Mr John Mann (Bassetlaw, Labour)

I beg to move amendment No. 20, in clause 9, page 11, line 14, after 'person', insert

', who may be his GP,'.

Mr Eric Illsley (Barnsley Central, Labour)

With this it will be convenient to discuss the following amendments:

No. 21, in clause 10, page 12, line 17, after 'a', insert 'GP or other'.

No. 22, in clause 10, page 12, line 26, after 'assessor', insert 'and his GP'.

Mr John Mann (Bassetlaw, Labour)

The amendments are intended to probe the Government's approach to assessment. In my view, the greatest weakness in the British drugs strategy is the person who undertakes the assessment. In reality, it is done by a range of people. As a result, the word ''script'' has taken on a new meaning; the addicts in my area repeatedly talk about getting a script. By that, they mean that someone who is not a medical professional makes a judgment on their treatment; that person then goes to a professional; and the professional comes in for a short time and writes the script. Those professionals are doctors.

I put it to the Minister that, in my area and everywhere else in the country, those professionals are the doctors who, shall we say, do not succeed when applying for jobs in general practice. The problem with that, which I have witnessed on many occasions, is that probation officers or drugs workers with no medical background—they may well come to the job with no training; perhaps they are psychiatry students or former drug addicts—operate under the generic term ''drugs worker'', which has no specific qualifications attached to it, and then presume to make decisions on treatment.

Those decisions are often wrong. The average dosage of methadone given in Nottinghamshire until nine months ago—it was comparable to that given in most of the country—was about 25 mg. That dosage does not work for most people, so they continue taking heroin on top of the methadone. It is hardly surprising, therefore, that they keep in contact with the criminal community and have a criminal lifestyle.

The way to break that cycle is straightforward. It is to have the person's own general practitioner overseeing the treatment. That happens in 90 per cent. of cases in my constituency, and the results are   phenomenal in terms of non-recidivism, reduction in crime, people returning to work and people remaining in treatment. We have moved from having two people under GP treatment to more than 320. The drop-out rate over the past 18 months is so small that it is possible to calculate it exactly. It is either five or six, depending on one's definition of dropping out.

Mr Michael Clapham (Barnsley West & Penistone, Labour)

Will my hon. Friend give way on that point?

Mr John Mann (Bassetlaw, Labour)

I shall.

Mr Michael Clapham (Barnsley West & Penistone, Labour)

What support services are available to GPs to help keep people on the straight and narrow?

Mr John Mann (Bassetlaw, Labour)

I come to that precise point; it is the key, and we have used it over the past 18 months in Bassetlaw with great success. First, the primary care trust has taken responsibility for drugs treatment. Secondly, rather than the GP and the medical generalist or specialist acting as support to the drugs worker, the drugs worker acts as support to the GP. That is exactly how all other chronic relapsing diseases are treated in the community. The GP may call in mental health specialists, drugs workers or housing officers, but the GP is responsible for overseeing the treatment.

Dr Brian Iddon (Bolton South East, Labour)

It sounds as if my hon. Friend proposes returning to the pre-1971 British system. Am I correct?

Mr John Mann (Bassetlaw, Labour)

It is as near to that as would make no difference. I should point out, however, that treatment methodologies are far more sophisticated these days. One could describe what I am talking about as the previous British system, but one could also describe it as the Australian, the New Zealand, the Swedish or the French system, because that is what it is. It is the GP who makes the decision on treatment, in co-operation with other agencies where necessary. Probation officers, drugs workers and mental health specialists will therefore have an input, but the GP will make the decision and have the responsibility.

This approach has one other fundamental impact, which relates to the definitions of rehabilitation, and it is vital. Residential rehabilitation is one of the options available to GPs and their patients, and they can use either cognitive behavioural therapy on a day basis, which is non-residential, or something similar on a residential basis. However, for people who have been on drugs—who have, almost invariably, led a life of crime—the first form of rehabilitation is the ability to walk into their own GP practice. When we move from one part of the country to another, what is the first thing that we do when we engage with our new community? We register with a GP. The non-connection with one's GP is a key issue in non-rehabilitation; once we turn that situation round, we can rehabilitate people and address all the other health-care issues, which is precisely why drop-out rates are so incredibly low. 

Mrs Cheryl Gillan (Shadow Minister, Home Affairs; Chesham & Amersham, Conservative)

As I indicated to the hon. Gentleman before we came into the Committee, I have great sympathy with the amendments, and I am listening carefully to determine whether my hon. Friends and I can support him. However, does he agree that it is also important to recognise the medical profession dimension, because many of the individuals to whom we talk have complex make-ups? We are not necessarily talking about people who will display their full medical history to an ordinary assessor, although it would be available to a GP. It is almost essential that there is a medical profession dimension, because such individuals may have many other problems, which the GP will be treating.

Mr John Mann (Bassetlaw, Labour)

Some of these people have only one problem, which can be dealt with straightforwardly; others have complex problems, which will require ongoing, detailed work involving a range of specialists. However, it is the ability to go not simply to a GP, but to one's own local doctor's surgery, that is critical to improving not only people's health, but their mental health. That is the critical point; that is my definition of rehabilitation.

That approach is proven. In one area of my constituency, Worksop, there are 9,000 people who come not under the Mansfield District primary care trust, rather than the Bassetlaw trust. Mansfield uses the British system—the new one, not the previous one—and people there who have exactly the same problem, but who live 10 miles away, routinely see a drugs worker, rather than a GP. The drugs worker will make a decision on treatment, and a distant GP, who is no longer in general practice, will come and write a script. Those involved do not even see the GP; the script is written at a distance, based on the drugs workers' recommendations.

I am challenging that approach, because it is unethical and, I would suggest, illegal, although it is absolutely main stream in the drugs system in Nottinghamshire, and elsewhere. Someone will write a script for a person who they do not know, based on the recommendation of a drugs worker. I have met drugs workers and probation officers who are proud to tell me that they know what they are talking about; they tell me face to face that they know what to prescribe. Well, first of all, they do not; secondly, they have no insurance liability for what they are doing, and neither do the people above them; thirdly, their decisions, in my experience, are normally wrong; fourthly, it is not simply a matter of pumping people up with methadone or buprenorphine, or of using a naltrexone implant, and hoping for the best. We cannot just stick people on a detox and hope that they come through that, or put them in residential rehab and hope that everything works out all right.

All those measures are modalities that a general practitioner can use; each of them may well be appropriate, but they may often change during a course of treatment that could last years or a lifetime. Being within the general practice system, and going to one's own doctor, gives an accountability and a democracy to the system, and it fundamentally works   because it means that people address their other health needs. The GP can act as the factor that fires those people to get back into work.

Dr Brian Iddon (Bolton South East, Labour)

Is not one of the problems the fact that many GPs are afraid of prescribing in this area because they have not been trained in it, either before or after they graduated? Is not there a need for proper training? A second problem is that many people are given such low doses of methadone that it does not give them the buzz that they have been getting on the street, so they return to the street to top up with heroin. Low doses of methadone are given because it can be a dangerous drug at the higher doses that are so necessary for some drug addicts. I come back to the original point: training on dose levels is extremely important.

Mr John Mann (Bassetlaw, Labour)

My hon. Friend is right that training is important, and he emphasises my point that a competent medical practitioner should be making these decisions, not an amateur. It is amateurs who are, in reality, making the decisions. My evidence for that comes from what I have seen and heard. Probation officers and drugs workers, who I could name, have told me that they make these decisions. They are not competent or qualified, and the decisions are wrong. They under-prescribe methadone to be safe and often fail to use alternatives such as buprenorphine. That is a problem. Building GPs into the system is fundamental to the success of the Government's drug strategy.

Mrs Cheryl Gillan (Shadow Minister, Home Affairs; Chesham & Amersham, Conservative)

The hon. Member for Bassetlaw (John Mann) has done some detailed work on drugs in his constituency, which is to be commended. He has put much thought into the three amendments, which would have the effect of involving the object of the treatment with his or her own GP. I have sympathy with what he has said.

The hon. Member for Bolton, South-East (Dr. Iddon) took the words out of my mouth; one problem with the amendment relates to cost. On the point about GPs' training on drugs treatment and provision not being sufficient, it is certainly not standard throughout the country. People are trained to different levels. The amendment would involve extra resources and training throughout the health service. It would seem that every GP's practice would need to have someone with a greater level of expertise than is to be found currently.

Dr Brian Iddon (Bolton South East, Labour)

Is not any treatment much cheaper than the cost to society of having a serious drug addict stealing property to top up his or her addiction?

Mrs Cheryl Gillan (Shadow Minister, Home Affairs; Chesham & Amersham, Conservative)

We are of one mind. When the Minister turns the amendment down, her problem with it will be the immediate cost, but we should be looking ahead and thinking of the long-term saving in terms of the cost to society. There is no doubt about it: failure to treat young people—failure to treat any drug addict—results in tremendous on-costs. We will come to that later, when we discuss other clauses. One of the new clauses that I have tabled is a device to bring up that subject.

The evidence that has been produced by the National Treatment Agency shows that treatment programmes are not being entirely successful. The involvement of the GP will help to put the emphasis on the fact that we seek successful rehabilitation and not just the cheap statistics of people going into drug treatment, which seems to be how we measure success. There is no doubt that more people are undertaking drug-treatment programmes, and I commend that, because the more people who start them, the more people—we hope—will finish them.

The test for the programmes is on people entering, sustaining and coming through the other end of them. There will be an increased likelihood of more cost savings, if we are to consider the matter in hard-nosed financial terms, more rewarding outcomes for the individuals and a much lesser cost to society. Therefore, I support the amendments tabled by the hon. Member for Bassetlaw. I hope that the Minister will take them on board and accept amendments from her own side, in the vein that she has exhibited earlier in the passage of the Bill.

Mrs Angela Watkinson (Shadow Minister, Education; Upminster, Conservative)

I support the amendment. It is eminently sensible. It is ideal if the drug user is treated by their own GP, but there is one caveat. There might be GPs who are reluctant to be involved in the general area of drug treatment. It is important that other people are willing to do it. Some GPs are reluctant to have drug users coming to their surgeries, where their behaviour might be disruptive. The inclusion of this provision is an additional option in the range of people who might be able to perform the service, albeit the ideal one, and, with the caveat I mentioned, I support the amendment.

Mr Henry Bellingham (Shadow Minister, Economic Affairs; North West Norfolk, Conservative)

I certainly support the amendment. It has been pointed out that there could be unnecessary extra cost implied in it, but we should consider the wording presented by the hon. Member for Bassetlaw. He is saying not that a GP has to be the person who undertakes the assessment, but that they could be. The provision leaves that open and provides that extra option. I think that I am correct in that conclusion. It builds in flexibility, which I support.

On the availability of GPs, we want more GPs becoming involved in the treatment and the rehabilitation of drug addicts and drug offenders. My   concern relates to the number of GPs who have been struck off. I know that I am moving into other territory, but I hope that the Minister will bear in mind the serious problems that are being faced in the profession and the signal that has been sent to GPs as a consequence of the suspension of a number of doctors, including what happened to Dr. Adrian Garfoot. There is a batch of other doctors who have been struck off. That has sent a signal to GPs that this is a difficult area in which to become involved. That background will make the amendment more difficult in practice, but I support it.

Ms Caroline Flint (Parliamentary Under-Secretary (reducing organised and international crime, anti drugs co-ordination and international and European issues), Home Office; Don Valley, Labour)

I shall clarify the matter. We are talking about someone who has just been tested for class A drugs. Should that prove positive, they will see an assessor at the police custody suite. We are talking about that person. If the Bill is enacted we will not only have drug tests on arrest, but a mandatory assessment. Straight away, or as soon as possible, after that test, usually in one of the custody suites in the police station, someone will meet and engage with that person about their drug-taking behaviour. The point of that is to strike while the iron is hot. Such people are there primarily to engage with the person. They might have a background in drug support and counselling, but more than anything else we want them to motivate the person to listen. Their job will be to engage with the person and tell them what is on offer, such as prescribing, immediate access to a general practitioner or a hospital, or identifying whether the person has other problems in his life.

Mrs Cheryl Gillan (Shadow Minister, Home Affairs; Chesham & Amersham, Conservative)

Will the hon. Lady give way?

Ms Caroline Flint (Parliamentary Under-Secretary (reducing organised and international crime, anti drugs co-ordination and international and European issues), Home Office; Don Valley, Labour)

No, I wish to continue making my point because it is crucial to our discussions on the amendments.

They will need to find out whether the person has a home or is living on the streets, and whether they have dependants. They will need to discover whether anyone else in the house takes drugs, whether the person has a job and is committing crimes at the same time, and what other issues in the person's life need attention. If an appointment is required, they will need to know where he lives, and how easy it will be for the person to keep the appointment with a medical practitioner to undertake a full medical assessment of his needs and receive the right treatment along with everything else.

I do not support the amendment tabled by my hon. Friend the Member for Bassetlaw because we are not talking about the person who will decide the level of dosage for the individual. I agree with some of the points made by my hon. Friend the Member for Bolton, South-East, but, to pick up on the argument of my hon. Friend the Member for Bassetlaw, I shall refer to one of the issues that concerned me greatly when I came into my job and which is pertinent to the other discussions about the GP's position. Unfortunately, not all GPs are champing at the bit to deal with drug addicts in their community. That is sad because   people, no matter what their health problem, deserve a health service. Yes, it should be provided in hospitals, but it should also be provided in the community. No massed ranks of GPs are lining up to deal with such matters, and some have good reasons for that. They are worried about being isolated and not having the necessary back up and support, or about how they would provide possible substitutes for people in a busy, crowded practice and, thus, how the physical dimensions of the practice would operate.

Mrs. Gillan rose—

Ms Caroline Flint (Parliamentary Under-Secretary (reducing organised and international crime, anti drugs co-ordination and international and European issues), Home Office; Don Valley, Labour)

I want to continue my point, after which I shall take interventions. We can do something about people with legitimate concerns, but let us consider the community outlined by my hon. Friend the Member for Bassetlaw in which one GP practice was working alongside a drug action team and others. I refer to the position in which there is shared care with a multi-agency group and others, who have conferences with the person responsible for housing matters and which is pivotal to clinical and medical interventions and the provision of advice about appropriate treatment and whether it should take place in the community or residentially.

Such a system is excellent and I am pleased that it seems to be working in my hon. Friend's constituency. We are supporting such a model through the additional funds that we are putting into drug action schemes. Indeed, only recently the Government made it a requirement for primary care trusts, as part of their performance rating, to deal with drug addiction in their communities. Not so long ago, that was not the case. PCTs must now attend to such issues and we are providing resources for them to do that.

I have visited the constituency of my hon. Friend the Member for Stockton, South (Ms Taylor). She will agree that there are some excellent GP-based services, but another GP service may unfortunately not want to be involved. On one side of the street is a residential shelter run by a charity for those with drug addiction problems, while on the other side of the street is a GP practice that will not help the shelter provide the medical treatment that people need.

Mr Crispin Blunt (Assistant Chief Whip, Whips; Reigate, Conservative)

The Minister has made the case for the amendments of her hon. Friend the Member for Bassetlaw. He is not attempting to impose GPs on the system, but the amendments seek to make it clear in the Bill that the assessor may be the person's GP. If, in the situation that she describes, the person who is under assessment expresses confidence in his GP, that GP might well be the most appropriate person to undertake the assessment. The option should at least be considered in the initial assessment and it is surely important for the general practitioner, if willing, to be involved when it comes to the care plan. As the Minister says, if PCTs are to be involved in assessments, it is likely that GPs will be pushed in the direction of doing exactly what she thinks is best practice.  

Ms Caroline Flint (Parliamentary Under-Secretary (reducing organised and international crime, anti drugs co-ordination and international and European issues), Home Office; Don Valley, Labour)

The problem is that we are talking about the first point of contact after somebody has been tested for class A drugs. The Bill does not ignore the role of GPs. We give guidance through the National Treatment Agency and through our drug intervention programmes on how people should work with others and how clinical intervention should be delivered. All such schemes are part of the drug intervention programme. I acknowledge that it is done better in some areas than in others; that is life. The Government have to help the ones who do not do it so well to become as good as those in the better areas. Bassetlaw is a case in point.

If my hon. Friend the Member for Bassetlaw would like to tell me about the situations and name the people who—apparently without any clinical training—are prescribing doses for individuals, I shall be happy to follow that up, because it should not happen. They might not be GPs, and if he has concerns about other qualified doctors prescribing, he should tell me about those as well. The point is that where the system works well, it is where the personnel in multi-agency teams, whether on the clinical side or dealing in other areas, work together to help the individual.

Mrs Cheryl Gillan (Shadow Minister, Home Affairs; Chesham & Amersham, Conservative)

I have been following the Minister's argument carefully, and I think that she is being slightly disingenuous in the impression that she is trying to give the Committee. Either that, or the Bill has been hastily and poorly drafted, because it does not say that the assessment concerns whether somebody is in a job or housing or what have you. Subsection (3)(a) says that it is an appointment with

''a suitably qualified person''—

we have doubts about that—

''for the purpose of establishing whether the person is dependent upon or has a propensity to misuse any specified Class A drug.''

Somebody needs fairly special and high-level qualifications to establish that. It is not about whether the person has a home. Subsection (3)(b) talks about the assessor thinking

''that he has such a dependency or propensity''

and could

''benefit from . . . assistance or treatment''.

Those are clinical judgments, and the Bill requires a suitably qualified person to make them. We would be looking for a very special person, and the Bill would be improved by the inclusion of the option of using a GP. The Minister is giving a wrong impression about what the person is going to do with the offender.

Ms Caroline Flint (Parliamentary Under-Secretary (reducing organised and international crime, anti drugs co-ordination and international and European issues), Home Office; Don Valley, Labour)

The hon. Lady is right. We are looking for very special people. Those special people would have to be found in a short space of time to go to police stations as soon as possible after somebody has tested positive for class A drugs, to engage with that person and to discuss his drug taking—which will have been proved—not to specify what ought to be prescribed. That should be followed up with a suitable, more detailed, examination by somebody who is better qualified to do it. It will not be the job of that individual to sort out the person's housing from the prison suite. The point is that the assessor in the prison   custody suite—[Interruption.] All right, we are in the police station still, but it is not for that person to sort out the housing.

The assessor is part of a multi-agency team working with a number of agencies and individuals. They should be able to pick up the phone and say, ''We have Mr. So-and-so here. He has just tested positive for class A drugs and he might get police bail, but he has nowhere to stay tonight, so can you help sort the problem out?'' It is not for them to be the master of all the different forms of help that an individual might need, but they are a point of contact for that individual to have that immediate discussion.

Mr. Blunt rose—

Ms Caroline Flint (Parliamentary Under-Secretary (reducing organised and international crime, anti drugs co-ordination and international and European issues), Home Office; Don Valley, Labour)

I want to make a little progress.

That is the right way forward.

Training for GPs has been mentioned, and, as I have said, I would like to see more training, but I would also like more GPs to see such work as part of their core role in the community. It is about culture as well as training, and about changing an attitude as much as anything else.

The Government have provided funding to the Royal College of General Practitioners to develop and run a course to assist health care professionals in developing skills to work with drug misuse. Part of that is about overcoming their fears and concerns, but it is also important to deal with some of the issues that surround prescriptions. The range that the Department of Health provides is quite extensive. However—I understand why—GPs often tend to go for a lower dosage, which sometimes means that people supplement it, and we obviously do not want that.

We will continue to work with the Department of Health to increase the number of GPs working with drug users. I am pleased to say that in 2003-04, the percentage of GPs involved with shared care schemes was 31 per cent., which is a substantial increase, but still only 31.3 per cent. of all GPs. Such schemes are key, because even with these amendments the GP alone will not necessarily solve the problem or provide rounded support and back up, as sometimes it is a matter of the shared care worker bringing the person to the GPs surgery, because the nature of such people is that they are chaotic, and because we need follow up outside the GP's surgery, and with the best will in the world I do not think that many GPs are prepared to sign up to a 24-hour commitment.

I acknowledge the views of my hon. Friend the Member for Bassetlaw, but I do not think that the amendments are necessary for what this part of the Bill is trying to address, which is immediate contact after a class A drug test. The amendments would specifically include as a suitably qualified person for initial and follow-up assessment a GP or the GP of the person concerned. That is not helpful, because, as I said, the initial and follow-up assessments are about engaging the person and ensuring that they are seeing the   professionals as part of their care plan. However, that should be carried out by one person who can make sure that that is happening.

In drug intervention programme areas, anybody who is taken on to the scheme is given a caseworker—who is not necessarily the doctor or someone who is sorting out housing—who gets to know that person, makes sure that they turn up to appointments and that they take part, and gets feedback from the other professionals to determine whether there are other problems or issues. If someone recommends something that involves funding, the caseworker can go away and try to sort out some of the funding issues and problems with the drug action team or with others.

Mr Crispin Blunt (Assistant Chief Whip, Whips; Reigate, Conservative)

The Minister has said that a third of GPs are part of the scheme. Is not the key issue that an individual GP has been chosen and is part of the community? Someone is dropped into the criminal justice system at the moment of arrest or when they are in the police station, and they are given an assessor and everything is then done for them. It may be that if a GP was prepared to assist and look after the person, as one would hope would be the case, that person might have confidence in their GP. They therefore might ask for their GP to be their assessor. Those ideal circumstances are when one wants to keep the link between the community involvement of the individual and the criminal justice system. Otherwise, the person is just dumped in the criminal justice system and has then lost an important link in their successful rehabilitation.

Ms Caroline Flint (Parliamentary Under-Secretary (reducing organised and international crime, anti drugs co-ordination and international and European issues), Home Office; Don Valley, Labour)

I invite the hon. Gentleman to see some of our drug intervention programmes. The concept that they are about dumping people in the criminal justice system, with no connection to the wider community, is ridiculous.

The whole point of the scheme is to stop what was the dumping of people in the criminal justice system, where their drug addiction was not dealt with. People could go to the courts and to prison and deal with a whole range of professionals along the way, but there would never be any joined-up thinking. Someone would leave prison, but no one would know, and whatever drug treatment that they had received in prison would be undone within 24 hours. I am afraid that that still happens today, which is why we are putting resources into stopping it as much as possible.

We are fighting against that, and multi-agency working with community-based teams is already happening. If one visits a drug action team in an area where they have such a programme, and one sits down and talks to the people who are running it, one will find that a mixture of different statutory agencies are involved. They include the local authority, the police, the health service, voluntary agencies and community groups, with, of course, at the heart of them, the individual.

The amendment would provide that an initial assessor may be the GP of the person required to attend the initial assessment. My point is that we are talking about people being arrested at all times of day   and night. They have just been tested for class A drugs. The police have contracted the arrest referral workers to work certain hours and to be at the key point in the process. I do not even agree with the concept that the GP should be involved at this stage, but, with the best will in the world—

Mrs Angela Watkinson (Shadow Minister, Education; Upminster, Conservative)

Will the Minister give way?

Ms Caroline Flint (Parliamentary Under-Secretary (reducing organised and international crime, anti drugs co-ordination and international and European issues), Home Office; Don Valley, Labour)

No. I would like to finish the point. With the best will in the world, a GP—no matter how concerned about the individual—is not necessarily going to come out in the middle of the night, or leave a busy surgery, to deal with someone within what we want to be a relatively short time after being drug tested. I think that that idea is utopian, and I am not even sure that it is necessary.

One of the issues that will be discussed between the assessor and the individual who has just been tested will be whether they are having any treatment or already using a script. Some people are already receiving treatment—there is no doubt about that—but are still out there using drugs off the street and committing crimes as well. That should obviously be part of the discussion.

Of course, if someone has a GP—unfortunately, a lot of the people we are talking about do not, because the GPs will not put them on their books—

Ms Dari Taylor (PPS (Ms Hazel Blears, Minister of State), Home Office; Stockton South, Labour)

No address.

Ms Caroline Flint (Parliamentary Under-Secretary (reducing organised and international crime, anti drugs co-ordination and international and European issues), Home Office; Don Valley, Labour)

My hon. Friend is right—such people have no address. However, if a GP were willing to help, it would be ridiculous to suggest that he should not. If GPs are willing to work with the clients we are talking about—people coming through the drug interventions programme—we would like to harness them in the system. I am not in favour of making it hard for myself or for drug action teams. If there are willing professionals in a community that want to work with a drug action team on drug intervention programmes and be there for their patients, someone would have to be foolish to turn that down. That is exactly what is happening where programmes are working well. What we have to make sure is that they are working better across every community.

Amendment No. 20 would provide that an initial assessor may be the GP of the person required to attend the initial assessment. That is what it means—to attend the initial assessment. All that that might involve in terms of added bureaucracy and organisation is not appropriate at this point in the process.

Amendment No. 21 would specifically make a GP ''a suitably qualified person'' for the follow-up assessment and could be interpreted as implying that a GP would be the option of first choice as a follow-up assessor. We have to give flexibility to the drug intervention programmes to understand what is happening in their areas. That is not to exclude a GP at all, but is about saying that, unfortunately, we do not have that equality of support and engagement by some health professionals in all parts of the country.

I shall give another example. Not so long ago, I was pleased to visit a funded Middlesbrough GP practice, which looks like an ordinary practice to the outside world. However, its only patients are drug addicts or former drug addicts, although nobody would know that from the outside. It had to be developed because of the problem of getting other GPs to engage. It provides treatment not only for drug addiction, but for any health issue—treatment such as anyone would get from their GP practice: for pregnancy, for a cold, for falling down and spraining an ankle or whatever. That practice will deal with anything like that, but it is just for people who are using or have used drugs. I am afraid that that is the reality in which we live.

We do not want to be too prescriptive in the Bill; we want to allow for flexibility and any changes that may be appropriate over time. The Bill intentionally provides for assessments to be conducted by a suitably qualified person, defined in clause 19 as

''a person who has such qualifications or experience as are from time to time specified by the Secretary of State for the purposes of''

these provisions.

People who work with drug users come from a wide range of backgrounds and have a wide range of qualifications and experience. Systems for developing and assessing competence are being put in place as part of DANOS, the drugs and alcohol national occupational standards, which specify the standards of performance to which people in the drugs and alcohol fields should be working. That is a first, and it is groundbreaking because we are developing that service and help and support for such people, who have been neglected by Governments for generations.

As I said, the Bill's provisions do not preclude in any way a suitably trained and experienced GP from carrying out such assessments. However, most generalist GPs do not have suitable experience or training in this area of work. It is important to remember that the assessments under the provisions are not confined to a basic discussion about clinical or medical treatment issues; they are also designed to determine what other assistance and support services are needed and what other experts and professionals need to be contacted by the assessor to help form an integrated, comprehensive and sustainable care plan.

Overwhelmingly, the aim of the assessment is to motivate the drug user to take up treatment and remain engaged. That is one of the key aspects of the process: whether a connection can be found with that individual that could lead on to more detailed discussions and health support. As I said, a police station is not necessarily the best environment for that.

My hon. Friend also expressed concerns about probationers and officers having more than an appropriate role in defining clinical treatments. If he wants to talk about that, I shall be happy to listen. I also hope that I shall be able to work with him to campaign for more of what he seems to have in his constituency, which I am sure is a result not only of his intervention, but of the resources that we are putting in and the changing attitude of those on the front line of health care, whatever people's needs. I hope that, on the basis of my remarks, he will withdraw the amendment.

Mr John Mann (Bassetlaw, Labour)

I thank my hon. Friend for her comments, which were addressed primarily to amendment No. 20. It might be appropriate on Third Reading to table a modified amendment relating to the follow-up assessment, which is the critical issue.

In essence, the Minister is saying, ''We in Britain have got it right, but the French, the Swedes, the Australians and the New Zealanders have got it wrong.'' I put it to her that those countries have not got it wrong. Part of my constituency has GP-led treatment and part of it does not, so I can compare the system that operates in most of the country with the system that we have introduced in Bassetlaw.

Hon. Members mentioned cost and the cost savings are as follows. Accident and emergency admissions for drug overdoses have fallen in Bassetlaw from 173 a year to 39 a year. Deep vein thrombosis during in-patient stays has fallen by 400 per cent.

Ms Caroline Flint (Parliamentary Under-Secretary (reducing organised and international crime, anti drugs co-ordination and international and European issues), Home Office; Don Valley, Labour)

Will my hon. Friend give way?

Mr John Mann (Bassetlaw, Labour)

No. I will not take an intervention. If the Minister compares the statistics for Kingsmill hospital in Mansfield, which is the part of my constituency that does not have the system, she will find that cases of deep vein thrombosis during in-patient stays have risen, which means that drug addicts take up hospital beds. If she compares the statistics on acquisitive crimes, such as burglary and shoplifting, for Warsop with those of Bassetlaw—the police have given the Home Office the statistics—she will see what happens when a GP-led service is put in place.

My hon. Friend will have copies of the correspondence between the PCT and the drug action team. She will see that our system is not a shared-care system but a GP-led system, which draws in all the services that the GP requires. That is not the shared-care system that allegedly operates in Mansfield, whereby one of my constituents has to go to a drugs worker to get methadone and another GP to get antidepressants. That is total nonsense and also expensive.

Amendment, by leave, withdrawn.

Question proposed, That the clause stand part of the Bill.

Dr Brian Iddon (Bolton South East, Labour)

I have a great deal of sympathy for the comments that my hon. Friend the Member for Bassetlaw has been making in the past hour. We have to return to the system of engagement of the majority of GPs. Until we do, and for the reasons he has adequately explained, we will not get on top of the problem in the way that many other countries have.

I want to develop three themes. First, the regulatory impact assessment for the Bill shows that 113,000 additional tests might be undertaken in police stations as a result of people being brought in. According to annexe A of the RIA, on page 35, some 35,000 of those tests will be positive. The system is already creaking because we do not have enough specialists, whether GPs or others, to treat people adequately. If the Bill is enacted—that is a big ''if'', of course—can the system cope with another 35,000 people on top of those who are trying to get into the NTA schemes?

Clauses 9 and 10, and subsequent clauses, deal with assessment, but, for the reasons given by my hon. Friend, we cannot separate assessment from treatment because the two are so intimately related that we cannot ignore the treatment. Last March, the National Audit Office published a report entitled ''The Drug Treatment and Testing Order: early lessons'', which drew widely on research undertaken by London South Bank university, alongside a report entitled ''Review of criminal justice interventions for drug users in other countries''.

The two reports showed that the position in Britain is rather bleak compared with that in other countries. Only some 28 per cent. of drug treatment and testing orders are completed satisfactorily, and some 70 per cent. of participants still tested positive for opiates after 12 months. Two years after the orders commenced, the reconviction rates were as high as 80 per cent., which is unacceptable. Interestingly, the London South Bank university research studied all other countries, but it did not study France, the country just across the Channel that has been mentioned this morning, which is having enormous success with drug treatment programmes. I cannot understand why that study did not cover France.

What is the big difference between the way in which we deal with serious drug addicts in this country and the way in which France and the countries mentioned by my hon. Friend treat people? The simple answer is that we are stuck on methadone, methadone,   methadone. I am sorry to bang an old drum that I have banged many times before, including on Second Reading and in several Adjournment debates. Why are we so stuck on methadone in this country? Let me say right from the start that it has been a successful drug treatment, and it is the preferred drug for many patients. It is, however, highly addictive, and is more addictive in some people even than heroin. It has a very narrow window of toxicity, which means that people must be trained to administer it and to monitor those who are taking it. As I said, many of the people who are prescribed it are prescribed such low doses that it is totally ineffective, which is a complete and utter waste of money. It can also cause fatal respiratory depression, and has resulted in some of the tragic deaths that we have seen.

France, Australia and other countries have turned increasingly to buprenorphine. France is reliant less on methadone than on buprenorphine and indeed other choices of treatment for drug addicts: methadone and buprenorphine are not the only two possibilities. It has surpassed this country's success rate, because it uses a drug that acts as an antidote to itself in higher doses, which means that, unlike methadone, there is no point in ramping up the dose of buprenorphine. There is virtually no black market for the drug and—this is the real point—it is so safe and effective that general practitioners who are not trained in treating drug addicts can administer it.

In conclusion, we must return to the old British system, or the new British system, as my hon. Friend described it, bring in more GPs, and persuade them to prescribe other antidotes to heroin than methadone.

Mrs Cheryl Gillan (Shadow Minister, Home Affairs; Chesham & Amersham, Conservative)

The clause is chiefly about the initial assessment following testing for the presence of class A drugs, but the amendments give rise to several issues that the Minister has not addressed, and I would like to know her view. The first is very simple. I want to ask her about a drafting point. Clause 9(2) says that:

''A police officer may, at any time before the person is released from detention at the police station, require him to attend an initial assessment and remain for its duration.''

Clause 12 deals with attendance at initial assessment, and gives the impression that it is going to be at another time and place. Can the Minister clarify whether the initial assessment does not have to take place before that person is released from detention? At the moment, I think that could be read ambiguously, and could be interpreted to mean that the initial assessment has to take place before the person leaves the police station, immediately following their detention, because they have tested positive for class A drugs.

I want to establish with the Minister not whether that is poor drafting—it is poor drafting, actually, otherwise this issue would not have come up—but whether the person can leave the police station, go home, and then come back at another time for an initial assessment. Otherwise a conflict is set up between clauses 9 and 12, which would create difficulties of interpretation in a court.

My second point also refers to clause 9(2), which refers to a ''police officer''. I would like clarification as to what sort of police officer. Again, we had this debate at an early stage, where the rank of inspector became an issue. I want it put beyond all reasonable doubt. This could even be a community support police officer, or a special constable, because I presume a ''police officer'' covers any rank, at any time, in any place whatever. Does it include all ranks and all types of police officers, including CSOs?

In clause 9(3), what is a ''suitably qualified'' assessor? What qualification must these assessors have? Is a member of the church who has worked with drug offenders, for example, a suitably qualified assessor? If the assessment has to take place in the police station before the person has departed, what will the availability of these assessors be? If one is not available, how do we get this clause to operate to keep the person who has tested positive within the ambit of a potential path into treatment? I hope that the Minister will be able to satisfy me on those practical difficulties.

Why does clause 9(5) specify people who have

''attained the age of 18''?

We could have this debate on one of the new clauses. Nevertheless, why has the Minister gone to the lengths of producing a good and interesting idea for getting and retaining people on the path to treatment, only for the Bill to exclude the under-18s, who are the people who are most in need, who would benefit most, and who are most in danger of dropping out of the equation? I would like the Minister to explain the thinking behind that. Why does she want that cut-off point at 18 when people under that age would benefit?

In light of some of our accommodations and the experience of Committee members, I would like the Minister to explain what will happen if a person is detained at a police station and reveals a class A drug, and at any time before they are released from detention a police officer requires them to attend an initial   assessment, and it is then discovered that they are in this country unlawfully? How will these provisions affect such immigrants? What will happen to their immigration status? What will subsequently happen to them? That is a major problem in terms of drugs, and I ask the Minister to provide further and better particulars.

Ms Caroline Flint (Parliamentary Under-Secretary (reducing organised and international crime, anti drugs co-ordination and international and European issues), Home Office; Don Valley, Labour)

I shall begin by addressing the points of my hon. Friend the Member for Bolton, South-East. I am the last person who would suggest that there is not more that needs to be done, but I hope that he would he agree that where we are now is a huge improvement on where we were in the past.

Dr Brian Iddon (Bolton South East, Labour)

I accept that this Government have done a great deal since 1997, and I am proud of their achievements in treating drug addicts. Far more addicts are being treated now than in 1997, and I look forward to the continuation of the Government's good policies and their improvement of them. We are trying to be critical in a constructive way.

Ms Caroline Flint (Parliamentary Under-Secretary (reducing organised and international crime, anti drugs co-ordination and international and European issues), Home Office; Don Valley, Labour)

I thank my hon. Friend for that, and I have great sympathy with some of the issues that he raised. I said earlier that one of the problems that we are having to overcome is a cultural attitude towards the treatment of those with drug addiction problems within the health service, at primary care or other levels. There is another problem about people having sufficient confidence and understanding to use and interpret guidelines that are provided by the Department of Health and the NTA—the models of good practice and the models of care—in a way that is most appropriate for the individual.

The prescribing of methadone is one of many options. There are a number of alternatives to methadone, which are outlined and available and can be used. However, there is a problem in getting the people on the ground—GPs and others—to be prepared to use those alternatives. It is right for us to be doing that work. Department of Health officials and the NTA are trying to address that problem. With regard to crack addicts and substitutes such as methadone, there is no alternative.

It is also right for us to build up awareness of what is happening in the treatment of drug addiction not only in parts of this country where provision is good, but elsewhere. In some places, there is a more traditional response. We do not think that we have got everything right and that other countries are not doing interesting work. We look at what other countries are doing, and we keep an open mind about different treatments and how they apply. The involvement of carers, users and former users is crucial in guiding us on what works. That is the test—what works—and it might differ from one person to another.

I am pleased that the NTA advisory board now has representatives from user and carer groups. I met two representatives from those groups to discuss their work; I am keen—as are officials in the Home Office—  that we should have links with such people as well as with professionals and experts. We should encourage the same approach at drug action team level. I know that in my hon. Friend's constituency, Tina Williams, who is a representative of carers on the NTA board and whom I have met, has shown that there is added value in listening to people from those backgrounds, and ensuring that we get services right and that they pass the test of what works.

Mr Michael Clapham (Barnsley West & Penistone, Labour)

My hon. Friend has made it clear that the way in which treatment is applied varies between localities, and we have heard what my hon. Friend the Member for Bolton, South-East (Dr. Iddon) had to say on that, but has the Minister discussed with her colleagues at the Department of Health how best practice could be driven through the NTA? The wide variation between localities means that we need to drive best practice through to get uniformity of treatment.

Ms Caroline Flint (Parliamentary Under-Secretary (reducing organised and international crime, anti drugs co-ordination and international and European issues), Home Office; Don Valley, Labour)

We have such discussions, and the NTA is now accountable to both the Department of Health and the Home Office. Every quarter, I have a working lunch with treatment-providers from the voluntary sector, and I was pleased, recently, to have Paul Hayes from the NTA join the group when we discussed commissioning in relation to services and specification to ensure that good services are recognised and poorer services dealt with.

It is also important that we improve treatment standards, and the group has discussed how to drive them forward. More than ever, there is good work going on, but people can learn from each other. We will try to help people do that by having regional conferences on drugs, at which we will bring stakeholders from across the region together to engage in what is happening in different parts of the region and, I hope, share best practice. That is not an end in itself, but it is important.

It is also important that we get behind the national averages, so that we can pinpoint areas in which we are not doing well—for which there might be legitimate reasons. We are building a new industry, and we have to build up workers to be part of it, and get workers such as nurses and doctors to want to work in it. Therefore, we have a lot of work to do. It is important that we look for the best and the worst, and try to tackle both—we need to praise people, but we also need to say, ''Please improve your standards; this is how you can do it,'' and give good advice.

I move to the questions asked by the hon. Member for Chesham and Amersham (Mrs. Gillan). She is right to say that the initial assessment does not have to take place before the person leaves detention—clause 11(8), which allows police to notify the person of a change to the time of the initial assessment, supports that interpretation—so there is flexibility. As I said, people could be arriving at all times of day and night, which may cause problems with the management of an efficient and effective service.

As we discussed earlier, the assessment may have to be done by someone else. The assessment does not rule out the possibility of other people leading if that is the   most appropriate solution. If someone is already participating in a scheme with their GP, it might be appropriate for the GP to lead, with others, if there is a follow-up assessment.

In answer to the question about the definition of police officer, I understand that it means any rank of police officer, but not civilian staff, so it does not mean community support officers. I will double check that and inform the Committee if I am wrong, but that is my understanding.

I do not want to enter into the debate about under-18s, because we will discuss this in more depth in a debate on a new clause, and there is a danger of having a repeat discussion on the issue.

The point about someone who is not in this country lawfully is interesting. For now, I hope that the following answer will suffice, but I will look into the matter in more detail. Someone who has committed an offence in the UK would be dealt with first in accordance with UK criminal law, but we may not know their nationality or legal status in the country at that point or for some time, so what we are dealing with first and foremost is the fact that they have committed a crime.

On the point about immigration law, my understanding is that it would continue to apply, so if immigration law takes into account the fact that the criminal offence has been committed in the UK, which it does, nationality and legal status will continue to be irrelevant. Such matters become more complicated if someone is not legally entitled to be here, but the fact that they are not legally entitled to be here would not prevent the authorities from pursuing the criminal offence for which they have been charged. It is very important that we deal with criminal activity as well as illegal status in the UK.

Mrs Cheryl Gillan (Shadow Minister, Home Affairs; Chesham & Amersham, Conservative)

I hope that the Minister will address the training problem to which I referred before she concludes her remarks. It is key, but I am grateful for her clarification. I accept what she said about the position on immigrants, but ask her to respond to me further in person or in writing, because the situation is more complex than first meets the eye, particularly since, once clause 9 bites, we will use up resources in the UK when someone is to be deported or will not remain in this country for very long. I would like a critical path analysis of what happens when the person concerned is an illegal immigrant.

Ms Caroline Flint (Parliamentary Under-Secretary (reducing organised and international crime, anti drugs co-ordination and international and European issues), Home Office; Don Valley, Labour)

I will consider that point in more detail.

With regard to the training problem, I said that clause 19 defines a suitably qualified person as

''a person who has such qualifications or experience as are from time to time specified by the Secretary of State for the purposes of this Part.''

As I said, people who work with drug misusers come from several different backgrounds. With the NTA and others, we are developing systems for assessing competence in line with the drugs and alcohol national occupational standards—DANOS—which will specify the standards of performance to which people in the drugs and alcohol field should be working. 

Mrs Cheryl Gillan (Shadow Minister, Home Affairs; Chesham & Amersham, Conservative)

I was hunting for that information before, and I wanted to include it in my contribution to the clause stand part debate. At the end of 2003, a major providers group, with which I am sure the Minister is totally familiar, published a very useful report on the opportunities for and barriers to drug treatment, in which it made a specific point about the work force. It said:

''There is currently a lack of clarity on how best to train, recruit and further develop a pool of competent, qualified and motivated drug workers. The confusion has been exacerbated by the involvement of a number of different bodies and organisations and by a failure of Commissioners to ensure that adequate provision for the development and training of staff is incorporated into contracts.''

That reflects a concern that we all have about what is happening in this area. I, for one, will welcome it if the Minister can show that she is making swift and positive progress on this, because it has been an issue for several years.

Ms Caroline Flint (Parliamentary Under-Secretary (reducing organised and international crime, anti drugs co-ordination and international and European issues), Home Office; Don Valley, Labour)

This area is growing and developing. We are in the process of making a huge amount of change. We are on a journey from a situation in which there was very little treatment available unless one could pay for it to a situation in which we are trying to provide rapid treatment, for which there is obviously a demand beyond our current capacity. In this area and others, the key issue is the commitment and conviction of Governments to see it as a priority and to ensure that the resources are there. We can ask for training and treatment, but the fundamental question is, ''Are they going to be paid for and resourced?'' I can stand here and happily share with the Committee the fact that a record amount of resources are going into this area, rising to £1.5 billion this year. That is not just for treatment, but for the criminal justice system through the drug intervention programmes, as well as prevention and working with children and young people. We are committed to a path of expanding opportunities for treatment.

It is not just about resources, but their effective use. That is why we are looking both at the training and, as I said to my hon. Friend the Member for Barnsley, West and Penistone (Mr. Clapham) earlier, the commissioners and their competencies, so that they know what they are looking for and can say to treatment providers ''Look, you are not providing quite what we want,''—residential rehabilitation, for example—''but this is what we are looking for. Can you help us with that?''. They would get a more dynamic engagement, which would help some services adapt to today's needs. One of those is that, ultimately, somebody has to come back into, and live in, the community. Whether they have been in prison or residential treatment, we hope that they will ultimately be part of the community with more ongoing support. We are developing this area, and working on models of care with the NTA and others to ensure that we will continue to do so. I hope that that is enough assurance for the hon. Lady for now.

I hope that I have covered most of the points people have raised on this issue this morning. I note that my hon. Friend the Member for Bassetlaw (John Mann) is unfortunately no longer here. These clauses are very   important. They are about early engagement with people who are testing positive for class A drugs, and trying to ensure that the assessment is not an end in itself, but a means to an end. It is a means to all those other professionals and experts who can provide that full and comprehensive care plan. I hope that that will mean that when the person arrives at court—let us not forget that many of these people will be charged—there will be a report to that court that this person is engaging in treatment. That is very worth while indeed.

Question put and agreed to.

Clause 9 ordered to stand part of the Bill.