Health and Social Care Bill

Earl of Sandwich Excerpts

Tuesday 11th October 2011 Lords Chamber

[The Earl of Sandwich]

My Lords, I start with a health warning: prescribed drugs can kill—a message which I recommend that all GPs pin up in their surgeries forthwith. The Minister already knows why I am saying this and why I have entered this debate today, and I will try not to repeat what I have said in this House previously. I will explain later how my intervention fits into the Bill and may lead me to put down amendments. I apologise to the Minister and to the House that, because of minor surgery, I will not be able to attend the wind-up speeches tomorrow.

Just over a year ago, as vice-chair of the All-Party Group on Involuntary Tranquilliser Addictions, I put the case for a vulnerable group in society which I feel has been virtually ignored by the health service. In most cases, these people—including a member of my own family— have been left in their homes in intolerable pain. These non-patients, through no fault of their own, have become victims of addiction to and withdrawal from prescribed drugs, such as benzodiazepines. There are an estimated 1.5 million people at risk, including many whose doctors and psychiatrists connive at overprescription and are then, it seems, incapable of coping with its ill effects. It is a scandal that has been known about since the 1960s. What are the Government doing about it?

To be fair, the Ministers responsible—Ann Milton and the noble Earl, Lord Howe—have both given me personal encouragement by way of letters and meetings during the past year. I sincerely believe they would like to make some headway. Earlier this year, the Department of Health published two reports by the National Treatment Agency and the National Addiction Centre, but these reports take us no nearer to policy-making. In reviewing the evidence, they were unable to identify the size of the problem or to separate legal users of prescribed medicines from illegal substance misusers. Apparently, the number of prescriptions is available but the number of patients—which is held on the GPs’ databases—has been left unanalysed. So what benefit has there been for the patients from these reports? There are none that I can see. They are not a threat to society, so the suspicion must be that they are therefore lower in the order of priorities than illegal drug addicts, who are the only beneficiaries of the Government’s drug strategy and, of course, of public money. Yet the pain of withdrawal from prescribed drugs can be far worse than withdrawal from heroin, so there is blatant injustice in the system.

I also believe there is a gap in understanding between the department and its related health services, and this is relevant to the wider debate about tiers of authority. I give one example. My family and I have tried to put together research on the extent to which limited services for benzodiazepine patients exist in places like Oldham, Bristol, Cardiff, Belfast, Newcastle and the London Borough of Camden. I noticed that the Department of Health included Wandsworth in its list, so I telephoned the number it gave me. I was subsequently given three more telephone numbers and was finally advised by the PCT to contact the addiction centre in Roehampton, which advertised the service. One visit was enough to prove that the service did not actually exist. The psychologist involved admitted that it was a gap, and that they would have to take advice on setting up such a service.

Can this situation be a one-off? I suspect not: it is clear that other addiction centres do not have the necessary expertise. They have not had to deal with, nor been trained in, benzodiazepines except as part of a cocktail of illegal drugs. They will have experts in hard drug addiction and substance misuse, who either turn away occasional prescribed-drug patients or give them inappropriate and dangerous cold-turkey treatment, as happened in our case. The specialised services that exist are mainly independent of the NHS and are largely staffed by volunteers who have suffered withdrawal themselves and who, through that experience, have become the experts. A few work with their local PCTs or are funded by them and are properly recognised as the best practice in their area, but most counties in the UK simply do not have these services.

What is the expertise? In the case of addiction, the most important thing is gradual withdrawal with careful tapering and psychological support. The expert manual on tapering was written by Professor Ashton of the University of Newcastle. Patients need places to meet addiction workers—ideally in specialised clinics, existing multipurpose centres or church halls—and they need help with transport. Counselling by telephone or e-mail is important. It is not ideal, but helplines and the sharing of experience online enormously help those who spend long hours alone in their rooms in pain. Alternative therapies are available through the NHS, but these are not always appropriate in connection with prescribed-drug addiction. Families need professional support as well.

This is where the Bill comes in. At a time of economic cutbacks, we should be paying much more attention to these voluntary services, which provide real value for money. This Government evidently want to increase the role of the private sector, and that includes local voluntary agencies, but how will local authorities and CCGs cope if there is no national plan or funding? The health service created the problem of prescribed-drug addiction, so why can it not find the funding and design best practice to help its victims? Services may be managed by individuals who run their own charities and are not subject to direct management control by the NHS. Not-for-profit organisations are already within the network of healthcare in this country and need not be subject to the controls and regulations which in effect strangle many existing frail voluntary services.

I would therefore like the Government to give much more encouragement to the people who are already working on the front line to help the victims of prescribed-drug withdrawal. These services, I can testify, are of a high standard and should go straight on to the list of qualified providers. It is time for the DoH to recognise them and organisations like them throughout the health service and give them support.