Drug Treatment Services

– in Westminster Hall at 4:30 pm on 16th July 2019.

Alert me about debates like this

Photo of Jeff Smith Jeff Smith Opposition Whip (Commons) 4:30 pm, 16th July 2019

I beg to move,

That this House
has considered drug treatment services.

It is a pleasure to see you in the Chair, Mr Hollobone. This is a very timely debate, because today we learned shocking new figures for drug-related deaths in Scotland. There were 1,187 drug-related deaths last year, which is an increase of 27% on the previous year and the highest drug death rate in the EU. We await the 2018 figures for England and Wales without much hope for better news or an improvement.

Today also sees the launch of a new report called “Towards Sustainable Drug Treatment Services” by the research-led biotech company Camurus, which has done some extremely interesting research on the state of drug treatment services, including anonymised surveys of 22 directors of public health in England. I thank Camurus for sight of that report and thank those who have sent me briefings from other organisations, including the Hepatitis C Trust, Release, the Alcohol Health Alliance UK, the Local Government Association, Humankind and the Royal College of Psychiatrists. I will not be able to refer to all those briefings in this relatively short debate, but a couple of themes emerge from most if not all of them.

First, there is worry across the sector that the whole drug treatment services system is under pressure—some would say under threat. Since around 2012, Government cuts have squeezed treatment services so much that they are under strain and struggling to cope with demand. In 2010, the coalition Government inherited one of the best drug and alcohol treatment systems in the world, with over 250,000 people treated every year. Drug-related crime was decreasing, HIV and AIDS were under control, and tens of thousands were overcoming addiction through opiate substitution or abstinence-based programmes. The Labour government prioritised that sector in the late 1990s as part of their social exclusion agenda, and raised treatment budgets from around £200 million per year in 1998 to more than £1 billion by 2003.

When the coalition Government’s austerity really began to hit public services, the hardest-hit area was local government. When local authorities became responsible for the funding and commissioning of drugs services under the Health and Social Care Act 2012, they were already struggling with the reduction of approximately 37% in central Government funding between 2010 and 2016. Between 2014 and 2019, net expenditure on adult drug and alcohol services decreased by 19% in real terms. In 2017, the Advisory Council on the Misuse of Drugs warned that local authority funding would prioritise mandated services over non-mandated services, such as drug services,

“particularly if service users are stigmatised or seen as undeserving.”

All the stakeholders who contacted me have expressed their dismay at the impact of the cuts in recent years. More than a third of the public health directors surveyed by Camurus believe they will be unable to keep up with demand for substance misuse services in the coming year.

Photo of Jim Shannon Jim Shannon Shadow DUP Spokesperson (Human Rights), Shadow DUP Spokesperson (Health)

I thank the hon. Gentleman for giving way and for bringing this important debate to Westminster Hall. The figures for Scotland are horrendous, but the figures for the United Kingdom, including Northern Ireland also show a rise. Does he agree that the current system is not equipped to deal with the level of drug abuse and need for treatment, and that the waiting times for dedicated facilities leave people without support for too long, which inevitably leads them back to their coping methods and further addiction? Those facilities need to be upgraded and made more available.

Photo of Jeff Smith Jeff Smith Opposition Whip (Commons)

I agree with the hon. Gentleman; not for nothing is the UK labelled the drug-death capital of Europe. That should worry us across the UK.

The second theme that emerged from the reports is the real worry about the future of services after 2020 if the ring-fenced public health grant for local authorities ends and funding moves to general local authority funding. A report by the Select Committee on Health and Social Care showed that public health budgets have been cut every year since 2013, with alcohol and drug treatment services facing the biggest cuts. Councils have reduced spending on adult drug misuse by an average of 27% since 2015-16, and almost one in five local authorities have cut budgets by 50% or more since then.

The highest cuts have been disproportionately concentrated in areas with high rates of drug-related deaths, according to the Camurus report. More than half of the directors of public health surveyed believe that the removal of ring-fenced public health grants will result in further cuts. Service providers are struggling to maintain their current offer, and have even less capacity to make additional outreach efforts that are needed, such as offering proactive early prevention measures or engaging under-represented groups and communities who come less into contact with available services.

I wish I had more time to talk about hepatitis C, which is a really important issue. Stuart Smith, the head of community services at the Hepatitis C Trust said:

“I walk into many drug services around the country and it’s chaos. They’re being asked to do so much with so little resource. I’m not sure how many of them can even feasibly have it on their priority list to discuss hepatitis C with clients.”

Hepatitis C is a very harmful condition but it can be prevented and cured if we have the resources to do so.

This is another story of austerity hitting the services that are most needed by the most vulnerable in society, but—this is the third theme that emerges from the sector responses—it is also a story of false economies. Spending on the recovery and reintegration of people who struggle with drug and alcohol dependency is one of the smartest spend-to-save investments that a Government can make. Strong evidence suggests that properly funded drug treatment services help to drive reductions in drug deaths, crime, and rates of blood- borne viruses. Research that the Government themselves commissioned concluded that drug treatment can “substantially reduce” the social costs associated with drug misuse and dependence, with an estimated cost-benefit ratio of 2.5:1. Depending on the breadth of the definition of “social costs”, that ratio could be calculated far more favourably and take into account factors such as lower crime, fewer health problems, less benefit dependency, lower social services spending and so on. Public Health England estimates that for every £1 invested in drug treatment services, there is a £4 social return.

Drug treatment and harm reduction services are cost-effective and offer good value for money, so this is a classic example of funding reductions in one part of the public services leading to spending increases in another. To quote Ron Hogg, police and crime commissioner for Durham and Darlington, who in my view is one of our most progressive PCCs:

“As PCC, I have concerns regarding the future allocation of public health funding in Durham, via the Public Health Grant, and the knock-on effect for policing. I am fearful that I will face the triple whammy of a reduction in police funding, a further reduction due to changes in the funding formula, and the consequences of a decrease in public health funding. The consequences of these changes are likely to include a significant increase in crime in County Durham and Darlington.”

We know that half of acquisitive crime in the UK is directly related to drug dependency.

Photo of David Hanson David Hanson Labour, Delyn

I am grateful that my hon. Friend has raised the issue of crime. Is he aware that crime prevention orders and drug and alcohol treatment orders attached to sentences have fallen? Drug treatment orders have fallen from 8,734 in 2014 to 4,889 in 2018, and alcohol treatment orders have also halved. People are not getting drug treatment orders as part of their sentence in the community, which leads to the same threats that my hon. Friend describes.

Photo of Jeff Smith Jeff Smith Opposition Whip (Commons)

I thank my right hon. Friend for making that important point. Durham constabulary’s Checkpoint scheme, through which low and medium-level offenders with drug dependency are diverted into treatment rather than the criminal justice system, has reduced arrests by 11% and convictions by 9.7%, and has made a positive contribution in relation to participants’ drug use, physical and mental health, finances, accommodation status and relationships. There are benefits right across society when we send people into help and treatment, rather than into custody.

A number of stakeholders have identified that the lack of resources not only puts a strain on current treatments and activities, but stifles innovation in new ideas and treatments. That leads me to another key point, which is on our wider approach to drug treatment and policy. There are measures that we can take to reduce deaths and that would lead to less demand on drug treatment services, but the Government are either not encouraging or not permitting them. The most obvious is what many call drug consumption rooms, although I prefer the term overdose prevention centres, which are aimed at those with severe addictions. People will take their drugs—they have them in their possession, so they will inject them, and there is no way that we can stop them doing that—but rather than being left to inject their drugs in a bedsit or back alley, alone with an increased risk of overdose, they can go to one of the centres, where a nurse is on hand; they can use in a sterile clinical space with medical supervision, and naloxone on hand to reverse any overdose.

There are two great benefits to the centres. First, they save lives: no one dies of an overdose in such facilities. Secondly, they also have services for addicts to engage with. It might be the first time that addicts have come into contact with services, so they could be encouraged into other treatment options. At least 100 drug consumption rooms operate in at least 66 cities around the world, in 10 countries. In a number of European countries, such as in Spain, Germany and the Netherlands, supervised drug consumption has become an integrated part of services offered within drug treatment systems.

Police and crime commissioners and health professionals have been assessing the value of piloting such facilities in various areas, but the Government position is to block the pilots. Furthermore, the Government are unwilling to revisit the legislative framework, and so are insistent that we cannot make provision for the centres. However, according to the European Monitoring Centre for Drugs and Drug Addiction last year:

“There is no evidence to suggest that the availability of safer injecting facilities increases drug use or frequency of injecting”.

Equally:

“These services facilitate rather than delay treatment entry and do not result in higher rates of local drug-related crime.”

Drug consumption rooms, overdose prevention centres or whatever we want to call them simply make sense, and it is very regrettable that the Government will not allow them to become part of our treatment landscape.

On the subject of innovative models of service delivery, I mention the Checkpoint scheme in Durham.

Photo of Jonathan Lord Jonathan Lord Conservative, Woking

The hon. Gentleman is making some excellent points. Does not the thrust of his argument lead to the conclusion tha, if one were to regulate and control but decriminalise more broadly, many of the social ills and medical problems might be reduced? Is it not time for a royal commission to look more broadly at the troubling social disease of drugs?

Photo of Jeff Smith Jeff Smith Opposition Whip (Commons)

The hon. Gentleman makes an excellent point. I absolutely agree that we need regulation and control. Personally, I am not sure about royal commissions, because they tend to kick things into the long grass a bit, but perhaps a parliamentary commission or some other way of looking at the problem, trying to come to a consensus and taking the politics out of it—stop people weaponising drugs as a political issue—is the way forward. We need to look at that, because our system is not working. This is not a debate about wider drug policy but, clearly, that policy is not working, and it is resulting in the kind of problems that we face—addicts need the kind of drug treatment services that this debate is about.

I will try to be quick, because other people want to contribute to this short debate. On innovative models of service delivery, naloxone is a life-saving medication that can be used to reverse opioid overdose. However, coverage across England remains poor and the guidance is confusing. If we cannot convince the Government to increase funding for naloxone treatment by implementing a national naloxone programme, they should at least offer national support and guidance for local authorities and prisons. Finally, on drug safety testing, the Home Office’s refuses explicitly to sanction drug safety testing, which is a simple measure that could save lives and result in fewer people needing treated for drug harms.

We therefore need a refocus of our spending priorities. Funding constraints are curbing the effectiveness of proven treatment and harm reduction measures at the same time as we spend fortunes on drug law enforcement. In 2014-15, for example, an estimated £1.6 billion was spent on drug law enforcement, compared with only £541 million on drug treatment and harm reduction services over the same period. However, while we know that treatment services are cost-effective and save money, the Home Office’s own evaluation of its last drug strategy could not demonstrate value for money in drug law enforcement or enforcement-related activities.

The Government, unfortunately, are preoccupied with trying to stop people from taking drugs—something no one has managed to do in centuries of human behaviour—instead of focusing on harm reduction and treatment. Problematic drug users are stigmatised by our policies and treated as criminals, leaving them less likely to access the life-saving drug treatment services that they need, for fear of arrest. Meanwhile, the services that are available—as we heard earlier—have had their funding slashed and continue to be squeezed.

I need to conclude with some proposals. First, the one consistent message from all stakeholders who have been in touch and care about the issue is that we need to reverse the cuts to our struggling drug and alcohol treatment system. We need to reinvest in those services. The Camurus report released today states:

“The evidence shows that we are fast approaching a point at which we risk doing irreparable damage to our hard-won recovery system, leaving services unable to meet the scale of need that exists.”

The Government must therefore use the upcoming spending review to increase spending on drug treatment services. They need to provide local authorities with additional funding towards those services, without which the ability of services to meet demand will continue to decline.

Among other proposals I suggest the Government should consider guaranteeing the delivery of substance misuse services by making them a statutory, mandated service to end the ambiguity about their delivery and to underline importance of protecting budgets. The Government should also look at the commissioning regime—the consensus among many stakeholders is that it is not working and is too variable—to see whether it is fit for purpose. A 2017 report by the Advisory Council on the Misuse of Drugs asked whether the constant re-procurement of addiction services creates unnecessary instability in the system, resulting in poorer recovery outcomes, which is something I have seen on a small scale in the area of south Manchester I represent. Finally, we need to remove barriers to overdose prevention centres and drug safety testing to encourage faster use of heroin-assisted treatment. Such proposals can stop deaths and reduce the numbers going into treatment. We are looking at a public health emergency, and we need to act.

The shadow Health Secretary, my hon. Friend Jonathan Ashworth, has talked movingly about his experience of alcoholism in his family. He has promised that a future Labour Government will reverse the decline in the drug and alcohol treatment sector. I fully support him in that endeavour, but we cannot wait. We need the Government to act to safeguard our drug treatment services and, most importantly, to safeguard those who use them.

Photo of Philip Hollobone Philip Hollobone Conservative, Kettering

The debate can go on until 5.30 pm. I am obliged to call the Front Benchers from no later than seven minutes past five o’clock. The guideline limits are five minutes for the SNP, five minutes for Her Majesty’s Opposition and 10 minutes for the Minister, and Jeff Smith has two or three minutes at the end to sum up the debate. Five Back Benchers are seeking to contribute, so there will need to be a time limit, which is four minutes each, and then everyone will get in.

Photo of Daniel Poulter Daniel Poulter Conservative, Central Suffolk and North Ipswich 4:48 pm, 16th July 2019

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

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

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

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

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

Photo of Ronnie Cowan Ronnie Cowan Shadow SNP Spokesperson (Infrastructure) 4:52 pm, 16th July 2019

I thank Jeff Smith for securing this debate.

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

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

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

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

Photo of Luke Graham Luke Graham Conservative, Ochil and South Perthshire

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

Photo of Ronnie Cowan Ronnie Cowan Shadow SNP Spokesperson (Infrastructure)

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

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

Photo of Crispin Blunt Crispin Blunt Conservative, Reigate 4:56 pm, 16th July 2019

I congratulate Jeff Smith on securing this debate and on speaking so well. Happily, much of what I intended to say I now do not need to, not that I would have time to say it anyway.

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

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

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

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

If we do not invest resources properly, we will simply find that we carry the burden of the consequences of the damage that has been done to all those people. There is an infinitely better way to do things, and I urge the Minister to try her hand at effecting the system change that is needed to do things infinitely better.

Photo of Mary Glindon Mary Glindon Shadow Minister (Environment, Food and Rural Affairs) (Farming and Rural Communities) 4:59 pm, 16th July 2019

It is an honour to serve under your chairmanship, Mr Hollobone. I congratulate my hon. Friend Jeff Smith for an excellent speech and for his commitment to tackle unswervingly the problems associated with drug and alcohol abuse.

I am pleased to speak as co-chair of the drugs, alcohol and justice cross-party parliamentary group that last week considered the Advisory Council on the Misuse of Drugs’ recent report, “Custody-Community Transitions”. The report is helpful in providing advice on how to reduce drug-related harms that happen when people move between custody and the community. I hope the Minister will agree to implement the report’s practical recommendations as soon as possible to ensure continuity of care.

Some simple changes could make a huge difference. For example, it suggests prisoners with complex needs should not be released on to the streets on Fridays. Given that last year only 12% of prisoners with drugs problems left prison with naloxone, which can reverse the effects of overdose, the report recommends that naloxone should be issued to all prisoners with drug problems on leaving custody.

We have record rates of drug-related deaths, yet drug treatment budgets have been slashed and services cut, as has already been said. I am sad to say that my region, the north-east, is the worst affected in England. Today we have heard that drug-related deaths in Scotland have gone up by a staggering 27%. We can only tackle these soaring statistics if substance misuse services are made mandatory and drug treatment budgets ring-fenced.

Instead of investing in harm reduction, we waste valuable resources on an unwinnable war on drugs, treating this as a criminal justice rather than a public health issue. We have excellent examples of a different approach being taken in the checkpoint scheme in County Durham and the Thames Valley diversion scheme. They show effective alternative solutions—not easy options, but positive ways of getting people out of trouble and into treatment. Another innovation to help drug users would be the introduction of drug-consumption rooms—effectively overdose prevention centres—which the Government stubbornly refuse to allow, despite conclusive evidence that they are of massive benefit.

In summary, I will quote Paul Townsley, chief executive of the charity Humankind:

“These challenging times provide an important opportunity to cement the evidence base of what our service users and our communities need, but to achieve this we will need stable funding and commissioning… Government has a duty to act now to ensure treatment services are accessible to all who need them. We call on Government to ensure that substance misuse treatment is a prescribed local public health activity.”

I can only concur.

Photo of Paul Sweeney Paul Sweeney Shadow Minister (Scotland) 5:02 pm, 16th July 2019

Thank you for calling me to speak, Mr Hollobone. I congratulate my hon. Friend Jeff Smith on an excellent introduction to the debate and on the vital points he made.

Last week, one of my constituents, Chelsea Bruce, died of a drugs overdose. She was 16-years-old. She is another figure to add to the 1,187 deaths in Scotland in the last year. It is particularly poignant because this time last year I presented Chelsea with an award at her school, where I talked about the potential of the future and what young people could go off and do in the world. To think that that girl now lies dead for entirely preventable reasons sickens me. I wonder about the damage that has been caused to her family and the trauma that has been caused to her friends, who now live in a mixture of grief and fear of what drugs can do to them.

Chelsea might not have come to harm had she been able to have the pills tested, to have had a testing kit or to have sourced the pills from a supplier who had had them tested. There are now very high-strength MDMA pills in circulation. Sometimes it is not MDMA but other substances that mimic some of the effects of MDMA; that could have been a factor in Chelsea’s death. That is something we need to understand in this House and respond to with great urgency.

I have been following the campaign for drug policy reform closely since my election, and ensuring that a public health approach is at the heart of how we begin to properly tackle this devastating blight on our country is critical. I am personally convinced of the merits of decriminalisation of people who use drugs and minor drug possession for personal use, based on international examples, most notably in Portugal. I am pleased that the introduction of safe drug consumption facilities is Labour party policy and we will be campaigning to ensure that we go even further in our next manifesto.

However, I am alarmed at the lack of impetus to put in place practical policies now, which could save lives in my city where drug-related deaths have reached epidemic levels. They are now 1,000% higher than the European average; that is a public health emergency by any definition. While many are big on rhetoric, our public policy is years behind where it should be in addressing this appalling crisis of death and misery.

The Home Office and the Lord Advocate have been intransigent about the piloting of safe drug consumption in Glasgow. A model that has a worldwide track record of saving lives has been discussed. While the Home Office refuses to change the obsolete Misuse of Drugs Act 1971, the Lord Advocate, Scotland’s chief law officer, claims that a letter of comfort is insufficient to avoid possible prosecutions of NHS staff who might work in such a facility or those who would use it, unless the law is changed by the UK Government.

The chief executive of the Scottish Drugs Forum, David Liddell, believes that much more can be done to facilitate reform within current legislation. Last week, I suggested to the Scottish Affairs Committee that the Lord Advocate is being too risk averse and conservative in approach. I have now written to the Lord Advocate to challenge him on that point. It is certainly no good for Scottish Government Ministers and Glasgow City Council to abrogate their responsibility for this public health crisis by conveniently blaming Westminster, as unco-operative and unhelpful as it might be on this issue, when they have cut victim services in Glasgow by over a quarter in recent years, causing the closure of rehabilitation services and needle exchanges, as well as the end of central Government funding for the national naloxone programme.

While a heroin-assisted treatment pilot will launch in Glasgow later this year, it will be highly targeted and the thresholds for access will be difficult to reach for most of Glasgow’s problematic opiate and cocaine users, who are often polydrug users. That is why I have also asked for the Lord Advocate’s advice on an additional innovative model that could be adopted in Glasgow, a safe prescribing clinic, where instead of illicit drugs of an unknown purity being brought into the facility for use under clinical supervision— as in a drug consumption room—pharmaceutical diamorphine and cocaine can be prescribed freely for use in a supervised clinical environment. As well as bringing all the benefits of DCR, it removes the stranglehold that criminal gangs have over the drugs supply chain and removes the financial dependency that many people with drug problems face to feed their habit, and the crime that goes with it. Combine that with supervised drug facilities like the Loop in Bristol and WEDINOS in Wales, and we could be on to something that reduces harm.

Saving one life is one life that is worth it, and we should take urgent action now.

Photo of Alison Thewliss Alison Thewliss Shadow SNP Spokesperson (Treasury), Shadow SNP Spokesperson (Housing, Communities and Local Government) 5:07 pm, 16th July 2019

I am glad that Jeff Smith secured this debate, because it is very timely for Glasgow and for Scotland more widely.

Let me start by saying that every single one of the 1,187 deaths last year is a tragedy—a tragedy for the families who lost a loved one and, as Mr Sweeney said, a tragedy because of the potential that was lost as a result of that person passing away. We should bear those people in mind whenever we talk about drugs policy.

Ideally, I want those people, who have an illness, to be able to get medical help as if they had any other illness. If they had cancer, we would not stigmatise the cancer drug that kept them well. That is what methadone does—it supports people and stabilises their lives.

Photo of Luke Graham Luke Graham Conservative, Ochil and South Perthshire

It is not stigmatisation; it is data led. We saw information today that more people die from the use of methadone. I am not asking the hon. Lady to cancel anything; I am asking whether she will join me in calling for a review. We need a review of all our drug laws across the board. She knows that I agree with her on many aspects of this policy. I seek a review, not to cancel out or stigmatise.

Photo of Alison Thewliss Alison Thewliss Shadow SNP Spokesperson (Treasury), Shadow SNP Spokesperson (Housing, Communities and Local Government)

When the hon. Gentleman talks about methadone, the result is that he stigmatises it. That may not be his intention, but that is the result. He may have heard Kirsten Horsburgh from the Scottish Drugs Forum talking on “Good Morning Scotland” this morning about that being stigmatising for people. We need to get away from that stigma. We need to look towards treatment and harm reduction.

To that end, I and my SNP colleagues have argued for three years for a drug consumption room for Glasgow. That could go ahead as a pilot if the UK Government got out of the way and let us do it. It is three years since NHS Greater Glasgow and Clyde produced its “Taking away the chaos” report, the business case for that drug consumption room, which Saket Priyadarshi and his colleagues worked away on. That has been sitting there for three years. The UK Government are standing in the way of the life-saving intervention a drug consumption room would bring.

That drug consumption room would not save everybody—at the moment, it would be just for Glasgow—but it would make a huge difference to the people I know who inject in dirty bin sheds and back lanes and on waste ground yards from my office, time and again. It is the job of the rest of society to try to pick up the pieces of that—to pick up the discarded needles that are left behind. Those people would have the dignity of a drug consumption room within a few paces, where they could go to inject drugs, receive medical help and get support now, if the UK Government approved it. It is an absolute tragedy that that is not happening, and a huge source of frustration.

Mr Sweeney mentioned the Lord Advocate. The Lord Advocate is the Lord Advocate; we cannot intervene in the decisions that the chief legal officer takes on this. If he says that that is not within the law, that is his legal opinion. He is the chief legal officer, and that is his decision. It rests with the UK Government to make that change under the Misuse of Drugs Act 1971.

Photo of Alison Thewliss Alison Thewliss Shadow SNP Spokesperson (Treasury), Shadow SNP Spokesperson (Housing, Communities and Local Government)

I have already given way to the hon. Gentleman, and I am short of time.

The Misuse of Drugs Act is reserved. Where we have had powers in Scotland on alcohol, we brought in minimum unit pricing; on smoking, we brought in the end of smoking in public places. This is a medical intervention that we wish to pursue in order to save people’s lives. Glasgow, where it can, has applied for a heroin-assisted treatment programme; when that is up and running, it will be able to treat 60 people, but there are an estimated 400 to 500 people who inject publicly within Glasgow city centre alone. That medical heroin-assisted treatment programme is limited in size, scope and scale, because it is a treatment programme and people must be able to engage with that.

No doubt the programme will make a huge difference to those lives, but it almost goes without saying that if 394 people died in Glasgow last year, and it can only deal with 60 people at a time, it is not enough. It is clear that we need the entry level that drug consumption rooms will give, meaning that people can go in without any kind of barrier or stigma associated with seeking help, and are able to reach those treatment services. It needs to be an easy way for people to get in and get treatment within those services.

The Scottish Government are pursuing this. We are doing what we can. We have a new drugs taskforce, chaired by Professor Catriona Matheson from the University of Stirling, which is looking at all the things we do in the Scottish Government in the round and where improvements need to be made. Both I and the Scottish Government accept that improvements need to be made, but the UK Government also need to play their part.

I will mention organisations such as Turning Point Scotland in my constituency. They drive a van around as a needle exchange, but they know that as soon as they give that needle to somebody, that person is going around to the car park at the back, to inject in a dirty back lane. That is not good enough. Not one UK Government Minister has yet come to visit Glasgow to justify their position; I urge this Minister and any of her colleagues, whoever they may be, whenever the new Prime Minister eventually turns up, to come to Glasgow and tell me why this cannot be done.

Photo of Julie Cooper Julie Cooper Shadow Minister (Health and Social Care) (Community Health) 5:12 pm, 16th July 2019

It is a pleasure to serve under your chairmanship, Mr Hollobone.

I begin by thanking my hon. Friend Jeff Smith for bringing this debate on this very important subject. As we have already said, the debate is timely, as we hear today that 1,187 people died drug-related deaths in Scotland last year, an increase of 27%. I can say from personal experience of delivering services to drug users in a community pharmacy in my constituency that the problem is not confined to Scotland.

The problem is not new, but there is no doubt that cuts to budgets for addiction support services in recent years have made the situation worse. The cuts to public health budgets that have had an impact on this are downright irresponsible. There have been numerous calls over the years for us to take steps to address the problem, but instead, we prefer to speak about getting tougher in tackling the trade in illegal drugs. Meanwhile, police chiefs are on record as saying that there is no way that police will ever stop addicts buying from dealers, but still we continue to chase drug addicts like criminals.

While other countries move increasingly to a public health approach to drug use, the instinct in the UK is to criminalise addicts. It is worth noting that in Portugal, where drug use has been decriminalised, there has been a steep fall in the number of drug-related deaths and even in the number of drug users. It is time for an intelligent approach here in the UK, an approach that stops drug dealers preying on vulnerable addicts and that recognises that drug addicts are not alien beings, but people in our communities in need of help, not a criminal record.

Drug addicts have families and children who need and love them. My hon. Friend Mr Sweeney spoke movingly of his constituent Chelsea, reminding us of the humanity in all this. In the first instance, addicts need support to stay alive, to safely manage their addiction, to overcome it and to recover their lives.

So what can the Government do? The Advisory Council on the Misuse of Drugs has clearly said that maintaining funding of drug treatment services is essential to preventing drug-related death and drug-driven crime in communities. It has also said that if resources are spread too thinly, the effectiveness of drug treatment will suffer, leading to drug-related deaths and drug-driven crime. As a first step, I hope the Minister can tell us that her Government will restore funding to addiction support services, but I also hope she will go much further and consider new ways of tackling the problem to save lives.

Both supervised consumption rooms and heroin-assisted treatments are possible ways to effect some positive changes. Supervised consumption rooms reduce the risk of disease transmission, prevent overdose and also present an opportunity to refer users to appropriate addiction services. Heroin-assisted treatment allows for the provision of pharmacological heroin to dependent individuals who have not responded to other treatments, and involves patients receiving heroin in a clinical setting from a doctor under strict controls.

That has many benefits. It reduces the use of street heroin, which can be of dubious quality and variable strength. It takes away the need for criminal drug dealers, who are preying on vulnerable people and profiting from their addictions. It gets addicts into treatment. It stops desperate addicts resorting to criminal activity to fund their addiction. It improves access to recovery services, HIV treatments and services to address adverse life circumstances. As the police remind us, it also stops drug-taking in open spaces in the community and protects the wider public from contact with used needles.

Both those services reduce pressure on other services in the NHS, police and justice systems, protect the wider public from contaminated needles and ultimately save public money. Cuts to those services are short-sighted in the extreme. Those initiatives are supported by the British Medical Association, and it is a fact that other countries are doing better than us because they have implemented those programmes.

I say to the Minister that we need urgent action. We need mandatory commissioning of drug and alcohol treatment services. We need to amend the Misuse of Drugs Act to enable an innovative, health-focused approach to tackling this problem. We need a Government with the courage and the compassion to act to save lives.

Photo of Seema Kennedy Seema Kennedy The Parliamentary Under-Secretary for Health and Social Care 5:16 pm, 16th July 2019

It is a pleasure to serve under your chairmanship, Mr Hollobone. I begin by sending my sympathies and those of the whole House to Chelsea’s family and friends. It is a reminder to us all of the seriousness of the subject we are discussing today. I also thank Jeff Smith for securing this important debate.

Many of the hon. Members who have spoken are devoting their parliamentary lives to this issue, because they feel so strongly about it. They have raised questions that are a matter not only for me and my Department but for other ministerial colleagues, particularly those in the Home Office, and I will transmit the many challenges that have been set for me today to those colleagues.

We have made some progress in reducing drug dependency-related harms, but, as the hon. Gentleman pointed out, this is an ancient problem. We have made progress but we are not at all complacent, and events such as the death of a girl such as Chelsea remind us that there is much more to do. I have to work with other Government Departments, public health experts and local government to continue supporting people through recovery and to prevent them from ever taking up drugs in the first place.

We published a drugs strategy in July 2017 and it is being rolled out. We know about the serious health harms of drug use, including blood-borne viruses, overdose and death, which have been outlined in great detail by hon. Members. We know that the majority of people who need treatment for drug problems are also experiencing mental health issues. We know that drugs cost £10.7 billion a year in policing, healthcare and crime costs; it is estimated that drug-fuelled theft alone costs us £6 billion a year. There is both an economic case and a moral case for us all to act on this.

It is encouraging that drug use in England and Wales is lower now than it was a decade ago. In 2016-17, 8.5% of adults had used a drug in the past year, compared with 10.1% of adults in 2006-07. More adults are successfully leaving treatment than in 2009-10, and the average waiting time to access treatment is two days.

I will pick up on some of the points that hon. Members have made. On the drug-related death figures for Scotland, health is a devolved matter, but of course—[Interruption.] I am afraid I cannot hear what Alison Thewliss is saying.

Photo of Seema Kennedy Seema Kennedy The Parliamentary Under-Secretary for Health and Social Care

I will come on to that. However, health is a devolved matter. Any death is a tragedy, but the figures are really worrying. I understand that the Scottish Government have appointed Professor Catriona Matheson to head up a drug deaths taskforce, to look at the main courses of death and to examine how to save lives.

My hon. Friend Dr Poulter raised the question where responsibility for public health should sit. Clearly, he thinks its sitting with local authorities is not right, but that is a broader question of public health commissioning that I do not know if we can get into here. However, he has a wealth of experience in this, and I will take away some of the points that he raised.

Photo of Julie Cooper Julie Cooper Shadow Minister (Health and Social Care) (Community Health)

Does the Minister agree that, while we can argue about who should be responsible, as long as public health is the responsibility of local authorities, cutting their budgets is irresponsible?

Photo of Seema Kennedy Seema Kennedy The Parliamentary Under-Secretary for Health and Social Care

I will come on to funding.

My hon. Friend Crispin Blunt takes great interest in this issue. He spoke about the legislative framework for drugs, which is a matter for the Home Office. As I said, I will talk to ministerial colleagues about that. The Government are putting together a formal response to the report on custody-community transitions, with input from many Departments, including the Department for Work and Pensions, the Ministry of Justice and the Home Office. I think we have until the end of the summer to issue that response.

Local authorities will want to increase the provision of naloxone to people who are not in treatment, perhaps through outreach workers, hostels or needle and syringe programmes. Public Health England is working alongside the National Police Chiefs’ Council and Her Majesty’s Prison and Probation Service and recently updated its advice and guidance on naloxone availability in prisons. The problem with drug testing kits is that not all of them are entirely accurate, which might give people false reassurance. More sophisticated testing has been available at some festivals in one pilot, but again this is a matter for the Home Office.

Hon. Members talked about the international evidence that drug consumption rooms can be effective at addressing public nuisance issues and health risks for users and for the wider public, but there is a risk that such facilities would be introduced at the expense of other more relevant, evidence-based drug services for local areas. There is currently no legal framework for the provision of drug consumption rooms, but we support a range of evidence-based approaches to reducing health-related harms. Again, we are committed to widening the availability of naloxone to prevent drug-related deaths. I acknowledge the strength of feeling on drug consumption rooms in the House.

Photo of Crispin Blunt Crispin Blunt Conservative, Reigate

This is a narrow point, but I invite the Minister to talk about overdose prevention facilities, rather than drug consumption rooms. One can understand the difference that might make to their reception in local communities; they are about preventing death.

Photo of Seema Kennedy Seema Kennedy The Parliamentary Under-Secretary for Health and Social Care

Briefly, and then I must continue, because I want the hon. Member for Manchester, Withington to be able to make his concluding remarks.

Photo of Alison Thewliss Alison Thewliss Shadow SNP Spokesperson (Treasury), Shadow SNP Spokesperson (Housing, Communities and Local Government)

The Minister talks about there being no legal framework, but it is the job of the UK Government to provide that. If she wants any assistance, I have a 10-minute rule Bill still waiting to be heard that she could implement.

Photo of Seema Kennedy Seema Kennedy The Parliamentary Under-Secretary for Health and Social Care

As I say, that is a matter for the Home Office. I sense the hon. Lady’s frustration, but I am not responsible for that area. I have already said twice that I am happy to take that point away. Tabling business in the Chamber really is not my responsibility. I sense and am cognisant of the frustration in the House.

Under the 2017 drug strategy, we are involved in delivering actions across four themes: reducing demand to prevent drug use and its escalation; restricting supply; building recovery; and a new strand focused on global action, which is important. We need a partnership-based approach alongside the treatment system; other partners, such as the mental health and criminal justice systems, have key roles to play in securing the drug strategy’s aims.

I attend a cross-ministerial drug strategy board with Ministers from the Ministry of Housing, Communities and Local Government, the Home Office, the Ministry of Justice and representatives of Public Health England. Additionally, the Home Secretary has appointed Professor Dame Carol Black to lead a major review of drugs, looking at a range of issues, including the system of support and enforcement around drug misuse, to inform our thinking about tackling drug harms. Dame Carol will report later this summer.

I acknowledge the concerns about the funding of public health services, and that local authorities need to make difficult choices about how they spend their money to be able to continue providing effective drug treatment services. Local authorities will receive £3.1 billion in this financial year, ring-fenced exclusively for use on public health, including drug addiction. In addition, we are investing more than £16 billion for public health over the five years to the end of 2020. It is a condition of the public health grant that local authorities have regard to the need to improve the take-up and outcomes from drug and alcohol misuse treatment services. Public health funding is a matter for the next spending review, in which it will be looked at in the light of the best available evidence.

Photo of Paul Sweeney Paul Sweeney Shadow Minister (Scotland)

Does the Minister accept that it is within the remit of the Department of Health and Social Care to consider the possibility of not only drug consumption rooms but expanding the scope, based on a heroin-assisted treatment facility, to provide safe prescribing clinics, which have far lower thresholds and which would provide greater access to safe drug use?

Photo of Seema Kennedy Seema Kennedy The Parliamentary Under-Secretary for Health and Social Care

I will have to respond to that in writing.

It is not possible for the treatment system to bear sole responsibility for responding to these challenges. Where necessary, the Government are prepared to act to ensure that our response enables us to reduce the harms caused by drugs. We are already acting on designating third-generation synthetic cannabinoids, such as Spice, as class B drugs under the Misuse of Drugs Act. In response to the increase in drug-related deaths, PHE has been working to better understand how to best protect people from dying of overdoses.

Although we have made strong progress in tackling the human and financial harms associated with drug misuse, we know that there is more still to do, and that there are emerging challenges that we need to tackle. We will approach these issues with the full range of partners who are essential to delivering the drugs strategy, enabling us to build on such achievements—without being complacent—and drive further progress.

Photo of Jeff Smith Jeff Smith Opposition Whip (Commons) 5:27 pm, 16th July 2019

I thank all right hon. and hon. Members who have made such excellent contributions to the debate. I will mention two in particular. I was very much enjoying the speech of Dr Poulter until he was cut off in his prime. He made some important points about commissioning. That is not something I went into in detail, but it is certainly something that the Government need to consider. My hon. Friend Mr Sweeney told the story of Chelsea, which brought home the ways that our drug policy is failing and the way that we need to address issues that end up in tragedies like Chelsea’s sad death.

I also thank the two Opposition Front Benchers for their powerful speeches, which had a welcome focus on support, rather than the criminalisation of addicts. That is absolutely the way that Government policy needs to go. I thank the Minister for her response. We have a Health and Social Care Minister here, which is exactly right; on a general principle, when talking about drug policy, we should have a Health and Social Care Minister. Responsibility for the policy should be situated in that Department, but as the Minister rightly pointed out, much of the responsibility is currently in the Home Office.

The focus on the legal framework was interesting, as was the frustration about how the legal framework fails us and how the focus on criminalisation fails us and distracts us from focusing money and resources into the drug treatment services that we so badly need. I hope the Minister will go back to colleagues in the Home Office and talk about this. I was expecting the debate to be a lot more about cuts to drug treatment services, rather than the legal framework. However, I think that brings home the frustration that many of us feel: that a progressive drugs policy is being blocked by the fact that responsibility is situated in the Home Office, rather than in Health and Social Care.

The Minister mentioned a couple of points that I question. Without a national framework or programme, we will end up with a postcode lottery for naloxone, which is a real concern. She talked about the legal framework for drug consumption rooms, but that is for the Government to change, as Alison Thewliss said. Drug testing is very sophisticated these days. A charity based in my constituency operates excellent drug testing in festivals and city centres around the country. We have nothing to fear from the drug testing that those sorts of organisations carry out.

I finish by urging the Minister to do two things. First, the spending review is coming up. I hope she will be going in to bat for her Department, and particularly for investment in drug treatment services.

Motion lapsed, and sitting adjourned without Question put (Standing Order No. 10(14)).