Drug Treatment Services

Philip Hollobone Excerpts

Tuesday 16th July 2019 Westminster Hall

[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.

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

I congratulate the hon. Member for Manchester, Withington (Jeff Smith) on securing the debate. I agree with everything he said. I draw the attention of Members to my declaration of interest as a practising NHS psychiatrist and as someone who has worked in drug addiction, or drug treatment, services.

I do not intend to rehearse the discussion on the lack of, or reduction in, funding for the treatment of addiction services since the commissioning moved to local authorities, because that argument has been well established. The challenge we face is how to encourage more people to engage with addiction services and how to improve the quality of care available to those who are drug and alcohol-dependent. In my view—this is increasingly the consensus—commissioning by local authorities has probably been the single biggest failure of health legislation under our Government, and we need to revisit that if we want to improve the quality of care available to the patients we are looking after.

Between 2009-10 and 2016-17, the number of people with opiate addiction who access services has reduced by about 16%. Heroin deaths are on the rise; the number of people presenting with alcohol-related illness, pathology and morbidity is rising; and alcohol-related deaths are rising. Our current approach to additions is not working, which appears to be that the NHS will patch you up as best it can. We are not doing a good job of preventing people from appearing in A&E or in the acute hospital because the commissioning of addiction service is not right. While I do not believe that local authorities are in the right place to commission services, the lack of funding they receive has been a contributing factor.

There are five key challenges and problems with commissioning by local authorities. The first is the quality of patient care delivered. There is poor integration of services between the NHS and the providers that often are commissioned by the local authority, be they in the private sector or the charitable sector. Historically, NHS services have had a good integrated approach between physical healthcare and addictions care. NHS providers have a joined-up approach to treating people with hepatitis, HIV and other physical health problems, or older addicts who may need support for physical health needs, such as cardiac or respiratory problems they may develop as a result of their addictions, particularly if they smoke heroin. That does not happen when there is fragmented commissioning by private-sector providers and local authorities. That needs to change for the benefit of many patients.

Secondly, all private sector providers operate under their own IT systems that have no integration with the NHS whatsoever, so an NHS doctor does not know necessarily what care those private providers are giving. That is dangerous because there is no continuity of healthcare and it is fragmented, to the extent that one part of a supposed health system cannot see what is happening elsewhere.

[Mr Philip Hollobone (in the Chair)]

Order.