Drug Treatment Services

Jeff Smith Excerpts

Tuesday 16th July 2019 Westminster Hall

[Jeff Smith (Manchester, Withington) (Lab)]

I beg to move,

That this House has considered drug treatment services.

It is a pleasure to see you in the Chair, Mr Hollobone. This is a very timely debate, because today we learned shocking new figures for drug-related deaths in Scotland. There were 1,187 drug-related deaths last year, which is an increase of 27% on the previous year and the highest drug death rate in the EU. We await the 2018 figures for England and Wales without much hope for better news or an improvement.

Today also sees the launch of a new report called “Towards Sustainable Drug Treatment Services” by the research-led biotech company Camurus, which has done some extremely interesting research on the state of drug treatment services, including anonymised surveys of 22 directors of public health in England. I thank Camurus for sight of that report and thank those who have sent me briefings from other organisations, including the Hepatitis C Trust, Release, the Alcohol Health Alliance UK, the Local Government Association, Humankind and the Royal College of Psychiatrists. I will not be able to refer to all those briefings in this relatively short debate, but a couple of themes emerge from most if not all of them.

First, there is worry across the sector that the whole drug treatment services system is under pressure—some would say under threat. Since around 2012, Government cuts have squeezed treatment services so much that they are under strain and struggling to cope with demand. In 2010, the coalition Government inherited one of the best drug and alcohol treatment systems in the world, with over 250,000 people treated every year. Drug-related crime was decreasing, HIV and AIDS were under control, and tens of thousands were overcoming addiction through opiate substitution or abstinence-based programmes. The Labour Government prioritised that sector in the late 1990s as part of their social exclusion agenda, and raised treatment budgets from around £200 million per year in 1998 to more than £1 billion by 2003.

When the coalition Government’s austerity really began to hit public services, the hardest-hit area was local government. When local authorities became responsible for the funding and commissioning of drugs services under the Health and Social Care Act 2012, they were already struggling with the reduction of approximately 37% in central Government funding between 2010 and 2016. Between 2014 and 2019, net expenditure on adult drug and alcohol services decreased by 19% in real terms. In 2017, the Advisory Council on the Misuse of Drugs warned that local authority funding would prioritise mandated services over non-mandated services, such as drug services,

“particularly if service users are stigmatised or seen as undeserving.”

All the stakeholders who contacted me have expressed their dismay at the impact of the cuts in recent years. More than a third of the public health directors surveyed by Camurus believe they will be unable to keep up with demand for substance misuse services in the coming year.

[Jim Shannon (Strangford) (DUP)]

I thank the hon. Gentleman for giving way and for bringing this important debate to Westminster Hall. The figures for Scotland are horrendous, but the figures for the United Kingdom, including Northern Ireland, also show a rise. Does he agree that the current system is not equipped to deal with the level of drug abuse and need for treatment, and that the waiting times for dedicated facilities leave people without support for too long, which inevitably leads them back to their coping methods and further addiction? Those facilities need to be upgraded and made more available.

[Jeff Smith]

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

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

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

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

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

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

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

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

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

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

[David Hanson (Delyn) (Lab)]

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

[Jeff Smith]

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

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

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

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

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

Equally:

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

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

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

[Mr Jonathan Lord (Woking) (Con)]

The hon. Gentleman is making some excellent points. Does not the thrust of his argument lead to the conclusion that, if one were to regulate and control but decriminalise more broadly, many of the social ills and medical problems might be reduced? Is it not time for a royal commission to look more broadly at the troubling social disease of drugs?

[Jeff Smith]

The hon. Gentleman makes an excellent point. I absolutely agree that we need regulation and control. Personally, I am not sure about royal commissions, because they tend to kick things into the long grass a bit, but perhaps a parliamentary commission or some other way of looking at the problem, trying to come to a consensus and taking the politics out of it—stop people weaponising drugs as a political issue—is the way forward. We need to look at that, because our system is not working. This is not a debate about wider drug policy but, clearly, that policy is not working, and it is resulting in the kind of problems that we face—addicts need the kind of drug treatment services that this debate is about.

I will try to be quick, because other people want to contribute to this short debate. On innovative models of service delivery, naloxone is a life-saving medication that can be used to reverse opioid overdose. However, coverage across England remains poor and the guidance is confusing. If we cannot convince the Government to increase funding for naloxone treatment by implementing a national naloxone programme, they should at least offer national support and guidance for local authorities and prisons. Finally, on drug safety testing, the Home Office refuses explicitly to sanction drug safety testing, which is a simple measure that could save lives and result in fewer people needing treated for drug harms.

We therefore need a refocus of our spending priorities. Funding constraints are curbing the effectiveness of proven treatment and harm reduction measures at the same time as we spend fortunes on drug law enforcement. In 2014-15, for example, an estimated £1.6 billion was spent on drug law enforcement, compared with only £541 million on drug treatment and harm reduction services over the same period. However, while we know that treatment services are cost-effective and save money, the Home Office’s own evaluation of its last drug strategy could not demonstrate value for money in drug law enforcement or enforcement-related activities.

The Government, unfortunately, are preoccupied with trying to stop people from taking drugs—something no one has managed to do in centuries of human behaviour—instead of focusing on harm reduction and treatment. Problematic drug users are stigmatised by our policies and treated as criminals, leaving them less likely to access the life-saving drug treatment services that they need, for fear of arrest. Meanwhile, the services that are available—as we heard earlier—have had their funding slashed and continue to be squeezed.

I need to conclude with some proposals. First, the one consistent message from all stakeholders who have been in touch and care about the issue is that we need to reverse the cuts to our struggling drug and alcohol treatment system. We need to reinvest in those services. The Camurus report released today states:

“The evidence shows that we are fast approaching a point at which we risk doing irreparable damage to our hard-won recovery system, leaving services unable to meet the scale of need that exists.”

The Government must therefore use the upcoming spending review to increase spending on drug treatment services. They need to provide local authorities with additional funding towards those services, without which the ability of services to meet demand will continue to decline.

Among other proposals I suggest the Government should consider guaranteeing the delivery of substance misuse services by making them a statutory, mandated service to end the ambiguity about their delivery and to underline importance of protecting budgets. The Government should also look at the commissioning regime—the consensus among many stakeholders is that it is not working and is too variable—to see whether it is fit for purpose. A 2017 report by the Advisory Council on the Misuse of Drugs asked whether the constant re-procurement of addiction services creates unnecessary instability in the system, resulting in poorer recovery outcomes, which is something I have seen on a small scale in the area of south Manchester I represent. Finally, we need to remove barriers to overdose prevention centres and drug safety testing to encourage faster use of heroin-assisted treatment. Such proposals can stop deaths and reduce the numbers going into treatment. We are looking at a public health emergency, and we need to act.

The shadow Health Secretary, my hon. Friend the Member for Leicester South (Jonathan Ashworth), has talked movingly about his experience of alcoholism in his family. He has promised that a future Labour Government will reverse the decline in the drug and alcohol treatment sector. I fully support him in that endeavour, but we cannot wait. We need the Government to act to safeguard our drug treatment services and, most importantly, to safeguard those who use them.

[Mr Philip Hollobone (in the Chair)]

The debate can go on until 5.30 pm. I am obliged to call the Front Benchers from no later than seven minutes past five o’clock. The guideline limits are five minutes for the SNP, five minutes for Her Majesty’s Opposition and 10 minutes for the Minister, and Jeff Smith has two or three minutes at the end to sum up the debate. Five Back Benchers are seeking to contribute, so there will need to be a time limit, which is four minutes each, and then everyone will get in.

--- Later in debate ---

[Jeff Smith]

I thank all right hon. and hon. Members who have made such excellent contributions to the debate. I will mention two in particular. I was very much enjoying the speech of the hon. Member for Central Suffolk and North Ipswich (Dr Poulter) until he was cut off in his prime. He made some important points about commissioning. That is not something I went into in detail, but it is certainly something that the Government need to consider. My hon. Friend the Member for Glasgow North East (Mr Sweeney) told the story of Chelsea, which brought home the ways that our drug policy is failing and the way that we need to address issues that end up in tragedies such as Chelsea’s sad death.

I also thank the two Opposition Front Benchers for their powerful speeches, which had a welcome focus on support, rather than the criminalisation of addicts. That is absolutely the way that Government policy needs to go. I thank the Minister for her response. We have a Health and Social Care Minister here, which is exactly right; on a general principle, when talking about drug policy, we should have a Health and Social Care Minister. Responsibility for the policy should be situated in that Department, but as the Minister rightly pointed out, much of the responsibility is currently in the Home Office.

The focus on the legal framework was interesting, as was the frustration about how the legal framework fails us and how the focus on criminalisation fails us and distracts us from focusing money and resources into the drug treatment services that we so badly need. I hope the Minister will go back to colleagues in the Home Office and talk about this. I was expecting the debate to be a lot more about cuts to drug treatment services, rather than the legal framework. However, I think that brings home the frustration that many of us feel: that a progressive drugs policy is being blocked by the fact that responsibility is situated in the Home Office, rather than in Health and Social Care.

The Minister mentioned a couple of points that I question. Without a national framework or programme, we will end up with a postcode lottery for naloxone, which is a real concern. She talked about the legal framework for drug consumption rooms, but that is for the Government to change, as the hon. Member for Glasgow Central (Alison Thewliss) said. Drug testing is very sophisticated these days. A charity based in my constituency operates excellent drug testing in festivals and city centres around the country. We have nothing to fear from the drug testing that those sorts of organisations carry out.

I finish by urging the Minister to do two things. First, the spending review is coming up. I hope she will be going in to bat for her Department, and particularly for investment in drug treatment services.