Drugs

Lord Hunt of Kings Heath Excerpts

Thursday 4th February 2016 Grand Committee

[Lord Hunt of Kings Heath (Lab)]

My Lords, I warmly endorse the comments of the noble Baroness, Lady Walmsley, and welcome my noble friend’s introduction to this very disturbing and important debate. We have all studied the ONS figures and noble Lords have already referred to the fact that the mortality rate from drug use has been recorded as the highest ever. My noble friend referred to how deaths involving heroin and/or morphine between 2012 and 2014 increased by almost two-thirds, while other figures from the ONS also show increases. It would be fair to ask the Government what their current analysis is of the reasons for that.

My noble friend has said that he is concerned that a change in government policy, because they felt that too many people were, as he put it, “parked on methadone”, has seen the introduction of an incentivised programme essentially to encourage drug users to complete their treatment more quickly and achieve abstinence. However, that has brought with it some perverse consequences. One thing it shows is that there are always risks in trying to incentivise clinical behaviour through some kind of payment or lack of payment, so we need to be very careful. What risk assessment was undertaken of the impact of this change, because it is important not only in itself but in relation to the future direction of government policy?

My noble friend asked two specific questions: whether the Minister will agree to set up an investigation into the causes of these drug-related and mental health deaths in order to see how many had been given a dual diagnosis and, as I have mentioned, a risk assessment of the decision to bring in, as he called it, a payment-by-results approach to discouraging the use of methadone. He asked for another risk/impact assessment of the overall current strategy, and I must say that I very much endorse his recommendations.

My understanding is that Public Health England is investigating the trends around drug misuse deaths. I have looked at its recent publication, but what I could not find was any reference to the issue raised by my noble friend—the policy change to payment by results. In the light of this debate, is PHE investigating that specific issue? Will PHE, which is after all a part of the Department of Health, explore that area?

My noble friend and the noble Baroness, Lady Walmsley, also talked about the issue of drug treatment funding and the role of local authorities. I was interested to see the NICE guidance, or at least the local government briefing it produced in May 2014, which provides a lot of good advice for local authorities. I know that advice to local government from NICE is not at all mandatory in the way in which a technology appraisal might be for the NHS, but what is the Minister’s analysis of how far local authorities are following that guidance? Do the Government or NICE itself have any responsibility at all to make sure that local authorities are doing the right thing here?

One then comes to the issue of funding. On Monday, the noble Lord again referred to the amount of additional money put into the health service. He will know that around half has come from other pockets of Department of Health expenditure, including of course the public health budget. Clearly, the concern is that there will be an impact on those services where we depend on local authorities for funding under a public health banner. Again, what assessment has his department made of the impact of the reduction in funding for public health on the kind of community services that are so much more important?

None of this can take place without echoing a concern around mental health issues more generally. We all signed up to parity of esteem. The Government have said that they are committed. I believe that they have issued instructions to clinical commissioning groups about mental health service funding, but word reaches us that the reality is somewhat different. My noble friend Lord Patel has raised an important, difficult specific point. It cannot be divorced from overall considerations about mental health policy. If one considers the four-hour A&E target that is not being met, we know that a lot of people who are coming to A&E one way and another have mental health issues. I cannot help wondering whether for CCGs to reduce funding to mental health services has not been counterproductive in terms of the pressure that it has put on other parts of the system. I accept that my noble friend has raised a specific, serious point. If the Government cannot answer the exact point today, I hope that they will agree to some kind of review so that we see the outcome.