Welfare Reform Bill

– in a Public Bill Committee on 10th February 2009.

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[Mr. David Amess in the Chair]

Photo of Sir David Amess Sir David Amess Conservative, Southend West 10:30 am, 10th February 2009

Good morning everyone. At the start of our scrutiny proceedings on the Welfare Reform Bill, I have to go through a script of the usual announcements. Members may, if they feel hot, remove articles of clothing—I am relaxed about that. I ask Members to ensure that mobile phones and pagers are turned off or switched to silent during Committee sittings. I remind the Committee that there is a money resolution in connection with the Bill, copies of which are available in the room.

I also remind Members that adequate notice should be given of amendments. To be eligible for selection at a Tuesday sitting, amendments must be tabled by the rise of the House on the previous Thursday. For a Thursday sitting, amendments must be tabled by the previous Monday. As a general rule, I and my fellow Chairman, Mr. Jim Hood, do not intend to call starred amendments. In the recess, it will be possible to table amendments up to 4.30 pm on Thursday 19 February, for debate on Tuesday 24 February. I am sure that it would help hon. Members if amendments were tabled before the rise of the House tomorrow so that we are able to see them in print before the recess on Thursday. Any amendments tabled just before the recess onwards may be accompanied by a brief explanation to be printed on the amendment notice paper. This is the latest experiment with explanatory statements on amendments, and the Procedure Committee would welcome Members’ views on those statements. During the week’s break, Members will no doubt like to reflect on these latest developments, and then pass their views on to the Speaker and to the Chairmen’s Panel.

Not everyone is familiar with the process of taking oral evidence in Public Bill Committees—these are early days—so it might help if I briefly explain how we will proceed. I should say immediately that we are indebted to our very wise Clerk. If Members have any queries about procedure or how to deal with particular issues, I know that our Clerk would be only too happy to assist.

The Committee will be first asked to consider the programme motion, on which debate is limited to half an hour, although we do not have to take half an hour. We will then proceed to a motion to report written evidence and then to a motion, which I hope we can take formally, to permit the Committee to deliberate in private in advance of the oral evidence sessions. Assuming that the second of those motions is agreed to, the Committee will then move into a private session. Once the Committee has deliberated, the witnesses and members of the public will be invited back into the room and our oral evidence session will commence. If the Committee agrees to the programme motion, it will hear oral  evidence today and on Thursday, and revert to the more familiar proceedings of clause-by-cause scrutiny after the recess.

Photo of Tony McNulty Tony McNulty Minister of State (Welfare Reform; Minister for London), Department for Work and Pensions, Minister of State (Employment and Welfare Reform; Minister for London), Department for Work and Pensions

I beg to move,

That—

(1) the Committee shall (in addition to its first meeting at 10.30 am on Tuesday 10 February) meet—

(a) at 4.00 pm on Tuesday 10 February;

(b) at 9.00 am on Thursday 12 February;

(c) at 10.30 am and 4.00 pm on Tuesday 24 February;

(d) at 9.00 am and 1.00 pm on Thursday 26 February;

(e) at 10.30 am and 4.00 pm on Tuesday 3 March;

(2) the Committee shall hear oral evidence in accordance with the following Table

TABLE

Date

Time

Witness

Tuesday 10 February

Until no later than 12.15 pm

The Royal Association for Disability and Rehabilitation (RADAR) and Oldham Metropolitan Borough Council

Tuesday 10 February

Until no later than 1 pm

Drugscope

Tuesday 10 February

Until no later than 5.30 pm

Barnardo’s, the Child Poverty Action Group and Gingerbread

Tuesday 10 February

Until no later than 6.20 pm

Professor Paul Gregg (Bristol University)

Thursday 12 February

Until no later than 10.25 am

Department for Work and Pensions

(3) proceeding on consideration of the Bill in Committee shall be taken in the following order: Clauses 1 to 3; Schedule 1; Clauses 4 to 7; Schedule 2; Clauses 8 and 9; Schedule 3; Clauses 10 to 19; Schedule 4; Clauses 20 to 40; Schedule 5; Clauses 41 to 44; Schedule 6; Clauses 45 and 46; Schedule 7; Clauses 47 to 50; new Clauses; new Schedules; remaining proceedings on the Bill;

(4) the proceedings shall (so far as not previously concluded) be brought to a conclusion at 7.00 pm on Tuesday 3 March.

I welcome you to the Chair, Mr. Amess. I am sure that our deliberations will be focused, but huge fun at the same time. I have no doubt that this will be slightly different from the last Bill that I took through—the Counter-Terrorism Bill—and that there will be far more harmony this time. The scrutiny unit has said that during Thursday’s sitting, for which the programme motion mentions only the Department for Work and Pensions as witness, it is I, the Under-Secretaries of State for Work and Pensions, my hon. Friends the Members for Chatham and Aylesford and for Burnley, and a lead DWP official who will give evidence. When we discussed that in the Programming Sub-Committee, I said that I was perfectly happy for this Committee to choose whomever it wanted to give evidence. I am not clear that that is by common agreement. The motion still refers to the DWP, so this does not affect the motion. If, between now and Thursday, colleagues on the Committee decide they want some variation of DWP personnel, I am more than amenable to listening. With that one caveat, I am happy to commend the motion to the Committee.

Question put and agreed to.

Resolved,

That, subject to the discretion of the Chairman, any written evidence received by the Committee shall be reported to the House for publication.—(Mr. McNulty.)

Photo of Sir David Amess Sir David Amess Conservative, Southend West

Copies of memoranda that the Committee receives will be made available in the Committee Room.

Resolved,

That, at this and any subsequent meeting at which oral evidence is to heard, the Committee shall sit in private until the witnesses are admitted.—(Mr. McNulty.)

The Committee deliberated in private.

On resuming—

Photo of Sir David Amess Sir David Amess Conservative, Southend West

Welcome to our oral evidence session. I would like to say to the witnesses that while parliamentarians are used to such proceedings, they can be a bit of an ordeal for people who have never taken part in them before. Take deep breaths, if you feel nervous in any way, and relax and enjoy the session. I assure you that Members of Parliament will not harm you; they will simply ask a number of questions to gather evidence before they begin detailed scrutiny of the Bill.

We will now hear oral evidence from our witnesses. For the record, will you introduce yourselves?

Liz Sayce: My name is Liz Sayce and I am the chief executive of the Royal Association for Disability and Rehabilitation.

Paul Davies: My name is Paul Davies and I am the service director for adult and social care for Oldham metropolitan borough council.

Q 1

Photo of Sir David Amess Sir David Amess Conservative, Southend West

Thank you. You have already done brilliantly, but try to shout, because the acoustics are not absolutely brilliant and the microphones do not pick everything up. It is not only parliamentarians who have to hear what you say, but the people writing the record.

Before calling the first member of the Committee to ask a question, I remind all Members that questions should be limited to matters within the scope of the Bill and that we must stick strictly to the timings in the programme order. I hope that I will not have to interrupt anyone in mid-sentence but, if necessary, I will.

Before we turn to the questions, I would like our two witnesses to make opening statements about the Bill. You can speak for as long as you want and comment on the Bill, which will give parliamentarians the opportunity to reflect on what you have said before the questioning begins.

Liz Sayce: Thank you. I would like to concentrate particularly on the right to control in the Bill but, on a broader level, RADAR supports the Bill’s general direction. We agree that nobody should be written off and that disabled people should be enabled to work and should have the support that they need to work. I will be happy to take questions on other parts of the Bill, if members of the Committee wish to ask them.

I want to focus especially on the right to control because it really matters to disabled people. Having control over the services that you need to live your life and participate fully in society, including through education, employment and economic activity, is a huge change from having services provided as thought fit by service providers.

I would like to give some examples. I talked yesterday to people involved in the individual budget pilots relating to people with mental health problems. There are sometimes anxieties that people with mental health difficulties will not be able manage their individual budgets. There are some tremendous examples of people developing dementia being enabled, through the resources available, to carry on doing the activities that really matter to them—from fishing to watching sport on TV. Other examples include people who, rather than going to a day centre, start pursuing their own interests by going to college or pursuing interests in music, sport and so on, thereby regaining the confidence and motivation to get back into employment. People are also pooling resources and joining forces to buy the support that they jointly want. For example, a couple of people have rented a workshop to set up their own business, and a group of people have paid an art teacher, because that is something that they particularly want to pursue as a group.

I therefore think that the right to control is absolutely transformative, and disabled people around the country really welcome it. It builds on the important work of the 2005 report “Improving the life chances of disabled people” and the 2008 independent living strategy. It also builds on the success of direct payments. Initially, there were many anxieties about whether disabled parents would be able to manage direct payments, whether there would be the right staff to support them, and whether people would run off with the money, but those fears have not been borne out by the experience of direct payments. We are confident that the right to control could be just as successful.

The right to control will give disabled people a kind of guaranteed tool. If they take on more responsibility to work where they can, which we support, it is really important that they then have the tools to make that happen, and the right to control is an important part of that, alongside other parts of the contract that need to be in place, such as through the equalities Bill and pathways to work.

There are a few areas in which we think the Bill could be strengthened or go further, and I have several examples. First, we welcome the Secretary of State’s clarification on why community care and health funding are excluded, but we have experts who have looked at that and think that it would be preferable to require the pooling of funds. The whole point of the right to control, as set out in the White Paper, was that it promised to give disabled people the power to take a range of funding streams, and people want to be able to access that range of funding streams and pool resources to achieve what they want in their lives. If the funding streams remain separate, there is a risk that part of the White Paper’s goal will not be achieved. We are looking at that to see whether further amendments might be helpful.

Secondly, in clauses 31 and 32, we think that there could be better alignment with the individual budget process. We think that people should basically have a right to be told the resource allocation up front, rather  than having to ask for it. We also feel that it should be based on a self-directed assessment, rather than an assessment by the professional. A person should assess what they need, and then they will be in control of their plan, with the support of caseworkers or professionals.

We are slightly worried about the affordability clause. We understand all too well that public money is limited, but we want to ensure that that cannot be used as an excuse. We have a few other detailed comments, which I will be very happy to come back to, but I have one final point. There is a helpful provision in the Health Bill that recognises the important role of the voluntary sector in enabling people to use personal budgets through advocacy and brokerage, and we think that enabling several people to band together to use budgets would be helpful. People cannot always use the budgets without the right support, so such a provision would be useful.

Q 2

Photo of Sir David Amess Sir David Amess Conservative, Southend West

Thank you very much indeed for that full and concise explanation. May we now hear from Oldham council?

Paul Davies: I agree with everything that has been said and will give a little more detail from our perspective. It is worth saying that Oldham council has taken something of a lead on personal budgets in adult social care, and that is important because there is a bit of a worrying point, if I am honest. About 1.75 million people across the country use adult social care or social care services in one form or another, but only 10,000 of them have a personal budget, which is a tiny part of the overall figure—really just a drop in the ocean.

That reflects the history of choice and control in adult social care. We have had direct payments since the 1990s, but progress under the direct payments legislation has been very slow and disappointing. I make that point because I think that it contains the seed of a warning for the Bill, and from my perspective there is no question but that the figure of 10,000 for people with personal budgets, over 2,000 of whom are in Oldham, is insufficient and represents an insufficient pace. There are several reasons for that, some of which relate to the difficulty that organisations—whether central bureaucracies or local authorities—have in reorganising their services to meet a new agenda.

My concern is similar to that expressed by my colleague: the provisions in the Bill could be more ambitious. Our experience in Oldham—and it is a strong experience on the numbers alone—is that division in funding streams is a sovereign recipe for ensuring that people who use services, or try to negotiate their way through them, do not manage to make any progress. It is extremely difficult, even when you have partially integrated funding streams, to deliver success for people, because the organisations that retain responsibility for that element of their funding keep their own mechanisms of control, their own routes and their own way of doing things. For people using the service and trying to take control of their lives and services, it is frankly a bit of a nightmare.

If people do not have that element of choice and control, we cannot see any other way by which to empower them to take control of their own lives, to become co-producers in the delivery of their own services and to contribute all the good things they have to offer as full citizens. Within the current adult social care  system, none of that takes away from a local authority’s duty of care—that is not reduced in any sense by any of this.

I think that that is important, because it seems to me that there are two elements that need to be picked up: duty of care and affordability. Our experience in Oldham is that things are unaffordable if you do not reform your existing systems—that is what causes a problem. There is a remorseless logic to giving people choice, control and money but, in doing so, you have to unpick some of your existing arrangements. That is very difficult and perhaps explains why there are only 10,000 people with a personal budget.

There are some hard questions to be asked once you go down that route. When you do so, however, you get something of an explosion of creativity among the people who are using, choosing and controlling their own services. I will give you a generalised anecdote. If I tell somebody that I spend £40,000 a year on their care they say, “You must be joking. I could do considerably better than that for half the money.” To be honest, they are very often right.

There are some key lessons that we need to learn about the integration of funding streams. We need to ensure that there is a system lead—for want of a better description—for all aspects of a person’s life, whether it is employment, where they live or the care services that they receive, if they receive them. We will not be able to deliver this absolutely fantastic agenda of personalisation if we do not make things workable for people. You cannot expect people who have been out of employment for a very long time and may have lost their skills, or may never have been in employment or had any form of meaningful day time activity, to exercise choice and control in their own lives if you do not make the system simple and put in place guidance and support. If that is not delivered by the Bill, the system will fail and not deliver what is required.

Photo of Sir David Amess Sir David Amess Conservative, Southend West

Thank you very much for that very helpful evidence.

Q 3

Photo of Mark Harper Mark Harper Shadow Minister (Work and Pensions)

Both of you had a consistent theme of making sure that different funding streams were integrated and available to individuals. The Bill currently provides for funding streams from only the Department for Work and Pensions to be included, and as Liz Sayce said, that does not include the adult social care funding. The Department has said, in written answers, that it is going to consult on how its own funding stream should be included in their pilot programmes and whether the disabled facilities grant and adult social care should be included. I got the sense, from your evidence, that you very much think that it should and I want to get a sense from you of how critical that you both think that is.

We are very supportive of what the Government are doing across Government about individual budgets, but there is a danger that different Departments are setting up their own. We already have adult social care: this one from the Department for Work and Pensions; the Department of Health is looking at personal budgets for health care; and the Department for Children, Schools and Families is looking at piloting individual budgets for disabled children. It seems to me that there is a  danger that we are just going to replicate different Departments and different funding streams. Individuals will not actually have control and will have to battle with a number of Departments and a number of funding streams with different rules, and will not be able to bring them together. I would like a sense for the Committee, before we debate the Bill, about how critical it is to grapple all those funding streams together.

Liz Sayce: It is very important for two reasons. First, individuals talk to us about the fragmentation of the system and how difficult it is to navigate through it. People want to have control through a simple route to access either the pot of money or the right for that money to be used on their behalf across the different funding streams. Quite often the Departmental boundaries do not make intuitive sense to the individuals. There is a lot of overlap in what we call social care or health care and support for employment. Some of the things you need for social care might very well help you in your journey into employment because it might be about having a PA to support you. That PA helps you to get up and get out of the house but can also help you to travel to work. These things are all interlinked. Having to navigate through multiple gateways is a complexity that people would prefer to do without, to put it mildly.

The other thing is that there is a risk of a poor use of resources if you have multiple assessments and multiple funding schemes. Our sense is that the right to control with integrated funding streams, where possible, will lead to a better use of resources because the individual in their self-assessment will be able to say what they most need such as, as Paul was saying, “I could do better if I knew how much money there was across the piece.” It is critical. Obviously there are real complexities in delivering it. We certainly intend at RADAR to seek expert advice on potential amendments to this part of the Bill to see whether some kind of requirement to pool budgets might work better than simply having an exemption, and what is obviously a very genuine intention to align the piloting where possible and to consult. There is a lot of agreement that people want to move towards better alignment. It is a question of how and at what pace to do it. We do not want that pace to be too slow.

Q 4

Photo of Meg Munn Meg Munn Labour, Sheffield, Heeley

I share the frustration about how slow the process is. I worked in social services in the ’90s and remember some early attempts to do precisely the kind of things that Ms Sayce was talking about, and people’s fear about what that would mean. It seems to me that, however many years on, we should be well past that, but we are not. How much do you feel that what is holding people back is about what is in the legislation, and that this is an opportunity to do something about that? How much is about the structural problems which are out there and will continue to exist, regardless of whether or not we change the legislation?

Paul Davies: Speaking from our experience at Oldham, which probably holds good for many other places, too, we tried to integrate as many funding streams as possible into our individualised budget allocation to include just everything we could. Some of it worked extremely well. For example—and this is not a plea for control by local authorities—the parts of the funding streams that were controlled within the local authority were relatively  easy to integrate. There was not a significant problem with that because there was a single source of authority for integrating those streams. We had some success in integrating Supporting People funding with support from the Department, because it was within the gift of the local authority for us to do that through negotiation with the Department. That works very well. We have had very good success with integrating continuing health care funding in Oldham, although I know this is not the universal experience. That is simply through a co-operative effort with our local primary care trust. It is a bit of an exemplar for how one can make life easier for people.

Where we struggled was in integrating Access to Work funding. Colleagues in the DWP worked their socks off to make it work. They really tried very hard. They were fantastic, but they just could not make it work around the rules and regulations. Nor could we. That was a real problem for us and it remains something of a separate stream that we have to work to. We had a similar frustration with the independent living fund. I know that that has been much discussed. There are basically two completely different funding schemes with mutually exclusive assessment systems. None the less, we managed to get some success in integrating those. In terms of economy of effort, which is what we are looking for here, a lot of hard work was required to integrate those funding streams that were not naturally within the control of one organisation.

Q 5

Photo of Meg Munn Meg Munn Labour, Sheffield, Heeley

So the issue is about the detail, the requirements, the criteria and so on that will be in place, because inevitably you have to limit who is entitled to things and how it is done, as opposed to, in your case, the unwillingness of one of the organisations to take part.

Paul Davies: I would not say that it was unwillingness; it was simply inability.

Q 6

Photo of Meg Munn Meg Munn Labour, Sheffield, Heeley

If you look at child care legislation on meeting the needs of a child, other organisations, beyond the local authority, are required to assist in doing that. I wondered whether, along with changing criteria around spending, one mechanism might be permissive criteria within the legislation.

Paul Davies: My gut feeing is that permissive does not do it. It requires something more direct. For that reason, I am also concerned about the unreasonable financial burden, because, I suspect, we are potentially building into this a system of gateways that does not need to be there, through which those organisations that are willing and able will pass, and those that are either unwilling or unable will not. I think that it needs to be something more than permissive. To deliver something that works, my feeing is that to bring the full fire—for want of a better description—of all these different organisations wrapped around the individual, it needs to be more directive.

There is good work outside of Government; organisations such as In Control are looking at how different funding streams can be integrated through a simple resource allocation system. That is the key; it is about the individual knowing how much money they have to meet their needs, having a set of defined outcomes that they have to work towards and having a vehicle for delivering them. In our experience, where one is able to integrate  those funding streams into that single delivery vehicle, wrapped around the individual, with that individual having choice and control, it works. What does not work is a load of bureaucratic jiggery-pokery at the back as organisations try to sort things out, and not always seamlessly. That is a not the way to ensure that we get people into employment, meaningful daytime activity or a system of care that suits them.

Q 7

Photo of John Howell John Howell Conservative, Henley

May I pick up on a couple of points relating to the level of support? One thing that concerns me is that in rural constituencies, which many of us represent, the choice will not be there and the cost will be greater, so budgets will not go as far as they ought to. Have you picked up on that concern?

Paul Davies: Oldham sees itself as a country town really. A large part of our borough is in a rural area in the national park, but we also have a densely inhabited section close to Manchester, so we are a mix. Your concerns are entirely justified, but in the case of adult social care it is the responsibility of the director of adult social services to ensure security and sufficiency of supply. None of that takes away some of the things that we have to do. It is not simply about giving people the money unconditionally and saying, “There you are, get on with it. That’s absolutely fine,” and people discovering that there is nothing to use the money on or that it does not work for them.

There is work behind all this that, in my case, a local government agency is paid to do, which is ensure that supply is available and that there is a sufficient market, if that is required, or sufficient support, if that is required, to ensure that people’s needs can be met. That is part of the needs assessment that needs to take place between organisations.

At present, needs assessment, certainly in adult social care, has centred on the relationship between health and social care, but it needs to be broader than that because nobody’s biology is their biography. It is not just about health or anything else; it is, exactly as my colleague has said, about where they live, what employment is available and even, in the case of a very large local authority, what transport is available, as well as what role the whole council—in my case—is playing in concert with, for example, voluntary sector partners to ensure that there is sufficient supply. None of this takes away that responsibility to make sure that those things are in place to support the individual.

Q 8

Photo of John Howell John Howell Conservative, Henley

I understand the point you are making about the duty and how you intend to develop that. Nevertheless, it still prompts the practical question of how it is possible in a rural area to encourage new providers to come in and deliver the choice that people in more urban areas would expect.

Paul Davies: In my experience, there is a market. We were told very early on in Oldham that we would lose. It was a great concern among our providers, such as those offering domiciliary care, that the atomisation of the market, due to personal budgets coming in, would mean no work for anybody and people going out of business—it was all going to be terrible. In the first year, we more than doubled the number of providers coming to do business with us. The reason for that is simple.

I talked before about something of an explosion of creativity. If the scope of one’s imagination is the existing traditional system of support, you are quite right that there are limitations within that, because it is the way that organisations do business and have done in the adult social care base since the early 1990s, when community care came in. But actually, the support that people require is often non-traditional, things that I could not possibly imagine. I could never had made up the things that people come back to us to say that they need support with. Often to my great surprise, though less so now, the solutions that people reach to meet their own needs are so far away from the traditional but so effective that the issue of traditional sources of supply is minimised.

I guess that the point I am trying to make is that until you begin to give people the ability to do this and to control and deploy their own resources in a way that they feel comfortable with and that meets their needs, you cannot begin to guess what solutions they will come up with. Some of those solutions are within their neighbourhoods or often within their own families—ones that previously would not have been thought of. They are very unconventional solutions.

It might help if I give you some facts and figures. Our experience in Oldham is that about 50 per cent. of the people to whom we give a personal budget say, “Thank you. I do not want the money. I am happy either for you to control that or for me to have some element of control over how that money is spent. You crack on and deliver my services.” Another 25 per cent. say, “Thank you. I will take all the money. I will plan, organise and commission my own care and services, and deliver those. No problem.” The remaining 25 per cent. would say, “Thank you. We will take part of our mission critical services as a delivered service, but some element of it as services we will control ourselves.”

Q 9

Photo of John Howell John Howell Conservative, Henley

On that point about support, there has been an increase in the budget of one particular funding stream of Access to Work. Do you see that leading to it being spread more thinly across a larger number of people or leading to much higher individual use for larger adjustments?

Paul Davies: It is difficult to say. What I do know is that we have had a lot of success at delivering people into employment using Access to Work as a vehicle, but, as I said earlier, it has taken a lot of effort. It is inevitable that when you make the system easier for people, more will be empowered to use it and will take advantage of it. My view is, so much the better.

Q 10

Photo of James Plaskitt James Plaskitt Labour, Warwick and Leamington

I have questions for each of you. I will come to Liz first to give Paul a rest. In your evidence, you spoke about the importance of what you described as self-directed assessment, but you also spoke about the need for support for people to make those decisions. Especially in cases where we are talking about mental disability, there is a very difficult line to determine: at one extreme, someone can make all the decisions about their care and at the other extreme they cannot. There is a space in the middle where it can be done with support. Are you confident that the resources are there to give adequate support to make this work?

Liz Sayce: In the spirit of the Mental Capacity Act 2005 and the principles that lie behind it, there has been a shift in services around the country towards first  assuming that people will have capacity and offering the support to enable people to make decisions. There is the thinking that sometimes people might not be able to make decisions on certain things, but let us try to help them make decisions. I think that that has been very welcome. It has led to surprise in that some people who would have previously been thought of as unable to make decisions are now being seen as able to make them. That is partly why I used some mental health examples earlier—people with dementia, schizophrenia or learning disabilities having choice and control.

We are learning from the individual budgets that people are able to make a lot more choice and take a lot more control than would have been thought 10 or 20 years ago.

In terms of whether the support is there, it is really important that there are user-led organisations in every part of the country, as was laid out in the life chances report. There is, of course, a commitment to there being user-led organisations in each part of the country that can provide the kind of peer-led, user-led support that people find incredibly helpful. So, it is not only the professional, the case manager or whoever, advising and supporting somebody to create their own assessment and plan, but other people who have done it themselves.

Very often, people are initially limited in their imagination, but they then say, “Oh, you mean that rather than go to the day centre I could have driving lessons. Then I could go to visit my relative or I might be able to get a job in the next town.” It had not occurred to them that they could use the money for driving lessons, but once they have it, they are on a roll and things begin to develop.

So, I think that we are still on a path in terms of the implementation of the 2005 Act; we could do even better to ensure that people’s capacity is supported. Different parts of the country have different levels of the sort of peer-led support that I am talking about. That is a major priority, because some people clearly need advocacy and they need to be brought together so that collections of people can buy something. Some things that people want are not just individual. There are a couple of examples that I use, such as two people renting a warehouse together to set up a business.

Q 11

Photo of James Plaskitt James Plaskitt Labour, Warwick and Leamington

You are saying that there has to be a framework to support people who need support with making a choice.

Liz Sayce: Exactly.

Q 12

Photo of James Plaskitt James Plaskitt Labour, Warwick and Leamington

Are you satisfied that enough support is there so that when that new choice arrives it will be optimised by the people we want to aim it at?

Liz Sayce: At the moment, we are satisfied that that is taking place in some parts of the country, and to very high quality. We can see how it can work. But, it is not taking place in every part of the country, so we would like to see attention given in the Bill—I mentioned the analogy in relation to the health bill—to provision for the voluntary sector to make available that kind of support, including advocacy and brokerage, because without that the pace of change will not be what Paul and I have said it needs to be. We need to move on with this at a more rapid pace, and that needs advocacy and brokerage to be in place around the country.

Q 13

Photo of James Plaskitt James Plaskitt Labour, Warwick and Leamington

That is very helpful. Thank you. Paul, picking up exactly where you finished, in your evidence you raised a concern about the pace of progress that has taken place, and I think that you implied that there was a question about the pace going forward from here—whether it would come through quickly enough. Are you saying that you have encountered institutional inertia in bits of the system? Will that still be a problem as the Bill comes into effect? If you do think that, what can be learned and applied from the Oldham experience? Does something else need to be done in the Bill to help us overcome that problem, or is what is here sufficient?

Paul Davies: All the tools required to do all this are in place. All the knowledge and the experience required to make all this work are in place. As my colleague said, the fact that it is working in some parts of the country shows that it can be done; there is absolutely no reason why not.

The fact that that is not being done more widely is of huge concern: not only Oldham but all the other individual budget pilot sites were told very early on that some things would never work, by people who apparently knew that they would never work. Individual budgets would never work for people with mental health problems. They would never work for people with learning disability, or for people who misused substances, or for people with dementia. Frankly, that is rubbish—I choose my words with care—and experience shows that it is.

It seems to me that the centre—the Government—has invested a lot of time and effort in putting those mechanisms in place and working up the experience and the tools to make it all happen, and they are all available, but the direct answer to your question is yes, it seems to me that there is a lot of inertia in the system.

It falls into two parts. Quite honestly, some folks just do not get it, for want of a better description, and some say, “That’s all in the ‘Too difficult’ box and we can’t really do it.” Well, you can; any organisation can. I believe that there are the resources to provide the support out there, but at the moment they are doing other things.

If you look, for example, at productivity in adult social care, you will see that the Commission for Social Care Inspection went down at the same time as investment went up. There are reasons for that, and I feel—it is not just my own feeling—that a lot of that is tied up in the front end of services and in the nuts and bolts of making services work.

It seems to me that a simplified system of the sort I mentioned earlier would enable organisations to participate fully, taking full advantage of the tools that have been put in place to deliver a system that is quicker and slicker and more effective for people. Unusually for someone from a local authority, I am not sitting here saying that we need considerably more resources to be able to do that—not at all. I am saying that a bit more direction and a bit less permissiveness in the Bill would unlock all that.

People have had the option of direct payments since the 1990s, but across the country there are people who ask for a direct payment and are told that they will have to wait until the money becomes available the following year. I do not think that that is written anywhere in the legislation. There are issues about unlocking what has to be done.

Returning to a point that John Howell asked me about, in the original guidance on the community care legislation, some cracking good examples were given of what could be done in large rural areas. One that stuck in my mind was the suggestion that we could ask the landlord of the local pub to provide the meals for the elderly population of that rural area. That never really happened, and local authorities instead commissioned 200,000 frozen meals on wheels a year because we felt more comfortable with that.

If we are not using direction—instruction—and if we are not using good practice and the good work that is going on to guide and instruct practice, the pace will not be quick, and it has not been quick so far. It will remain at a relatively unsatisfactory level if those things are not in place. The system is a big system, as are all such systems, as far as the individual is concerned, and they are very difficult to organise. Unless there is a duty to co-operate and to deliver that single, wrap-around approach to the individual, the system will not work. If you do not do it that way, it will require people of good will and a critical mass within particular leadership organisations—the local authority or whatever it might be—to deliver it.

I also echo the point about user-led organisations. The Government have been fantastic at saying that they are trying to get away from the top-down approach and that they want people to be co-producers in this, but if we are to get the best out of that, we must ensure that there are in place not only statutory support mechanisms, but non-statutory mechanisms.

A responsibility to involve everyone who can help and support an individual needs to be included, and it needs to be our responsibility. There needs to be more than just a statement that we can do it or that we might do it if we feel like it.

Q 14

Photo of Paul Rowen Paul Rowen Shadow Work and Pensions Minister

I would like to move on to clause 8, which deals with the conditionality aspect for payments of jobseeker’s allowance and employment and support allowance. The Government have an ambitious target for getting people off incapacity benefit and back into work. What are the challenges and what support and training need to be put in place for Jobcentre Plus to be able to carry out some of the new powers that are in this Bill?

Liz Sayce: First, there are some issues with the graduated approach to conditionality and the use of the just cause for people not complying with particular aspects of what is expected under conditionality. We need to be absolutely sure that included in those just causes are things like inaccessible processes, transport difficulties that disabled people may face and issues that the parents of disabled children may face where perhaps it is much harder for them to find accessible child care facilities to enable them to take up their responsibilities in employment. There is a big training need there to ensure that people get treated fairly through this new system.

Secondly, Access to Work was mentioned earlier. In relation to work-related activity, at the moment Access to Work relates to employment but not necessarily to some of those other vocational activities, training and so on. Sometimes it is difficult for people to participate in the very thing that they need to enable them to get  back into employment. We would like to see the resources on Access to Work go into publicising the scheme more and ensuring that it is there for those other work-related activities, as well as paid employment itself. There are obviously concerns among disabled people around the country about conditionality. It is the issue of fairness. The training point is very important. People should not end up at the end of that conditionality route being expected to do community-based voluntary activity in order to get their benefits if the process leading up to that has not been fair. Some real questions are being raised by a number of disability organisations about that.

The final point is about getting skills. During a recession people want to keep their job if they possibly can or to get into work, and we applaud the intention not to take the foot off the pedal on welfare-to-work provisions. However the reality is that some people will be out of work. What better time for people to refresh and update their skills and to be ready for exactly the sort of jobs that will exist in the economy when we come out of the recession? At the moment, unfortunately, a third of people with no skills in this country and no qualifications at all are disabled people. Disabled people have been left behind by the skills revolution. That is an area of major importance and we need to make sure that the support services, the right to control, Access to Work and all these budget streams can be used by people who are seeking to develop their skills and their qualifications, as well as by those who are directly engaged in the labour market.

Q 15

Photo of Peter Lilley Peter Lilley Conservative, Hitchin and Harpenden

Mr. Davies, you mentioned that something like a fifth of the people with personal budgets in the country are in Oldham. Is it reasonable to suppose that you have probably pushed the process of moving towards personal budgets as far as is possible within the present legislative framework? If so, to what extent do you think the measures in the Bill and the programme of development that the Government have spelled out will enable you to carry it further or make it easier for other authorities to develop? Is there anything you would like to see in the Bill that would enable you and others to carry it further and faster?

Paul Davies: We are probably reaching the limits of the current legislation. In some cases we may have gone beyond those limits. There is something about the current system being stretched in terms of how one can manoeuvre within it. That is not to say that it is not, in some senses, quite permissive. The difficulty with a permissive system is that you can do it if you want to, or not, as the case may be, and I think that is what has caused some of the problems.

However, in direct answer to your question, I would like to see something that was more directive regarding organisations. For example, it is very difficult for somebody in Jobcentre Plus to understand—through no fault of their own—some of the difficulties associated with dealing with people who might have had chronic schizophrenia, or something similar, for some time. I think that a more directive duty to work closely with those agencies that understand all of that—and it is a duty to work together; it is not just a one-way street—would make a big difference. This is a many-hammers question, because every individual is a complex person with their own  needs and requirements. Unless we can get all those agencies working together—I truly feel that that has got to be directed; I can see no other way around it—we will not achieve what we need to achieve.

I would like to expand on the point about conditionality. The Government’s social care reform has conditionality within it—it is outcome-focused, there is a contractual requirement and the local authority retains the right to say whether a particular arrangement will go forward if it is satisfied that that arrangement makes best use of public money and is safe, among other things. It is not rocket science to have a similar conditional arrangement around every other element of this. That conditionality is there elsewhere in other parts of the Government’s programme. I think that best practice should be shared, not only across local authorities but across central Government as well, and I think that would make a huge difference.

Q 16

Photo of Peter Lilley Peter Lilley Conservative, Hitchin and Harpenden

A point which may be as much, if not more, related to Ms Sayce as to you, is that we are all familiar with the difficulties different institutions have in co-operating with each other. I used to say that it was more difficult to get one Government Department to co-operate with another than it was to get the United States and the USSR to co-operate at the height of the cold war. I think that that is true not just in central or local government and in other institutions, and it is clearly a problem.

I wonder to what extent the difficulty that institutions have in co-operating is that they find that the current rules and the current control that they have are a way of rationing resources, and that if they move to personalised budgets, they believe it will lead to an explosion of demand. The presumption in what both of you have said is that within a given budget you can get much more well-being, and that is why you want to move there. Is the reluctance to move towards creating more well-being due to Departments seeing the existing rules as enabling them to live within their budgets?

Paul Davies: I think that that is entirely true. There is a school of thought that feels that going down this route will unlock everything and then there will be no limit to what people will want. I think that that is a naïve and hugely mistaken view. The evidence is that, when you co-ordinate funding streams with an element of each relevant funding stream, you get more than the sum of the parts.

In the case of adult social care, there is something called a resource allocation system, which calculates the amount of money available to the individual according need, on a points-based system. It is very straightforward. It sounds remarkably simple, but it is something we have essentially not done since 1945 until about 2000. The previous system was like many other systems, in that need was assessed but no resource was set against that need, while some mechanism went on in the background that ultimately resulted in somebody receiving a service.

This is important, because a transparent resource allocation system that is able to integrate the different funding streams at whatever level and according to need deals with a lot of those objections, because the budget is the budget—it is finite. I am no different from any other local authority service director, in that my budget is limited too, and I have to live within that budget.  However, there is a better mechanism in this arrangement for dealing with that conundrum. When there is a properly integrated, transparent system for allocating the money—and it is resource-limited, because that is the amount of money you have got to spend and you have to make the best of it—it brings together much more than one budget alone. To me, that is the means of dealing with what we deal with now, which are resource-limited capped budgets, and of making better use of the money than we do at present. I am not sure if that answers your question.

Q 17

Photo of John Mason John Mason Scottish National Party, Glasgow East

My question is about how we deal with the fact that, as you said, every individual is different; if I understood you correctly, something like 50 per cent. of your folk prefer not to take control of the resources, 25 per cent. take full control and 25 per cent. are somewhere in between.

Paul Davies: That is our experience in Oldham.

Q 18

Photo of John Mason John Mason Scottish National Party, Glasgow East

Is that an ideal position or is the ideal to move to 100 per cent. control? What do you foresee? I assume that for some people choice is quite stressful and they do not want it. There is also the thing about the individual against the community. The example was of driving lessons against a day centre, and for some people getting the driving lessons would be right, but others might want the driving lessons, yet be better off in a day centre. Is that the case?

Paul Davies: That is a good question. I do not have an optimal position on the number of people we should end up with who choose to take the money and control their own services—if it is 100 per cent. then it is 100 per cent. The trick is demand management, which is perfectly possible. There is sufficient experience around now to judge who would prefer a more traditional service, such as a day centre; many elderly people in my area still choose that, but others prefer to take the money and do something different. If the experience is applied properly, it is sufficient to judge how the money works itself out and to ensure that one allocates the money and carries out the calculation accordingly.

You are right that choice is stressful for some people, which is why “choice” is the operative word. People are able to say, “Thank you very much, but I do not want to deal with that. I will tell you what my wishes are but please can you deal with it?” and we happily do that. One live example is that very early on in Oldham, somebody, who I think was taking the mickey, asked me whether people with substance misuse problems could have an individualised budget. The answer was yes, in principle, and, sure enough, eight weeks later somebody with a substance misuse problem came along and started managing her own money. She did that very well until her ex-partner came back on the scene and she said, “If my partner knows that I have money, he will make me spend it on drugs. Will you take control of the money and administer it on my behalf according to my wishes?” We did that.

On the stress and challenge issue, looking at mental health services across the country, it is no secret that they have—I would not say connived—co-operated in a system that is aimed at keeping people unwell, with no sense of “well-being,” which is a very important word. There is no expectation that people will come through their illness, to a greater or lesser extent, and find  themselves back in employment and living the same lives as the rest of us enjoy, as far as they are able. It seems to me that a system that does not take a view that we should be ensuring that everybody can maximise their potential does not work for folks.

On the physical delivery, everyone that I deal with needs support, by definition; the question is how much. That is what we are arguing over and what we need to put in to ensure that they can maximise their potential. These are the key elements. First, there is a need for traditional supply. Even in Oldham we have some traditional supply that some people choose, but it is more limited than it was and the services are completely different in complexion and character from those that we had four years ago. Secondly, as much as anything else it is about a will to win—a will to deliver and succeed and about putting that person at the centre to ensure that they are able to maximise their potential. I keep banging on about more direction rather than permissiveness because I think that a permissive arrangement for the agencies involved does not, on present evidence, seem to be delivering that aspiration in the way that I would like it to be delivered.

Liz Sayce: On the question whether it might be better for some people to be in a day centre, I do not think we can be confident that the one-size-fits-all supply models have been effective, either in terms of people’s satisfaction and quality of life, or in terms of other outcomes, such as the likelihood of people moving towards employment. On the latter, the evidence is variable, but there is no real evidence that attending a day centre or a sheltered workshop will help you on the path back to employment. It is often the reverse, actually—you get stuck there. Similarly, for the person who chose to go fishing rather than to a day centre, that was about preserving the activities that mattered to him with the people that mattered to him, given that he had developed dementia.

Although I agree that there is a role for traditional supply, I think it unlikely that it will be better for people. The evidence shows that, in terms of what enables people to get back into work, motivation is a key thing, so if you pursue something that really interests you, rather than going to a day centre and having whatever happens to be on offer, you are more likely to be motivated and encouraged. It is not rocket science that you are more likely to succeed in a job that you want to do, or that you are more likely to get a qualification for something in which you are interested. The evidence tends towards the suggestion that personalisation will deliver better outcomes, and that we do not need to be too worried about people choosing things that might not be as good for them as what went before.

Q 19

Photo of John Mason John Mason Scottish National Party, Glasgow East

I take your point that personalisation is generally better, but clearly some people will make the wrong decisions at times. On the example of substance abuse, it is tremendous that somebody actually recognised that there would be a problem if they had cash. I suspect that other people would not have recognised that. Are you therefore saying that people should not be proactive, or would you just allow them to make mistakes?

Paul Davies: All this comes into the issue of risk and whether we are able to proactively manage the risk associated with particular individuals, their own view of  choice and control, and what it is they want to deliver, as well as the risks to public money, safety and so on. There is in existence a perfectly well developed risk enabling tool that enables agencies to work with individuals—it is not a big, bureaucratic process—to assess what the risks are and what the outcomes will be for them, because as I said earlier, in adult social care it is conditional on delivering the outcomes. It is not a gift in that sense; there are outcomes to be had.

In Oldham, for example, we have a risk enablement panel. The panel has that title because its purpose is to enable risk rather than to avoid it in a bureaucratic sense. The panel ensures that the individual can have a discussion with the agency about the levels of risk, how the money is managed and how that is tied to their outcomes. As my colleague rightly said, if the outcome as far as an agency is concerned is that somebody should sit in a day centre, as has been the case, smoking their head off for the next 20 years, I am afraid that is not much of an outcome.

But if I may take the Oldham example again—it is the one with which I am most familiar—the risk enablement panel meets on a regular, if ad hoc, basis to discuss issues of risk that emerge from particular cases. The panel has three options: it can refuse the risk because it cannot live with it, it can agree the risk and state that it is absolutely fine, or it can agree the risk with certain changes. To my knowledge, in over 2,000-odd people, I think we have only ever refused about two plans. The individual—their carer or supporter can also be there—is part of a conversation with professionals on what that risk means to them, how it is managed and how they deliver the outcomes and aspiration in the conditional offer of money from the local authority. That is a way of developing the self-efficacy argument about people being part of taking control of their own lives as far as they are able and encouraged to do so. Having seen the alternative, particularly in the field of mental health services and vulnerable adults, which is statutory organisations trying to take a view on what is best for folks, we have ended up with an awful lot of people on incapacity benefit and not a lot of movement on that.

Q 20

Photo of Mark Harper Mark Harper Shadow Minister (Work and Pensions)

I have two linked questions for both of you. First, the Government’s analysis states that the right to control for these funding streams will be tested in a small number of authorities from 2010. It seems from what both of you were saying that the right to control individual budget process has been well tested in adult social care. You know what works in your authority and there are examples from across the country of what works. Does the Department need to pilot this stuff or should it be braver about trying to move faster?

The linked part of the question is this: clearly the Department and the Government will be nervous about going fast and having things not work, but there is a cost on the other side of going too slowly. If you get better outcomes for the people themselves and you spend public money better, particularly in the current climate where that money is very limited, there seems to be an incredible cost in going slowly: you are forcing people to get worse outcomes and you are spending public money more inefficiently. Given that the Bill gives the Secretary of State quite wide-ranging powers to make regulations, should he be brave and make regulations that apply to everyone straight away? Then authorities that want to go faster can, and we can put  pressure on. Or should the Department do what it plans to do—pilot this in a few authorities, potentially for up to three years? So another three years will pass before we see a great deal of progress.

Liz Sayce: Clearly it is very important that evaluation and learning take place throughout the implementation. In that sense the trailblazer notion makes sense. There will be learning as this develops about what works in putting these different funding streams together. We need to understand the outcomes. We need to understand the cost-effectiveness and so on. It is important that there should be an evaluative element. There is a question about pace and cost. One of the issues that has been raised with us is that it can be more costly to double-run different systems within a local authority or another public body. There is a risk that, out of a concern for affordability, we create an additional cost through the double running of different systems rather than moving as quickly as possible to the system that we want and learning as we go.

Disabled people want to ensure that the resources available are spent on choice and control and in the most effective way possible. It would be worth considering whether there is another option, such as making it clear that developments have to happen within a constrained budget. It is not about implementing programmes that will not be cost-effective, but without the in-built delay from the piloting. Pace will be important and we will look for pace. So yes, there are some questions about it.

Paul Davies: I can well understand why people would want to feel the comfort of a pilot and see how that worked; I just do not agree with it. There is more than sufficient evidence to justify going straight ahead.

I had a wry smile when I saw that there was provision for an exit strategy. If I were to go back to any of the people in Oldham who have an individualised budget and tell them that there was an exit strategy and that I would take it off them and put them back into the old system, I probably would not survive very long. There is very strong evidence that once people get control over their own services and choices, they value it incredibly and it makes a big difference to them. Secondly—this is significant in the context of public services—even where the outcomes are not quite as good as they thought they might be in the beginning, the sheer fact of having choice and control makes a big difference and increases enormously the level of what in another context is described as customer satisfaction.

I will be strong about this. If the intention is to give control to some of those people whose lives are currently being wasted because the system is not supporting them to get back into employment and they are not playing their full part as citizens and doing all the other things they need to do, the period that is being suggested is far too long. We need to make a start on this today. We have the experience and the background knowledge. There is no reason why there could not be some conditionality, as was implied, in terms of budgets and so on. I see no problem with that at all because that is not an unreasonable thing to say. It seems that the vision is fantastic but the route being suggested to deliver will not be fit for purpose, for the simple reason I have already suggested.

I come back to direct payments legislation. It was perfectly possible for a local authority to run two competing systems, a direct payment system and a traditionally  delivered system in adult social care, as long as the authority had the money to do so. When the spare money came to an end, people either could not continue to make those choices or had to wait a year until the money became available, because the existing money was already tied up in a system that was not delivering what was required. For some people it was delivering what was required; I am not knocking all traditional services and I would never say that the system is broken in that sense.

If the money is tied up in delivering one set of arrangements it stands to reason that you cannot then just unpick small parts of it on a piecemeal basis and take it away and do something different. There is a massive opportunity cost as well as a financial cost in running two different systems. Oldham mainstreamed its processes very early on, simply because it is impossible to get away from the logic of having to extend the system across all services. A pilot, and possibly a subsequent pilot, is being suggested. I hope everything I have said makes it clear that I do not think that fits the bill.

Q 21

Photo of Paul Rowen Paul Rowen Shadow Work and Pensions Minister

In Oldham, Paul, you have been lucky to have the co-operation of the primary care trust so you have a firm measure of control over community services and adult social services. That is not included in the regulations in this Bill. I am thinking of an example of a young man who went to university; we had to get everyone together on a Friday afternoon. The council had agreed its money; the university had agreed what it was going to do. The PCT was reluctant to finance the support that young man needed. Will people be able to get the lifestyle changes that they want without adult and community care control as well?

Paul Davies: I would say two things. The first is not as flippant as it sounds—the harder we work, the luckier we get. Secondly, in terms of the duty to co-operate between the organisations, you are describing a situation that I am familiar with from across the country. It is probably the thing I get the most phone calls about—people asking whether there is a better way to do it. It is a fine example of not being able to join the whole system together around that individual.

There is another stream of work to be done about the duty for other bodies to co-operate, not just in employment. It is back to the vision and everyone playing their part in that. As the regulations stand, it is perfectly possible that someone could be receiving an individualised social care budget and, as their health deteriorated, move into a continuing health care arrangement but then find that they had lost all choice and control in that arrangement because the funding was coming through a health stream. There is good work going on in the health stream, looking at integration, but that is only in the health stream.

Q 22

Photo of Paul Rowen Paul Rowen Shadow Work and Pensions Minister

Should a duty to co-operate be included in the Bill?

Paul Davies: I would say so; yes.

Q 23

Photo of Sir David Amess Sir David Amess Conservative, Southend West

We seem to have exhausted our questioning, so before we thank you, do either of you have any final thoughts that you wish to leave these parliamentarians with, to have in the back of their mind as they go on to consider the Bill?

Liz Sayce: Access to Work is a very successful programme and brings back about £1.70 for every £1 spent on it. The recent announcement that the budget for Access to Work is to be increased is very welcome, but the programme has not delivered equitably for all disabled people. In particular, it has not worked so well for people with a fluctuating condition or a mental health condition. There is a real imperative to use that additional resource, ideally to make the support into work an entitlement. The support should be on offer as part of the quid pro quo: you will take responsibility for taking up employment, if you are able to, and the Access to Work support should be there, and more equitably so. In the White Paper there were welcome references to improving these services for people with fluctuating conditions, including mental health conditions. It is a very cost-effective programme and the more that can be done to make it available to everybody who really requires it, on an equitable basis and almost as of right, the better.

Paul Davies: I have a couple of things to say. My first point echoes that last point. Our experience in adult social care with people with fluctuating conditions is that everybody is assessed as though they were on their worst day—that is the way things work. Everyone is not always on their worst day, but they are assessed as if they were. There is not then the flexibility to deal with changes in the condition, to be able to roll forward money or take money from a forthcoming arrangement. That is very much a self-service model, and one that works for people and reinforces the choice and control. It is also a more efficient model, as any self-service catering arrangement demonstrates. So I think there is room for making all this work in a way that reinforces what I will say next.

Through absolutely nobody’s fault, we have socially excluded lots of people in this country over the years, as much because of systems as anything else, and this is a fantastic opportunity to link up the various systems and ensure that they all play their part in delivering the vision for the individual, which I know is shared around this room. It is the right moment to do it. If we do not do the things that I and my colleague have spoken about, we will end up with a lot of people who never get to maximise their full potential.

My experience in Oldham—this is also the experience elsewhere in the country—is that everybody has something to contribute, and enabling them to contribute brings to fruition all the things that we all want. If we insist on keeping people at home and on benefits, we are losing a marvellous opportunity to get people to play their full part in our society.

Photo of Sir David Amess Sir David Amess Conservative, Southend West

Thank you both very much for your time, for your evidence and for how you have responded to questions.

Q 24

Photo of Sir David Amess Sir David Amess Conservative, Southend West

I welcome our two witnesses from DrugScope, Dr. Roberts and Mr. Barnes. Would you introduce yourselves and explain who you are?

Martin Barnes: I am the chief executive of DrugScope and have been with the charity for nearly five years. Prior to that, I was the director of the Child Poverty  Action Group, so I find it interesting that we have the benefits side and the drugs side coming together on this issue.

Dr. Roberts: I am Marcus Roberts, the director of policy at DrugScope. I have had two stints at DrugScope, between which I was head of the policy and parliamentary unit at Mind, the mental health charity. I have also done a stint at the National Association for the Care and Resettlement of Offenders, so those previous posts give me an understanding of crime, drugs and mental health.

Q 25

Photo of Sir David Amess Sir David Amess Conservative, Southend West

Before colleagues ask questions, I invite you both to make a statement reflecting on the Bill. It does not matter how long you take.

Martin Barnes: Going back to the publication of the new drugs strategy last February and its commitment to improve drug treatment effectiveness and the outcomes for problem drug users, we welcome what is very much a new and positive emphasis on the importance of reintegrating people who are in or completing treatment. Linking the drugs strategy with the Government’s wider agenda of tackling worklessness, social exclusion and poverty was a welcome development. With regard to the Bill, clearly we strongly support the commitment to provide more support for problem drug users, particularly those in treatment.

DrugScope is a membership body for people who work in the drugs field or similar professions and basically share a common goal to minimise drug-related harms. We consulted extensively on the Bill’s proposals, as they appeared in the Green Paper in the summer, and there was universal welcome for the commitment to help problem drug users to reintegrate themselves and to provide more support through the benefits system for them to engage with training and employment.

However, there was considerable concern about the conditionality that linked the requirement to undergo treatment with the benefits system, and some of the initial proposals intended to enable the Department for Work and Pensions to identify problem drug users. There were considerable concerns about some of the initial proposals set out in the Green Paper, some of which have now been abandoned, particularly the proposal that it would be a condition of benefit to declare whether you were a crack cocaine or heroine user. We are pleased that that has not progressed.

It would be fair to say, however, that many of our concerns remain, and those come from members who work with problem drug users day in, day out. Some of our members who deal with the more challenging and marginally socially excluded members of our community were concerned about the various proposals on identification, the sanctions requirements, and the idea that they would have to undergoing drug treatment at the risk of benefit sanctions.

Dr. Roberts: I do not have much to add to that, but would like to underscore a couple of points. The commitment to get more problem drug users into work and help them along the path to employment is really welcome, but it is important to be realistic about the barriers that prevent many such people getting into employment. The range of barriers includes problems with skills and experience of work, problems with CV gaps and poor employment histories and problems with employers’ attitudes—that can be described as stigma,  but it is more generally about employers having anxieties about working with that group. That is why some of the material in the Gregg review, about recognising that there are people in the benefits system who should not simply be abandoned and written off, but are none the less quite a long way from a place where they could step into mainstream employment, is important. The issues about how we support that group are really important, but also quite thorny and tricky and need some thought.

Not only do we have problems with the impact of the sanctions regimes, but it is also quite likely that a system that was better at encouraging people to voluntarily disclose drug problems, which included a promise that, if they did, they would get proper support, encouragement and help, could more effectively identify people and bring them forward in ways that engage them more productively with treatment services than the stick of sanctions. On that point, the Government’s voluntary progress2work programme, which I think has been running since 2001, is linked to jobcentres and helps problem drug users to get into training and work and provides assistance on issues such as housing and debt. We would like to see that work being built on, and would have liked to see more evaluation and thought about the effectiveness of that approach being fed into the Bill.

Q 26

Photo of Meg Munn Meg Munn Labour, Sheffield, Heeley

In the last session, we heard about the importance of organisations working together to look at the range of issues for people who are considering getting back to work or getting into work for the first time. I assume that we would say exactly the same things about drug users: it is not about one part of their life, but about the whole range—it is about accessing treatment, accommodation issues, other health issues and Access to Work. Are you saying that there are things in the legislation as drafted that would prevent that? Are there things that we should be more directive on, as Mr. Davies said in the last session? There are sanctions, which seem to be the right thing at some point, but are there other ways in which the Bill could be improved to deliver the services to assist people?

Martin Barnes: The measures in the Bill specific to problem drug users, clause 9 and a new schedule, do not articulate what the positive support for problem drug users will actually be. The proposed legislation talks about things such as the identification requirement; the requirement to attend an interview; referrals for a substance misuse assessment; information sharing with the police, the probation service and others; the fact that a rehabilitation programme can be imposed on a claimant; and the fact that somebody can be directed to attend a specific place or institution for treatment. The Bill does not articulate what Ministers have described as the vision and aspiration to provide more support for problem drug users. That is the part of the Green Paper and the drug strategy that we welcomed and support, hence our concern about the Bill as it currently stands. There are other elements of the Bill that give the Secretary of State powers to provide additional financial support for certain people, such as those on jobseeker’s allowance. We do not have any similar provisions specific to problem drug users.

There are already some fairly positive developments under way. You are probably aware that the Department of Health is funding what are called drug co-ordinator posts. Every jobcentre district in England will have  dedicated staff who will work with local partners to encourage better understanding and good practice in the DWP and will very much become an additional resource in terms of building local partnership and planning. The National Treatment Agency for Substance Misuse recently published new guidance to encourage and support better commissioning practice on supporting problem drug users on to the various pathways to access training and employment. But that is quite top-level; the difficulty is getting the partnerships and planning happening on the ground, and inevitably, that often comes back to the question of resources.

If the aim of the Bill is delivered in terms of identifying more problem drug users through the benefit system and trying to get them into treatment, that will clearly put additional capacity pressures on the drug treatment system. Although we have seen significant increases in investment in drug treatment, which has been very positive and cost-effective and is showing positive outcomes, the pool treatment budget for the next three years is frozen in cash terms. Furthermore, the spend per person on drug treatment has been falling, and although efficiency savings—as they are inevitably called—can no doubt be found, at a time when drugs services and their partners are rightly expected to do more for problem drug users by helping them into housing, training and employment, the resources available to do so are actually falling in real terms in many areas.

Dr. Roberts: May I just make three very quick points on why the Bill might not help in accessing some of that other support?

First, a lot of the Bill is about getting people to disclose problem drug use, because if they disclose that they have a drug problem they can be helped and supported. I think it is important to contextualise that, because people’s experience will be that disclosing drug problems is a consistent barrier to their accessing support, whether it relates to housing or employment. It is important to be aware of the reasons why people might be reluctant to disclose.

Secondly, and more directly, I think that one impact of benefit sanctions could be damaging to some of the recovery capital that people rely on in a very direct way. For example, we recently held a seminar to discuss such issues with Adfam, a charity that works with the families and carers who work with drug users. Its concern was that, where benefit sanctions are applied, families, parents and so on will quite often pick up the financial slack. That could damage the supportive family environments that can help people get their life back on track.

My last point is a more general one about the political discourse. If you have a political discourse that portrays drug users on benefits as people whose primary problem is that they are not sufficiently motivated and may need to be sanctioned into actively seeking work and help, that creates a picture in the eyes of employers and others who might provide things like housing that does not speak positively of this group.

Q 27

Photo of Meg Munn Meg Munn Labour, Sheffield, Heeley

I am sorry; are you saying that people currently have a very positive image of drug users and that the Bill will make it worse?

Dr. Roberts: No; I am not. I am saying that people currently have quite a negative perception of drug users, and that that in itself is a substantial barrier to their  accessing things such as work and housing. If we are serious about getting that group socially included and into work and support, part of what we need to do is to help remove some of those perceptions, or work with people in ways that support them to engage more positively with that group.

Q 28

Photo of Meg Munn Meg Munn Labour, Sheffield, Heeley

I am not quarrelling with you about that general aim, which is clearly the aim of the legislation. I am saying that I do not see that the sanction conflicts with that. The sanction is a mechanism for encouraging motivation and allowing people to access support and move forward, rather than something that centres on how a drug user may or may not be seen more widely.

Martin Barnes: There has been a concern about the proposals to link benefit entitlement with the requirement to undertake treatment. Our understanding is that it was inserted into the drug strategy document quite late on. I remember having a conversation with an official at the Home Office and getting an off-the-record briefing on what was likely to be in the document. When I was told that it would include a proposal to reform the benefit system to introduce that form of conditionality, I remember saying to the official, “You do realise what will dominate the press coverage on this?” The official responded by saying, “No, there is lots of other stuff in here; it is about positive investment in drug treatment.” On the day that the strategy was published, however, most of the coverage given to the new strategy was on precisely this proposal, with headlines such as, “benefit addicts to lose benefits,” which created and reinforced the idea of being “tough” on what is—yes—an extremely unpopular and often very stigmatised and stereotyped group.

Similarly, when the Green Paper was published, we were informed that there had been a lot of effort, by some Government Departments who had a stake in this agenda, to ensure that the press were not directed towards those measures specific to problem drug users. While I take the point that there are quite specific and precise issues about how the sanctions may, or may not, motivate problem drug users, the Bill and these proposals also need to be seen on a wider canvas. Unfortunately, there is a concern that the driver for the proposals is partly either that it plays well to certain sections of the media gallery, or that it could act as a lightning-rod to focus attention on this particular unpopular group, rather than other aspects of the Bill. That is a legitimate concern that we have had, reinforced by the way that—as we understand it—this issue has been played to the media by the Government. It also is a concern among many of our members who can, first-hand, confirm how stigma and stereotyping can be a genuine barrier to people in drug treatment accessing basic support and services, whether it is housing, training or the reluctant attitude of employers.

Q 29

Photo of Meg Munn Meg Munn Labour, Sheffield, Heeley

So is it your position that there should never be any sanctions in relation to benefits for drug users?

Martin Barnes: Problem drug users who are claiming benefits are already as potentially likely to be sanctioned as other claimants for JSA. For example, from April—

Q 30

Photo of Meg Munn Meg Munn Labour, Sheffield, Heeley

No, I am not asking about what is happening. I am asking whether the position of your organisation and your members is that there should not, ever, be sanctions in relation to drug users.

Martin Barnes: To be more precise, I do not think that the evidence is there and it is not just our view, but also that of the UK Drug Policy Commission, which has recently done a lot of research, exploring the barriers for problem drug users trying to access training and employment. The evidence is not there to show that the use of sanctions and compulsion, in terms of the requirement to undergo treatment, will actually be effective.

Q 31

Martin Barnes: We do oppose the proposals for sanctions that require people to declare their problem drug use and whether they are receiving treatment—I could explain in more detail our concerns about that particular proposal—the requirement to undergo a substance misuse assessment and the requirement to undergo drug treatment as a condition of receiving benefit, as it is currently framed in the legislation.

Q 32

Photo of Meg Munn Meg Munn Labour, Sheffield, Heeley

We are not clear about whether you have answered to the question. My question is whether there are any circumstances in which drug users should be sanctioned, in terms of their benefits.

Martin Barnes: As I said, a problem drug user can currently be sanctioned for a number of reasons within the benefit system. The question you are posing is not one I can give a yes or no answer to, because unless you are precise in where that sanction might apply—

Q 33

Photo of Meg Munn Meg Munn Labour, Sheffield, Heeley

So you would admit that there are circumstances where it might be appropriate to sanction?

Martin Barnes: Yes, because currently if a problem drug user is not fulfilling the actively seeking work requirement of the JSA, or attending interviews when required to do so, they can be sanctioned—as can any other JSA claimant. Problem drug users are not being dealt with as some exceptional group within the benefit system at the moment. The difficulty is that they are often invisible within the benefit system and do not get the help and support they require. That is why we support that commitment to provide better support for problem drug users. We have serious concerns about the proposals in the Bill.

Q 34

Photo of Mark Harper Mark Harper Shadow Minister (Work and Pensions)

That was helpful clarification. First, by way of preamble, one of you mentioned progress2work. I visited the service that is delivered by Turning Point in Cardiff. I talked to some of the staff and clients. I got some flavour of the complexity of getting them either into work or back into work. I support what you said on that.

Following up on the point made by the hon. Member for Sheffield, Heeley, if someone is on out-of-work benefits because of their drug or alcohol problem, why should they not have to seek some treatment for that problem if it is the barrier to their getting into work? Certainly those looking from outside, those who work and pay taxes, cannot see why someone whose problem relates to their drug or alcohol abuse should continue to get taxpayers’ money if they are not willing to take some steps to sort that problem out. Why should they not be required to sort it out? I will ask you in a moment about the extent to which that treatment is available and the capacity. But in terms of the principle,  is your objection to compulsion and threatening to withhold benefits if they do not undergo treatment philosophical or practical? Is your view on that driven by what you think the practical outcomes will be, or do you think it is wrong in principle?

Martin Barnes: I think it is primarily on the practical issues, but there is also a wider concern. I have had conversations with the chief executive of a leading mental health charity, who has concerns about these proposals because of the potential for them to be extended to other groups. Why not, for example, require a person whose main barrier to work is perceived by the DWP as being a mental health problem to undergo appropriate treatment to reduce or sort out that mental health problem if that is indeed the main barrier to work? That is a genuine concern expressed to me by a chief executive of a mental health charity.

The main route to drug treatment tends to be voluntary. We have seen a significant expansion through the criminal justice system and the drug intervention programme to try to get people who have tested positive for a class A drug into treatment. Indeed, we supported that. The Bill is taking that much further. For the first time the state will require someone not just to engage with an adviser and have an assessment for drug treatment, but to undertake drug treatment as a condition of getting benefit. At present, that type of requirement can only be imposed under conditional bail requirements. A person can be required as a condition of bail to attend for drug treatment or, if they have been charged, sentenced and convicted, the sentence could include a requirement to undergo some form of drug treatment. The context of that is quite different from what is proposed in the Bill: to require somebody to undergo drug treatment as a condition of getting their benefit.

I am told by the NTA that 80 per cent. of drug services are delivered by the NHS or by third parties it has contracted to deliver. The NHS constitution says that you have a right to accept or refuse treatment that is offered to you and not to be given any physical examination or treatment unless you have given valid consent. I suggest that such consent can only be valid and only truly consensual where it is not made in the context of otherwise possibly losing benefit, with all the consequences of that.

The NHS constitution also says that you have the right to privacy and confidentiality and to expect the NHS to keep your confidential information safe and secure. I suggest that that is not compatible with the requirement in the Bill to answer questions either about your drug use or about whether you are in drug treatment. The constitution also says that you have the right to be involved in discussions and decisions about your health care. I suggest that that is not compatible with the power of the Secretary of State to impose, as set out in the Bill, a requirement to comply with a rehabilitation plan and to be directed to a place or institution that provides drug treatment. As the Bill is worded, that direction can mean that somebody is required, for example, to be a resident in a place that provides residential rehab. That will or may specify not just that somebody has to undergo drug treatment, but potentially the form of that treatment as well. How can that be compatible with what the Government reasonably have set out for every patient in the NHS constitution?

Q 35

Photo of Mark Harper Mark Harper Shadow Minister (Work and Pensions)

Dr. Roberts, do you want to add anything?

Dr. Roberts: The point is one of effectiveness rather than principles. There are both sorts of points. People will be identified and pushed forward through the investigative process set out in the Bill, which might include their initially being interviewed, and at some point having to submit to a drugs test, and the police perhaps being requested to provide information about them. Is someone emerging from that process likely to form a productive and constructive therapeutic relationship with the treatment service? Developing a system that is more effective in incentivising voluntary disclosure has more potential to engage more people in effective therapeutic relationships that will address their drug problems and help them back into work. I think that does speak to the issue about sanctioning, because anything that offers a positive incentive inherently has a stick attached to it. People who do not go down that route do not get the benefits associated with it, which might for example include, under the treatment allowance proposals, their not being required to abide by the normal job-seeking requirements for a period of time, to give them some space and time to focus on getting their drug problem under control. That, for me, is a carrot that can pull people into a voluntary form of disclosure and get them involved, which is likely to be more effective than a stick, although neither of those mechanisms will identify everyone who could benefit.

Q 36

Photo of Mark Harper Mark Harper Shadow Minister (Work and Pensions)

Given that you focus on the practical, what would your response be to the man in the street who does not think it right that he has to go to work and pay taxes to fund benefits for someone whose primary reason for not going to work is a drug problem and who is not willing to do something about it, when the man in the street can see that continuing for year upon year? How do we, as politicians, say to that person, “That is okay”?

Martin Barnes: I can understand the issue that you have outlined. The difficulty is the way that the DWP is attempting to address that in the Bill; that is where our concern lies. There are a number of ways in which people can be required to access drug treatment, as I have mentioned, not least through the drug intervention programme. If you have somebody in that situation who is not willing to engage with drug treatment, it is first important to understand why. Some people have had quite bad experiences of the treatment system and that might well be echoing around now, informing their perception of the support and help that is available. It is also important to understand the problems, barriers and difficulty that many problem drug users face. Addaction, for example, consulted many of its service users who are parents, and they expressed the concern that their children would be taken away if they declared their problem drug use. Some drug services are simply not sufficiently geared to supporting younger people, women or some people from black and minority ethnic groups, for example. So, it is not as straightforward as somebody just being reluctant to undergo drug treatment. There might be reasons why that person is in that space at that time, but has the DWP tried the supportive, voluntary approach? We do not have evidence of that unless it is particular schemes such as progress2work, which has been shown to be incredibly effective as a voluntary programme for getting problem drug users into training and support.

The other question is whether treatment will be successful if the person is of the mindset that they do not want to engage with drug treatment. If the motivation and the support structure are not there, the chances are that the person might well drop out of the system or relapse at an early stage. Part of the difficulty with the Bill and these proposals is perhaps a lack of understanding and appreciation of the sheer complexities, not only of supporting problem drug users but of how nuanced, sophisticated and varied drug treatments sometimes need to be to achieve the desirable outcomes.

Coming back to asking the man in the street, when the Government consulted on the drugs strategy I got no sense that people were banging on the door to say that they were concerned about the number of problem drug users on benefits. [Laughter.] You might laugh, but that did not come through in the consultation. Can I come back to the point of why you laugh? Probably because you pick up the attitude to problem drug users. Take yesterday’s headline in The Daily Telegraph.

Q 37

Photo of Meg Munn Meg Munn Labour, Sheffield, Heeley

Could we just be clear? I have estates in my constituency which periodically suffer a great deal as a result of people who have problem drug use. These are the people—Mark talks about the man or woman in the street—who come up and ask these questions. They are not the people who are going to respond to a consultation, but I can assure you this is an issue that most Members of Parliament will at times come across and people will raise it. To suggest that people do not think this is a problem is wrong. We are not raising this because we see it in the media; we are raising it because we see it on the streets of our constituencies.

Martin Barnes: The issue you are highlighting is an entirely right, fair and appropriate one and that is why it is right that the Government are putting the investment into the drugs strategy and particularly into drug treatment. We need to support, defend and make the case for drug treatment because it has been attacked unfairly and unreasonably in the media and some politicians have also unfairly and unreasonably attacked the drug treatment system, claiming that it is not effective and that it is a waste of money. The tangible benefits are there and we know we can do more to improve them. That is a commitment from the Government, from the NTA and from our members. It is symptomatic of a wider issue because perceptions about drug use are slightly on the increase.

The Government see this as a problem because, despite the rightful investment in the drugs strategy and treatment, public perception of the problem is going in the other direction. I am not saying at all that people do not perceive problem drug use as something to be tackled. The question—and it is your role to ask it when you come down to the specifics of the Bill—is whether this is the right way forward. The powers that are currently given to the Secretary of State and the DWP to make that link between benefit claim and attending treatment is what we have concerns about. We do not have any concerns about trying to tackle the problem of drug use in this country and particularly getting more people into treatment, better treatment and aftercare.

Q 38

Photo of Mark Harper Mark Harper Shadow Minister (Work and Pensions)

Let me give you the opportunity to say something about treatment and the capacity to deal with a large increase. The reason people are concerned—it was probably the genesis of the story you were about to refer to—is not out-of-work benefits but disability living allowance. You have portrayed a background over the last few years of increased drug treatment availability but over that period there has been a fourfold increase in the number of people claiming disability living allowance whose main reason for claiming has been alcohol or drug addiction. If treatment is increasingly available but there are more people claiming benefits as a result of their drug addiction, there is clearly a problem getting people to access that treatment. If we accept, for the sake of argument, that the Bill is effective—I know you do not think it will be, but let us assume—and there is a significant increase in the number of people on out-of-work benefits or DLA wanting to access treatment, what will they find? Is there sufficient capacity and treatment available across the piece? When they put up their hand and say, “Actually, I’d like to get my drug or alcohol problem sorted out,” will they find that there is no help available?

Martin Barnes: I will answer that, I promise, but first I want to comment on the apparent increase in the number of problem drug users claiming benefits. I do not think that we know why there has been an apparent increase. On one level it feels counter-intuitive, because drug use, overall, is falling and the number of problem drug users accessing treatment has significantly expanded—it has doubled over the past five to six years. In part, it might be that because people are engaging more with services, they are prepared to admit and confront their problem drug use, but again I do not have evidence to support that. You made the point that those numbers also include problem alcohol users, so we need to unpick what proportion of that increase in claimants are problem drug users, who are heroin and crack cocaine users for the purposes of the Bill, and what proportion use other substances.

Q 39

Photo of Mark Harper Mark Harper Shadow Minister (Work and Pensions)

The Bill tackles both. The powers in the Bill are not only for illegal drug use; they are also for alcohol.

Martin Barnes: That is right, but the initial intention is to prioritise crack cocaine and heroin users. The other point in the context of benefit claims is that a significant proportion of problem drug users also have other problems, not least mental health problems. The main reason for the benefit claim might be an identified drug problem, but there could well be other reasons contributing to that person’s inability to work, not least mental health problems. Some estimates suggest that up to 70 per cent. of people in drug treatment also have some form of mental health problem.

To answer your question about what a problem drug user would find, we have seen waiting times significantly reduce. I think that there is now an average wait across the country of three weeks, and there has been a very significant increase in capacity in the treatment system, but it is fair to say that it is variable. In some parts of the country, retention rates and waiting times are particularly good and improving, but in other parts of the country waiting times are longer and retention rates are not quite as good, so variability is still an issue.

If the proposals go ahead, it is difficult to predict how much additional capacity we would be talking about. The impact report suggests a very upward figure of anything around 60,000 people a year, but that is on the high side; it would effectively be a 40 per cent. increase in the number of people accessing drug treatment. With current resources and investment, and likely resources and investment over the next two to three years, I cannot see how the system could cope if that number were achieved, but as I said, I think that it is unlikely.

Q 40

Photo of Mark Harper Mark Harper Shadow Minister (Work and Pensions)

So you are saying that if the measures in the Bill are enacted and are successful—let us assume that they will be, because that will be the Department’s argument—the problem will be that, unless something changes, the treatment will not be available for the people that you identify as problem drug users mandated to access treatment, because of that significant increase in demand?

Martin Barnes: What may happen—and it is worded this way in the impact assessment, which addresses the question of resourcing—is that the Department of Health will achieve it through “reprioritisation” within the system. That increased capacity might be dealt with by the people who are referred via this route jumping to the front of the queue. That is what I understand by reprioritisation.

Q 41

Photo of John Mason John Mason Scottish National Party, Glasgow East

I have a couple of points. The first concerns children and child poverty. You have mentioned the possible effect on families of a sanctions regime. One suggestion was that the wider family could pick up the slack, which might suggest that the children themselves just carry on. It is always a difficult decision with children when one of the parents is a drug addict: do you leave them with the family, at a certain amount of risk, or do you take them into care? Have you done any work on the effect that that might have on children? Would more children be taken into care?

Martin Barnes: It is difficult to say, because we have not done any particular work or research on that. If a family on a low income have their benefit reduced, it is intuitive that that can have significant and serious negative consequences. With regard to children who live with parents or adults who are problem drug users, that is an area that the Government have given a particular commitment to in the drugs strategy. It is now six years since the Advisory Council on the Misuse of Drugs published its report, “Hidden Harm: Responding to the Needs of Children of Problem Drug Users,” which really put the issue on the policy agenda. It estimated that about a third of 1 million children might be in that situation, and in many respects they are vulnerable, and it is right that the Government have given the issue a higher priority than it had before the drugs strategy was published.

However, I cannot see how benefit sanctions, which remove benefits and reduce income, can have anything but negative consequences for the well-being of the family and the children. I understand that witnesses from the Child Poverty Action Group are giving evidence to the Committee this afternoon, and they will no doubt talk more widely about the potential impact of sanctions on child poverty and the welfare of families.

Q 42

Photo of John Mason John Mason Scottish National Party, Glasgow East

You said earlier that many problem drug users have underlying problems, which might relate to mental health or be much more general. It seems to  me that there is not much point in getting a person off drugs if you do not deal with the underlying problem, because they will just go back to drugs, alcohol or gambling. What is your experience of the time scales for people working through some of those problems?

Martin Barnes: If someone has been a long-term heroin user, the experience of our members suggests that getting that person, ultimately, drug-free can take several treatment interventions and could take six to seven years on average. There is no silver bullet for long-term, problematic drug users. It is the case that many problem drug users have other underlying problems, issues and needs, and they can be the most complex of the complex groups. I have mentioned mental health problems and poor physical health, and many of them will probably have had difficult experiences in the past, perhaps in childhood, which could have been significant contributing factors to their problem drug use.

Unemployment and poor housing are also important to consider. Homeless Link, for example, in its submission to the Green Paper, suggested that problem drug users are seven times more likely to be homeless, and low self-esteem and poor numeracy and literacy skills are also factors. In 2004 the National Audit Office published what was then really a watershed report, which stated that the role of drug treatment was not just to treat the substance, but also to deal with the wider needs of the person. That report was very much the catalyst for taking forward what is now more widely called the treatment effectiveness strategy. It is not only about addressing the misuse of the substance, but about looking at the wraparound aftercare support in order to achieve a successful outcome in drug treatment. If those underlying issues are not addressed, the chances are that you are keeping in place the factors that could lead someone to relapse later.

Dr. Roberts: I agree with much of that. Another relevant point is that under the Bill’s provisions people will be required to comply with treatment, and there is an issue about how you address the fact that most people’s journey out of a serious drug problem will naturally involve periods of relapse. Underlying the Bill there seems to be a view of treatment that sees it as a fairly short-term and straightforward process, but the challenge is in how you accommodate the rest of the structure to those long-term, complicated treatment journeys.

Q 43

Photo of Paul Rowen Paul Rowen Shadow Work and Pensions Minister

I have two questions. The first goes back to the issue of resources. We are told that there are 240,000 addicts on benefits. What proportion are currently getting treatment, and what would be the additional cost, in your view, of getting everybody on a course of treatment—if all 240,000 were to be put through the system?

Martin Barnes: These estimates are, in turn, based on estimates, so there is a question about how robust the figures are. The estimate is that about 100,000 of the 240,000 are not currently engaged with drug treatment services. According to NTA estimates, of the problem drug-using population as a whole, around one third of a million people are using heroin, crack or both. Some 60 to 70 per cent. of them are engaged with drug treatment in some form.

To answer your question about the likely cost, I must admit that I have not done the calculation.

Q 44

Photo of Paul Rowen Paul Rowen Shadow Work and Pensions Minister

The Government have not either. That is why I am asking the question.

Martin Barnes: Let us say that we try to get those 100,000 people into treatment. We could take a bold approach and try to get them all in at the same time. Considering that, at the moment, 200,000 people a year access drug treatment in England, to increase the capacity by another 100,000—these are very much back-of-the-envelope calculations—I would suggest at least a 50 per cent. increase in drug treatment funding, and that is based on the current level of provision. As I said earlier, the opportunity as well as the challenge at the moment is to make treatment even better, to make sure that people stay in longer and that we get people genuinely completing the treatment journey, and to link up with issues of housing, training, employment and support.

The drug treatment system is doing a good job, but it is now trying to do more with less money over the next couple of years. In real terms, the full treatment budget will be frozen. Obviously other funding can come in locally, and the spend per person in treatment has actually been going down, largely because of the increase in capacity. A lot of work is being done on the cost and effectiveness of treatment, and it is starting to deliver, but to return to your point, getting 100,000 people into the treatment system simply could not be done on the current level of resourcing if we want the outcomes that I think we want. Obviously, 100,000 is a ballpark figure.

Q 45

Photo of Paul Rowen Paul Rowen Shadow Work and Pensions Minister

This is a slightly different question. There is a group of drug addicts who are addicted to tranquilizers. Do you have an estimate of the numbers who have been put on treatment through no fault of their own? Again, what kind of support would be needed if this regime were to be implemented for them?

Martin Barnes: The focus, as intended, is primarily around heroin and crack cocaine users. Even those problem drug users could be misusing other drugs as well, not least alcohol. Obviously, drug treatment services try to engage with and respond to the issue of polydrug use—people misusing a range of different drugs—but that can be particularly difficult and challenging.

I do not know the answer to your question about the number of people who are misusing or dependent on tranquilisers, and it might be quite difficult to get evidence. The all-party group on drugs misuse recently published a report about the misuse of prescription and over-the-counter drugs, and one of the points that it made is that we simply do not know enough about the extent of dependency on prescribed drugs and medicines that have always had a legitimate use. What we do know, particularly from the evidence that was given to the all-party group’s inquiry, is that people who have a problem with the misuse of or dependency on such drugs often find it very difficult to access treatment and support.

One difficulty is that investment in drug treatment has been largely driven by the link with crime, and the focus is still very much on heroin and crack cocaine users. People, particularly adults, who have problems with other drugs, not least alcohol, do not always access the help and support that they need. There is often lack of support and provision for stimulant users and those who misuse drugs such as amphetamines. A drug that is not of particular concern at the moment, because, thankfully, its use is still quite low level, is crystal meth. There is an issue about the range of support that the existing capacity of treatment services can provide.

Q 46

Photo of Peter Lilley Peter Lilley Conservative, Hitchin and Harpenden

I apologise for slipping out, and I hope that my question was not asked in my absence.

When you argued your case and raised doubts about the element of compulsion and sanction in the Bill regarding drug users taking treatment, I was struck by the fact that you essentially based it on speculation about adverse outcomes, just as the Government and most of my constituents probably base their case on speculation about users and benefits. Are there any studies from countries such as Sweden that have used a more coercive approach that suggest that there is a beneficial effect when people are required to take treatment—the element of requiring people to take treatment is now built into the criminal justice system? Clearly, as far as my constituents are concerned, if the system is going to work, they have no compunction about requiring people to take treatment.

Martin Barnes: We do have some evidence in terms of an evaluation of the impact of measures in the current drug intervention programme. It is fair to say that there is not enough research, and in some respects, particularly regarding the impact of drug testing on arrest and the required assessment, evaluations on reducing reoffending are not as positive as you would expect.

The proposals in the drug intervention programme are that people may be required to undergo drug treatment as a form of community sentence or penalty. I think the evidence shows that outcomes can be at least as good as those for people who have entered the treatment system voluntarily. There is a difference with these proposals. I am not aware of international evidence, although there might be some in the United States, given its welfare structure, but is linking benefit conditionality and the requirement to undergo treatment likely to be effective?

We welcome Ministers’ commitment that this is about support—we think that the commitment is genuine—but when you come down to what is in the Bill and the actual powers that will be given to the Secretary of State and the DWP, we and many of our members have concerns. This comes back to what I said earlier and the new stuff from the NHS constitution. At the end of the day, drug treatment should be seen as therapeutic. The relationship between the person in treatment and the key worker is more effective when there is a genuine therapeutic relationship. Introducing compulsion, coercion, information-revealing requirements, or undermining confidentiality, at least as perceived by the problem drug user and their key worker, suggests that you could undermine the therapeutic relationship and, potentially, the effectiveness and outcome of that drug treatment.

You mentioned resources, and if we try to force people into drug treatment through such an unproven route, there is a question of whether it will be effective in terms of not just the outcome for individuals, but the impact on treatment services, and the time, resources and energy that the DWP will put in. Voluntary approaches, the evaluation so far, and progress2work show that it is possible to engage people constructively, not just in treatment, but in helping them into training and employment.

I should like to mention two other aspects on which a lot of research has been done. The National Institute for Health and Clinical Excellence recently published guidance saying that contingency management approaches—it is a horrible term, but it is what is used—where essentially you are trying to incentivise  somebody to take part in drug treatment, can have tangible and positive outcomes. That was reported in the media as given problem drug users iPods, which was absolute nonsense; it is about acknowledging in some way the progress that is being made. Research shows that people in treatment or considering treatment respond effectively to voluntary motivational triggers and supporters.

The other issue, just in case there is not time to deal with it at another point, is that much as we support the commitment to help problem drug users into training and employment, we also need to address the supply side—the reluctance of many employers to recruit and employ problem drug users when the problem is known. We are concerned about confidentiality in respect of these proposals and the way in which that could have an impact on not just criminal proceedings and the safeguards there, but, perhaps, the well-being of problem drug users in other contexts or civil proceedings.

Research shows that some 60 per cent. of employers will not want to employ somebody with a past history of problem drug or alcohol use, so giving a commitment to this group could be a way to start tackling issues involving stigma and barriers to employment, including the reluctance of employers. Equally, if employers are being encouraged to employ problem drug users, but perceive that a person is essentially motivated by the stick rather than the carrot, will they be any more likely to take them on knowing that they have a history of problem drug use? They want to see somebody who has demonstrated that they are motivated and committed to tackling the problem. The research shows that problem drug users can end up as very good employees once they are given support and such opportunities.

Q 47

Photo of John Baron John Baron Opposition Whip (Commons)

May I press you on resources, Mr. Barnes—you are in demand at the moment? Although I accept that the estimates are not precise, if the Bill becomes law, you could have up to 100,000 additional addicts seeking treatment. We have discussed the limitation on resources. As the resources are presently constituted, can you give us your best guess—I know this is a difficult question—as to how many extra addicts could be treated?

Martin Barnes: Oh, gosh. That is a very difficult question to answer. Also, the situation varies, because some parts of the country are being allocated additional resources within the pooled treatment budget as an attempt to enable more people in the local area to get into treatment. Some areas are seeing decreases in resources, and projections for the next two to three years show that some areas could see a reduction in pooled treatment funding of anything from 20 per cent. to 30 per cent. The issue of resources is therefore increasingly localised. In terms of what the system currently can cope with in respect of extra numbers, I could give you an opinion, but I could not give you something concrete and say, “That is hard and fast.”

Photo of John Baron John Baron Opposition Whip (Commons)

An opinion would be welcome.

Martin Barnes: In respect of where we are with the treatment system, it was right initially to focus on increasing capacity, catching up on years of underinvestment and getting the work force in place. Now, since this is and should be about improving effectiveness, the resource pressure will inevitably increase, because you are trying  to get people in treatment linking up to the housing and training providers, to get better access to primary health care, and to get in place the advocacy and support networks that would help people’s treatment and longer term outcomes. At the moment, the budget is being frozen at a time while drug treatment providers—many of our members—are trying to do more with fewer resources.

There also an important issue in respect of supporting the work force. One of our criticisms of the drug strategy is that there simply has not been enough commitment, attention and resource put into ensuring that people who work with problem drug users—not just in specialised environments, but in more generic services as well—have the knowledge, expertise and know-how to respond to the increasing pressures and expectations on them. It is always easy for any charity or group to say, “We need more money.” You hear that all the time, but the world is not like that at the moment. There is pressure on the treatment system to demonstrate effectiveness, but if we are talking about significant increases in capacity, I do not believe that the system can handle that and achieve the outcomes that we want with the current resource allocation.

Q 48

Photo of John Baron John Baron Opposition Whip (Commons)

May I be a little unfair and return to my original question? Can you give us your best guess? Are we talking about the lower end—10,000 or 20,000? Accepting everything you say, and that these figures are not precise, I would just like an indication of whether you think that we do not stand a chance at all, or whether, if we all pull together, there would be some chance of getting at least halfway.

Martin Barnes: I might sound like I am trying to avoid your question, but I am also thinking it through. The difficulty is that if we are talking about 20,000 people, how will that work geographically? Are there more people going into the system in some parts of the country than in others? How does that match up with current treatment provision? Also, what are the allocations likely to be over the next two to three years? Flexibility is built into the allocations; they are not cast in stone over the next two to three years. We are expecting the treatment allocation for the next financial year to be announced pretty soon—it was due last week.

My honest answer would be, given that the treatment system has achieved its target to more than double the number of people accessing treatment, that going beyond the 200,000 on average accessing every year would be extremely difficult without additional resources. In some parts of the country, there is undoubtedly additional capacity, but the situation is far from uniform.

Q 49

Photo of John Baron John Baron Opposition Whip (Commons)

Let me press you a little bit more. Taking a slightly longer term perspective, if budgets were frozen, would there be any additional resources that could be brought in from other areas to help with regard to this possibly quite sudden uplift in treatment need?

Martin Barnes: The pooled treatment budget is the primary source of funding, but local authorities and local partners can also allocate from within their own budgets. Part of the challenge in respect of the drug strategy and investment in drug treatment is ensuring that it is seen as a local priority. There is a reason why  the Government put a ring fence around the pooled treatment budget and why they set up the NTA: if they had not done so, chances are that the additional investment and spend on drug treatment, once this got down to local decision makers, would probably have been allocated elsewhere. That brings me back to the need for us still to make the case for why investing in drug treatment is the right thing to do and to say that it can be cost-effective. Unfortunately, that issue has become party polarised.

Local partners have the capacity to put in additional resources. I think that, from April, the Government and the NTA will be piloting new initiatives that will try to free up the way that local partners, including drug action teams, can allocate funding within their areas to better address what are regarded as more local needs and priorities. That might, depending on the evaluation, give us some lessons and learning on how better to get people pooling resources and allocating funding.

Q 50

Photo of Sir David Amess Sir David Amess Conservative, Southend West

There is very little time left. In 30 seconds, does either witness want to say anything to the Committee that they had forgotten to share?

Martin Barnes: I think that we have covered this in detail. Obviously, we will be seeking to brief and put forward more precise and detailed amendments with regard to particular concerns. It is not that we have problems in any way with the commitment to provide additional support, which can only be positive. However, from my experience—both from consulting our members at DrugScope, from CPAG, and from working as a benefits advisor—I know that there can be distance between a policy objective and what Ministers want, and what can actually happen at the front line on the ground, particularly when resources are limited and DWP and Jobcentre offices are under pressure, as they are at the moment. There can be a gap between the policy intent and the outcome and impact on individuals.

Photo of Sir David Amess Sir David Amess Conservative, Southend West

I have to interrupt you. I thank you both very much for the time that you have given to the Committee and for your responses.

The Chairman adjourned the Committee without Question put (Standing Order No. 88).

Adjourned till this day at Four o’clock.