mr Bayley. It is a pleasure to serve under your chairmanship. I apologise, but I have a very sore throat, so my voice is not quite as it should be. It is a pleasure to follow the hon. Member for Cambridge (Dr Huppert). I will certainly look to his pronouncements in future for an indication of Liberal Democrat policy.

I start by recognising that the report is an important piece of work. I pay tribute to the leadership of the Select Committee’s Chair, my right hon. Friend the Member for Leicester East (Keith Vaz). I also pay tribute to all the members of the Committee who contributed to the report, which draws upon the huge experience of different people and organisations. As we have heard, many different countries have been considered.

I had an opportunity to listen to some of the witness sessions. I heard Sir Richard Branson and Russell Brand give evidence, and I attended the Committee’s one-day conference in Parliament. I think it was very useful to invite the general public in to hear the deliberations of that Committee.

I visited Colombia after the Select Committee’s visit, and I know from my conversations with the Serious Organised Crime Agency officers based in Colombia that they were delighted to be able to explain the international role they play in addressing the drugs problem. They do some very important work, which I am pleased has been recognised in the report.

The report is wide-ranging and contains many recommendations. Because of the time, I will go through some of the recommendations that I believe are key. I look to the Minister to answer some of my questions on the approach the Government will take to addressing the Committee’s recommendations.

I start with the recommendation that the lead for drugs policy should be shared between the Home Office and the Department of Health, with a designated point person co-ordinating policy. That might seem an unlikely place to start, but I think it is absolutely essential that drugs policy is co-ordinated across Departments. I will address that theme in the points I raise this afternoon. The Opposition recognise the importance of a co-ordinated approach, and it is certainly important to recognise that there has been a high level of cross-departmental work on drugs over the past 10 years.

The Minister, although based in the Home Office, is responding on behalf of the Government, and I know he takes seriously his responsibilities on drugs. I question whether it should be necessary for two Departments to be involved with drugs, because the Minister is able today to discuss aspects of the drugs strategy that sit not only within the Home Office but within the Department for Education and other bodies, such as Public Health England and the NHS.

That leads me to the report’s recommendation on the need to strengthen and open up the inter-ministerial group on drugs, which the Minister chairs. One of the recommendations is that the group’s minutes, agendas and attendance lists should be published. I have spent much of the past 18 months trying to get details of those minutes, agendas and attendance lists through parliamentary questions, and I have resorted to freedom of information requests. I have been continually thwarted by the Home Office, so I think that recommendation would help us to understand and appreciate what is happening across Government.

We can see the importance of cross-Government working when we look at the record of achievement over the past 10 years on reducing the health harms of drug use, particularly heroin and crack cocaine use. All the key indicators are improving, and some of them have already been mentioned.

The number of drug users is falling, particularly among the 16-to-24 age group, although, as the hon. Member for Cambridge highlighted, that may not give us a true picture if we take legal highs into account. The number of drug deaths has fallen even more sharply—more than halving between 2001 and 2011—partly because we have had much better access to treatment and because treatment is more successful. The average waiting time to access treatment was nine weeks in 2001; it was five days in 2011, and it is getting more effective. Only 27% of treatment programmes were successful in 2005, but the figure rose to 41% in 2011.

Finally, and probably most importantly, more people are completing treatment. In 2005, 37,000 people dropped out of treatment before completion, whereas only 11,000 completed it. By 2011, those figures had almost reversed: 17,000 people dropped out of treatment, whereas nearly 30,000 completed it. I am sure we could see further improvement, and I am not complacent at all, but we ought to recognise that there has been huge improvement in treatment outcomes over the past 10 years. I say that in particular because much of what has been achieved was within the framework of collaboration.

The National Treatment Agency for Substance Misuse was set up as a joint Home Office and Department of Health project to ensure that drugs treatment had the required priority in the NHS. Although the NTA was funded by the NHS, the Home Office had representation on its board because there was clear acceptance that the Home Office had a key part to play. We knew that drug treatment was important in reducing crime. We wanted to ensure that those two parts, treatment and crime prevention, sat together. I think the NTA was an unprecedented success, and I pay tribute to the recently retired chief executive, Paul Hayes, who did an excellent job over many years.

I saw at first hand how collaboration can work effectively when I visited a drugs treatment facility in Wakefield run by Turning Point. In one building there were police officers, probation officers, social workers and a range of medics and support officers, which works very well, but I share the Committee’s concerns about how such a set-up will fare in the new frameworks. Such facilities will depend on the co-operation of the new police and crime commissioners, who will have some responsibility for funding, and the new health and wellbeing boards. In the case of the facility that I visited, the PCC will have to liaise with nine different health and wellbeing boards, each of which has a huge number of priorities. We need to keep an eye on how well such facilities continue to be funded under those new PCCs and health and wellbeing boards.

I am also concerned about the level of co-ordination between health and wellbeing boards and the criminal justice system. I am pleased that in my home city of Hull the police have been co-opted on to the health and wellbeing board, but I do not think that is the norm. I support the Committee’s recommendation that more information be collected from health and wellbeing boards on where their money is being spent and who is involved in that decision making. The Home Office should ensure that that includes information on co-ordination with criminal justice partners. Drug treatment is not sexy, but for it to keep working a huge number of local politicians will have to continue to prioritise drug treatment and the spending that it needs. I question whether, in the financing regime they have set up, the Government have put enough in place to incentivise local politicians to recognise that.

Quite rightly, much of the Committee’s report addresses how we can improve treatment and increase recovery rates, and I particularly want to mention prisons. The Committee makes a number of recommendations about improving provision in prisons, and that seems sensible. Will the Minister tell us how far the Government have started to implement some of the recommendations? In particular, I echo the Committee’s concerns about the importance of treatment and the availability of support at the prison gate to prevent recovering addicts from relapsing, especially because of the recent changes in the NHS. I understand that in-prison drug treatment is being commissioned not in the locality but by a national agency, but that what happens when the person leaves prison and returns to the community depends on the commissioning arrangements of the clinical commissioning group and the health and wellbeing board.

[Keith Vaz]

I thank my hon. Friend for taking part in the debate. Given the state of her voice, she probably needs a prescription, so I am grateful to her.

What is the Opposition’s position on compulsory testing on entry and exit? Everyone wants to help people, but if we do not know who needs help we cannot really give that help.

[Diana Johnson]

The Chair of the Select Committee makes a powerful argument for having data that allow us to understand the number of people affected and therefore how to treat them. I am sure the Opposition would want to consider that, recognising that the issue has been raised by the Committee, which sees it as an important part of tackling some of the problems in prison.

Will the Minister also address an issue that has arisen since the report was published, which is the use of the private sector in the probation services provided to people leaving prison? What thought has been given to ensuring that appropriate drug treatment and support is available through the new providers?

At the start of this Parliament, there was a lot of political rhetoric from Government Members about what constituted recovery, to which the hon. Member for Cambridge referred. The view at first appeared to be based on ideology and not on looking at the individual needs of each person. For some people a life of abstinence would be appropriate; for others, a life supported by methadone or another drug. When people want to move to abstinence, it is important that they have the necessary support to do so, and that a range of programmes are available to support them.

The Committee’s report highlights the large variations in the success of different programmes, which is of concern, because we want to ensure good value for money and that we get the right outcomes. An average success level of 41% could obviously be improved upon. Payment by results should help to improve standards, but I echo the concerns expressed by the Committee, and this afternoon by its Chair, about how that method of funding might hamper small providers. It is also important that support is given to a range of commissioning bodies to enable them to sort through the data on what is effective. Given the multitude of different commissioners, can the Minister explain what role Public Health England will play in guiding commissioners?

Of course, we all want to see fewer people taking drugs in the first place, and I will concentrate for a few moments on the need to have more effort directed at prevention. I agree with the Committee that drugs prevention and education are the strands of the drugs strategy to have had least work and least interest. In the review of the drugs strategy, the Government could identify just two areas of progress: they had relaunched the FRANK website, and they were reviewing the curriculum for schools. Since then, the curriculum review has finished, but my understanding is that there will now be even less drugs education in the science curriculum. That cannot be seen as progress. At the same time, the Government have abandoned Labour’s plans to make personal, social, health and economic education a statutory requirement for schools and have closed the drugs education forum.

Figures from Mentor, the drug and alcohol charity, show that at present 60% of schools deliver drug and alcohol education once a year or less. That education is often poor, incomplete or totally irrelevant; pupils aged 16 seem to get the same lessons as pupils aged 11. An example given was of sixth-form students being required to colour in pictures of ecstasy tablets as part of their drugs education. Earlier this year, Mentor told me:

“Drug and alcohol education should not be disregarded as a trivial add-on. It should be fundamental to pupils’ education. The links between early drug and alcohol use and both short and long term harms are clear, and there is compelling evidence showing longer term public health impacts of evidence based programmes. The cost benefit ratios are significant, ranging from 1:8 to 1:12.”

The Committee’s report is clear:

“The evidence suggests that early intervention should be an integral part of any policy which is to be effective in breaking the cycle of drug dependency. We recommend that the next version of the Drugs Strategy contain a clear commitment to an effective drugs education and prevention programme, including behaviour-based interventions.”

I wholeheartedly support that, and I repeat Labour’s commitment to bringing in statutory PSHE to achieve it, which I tried to do recently myself by introducing a ten-minute rule Bill in the previous Session.

For the interim, the Committee recommends

“that Public Health England commit centralised funding for preventative interventions when pilots are proven to be effective.”

Again, that is something I support. The Department for Education has a set of programmes that have been approved and are listed on the Centre for the Analysis of Youth Transitions database. A wide range of programmes, they are all evidence-based and have been tested and proved to be effective. They are life-skills programmes that not only tell children no, but empower them to resist peer pressure and to make informed decisions about alcohol and drugs. Furthermore, they dispel myths such as those going around suggesting legal highs are safe. What is unfortunately lacking at the moment, however, is the political leadership to get those lessons into schools.

I mentioned earlier my attempts to see the minutes of the inter-ministerial group on drugs. I never managed to get the minutes of the meetings, but I did get the agendas, which showed that in the first 18 months of this Government drugs education and drugs prevention were never discussed. Can the Minister tell us whether he has put either drugs education or drug prevention on the agenda of the group in the nine months that he has been chair? If not, perhaps he can promise to put something on the agenda of the next meeting. Previously, when there was a problem with prioritising drug treatment within the NHS, Ministers came together to form the National Treatment Agency. There now appears to be a problem with prioritising prevention work in schools and education and in public health, so perhaps the Minister can show a similar initiative and work with his colleagues to set up a cross-departmental body to tackle the issue.

Finally, I want to discuss the problem of the new psychoactive substances. The European Monitoring Centre for Drugs and Drug Addiction is now monitoring 280 new substances throughout Europe; 73 new substances came on to the British market last year, and they are now freely available from 690 online shops. In addition, the Angelus Foundation, which has already been mentioned, reports that there might be up to 300 “head shops” selling those substances on the UK high street. The figures are truly shocking and will terrify every parent in the country, but even those figures do not quite show how readily available the drugs are through peer-to-peer selling in schools. As the Chair of the Home Affairs Committee mentioned, even Amazon was recently selling the drugs, and some online sellers are sending out free samples to children once a new compound arrives from China. Our understanding of the dangers of legal highs has been greatly enhanced by the work of the Angelus Foundation, and I pay particular tribute to Maryon Stewart who founded the foundation after tragically losing her daughter, Hester Stewart, a medical student, from the legal high GBL in 2009.

As we heard, the Government have introduced temporary banning orders to make such drugs easier to prohibit. The Home Secretary promised that they would allow for swift and effective action. In two years, however, one temporary banning order has been used, during a period when more than 100 new legal highs have emerged on the market. I understand from the press that two more temporary banning orders are in the pipeline, which I will come on to.

The first thing we need to do to get better understanding of the harms of such drugs is, as the Select Committee said in its report, to improve data collection on drugs. Nowhere is that more pressing than with the new psychoactive substances. First, we need better information about their prevalence. I am very concerned that those drugs are not being properly recorded in the Mixmag drug survey or the British crime survey.

Secondly, we need to understand the harm they cause. I have heard from front-line practitioners in addiction services and A and E that they are encountering more and more people who have taken legal highs, but that is anecdotal and we need proper data collection. If someone presents to A and E having taken a legal high, that should be properly recorded.

Thirdly, we need the major databases to work together. For the last year, I have tried to ascertain how the EMCDDA database liaises with the Home Office’s much-touted early warning system. Last year, I asked why it was monitoring 13 substances when the EMCDDA had 47 on its list, but I have still not received a satisfactory explanation. I would also like to know how the Home Office’s system is informed by the TICTAC database of toxins, which is run by the NHS, and the National Poisons Information Service’s TOXBASE. In the past, work on collecting data was done by the Forensic Science Service, but it has been disbanded. I hope that the Minister will explain who is doing that work now.

This week, the Government announced that they will finally ban Benzo Fury. It is clear from the letter that the Home Secretary received from the Advisory Council on the Misuse of Drugs that there are real concerns that the system that has been set up is failing. The drug has been putting people in hospital since 2009, when it was first reported to TOXBASE, and since then there have been 65 more referrals. Will the Minister explain the point of a temporary banning order if it takes four years from the first hospital admissions to a ban on the sale of the drug on the high street? No deaths from this drug have been reported in the UK, but deaths have been reported in other countries. Professor Les Iversen, chair of the ACMD, said:

“Sooner or later we will get unexpected and serious harm emerging with one of these compounds and then we will blame ourselves for allowing them to be sold without the usual safety data.

That’s why I think this is a serious problem, it's not just a nice set of party drugs that we can let people get on with, it's a set of chemicals that are potentially very dangerous.”

I hope the Minister will respond to that comment.

The Committee’s report recommends that more advice and support be given to allow trading standards to take action against sellers, and that recommendation was also made by the UK Drug Policy Commission. What has the Minister done to investigate implementation of those two recommendations? Several recent attempts to take action through the courts have failed, and trading standards are already exceptionally stretched because of the massive cuts in local government. I hope the Minister will review that, and look at who is responsible for tackling online sellers.

I have highlighted a few of the key issues in the report, but there are many others. I again congratulate the Chair of the Home Affairs Committee—

[Dr Huppert]

The hon. Lady has highlighted some issues and talked about a failing system. Will she clarify her position on the suggestion of a royal commission to examine the matter and to try to fix the whole system, and on the concept of decriminalisation? Where does she stand on those two issues?

[Diana Johnson]

Perhaps I may correct the record. When I talked about a failing system, I meant the legal highs and the temporary banning orders that have been put in place. I am not sure that they are delivering what the Government intended them to do swiftly and efficiently.

On the other point raised by the hon. Gentleman, it is certainly important to look at what happened in Portugal, which I am pleased the Minister visited. I am particularly interested in what is happening in New Zealand with legal highs, and I hope the Government will look at the New Zealand Government’s experience. I think that President Santos is doing important work in Colombia. But today I wanted to concentrate on the issues in the report which the Government have an opportunity to respond to and to do something about. I am particularly concerned about the lack of action on education, and that has been my main focus.

I congratulate the Chair of the Select Committee on a well-reasoned and thoughtful report. I am pleased that we have had the opportunity to discuss it this afternoon, albeit with a small number of Members. The quality of debate has been high.

--- Later in debate ---

[Mr Browne]

I think that that is a good argument for elected politicians, including those who have participated in the debate this afternoon, to devote more time to thinking seriously about the subject. The point I was making about a royal commission was that we can put together an expert body of men and women who are full of integrity, knowledge and decency, and they could spend a long time thinking about the issue, but they would not produce “the right answer”, because I fear that the right answer does not exist in that form. They would produce a series of interesting observations and recommendations, which may match, to a high degree, the series of interesting observations and recommendations that the Committee made in its report. We would then have a debate along the lines of the one we are having this afternoon. As I said, although a royal commission would be a good opportunity for stimulating debate, I do not think that it would in itself necessarily reach the outcomes that we seek, because I am not sure that the outcomes are ever fully attainable.

A number of other issues have come up. The Government’s strategy has three prongs: reducing demand, restricting supply and building recovery. In addition, we have always said that we are open to learning from best practice in other countries. I have had the opportunity to travel, as recommended by the Committee, to Portugal, and last week I spent 24 hours in Denmark and 24 hours in Sweden. During the remainder of the year, my plan is to visit South Korea, Japan, the United States, Canada, the Czech Republic and Switzerland. We should be open-minded to the ideas that such other countries have come up with, because they are broadly equivalent to us in their economic and social development, and they are confronted by the same problems as us in terms of drugs policy. There is no reason to believe that every good idea in the world originates in this country, and they may well have ideas that we can learn from.

Going to Portugal was interesting—my hon. Friend the Member for Cambridge dwelt particularly on that country. I will write a report when I conclude the process, so I will not do a running commentary on a weekly basis. I thought Portugal was interesting, but I was perhaps slightly less bowled over by it than I might have expected to be, because in some ways, the Portuguese codify what, in practice, happens to a large degree in this country anyway. People might think that that is quite interesting in itself. The fact that Portugal has made that formal codification is a significant step, but, in practice, there are very few people in Britain who are in prison merely for the possession of drugs for personal consumption. People are in prison because they have stolen money to buy drugs, or because they have supplied drugs to others, but most people in Britain who present with a severe heroin addiction, for example, are treated. We try and find ways of enabling them to address their addiction and, in time, recover from it, rather than treating them straightforwardly as criminals. Therefore, the gap between what happens in Portugal and what happens in practice in the United Kingdom is perhaps not as great as some might say.

It was interesting, for example, to talk to the Portuguese about the impact of changes in their laws on infection and blood-borne illnesses caused by the injection of drugs. They had a very big rise in instances of HIV infection in intravenous drug users, and when they changed the laws, there was a dramatic fall. It is a striking graph—like a mountain, it goes up and then comes down, and there is a clear correlation. The only thing I would say is that their starting point was higher than the United Kingdom’s. They then went to a point that was dramatically higher than the United Kingdom’s, and they have now come down to a point that is just higher than ours—but they are still higher than us.

For a number of reasons, we have never had that level of infection in the intravenous drug-taking community. Because the scale of our problem is dramatically different from the scale of the problem that they were confronted with when they changed the law, we should not automatically assume that changing the law would have a similar impact on infection rates in this country. There are interesting lessons to learn from talking to people in other countries, but we should not automatically assume that changing the law in the way that other countries have will lead to the same public policy outcomes, as we are starting from a different point in this country.

The Portuguese are having conversations about how their law is working in practice. In my experience—I agree with my hon. Friend the Member for Cambridge—it was virtually impossible to find anyone in Portugal who wanted to turn the clock back and change the law to what it had previously been. Last week in Denmark, which is one of the more liberal countries in the European Union in terms of drugs policy, I found that some of the liberalising measures that had been taken had become widely accepted, even among people who had initially been sceptical about the changes.

In Portugal, however, there was a debate about whether it could modify its law and in some ways potentially strengthen it. The idea of having 10 days-worth of personal drugs consumption was thought by the Minister to be a high figure. There was a lobby or case for reducing that to five, or even possibly three days. I suppose that if someone who was minded to transport drugs for sale to others had 50 days-worth of supply that they wanted to take to another house five minutes’ walk away, they would be better making that journey five times, with 10 days-worth on them each time, because they would then not be breaking the law. There was some thought about whether that law was perhaps too liberal and could be slightly tighter to restrict the potential for abuse.

[Mr Clive Betts in the Chair]

My point is that there were many interesting features of the experience in Portugal, as there were in Denmark and Sweden. I am genuinely open-minded on this matter. I approach open-mindedly what changes we could consider and potentially even adopt in this country to make our laws more effective.

I heard the point that was made by the hon. Member for Kingston upon Hull North, who speaks for the Opposition, and others about where responsibility lies for drugs policy in the United Kingdom. It is worth noting that in all the countries that I have been to so far, the lead responsibility lies with the Health Department. In this country, of course, the lead responsibility lies with the Home Office. I am not sure that in practice that is as significant as it is regarded as being by both those who believe vehemently that it should remain with the Home Office and those who believe vehemently that it should not, because we have a cross-Government approach.

There needs to be a lead Department, and of course much of drugs policy is about law enforcement, so there is a persuasive case to be made for that being with the Home Office, but we also of course involve the Department of Health, the Department for Education, the Department for Communities and Local Government, the Department for Work and Pensions, the Cabinet Office and others in a cross-Government strategy on drugs, so I would not want anyone attending this debate to think that the Home Office ploughed on without listening to other parts of the Government.

The three parts of the strategy are demand, supply and recovery. We have a range of initiatives on demand reduction. The FRANK website and programme was mentioned during our debate. That has been updated and relaunched and is widely used as a source of information—particularly, but not exclusively, by young people. Another example is the Choices programme that we have developed. That focuses on preventing substance misuse and related offending among vulnerable groups of young people aged 10 to 19. The programme received funding of £4 million in 2011-12 and engaged more than 10,000 vulnerable young people.

This issue is not just about schools. In fact, many people take drugs for the first time when they have left school—when they are adults. Schools have a part to play, but so do other methods of education. It is worth noting that the number of young people taking up drugs and particularly school pupils experimenting with drugs has fallen markedly, so there does not seem to be a shortage of information among young people about the harmful consequences of taking drugs. Indeed, increasing numbers of young people seem to be mindful of those harmful consequences and, as a result, have not taken drugs.

[Diana Johnson]

In the light of the fact that for many years, as I understand it, it has been Liberal Democrat policy to have PSHE as part of the statutory national curriculum, I wonder whether the Minister, as a Liberal Democrat Minister in the coalition Government, is satisfied that enough is currently being done through the Department for Education to ensure that there is good drugs education in all our schools.

[Mr Browne]

This is a wider issue. I will engage seriously with the question, because I think that it is fair. It is about the degree to which we, as a Government and a country, use schools to inculcate desirable behaviour in children of school age. There is a powerful lobby in the House—I have received its representations—that says that it is crucial for part of the curriculum in schools to be about tackling drugs and the harmful effects of drugs.

I have also had representations from people saying that children should be taught in school about sexually appropriate relationships and that that should be part of the curriculum. I have also been told that children should be taught in school about responsible financial management, because children leave school without necessarily being able to make mature decisions about their personal finances. I have also been told that children should be taught in school how to cook properly, because large numbers of children are not as adept as hon. Members at this debate are at making delicious meals for themselves and that that should be part of the curriculum. I have been told that healthy eating more generally should be part of the curriculum in schools because otherwise children would eat unhealthy food through ignorance rather than because they preferred the taste of unhealthy food. I have also been told that there should be more awareness of alcohol and the dangers of cigarettes and that there should be more public health information generally.

The point that I am making is that there is a reasonable nervousness in the Department for Education that, unless we try to rationalise the activities that children are taught about in school, all of which are individually worthy—I think that everyone would accept that—teachers might get to the end of the school day and find that there is not much time left to teach children some of the core academic subjects that parents rightly expect them to be taught. There is a genuine debate about whether schools are there primarily to create good citizens or to educate children in core areas of academic knowledge. There is scope for a bit of a trade-off. Most people would want their children to be adept at maths, English literature and other typical academic subjects and to be rounded citizens at the same time, but there are only so many hours in the day and the Department for Education has to make some judgments about how to fill those hours intelligently.

On supply, we work closely with partner countries in Europe particularly. While I was in Portugal, I also took the opportunity to visit MAOC—the maritime analysis and operations centre—which is an initiative primarily involving Atlantic-facing European countries, although I think that the Dutch are also involved. They do not really face the Atlantic; it depends how far one thinks the Atlantic goes down the English channel. But the United Kingdom, the French, the Portuguese, the Spanish and others are working to try to intercept drug shipments.

Before becoming a Home Office Minister, I was a Foreign Office Minister who covered, among other places, Latin America. My right hon. Friend the Home Secretary has met the Presidents of Colombia and Panama. Home Office Ministers have met the Interior Ministers of Colombia and Brazil and the Foreign Ministers of Bolivia and the Dominican Republic. But I hope that I do not sound immodest when I say that I suspect that, probably more than anyone else in government, I have an insight into the countries that we have talked about. Since this Government formed, I have been to Colombia on three occasions and Peru on two occasions. I have been to Bolivia; I have been to Ecuador; I have been to Panama on two occasions and so on.

In the countries that I am talking about, the issue is cocaine, and there is indeed a severe impact on those countries. We recognise our responsibilities to them as a consuming country. We work closely with the Governments of all those countries to varying degrees and certainly with the President and Government of Colombia, to whom many in this debate have already paid tribute.

Recovery is an area where there is quite a lot of innovative public policy making. We have the world’s first payment-by-results programme to try to incentivise recovery outcomes. It is being piloted in eight areas, and I have attended an extensive meeting with people from the eight areas in the Department of Health to talk to them about the progress that they are making in Bracknell Forest, Enfield, Kent, Lincolnshire, Oxfordshire, Stockport, Wakefield and Wigan. We are optimistic that they will make good progress, but they will not all make identical progress. Part of what will be interesting about the pilot studies is how local providers, tailoring their services to their local problem, will produce outcomes that we hope will reduce harm and drug taking and enable people to recover in their areas.

There is an interesting debate, which I think my hon. Friend the Member for Cambridge touched on, about how one measures recovery. We have had that debate in Government. I accept, as I think most people do, that it represents progress when we take someone whose life is chaotic, who is a drug taker and who is unable to work or to take responsibility for themselves in quite elementary ways and we stabilise their life—perhaps through some programme of replacement drug treatment—so that that they can perhaps address some of their underlying social problems and, in time, find a job. I would not want the Government to fail to recognise that, because a lot of people, including in the voluntary sector, work to try to bring about that progress, which leads to improved outcomes for the people affected and, in many cases, for their spouses, their children and others around them.

The only caveat that I would enter is that the Government are cautious about regarding that as a desirable end point. Although some people may struggle to get beyond that point, most people—if they were talking about their own children, for example—would regard it as a desirable interim point. Ideally, however, they would like the end point to be that the person was free from addiction to whatever substance has made their lives so blighted and difficult in the first place.

There is an interesting, worthwhile and entirely valid debate about the point at which progress starts to put down roots and just becomes the new normal. If someone has been moved from a chaotic life on drugs to an ordered and managed life on drugs, that is definitely progress. If, 10 or 15 years later, they are living an ordered and managed life on drugs, one could argue that it is time for a bit more progress, and we might try to get them through to an end point where they are no longer on drugs at all.

What we do not want to do is to institutionalise the interim measure; we want to make interim progress, because that is better than making no progress at all, but we have to be careful about progress freezing before it has reached its most desirable destination. That is an insight into the conversations that we are having. Of course, if we are looking at payment by results, we then have to think about how we incentivise people not only to make progress but to complete the journey, rather than to leave it half completed.

The Ministry of Justice is doing lots of extra and innovative work on rehabilitation and on how to help offenders. The Government were not minded to accept the Committee’s recommendation on drug testing in and out of prison because we remain of the view that random testing is superior and that people who know when they will be tested may take measures to avoid showing up as positive. Other people may have different views, but we had good motives for objecting to that recommendation.

A lot of work is going on in the Ministry of Justice, rather than directly in my Department, on how we can help people who leave prison with a modest amount of money—£46, I think—and few other support structures to get back on their feet and rebuild a meaningful life, with housing and employment, rather than lapsing back into criminality. There are two interesting pilot studies on payment by results and on trying to incentivise prison providers to help people with rehabilitation once they have left prison.