Dame Carol Black’s Independent Review of Drugs Report

Forward Trust estimates that more than 2 million people are in need of help with alcohol, drugs or gambling, and its recent YouGov poll showed that 64% of people said that they knew someone personally struggling with addiction. Since I talked openly about my personal experience of addiction and recovery, I have been over- whelmed by the thousands of people who have reached out to tell me their personal stories—of the horror of addiction, and the blessings of recovery. The tragedy is that addiction is everywhere, yet remains so hidden.

In 2019 Dame Carol was commissioned by the then Home Secretary, the right hon. Member for Bromsgrove (Sajid Javid), to independently review illicit drugs in England. I thank her for her commitment and dedication over the last few years, and all those who contributed to this groundbreaking report. Most of all, I hope that my contribution today does justice to the absolute clarity that Dame Carol brings to these incredibly complex matters. Part one of her review was published on 27 February, and made for uncomfortable reading. The unflinching analysis detailed the extent of drug-related harm and the challenges posed by drug supply and demand, including the ways in which drugs fuel serious violence.

The Department of Health and Social Care swiftly commissioned Dame Carol to produce part two of her independent review, which focused on how to improve the funding, commissioning, quality and accountability of drug prevention, treatment and recovery services in England. Part two of her report, published in July, pulls no punches either. It says:

“Funding cuts have left treatment and recovery services on their knees. Commissioning has been fragmented, with little accountability for outcomes. And partnerships between local authorities, health, housing, employment support and criminal justice agencies have deteriorated.”

The report goes on:

“The workforce is depleted, especially of professionally qualified people, and demoralised. Vital services have been cut back, particularly inpatient detoxification, residential rehabilitation, specialist services for young people, and treatment for cannabis and stimulant users.”

As many as 80% of the public support more treatment and care for people struggling with addiction; less than 10% believe more punishment and condemnation would help. Intolerance, shaming, tougher punishments and denial will not rid society of addiction, because addiction is an illness. It is a matter of public health, and Dame Carol puts it best when she says,

It must be recognised that addiction is a chronic mental health condition, and like diabetes, hypertension or rheumatoid arthritis, it will require long-term follow-up.”

Sadly, as things stand, I cannot think of another illness that causes so much harm to society, that is given so little, and the sufferers of which are treated with such contempt. It is the only illness in which blame is placed on the person suffering. Instead of blaming the individual for making bad choices, we need to ask why so many people are turning to substances in the first place.

Now to the prevention, treatment and recovery system as it stands: not fit for purpose, in urgent need of repair, after years of austerity, continued disinvestment, fragmentation and a dire lack of accountability throughout. The Health and Social Care Act 2012 shifted addiction treatment out of the NHS mental health services on to local authorities, at the same time as their budgets were being slashed. On that matter, Dame Carol is clear:

“We recommend that funding for drug treatment be allocated to local authorities based on a needs assessment and then protected.”

We also urgently need to improve the situation for people suffering co-occurring mental ill health and drug or alcohol dependency. Too many people are being bounced between fragmented services and end up falling between the cracks. It is simply wrong that mental health services can require patients to reduce their alcohol or drug use, without providing the proper support to do so, before they can receive the treatment they need. Or that drug and alcohol services do not possess the competencies to support someone with significant mental health issues, thereby often leaving sufferers with no support whatsoever.

There must be a “no wrong door” policy. One young woman, whom I will call Jane, told me:

“It was as if I had to get more ill, drink and use more, until I got the right help and support. For 18 months, my mental health deteriorated. Mental health services couldn’t help me and addiction services struggled to support me because of my poor mental health. I was so frightened, I had to reach crisis point and rock bottom before I was able to be considered for residential treatment.”

Jane is now in recovery and leading a happy, healthy life, but she did not receive public funding. In fact, she was denied that. If it had not been for a chance meeting with Action On Addiction, which provided her with a bursary-funded bed, she would not be alive today. It should simply not fall to charities to catch the increasing numbers of people falling through the threadbare safety net. Access to treatment should not be about luck, only available to those who can afford it or those who live in a local authority that prioritises it.

Currently, the drugs treatment market operates in a similar way to that of adult social care. Providers are being squeezed and staff poorly paid. There is high turnover in the workforce and a depletion of skills. The number of medics, psychologists, nurses and social workers in the field is falling significantly.

It is time to repair that broken system and overhaul addiction treatment, and we have the road map for the future—the 32 recommendations of Dame Carol Black’s independent review of drugs. The scope of the recommendations is far-reaching and the solutions span many Government Departments, local government and other organisations.

Dame Carol’s review has pursued three main objectives: first, to increase the proportion of people misusing drugs who can access treatment and recovery support, including more young people, with earlier interventions to divert offenders away from the criminal justice system; secondly, to ensure that the treatment and recovery package offered is of high quality and includes evidence-based drug treatment, mental health and physical interventions, and employment and housing support; and thirdly, to reduce the demand for drugs and prevent problematic drug use, including use by vulnerable and minority groups and recreational drug users.

To achieve those objectives, significant changes need to be made in four areas: radical reform of leadership funding and commissioning; rebuilding of services; increased focus on prevention and early intervention; and improvements to research and how science informs policy, commissioning and practice. And the 32 recommendations cover a wide range of responsibilities.

The Government have already begun to set in motion some of the structural changes, which I welcome, and the policy commitments that will help to drive through the review’s recommendations. It is reassuring that Dame Carol herself will continue to act as an independent adviser to Government. However, the remaining recommendations are contingent on Government investment.

In January 2021, the Government announced £148 million of new money to cut crime and protect people from the harms caused by illegal drugs, which I also welcome, with £80 million of that money to be invested in treatment and recovery. That £148 million must be the first instalment of the £1.78 billion that Dame Carol has called for over the next five years and I hope that the Minister has come with hot-off-the-press Budget commitments. Dame Carol’s spending recommendation would restore addiction treatment to what it was before 2012. Although local authorities are well positioned to oversee services, drastic cuts to public health grants have led to cuts to addiction treatment services over many years. The Local Government Association has long argued that reductions to the councils’ public health grant, which is used to fund drug and alcohol prevention and treatment services, is a false economy, which will only compound acute pressures for criminal justice and NHS services further down the line.

I must stress to the Minister that if the Treasury is unable to find all the funding that the review calls for, the money it does find must not be thinly spread across the country. Instead, it should be targeted at those areas most in need, and efforts must be made at least to pilot the whole-systems approach that Dame Carol has called for. Small amounts of money given to each local authority will not bring about the long-term transformational change that the review demands.

There has simply never been the political will to act on prevention, treatment and recovery from drug and alcohol harm, but we have reached a crisis point, with record deaths, rising economic and social harms, and depleted treatment services. Dame Carol’s groundbreaking review, which was commissioned by this Government, is the moment for change, and the Government cannot meet their pledges to level up the deprived communities that they seek to represent, which are often found in the north, unless they recognise that. In the words of Dame Carol herself:

“The Government must either invest in tackling the problem or keep paying for the consequences.”

We need investment in treatment, as has been articulated, not only for mental health but for physical health as well. We need to build stability, too, with a housing first approach so that people have a house. When people leave the criminal justice system, they need a house, a treatment plan, a bank account, and also a job to move into if that is appropriate. We should look at the person and not just the issue.

We need to go further, so I urge the Minister to look at how we can create drug consumption rooms where people can engage with services, while recognising that it will take people six or seven attempts on average to move out of a life on drugs. Also, I want the Minister to look into heroin-assisted treatment so that we can take a different approach to break the cycle of substance misuse. There is a real opportunity ahead of us, and I trust the Minister will step up and deliver.

Finally, I want to reflect on the recovery strand. The amazing charity Faces and Voices of Recovery UK, run by Anne Marie Ward, is based in my constituency. In 2018, it launched a charter, a declaration of recovery rights for people seeking to recover from drug and alcohol addiction. That declaration, and the early-day motion that I tabled at the time to support it, was signed by many Members of this House, on a cross-party basis. It was compiled after a year of consultations across the UK into what the charity identified, even then, as a drug death crisis.

The declaration states that all people in recovery have a right to recover from addiction, if they find themselves in that situation. It seeks to build communities of recovery and pledges that people who are current or former substance users should be able to live their lives free from stigma, with access to quality care, meaningful political representation—which is a duty on us all—and well-informed choice, and touches on a range of other important aspects.

It has support from a wide range of organisations, including the Scottish Drugs Forum, Alcohol Change UK, the Scottish Recovery Consortium, the National Association for Children of Alcoholics, and so on. It is based on the underlying principle that people in recovery have a right to respect and dignity, and to live free from stigma and discrimination. If the Minister is not familiar with that document, I am very happy to send her a copy, and I very much hope that she will familiarise herself with it and adopt its principles as part of the Government’s response to Dame Carol’s report.

The Government are also failing to facilitate early intervention to divert young people away from drugs and crime, which is an issue raised by many of my constituents. Under the Tories, spending on young people’s services has been cut by 73%. Some 900 youth centres have been closed, and 4,500 youth worker jobs have been cut. Although today’s Budget announcements are welcome, it is obvious that the Government have reflected that much of this was a mistake.

For every £1 spent on addiction treatment, the Exchequer saves at least £3 in crime, health and benefit expenditure, and for every £1 spend on family intervention services, the Exchequer can generate £2.76 in savings. The public provision for prevention, treatment and recovery needs urgent repair, with the impact of the pandemic meaning that the problem will almost certainly get worse and act as a major barrier to levelling up.

To build on what my hon. Friend the Member for Liverpool, Walton has already said, I hope the Government will commit to take steps to adopt Dame Carol Black’s recommendations to properly fund and resource addiction recovery services and, importantly, cross-Departmental liaison. I hope the Minister understands why last week I asked when she had spoken to the Local Government Association and the Association of Directors of Public Health to discuss covid, addiction and other important issues, because they are so cross-cutting. I look forward to her response.

In closing, I would also like to pay tribute to the courageous stance taken by the chief constable of Cleveland, Richard Lewis, in his recent article in The Guardian where he said amongst other things that,

“The heroin-assisted treatment programme offers hope, if scaled up on a national level, that demand for heroin can be cut. When the state offers a meaningful alternative to the street drugs that can be bought from organised crime groups, the demand for them decreases.”

Finally, he said that the programme in Middlesbrough

“could possibly represent the beginning of the end for the ‘war on drugs’ that has already taken too many lives.”

I wholeheartedly agree, and I trust that the Government will take on board each and every one of the 32 recommendations that Dame Carol Black makes.