Drug Treatment Services

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.

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.

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.

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.

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.

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?

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 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.

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.

Order.

I thank the hon. Member for Manchester, Withington (Jeff Smith) for securing this debate.

Figures released today show that in Scotland there are more than three deaths a day due to drug use. But who really cares? Who are those people who are dying? It is the homeless; the isolated; the good-for-nothing; the detritus of society. People who inject themselves with poisonous substances do it to themselves—nobody makes them do it. How often have we heard that justification? Nobody is saying it in this place, but we know some people are thinking it.

Through a lack of compassion, but primarily through a lack of understanding, society has created a sub-culture of marginalised people who are pushed to the fringes of our day-to-day consciousness. It has become far too easy to dismiss them, ignore them and exclude them from our cosy lives. Problematic drug users are not getting high for the kicks; they are self-medicating because the pain of everyday life is so great that without the drugs they could not live. The sickness is not the drug use—the pain started long before the addiction. Of the 10% of drug users who develop an addiction, the vast majority have been physically, psychologically or sexually abused. Mix that with financial and aspirational deprivation and it makes a powerful mix that it takes powerful drugs to supress. That is why the support services must be about homelessness, mental health, security, continuity, understanding and compassion—everything that counters the chaos.

When I visited drug consumption rooms in Barcelona, I was particularly struck by one facility: a health centre where people visit their GPs for everyday ailments, which is attached to a hospital that people can be referred to. One part of the health centre is for homeless people to visit and pick up clean clothes, have a shower and shave. Over time, the staff build up a relationship with the clientele and come to understand why they are homeless and what can be done. Another unit attached to the health centre is a drug consumption room; the staff there have exactly the same attitude as the staff in the health centre, the GP surgeries and the homelessness unit. They want to know, “What is your problem, and how can I help?”

That is a million miles away from the stigmatisation that is so common in the UK. The mindset of approaching problematic drug use as a health issue pays great dividends: it is cheaper than pursuing and incarcerating people for drug possession; it frees up the police to fight crime; and, most importantly, it works across the globe. It does not work for everyone; tragically, there will always be drug-related deaths, but as we look at the figures released today let us not forget that, thanks to the naloxone available in DCRs, there has never been a death due to overdose in any DCR anywhere in the world. When will the UK Government come to terms with that?

On the reform of drug laws, we probably have a lot in common, but today’s shocking figures show that the number of drug deaths in Scotland is not only three times the average of the rest of the United Kingdom, even though we are all under the same laws, but the highest in Europe. If the hon. Gentleman wants a health-based solution, will he explain what, after 12 years of SNP stewardship of our health service in Scotland, can be done? What should be done through the devolved and central Governments working together?

The policy is a Europe-wide one; it is proven that the methods used elsewhere in Europe have helped the situation.

Glasgow stands ready to pioneer a DCR. There is cross-party support from Glasgow Council, backing from the SNP Scottish Government, and NHS Greater Glasgow and Clyde is fully on board. What in the name of goodness is stopping the UK Government from joining us?

I congratulate the hon. Member for Manchester, Withington (Jeff Smith) on securing this debate and on speaking so well. Happily, much of what I intended to say I now do not need to, not that I would have time to say it anyway.

I congratulate my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter); he began to get into the systemic problems in this area, which is what I want to focus my remarks on. We have a systemic problem in the assessment of the rate of return on the investment in drug treatment services, particularly compared with the rate of return on investment in law enforcement in drug policy.

According to the Government’s own statistics, we are not getting a satisfactory return at all on drug law enforcement. That is why the police’s operational policy has been progressively to withdraw from doing nugatory work, leading to effective decriminalisation in many parts of the country, simply because that is not a sensible use of resources. It certainly is a sensible use of resources to try to repair the lives of drug addicts. The cuts under the necessity of austerity, and the systemic issue that my hon. Friend referred to in respect of local authorities taking responsibility, have meant that we are making a shocking value-for-money judgment in the application of public resources in this area.

It has to be down to the Minister—no one else can do it—to review how we invest public money for the public good. That is at the kernel of this debate. If we do not make changes, enforcement authorities will continue to progressively withdraw, because they simply will not waste the public money they have been given by running ineffective operations. The just-retired chief constable of Durham, Mike Barton, is a huge authority on that, and I urge the Minister to talk to her Home Office colleagues about his experience.

There is a very clear overlap between the application of the law to drug users and recovery. One then gets into the toxic situation of stigma around those users. There is also a public health budget administered by local authorities, which are under pressure to use those resources elsewhere. People who have used drugs that we have made illegal do not get automatic support in our society, yet they are just as much part of our society as anyone else.