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.