Dame Carol Black’s Independent Review of Drugs Report

– in Westminster Hall at 4:30 pm on 27th October 2021.

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Photo of Yvonne Fovargue Yvonne Fovargue Labour, Makerfield 4:30 pm, 27th October 2021

Before we begin, I encourage Members to wear masks when they are not speaking, in line with current Government guidance and that of the House of Commons Commission. I remind Members that they are asked by the House to have a covid lateral flow test twice a week if coming on to the parliamentary estate. That can be done either at the testing centre in the House or at home. Please also give each other and members of staff space when seated, and when entering and leaving the room.

Photo of Dan Carden Dan Carden Labour, Liverpool, Walton

I beg to move,

That this House
has considered Dame Carol Black’s independent review of drugs report.

It is a pleasure to serve under your chairmanship, Ms Fovargue. I refer Members to my entry in the Register of Members’ Financial Interests. The damning conclusion of part two of Dame Carol Black’s review, setting out a way forward on drug treatment and recovery, was that

“the public provision we currently have for prevention, treatment and recovery is not fit for purpose, and urgently needs repair.”

I have called today’s debate because the report’s recommendations are too important to be left gathering dust on ministerial bookshelves. I want Dame Carol’s words ringing in ministerial ears. She says:

“Government faces an unavoidable choice: invest in tackling the problem or keep paying for the consequences. A whole-system approach is needed…This part of my review offers concrete proposals, deliverable within this Parliament, to achieve this.”

Of the review, Dame Carol says:

“It calls for significant investment, but the payoff is handsome: currently each £1 spent on treatment will save £4 from reduced demands on health, prison, law enforcement and emergency services. I am hopeful that the recommendations will be welcomed by this government as they strongly support its crime reduction and ‘levelling up’ agendas.”

The 32 recommendations are a gift to the Government, and should be a moment for change. It is fitting that the debate falls on Budget day. The economic cost of drug misuse is upwards of £20 billion each year; yet the spending on prevention and treatment stands at just £650 million. The recommendations give hope that real change is possible. Addiction is a national crisis. Drug and alcohol-related deaths are the highest on record, at the very moment that treatment services are most ill-equipped to deal with the soaring need.

Forward Trust estimates that more than 2 million people are in need of help with alcohol, drugs or gambling, and its recent YouGov poll showed that 64% of people said that they knew someone personally struggling with addiction. Since I talked openly about my personal experience of addiction and recovery, I have been over- whelmed by the thousands of people who have reached out to tell me their personal stories—of the horror of addiction, and the blessings of recovery. The tragedy is that addiction is everywhere, yet remains so hidden.

In 2019 Dame Carol was commissioned by the then Home Secretary, Sajid Javid, to independently review illicit drugs in England. I thank her for her commitment and dedication over the last few years, and all those who contributed to this groundbreaking report. Most of all, I hope that my contribution today does justice to the absolute clarity that Dame Carol brings to these incredibly complex matters. Part one of her review was published on 27 February, and made for uncomfortable reading. The unflinching analysis detailed the extent of drug-related harm and the challenges posed by drug supply and demand, including the ways in which drugs fuel serious violence.

The Department of Health and Social Care swiftly commissioned Dame Carol to produce part two of her independent review, which focused on how to improve the funding, commissioning, quality and accountability of drug prevention, treatment and recovery services in England. Part two of her report, published in July, pulls no punches either. It says:

“Funding cuts have left treatment and recovery services on their knees. Commissioning has been fragmented, with little accountability for outcomes. And partnerships between local authorities, health, housing, employment support and criminal justice agencies have deteriorated.”

The report goes on:

“The workforce is depleted, especially of professionally qualified people, and demoralised. Vital services have been cut back, particularly inpatient detoxification, residential rehabilitation, specialist services for young people, and treatment for cannabis and stimulant users.”

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

I commend the hon. Member for bringing this issue to Westminster Hall for debate and discussion. Does he agree that more should be done to ensure that alcoholism in particular is treated urgently, along with drugs, and that help needs to be given to families for rehabilitation, which he has referred to, not in a punitive fashion, which is how some would like to do it, but instead to help to draw people away from their addiction? That has to be done in such a way that people wish to get away from their addiction and try to move forward.

Photo of Dan Carden Dan Carden Labour, Liverpool, Walton

Absolutely. That is a valuable intervention, and it is good that we have a Health Minister responding to this debate, because it is a health response, joined up across Government, that this issue calls for.

Part two of the report goes on:

“Areas of the country with the highest rates of drug deaths or the poorest treatment services are the very same areas where the need to level up is greatest. These communities want to see urgent and effective action to tackle the violent drugs market, alongside purposeful efforts to rebuild treatment services and recovery support so that people can get the help they need.”

Photo of Tommy Sheppard Tommy Sheppard Shadow SNP Spokesperson (Constitutional Affairs)

The hon. Gentleman is making an excellent speech, and I very much endorse and support the recommendations of Dame Carol Black’s review. However, I have heard her present these reports, and she has been very clear that the framework that she was given—the parameters that she was allowed to look at—deliberately excluded any review of the legislation that frames this whole matter. Given that this is a unique health pandemic—because the victims of it are liable to criminal prosecution if they seek help, and many who would seek to help them would be liable to criminal prosecution if they tried to do so—is it not time for the Government to begin a review of the Misuse of Drugs Act 1971, to ensure a more up-to-date legal framework to deal with these problems? Would that not assist in the implementation of Dame Carol Black’s recommendations?

Photo of Dan Carden Dan Carden Labour, Liverpool, Walton

The hon. Member makes an important point, although it is one that I will not get drawn into today.

A month after part two was published, the Office for National Statistics confirmed that drug-related deaths had hit an all-time high in England and Wales—the highest number of deaths since records began. Drug deaths have risen 60% in the last decade. In 2020, 4,561 people lost their lives to drugs. Each life lost represents years of pain and suffering; each life lost leaves a family devasted and shattered irreversibly; each life lost is evidence of a missed treatment opportunity; and, most importantly for us today, it is important to accept that each life lost is a failure of policy, too.

I want to make special mention of the stigma that surrounds addiction. Someone who finds themselves dependent on a substance deserves the evidence-based health treatment and support that works, yet stereotyping and prejudice remain all too common in our approach to addiction. It was disappointing to see the Government’s response to the review referring to addiction as a “scourge on society”. The dehumanisation of people who become drug-dependent feeds into the stigma that we must eradicate, so we must steer the discussion, the policies and the treatment towards a compassionate and person-centred health response.

Last week I joined the Forward Trust at the launch of its “Taking action on addiction” campaign, which aims to improve public understanding of addiction as a erious, chronic mental health condition. The Duchess of Cambridge, patron of the Forward Trust, spoke there. I want to quote her at length:

“Addiction is not a choice. No one chooses to become an addict. But it can happen to any one of us. None of us are immune. Yet it’s all too rarely discussed as a serious mental health condition. And seldom do we take the time to uncover and fully understand its fundamental root causes.

“The journey towards addiction is often multi-layered and complex. But, by recognising what lies beneath addiction, we can help remove the taboo and shame that sadly surrounds it. As a society, we need to start from a position of compassion and empathy.”

As many as 80% of the public support more treatment and care for people struggling with addiction; less than 10% believe more punishment and condemnation would help. Intolerance, shaming, tougher punishments and denial will not rid society of addiction, because addiction is an illness. It is a matter of public health, and Dame Carol puts it best when she says,

“It must be recognised that addiction is a chronic mental health condition, and like diabetes, hypertension or rheumatoid arthritis, it will require long-term follow-up.”

Sadly, as things stand, I cannot think of another illness that causes so much harm to society, that is given so little, and the sufferers of which are treated with such contempt. It is the only illness in which blame is placed on the person suffering. Instead of blaming the individual for making bad choices, we need to ask why so many people are turning to substances in the first place.

Now to the prevention, treatment and recovery system as it stands: not fit for purpose, in urgent need of repair, years of austerity, continued disinvestment, fragmentation and a dire lack of accountability throughout. The Health and Social Care Act 2012 shifted addiction treatment out of the NHS mental health services on to local authorities, at the same time as their budgets were being slashed. On that matter, Dame Carol is clear:

“We recommend that funding for drug treatment be allocated to local authorities based on a needs assessment and then protected.”

We also urgently need to improve the situation for people suffering co-occurring mental ill health and drug or alcohol dependency. Too many people are being bounced between fragmented services and end up falling between the cracks. It is simply wrong that mental health services can require patients to reduce their alcohol or drug use, without providing the proper support to do so, before they can receive the treatment they need. Or that drug and alcohol services do not possess the competencies to support someone with significant mental health issues, thereby often leaving sufferers with no support whatsoever.

There must be a “no wrong door” policy. One young woman, whom I will call Jane, told me:

“It was as if I had to get more ill, drink and use more, until I got the right help and support. For 18 months, my mental health deteriorated. Mental health services couldn’t help me and addiction services struggled to support me because of my poor mental health. I was so frightened, I had to reach crisis point and rock bottom before I was able to be considered for residential treatment.”

Jane is now in recovery and leading a happy, healthy life, but she did not receive public funding. In fact, she was denied that. If it had not been for a chance meeting with Action On Addiction, which provided her with a bursary-funded bed, she would not be alive today. It should simply not fall to charities to catch the increasing numbers of people falling through the threadbare safety net. Access to treatment should not be about luck, only available to those who can afford it or those who live in a local authority that prioritises it.

Currently, the drugs treatment market operates in a similar way to that of adult social care. Providers are being squeezed and staff poorly paid. There is high turnover in the workforce and a depletion of skills. The number of medics, psychologists, nurses and social workers in the field is falling significantly.

It is time to repair that broken system and overhaul addiction treatment, and we have the road map for the future—the 32 recommendations of Dame Carol Black’s independent review of drugs. The scope of the recommendations is far-reaching and the solutions span many Government Departments, local government and other organisations.

Dame Carol’s review has pursued three main objectives: first, to increase the proportion of people misusing drugs who can access treatment and recovery support, including more young people, with earlier interventions to divert offenders away from the criminal justice system; secondly, to ensure that the treatment and recovery package offered is of high quality and includes evidence-based drug treatment, mental health and physical interventions, and employment and housing support; and thirdly, to reduce the demand for drugs and prevent problematic drug use, including use by vulnerable and minority groups and recreational drug users.

To achieve those objectives, significant changes need to be made in four areas: radical reform of leadership funding and commissioning; rebuilding of services; increased focus on prevention and early intervention; and improvements to research and how science informs policy, commissioning and practice. And the 32 recommendations cover a wide range of responsibilities.

The Government have already begun to set in motion some of the structural changes, which I welcome, and the policy commitments that will help to drive through the review’s recommendations. It is reassuring that Dame Carol herself will continue to act as an independent adviser to Government. However, the remaining recommendations are contingent on Government investment.

In January 2021, the Government announced £148 million of new money to cut crime and protect people from the harms caused by illegal drugs, which I also welcome, with £80 million of that money to be invested in treatment and recovery. That £148 million must be the first instalment of the £1.78 billion that Dame Carol has called for over the next five years and I hope that the Minister has come with hot-off-the-press Budget commitments. Dame Carol’s spending recommendation would restore addiction treatment to what it was before 2012. Although local authorities are well positioned to oversee services, drastic cuts to public health grants have led to cuts to addiction treatment services over many years. The Local Government Association has long argued that reductions to the councils’ public health grant, which is used to fund drug and alcohol prevention and treatment services, is a false economy, which will only compound acute pressures for criminal justice and NHS services further down the line.

I must stress to the Minister that if the Treasury is unable to find all the funding that the review calls for, the money it does find must not be thinly spread across the country. Instead, it should be targeted at those areas most in need, and efforts must be made at least to pilot the whole-systems approach that Dame Carol has called for. Small amounts of money given to each local authority will not bring about the long-term transformational change that the review demands.

There has simply never been the political will to act on prevention, treatment and recovery from drug and alcohol harm, but we have reached a crisis point, with record deaths, rising economic and social harms, and depleted treatment services. Dame Carol’s groundbreaking review, which was commissioned by this Government, is the moment for change, and the Government cannot meet their pledges to level up the deprived communities that they seek to represent, which are often found in the north, unless they recognise that. In the words of Dame Carol herself:

“The Government must either invest in tackling the problem or keep paying for the consequences.”

Several hon. Members:

rose—

Photo of Yvonne Fovargue Yvonne Fovargue Labour, Makerfield

A number of Members are waiting to speak. I am not imposing a formal time limit, but please keep contributions to four minutes or others will lose out. I call Rachael Maskell.

Photo of Rachael Maskell Rachael Maskell Shadow Minister (Digital, Culture, Media and Sport) 4:49 pm, 27th October 2021

It is a pleasure to serve with you in the Chair, Ms Fovargue. I congratulate my hon. Friend Dan Carden on securing today’s debate, and I thank Dame Carol Black for putting forward such strong recommendations: 32 in all that must be adopted in full.

Some 3 million people have used drugs in the last year—an indicator of why the issue is so urgent. As we have heard, in the last year 4,561 people have lost their lives, including a young boy in my constituency. That brings it home how important it is to tackle the issue and move it into a public health framework. We know that it preys on people whose lives have been afflicted with trauma and many complex needs, but it can also be indiscriminate. That path is not inevitable. Things can change, and the report describes a pathway for bringing about change.

I was struck by the call for a change in governance and ensuring that there is a central drugs unit. That should be a priority for No. 10 and a sub-committee of the Cabinet in order to bring together Government Departments to bring the laser-like focus that is needed. When money, time and people are focused, it can shift agendas. We need leadership. We need to build an evidence base and to invest in research on the best treatments and early intervention. If we take a half-hearted approach, we will not shift the dial. That is why the Minister should step up and make it possible to bring about change.

We need to see diversion as well so that people are not sucked into the criminal justice system, but brought out of it through diversion and ensuring that, for instance, young people are not arrested but pushed down the line of education, giving them a pathway out into apprenticeships and work, and giving them the chances in life that they have never had. We need to invest in and mentor young people so that their future goes a different way. Many of the people dealing drugs are being exploited by criminal gangs, and they too deserve a future that is very different from the paths that they are on.

We need investment in treatment, as has been articulated, not only for mental health but for physical health as well. We need to build stability, too, with a housing first approach so that people have a house. When people leave the criminal justice system, they need a house, a treatment plan, a bank account, and also a job to move into if that is appropriate. We should look at the person and not just the issue.

We need to go further, so I urge the Minister to look at how we can create drug consumption rooms where people can engage with services, while recognising that it will take people six or seven attempts on average to move out of a life on drugs. Also, I want the Minister to look into heroin-assisted treatment so that we can take a different approach to break the cycle of substance misuse. There is a real opportunity ahead of us, and I trust the Minister will step up and deliver.

Photo of Patrick Grady Patrick Grady Scottish National Party, Glasgow North 4:53 pm, 27th October 2021

It is a real pleasure to serve under your chairmanship, Ms Fovargue. I congratulate Dan Carden on securing this debate, on his courageous and dedicated approach, and on setting out so clearly the context of Dame Carol Black’s independent review. As he said, the whole point of commissioning reviews from independent experts is to provide a way forward, and not for them to simply sit on the shelf as the completion of a process when they should be the start of it. Precisely because they have been independent, they provide grounds for cross-party consensus that all of us, from all parties, can get behind. I hope that that comes out strongly from the debate today and in what we hear in response from the Minister.

It is not a secret that drug deaths in Scotland are unacceptably high and among the worst in Europe. I would imagine that most Scottish Members of Parliament will have come into contact with someone affected by, or connected to a death, whether that is a constituent or their family, a minister—some ministers in Glasgow have to conduct services far too frequently—or indeed through their own friends or family. Certainly, I have had all three of those experiences. Every death is a tragedy.

The First Minister has admitted that more should have been done, and that more needs to be done going forward. For me, that must include the adoption of the recommendations made by Dame Carol Black. It must include the kind of responses that my hon. Friend Tommy Sheppard spoke about as regards reform of the Misuse of Drugs Act—clearly, after 50 years, a piece of legislation that is well past its sell-by date. It is clearly not doing what it was originally intended to achieve.

I welcome the steps that the Scottish Government have taken so far, in the additional funding they have announced—£250 million over the next five years to be spent in a range of different responses. They continue to look at some of the things that Rachael Maskell spoke about, such as prevention facilities or drug consumption rooms—depending on what we want to call them—and heroin-assisted treatment facilities. They are not quite within the devolved powers, but the Scottish Government will do what they can. Ideally, the UK Government will give them the powers if they are not willing to legislate in those areas.

Finally, I want to reflect on the recovery strand. The amazing charity Faces and Voices of Recovery UK, run by Anne Marie Ward, is based in my constituency. In 2018, it launched a charter, a declaration of recovery rights for people seeking to recover from drug and alcohol addiction. That declaration, and the early-day motion that I tabled at the time to support it, was signed by many Members of this House, on a cross-party basis. It was compiled after a year of consultations across the UK into what the charity identified, even then, as a drug death crisis.

The declaration states that all people in recovery have a right to recover from addiction, if they find themselves in that situation. It seeks to build communities of recovery and pledges that people who are current or former substance users should be able to live their lives free from stigma, with access to quality care, meaningful political representation—which is a duty on us all—and well-informed choice, and touches on a range of other important aspects.

It has support from a wide range of organisations, including the Scottish Drugs Forum, Alcohol Change UK, the Scottish Recovery Consortium, the National Association for Children of Alcoholics, and so on. It is based on the underlying principle that people in recovery have a right to respect and dignity, and to live free from stigma and discrimination. If the Minister is not familiar with that document, I am very happy to send her a copy, and I very much hope that she will familiarise herself with it and adopt its principles as part of the Government’s response to Dame Carol’s report.

Photo of Rachel Hopkins Rachel Hopkins Labour, Luton South 4:58 pm, 27th October 2021

It is a pleasure to serve under your chairship, Ms Fovargue. I congratulate my hon. Friend Dan Carden on securing today’s debate. His campaigning on the issue has been excellent, and I am pleased to support the points he has raised. I refer to my entry in the register of interests, as I speak as a vice president of the Local Government Association.

We know that drug misuse has had a devastating impact on UK society, costing over £19 billion per year. Drug-related deaths have risen by 80% since 2012, and we are still seeing worrying rises in young people reporting early onset addiction. The latest LGA estimates suggest that around 200,000 people are receiving help for substance misuse, and another 100,000 are not receiving support. Addiction must be seen as a chronic health condition. Like other conditions, it requires long-term follow up. Trauma and mental ill health are identified as key drivers and an accompaniment to much addiction. They are comorbidities, rather than separate problems.

Tackling the problem requires a holistic multi-agency approach, with Government Departments working together to invest in and improve treatment, employment, housing support, and the way people with addictions are treated in the criminal justice system. However, access to addiction treatment and recovery is now a postcode lottery. More than half of state-funded residential addiction rehabilitation centres in the UK have closed in the last eight years, and the capacity of prison recovery programmes has reduced by over 60% in the same period. In some local authorities, funding for addiction services has been cut by more than 40%.

Since 2014-15, the Government have presided over a real-terms cut of £700 million to local councils’ public health funding, and single-year settlements and the late allocation of budgets have created unnecessary uncertainty. The LGA has long argued that reductions to councils’ public health grant, which is used to fund drug and alcohol prevention and treatment services, are a false economy that will only compound acute pressures for criminal justice and NHS services further down the line.

The Government are also failing to facilitate early intervention to divert young people away from drugs and crime, which is an issue raised by many of my constituents. Under the Tories, spending on young people’s services has been cut by 73%. Some 900 youth centres have been closed, and 4,500 youth worker jobs have been cut. Although today’s Budget announcements are welcome, it is obvious that the Government have reflected that much of this was a mistake.

For every £1 spent on addiction treatment, the Exchequer saves at least £3 in crime, health and benefit expenditure, and for every £1 spend on family intervention services, the Exchequer can generate £2.76 in savings. The public provision for prevention, treatment and recovery needs urgent repair, with the impact of the pandemic meaning that the problem will almost certainly get worse and act as a major barrier to levelling up.

To build on what my hon. Friend the Member for Liverpool, Walton has already said, I hope the Government will commit to take steps to adopt Dame Carol Black’s recommendations to properly fund and resource addiction recovery services and, importantly, cross-Departmental liaison. I hope the Minister understands why last week I asked when she had spoken to the Local Government Association and the Association of Directors of Public Health to discuss covid, addiction and other important issues, because they are so cross-cutting. I look forward to her response.

Photo of Yvonne Fovargue Yvonne Fovargue Labour, Makerfield

I will be calling the SNP spokesperson at 5.10 pm.

Photo of Andy McDonald Andy McDonald Labour, Middlesbrough 5:01 pm, 27th October 2021

It is great to see you in the Chair, Ms Fovargue. I congratulate my hon. Friend Dan Carden on his bravery and on securing the debate.

I very much welcome the review by Dame Carol Black, but I note with great sadness her stark observation that Governments have de-prioritised these problems—from drugs entering the country, right through to helping drug users access appropriate treatment and achieve recovery. It is that second aim on which I will concentrate my brief remarks because, sadly, Office for National Statistics data show that the north-east is the worst area in the country for drug-related deaths. That makes it all the more important that programmes to address addiction as a health and public protection issue are successful. Accordingly, I was delighted in 2019 that the then Labour police and crime commissioner for Cleveland, Barry Coppinger, provided the essential funding, derived from the proceeds of crime, for the heroin-assisted treatment programme based in my Middlesbrough constituency—the first and only one of its kind in the UK.

This is undoubtedly a hard road, but there is no doubt that the programme has been immensely successful. The first cohort accepted on to the scheme were 14 of the most at-risk individuals in Middlesbrough, who caused the most concern to the criminal justice agencies and the health and social care services. Some had been using street heroin for over 20 years, and all other treatment had failed. Whereas six of them had committed 541 detected crimes before the scheme, with an estimated cost to victims and the public purse of £2.1 million, their combined crimes fell to three lower-level offences after starting their treatment.

In all cases, the individuals concerned either completed their probation or showed improved compliance with a probation order, and there was a 98% attendance rate at the twice-daily sessions, which continued through covid and lockdowns. None of the participants went back to sleeping on the streets, their use of illicit substances declined markedly, and their mental wellbeing improved. I am delighted that the clinical lead on the programme, Danny Ahmed, has been in Parliament today, and I pay great tribute to the superb work that he and his colleagues have done in showing the country the way to address this most complex of issues.

In closing, I would also like to pay tribute to the courageous stance taken by the chief constable of Cleveland, Richard Lewis, in his recent article in The Guardian where he said amongst other things that,

“The heroin-assisted treatment programme offers hope, if scaled up on a national level, that demand for heroin can be cut. When the state offers a meaningful alternative to the street drugs that can be bought from organised crime groups, the demand for them decreases.”

Finally, he said that the programme in Middlesbrough

“could possibly represent the beginning of the end for the ‘war on drugs’ that has already taken too many lives.”

I wholeheartedly agree, and I trust that the Government will take on board each and every one of the 32 recommendations that Dame Carol Black makes.

Photo of Mary Glindon Mary Glindon Opposition Whip (Commons) 5:05 pm, 27th October 2021

It is an honour to serve under your chairmanship, Ms Fovargue. I congratulate my hon. Friend Dan Carden on securing the debate, and on the way that he spoke with great knowledge and passion. I declare my interest as co-chair of the drugs, alcohol and justice cross-party parliamentary group. In that capacity it was my privilege to introduce Professor Dame Carol Black to address our group the week after she published her report. My co-chair, Lord Ramsbotham, has repeatedly asked in the other place when the Government will establish the long-awaited royal commission on the criminal justice system. I hope the Minister may have some news on that for us.

Dame Carol’s report recommended earlier interventions for offenders to divert them away from the criminal justice system, particularly prison. Providing people with pathways into treatment, rather than into the criminal justice system, seems an eminently sensible approach because, as Dame Carol observed:

“Rarely are prison sentences a restorative experience.”

Over a third of prison places in England and Wales are taken up because of drug-related offences.

I pay tribute to the pioneering work of the late Ron Hogg, who, as Durham’s police and crime commissioner, introduced a successful checkpoint scheme. We have since heard of other excellent diversion schemes, such as those developed in the West Midlands and in Thames Valley—we desperately need more like them. I am glad that Ron’s successor, Joy Allen, along with Dorset PCC Dave Sidwick, is leading the PCCs’ work on addiction. I am sure the Minister will join me in welcoming their dedication to helping people towards a safer and healthier future.

Dame Carol understands that addiction is a chronic health condition, arising as people try to cope with trauma and other issues. Her report rightly condemned the current situation as intolerable. Drug-related deaths are at record levels, the impact of drug-related harms in many places is getting worse and the worst affected areas are those with greatest deprivation. I am sad to say that the highest rate of drug misuse deaths in 2020 was once again in the north-east, which according to the ONS has had the highest rate of drug misuse for the past eight years, with a significantly higher rate than other regions of England and over three times the rate of London.

We know drug treatment has seen years of disinvestment. Some services have seen budgets nearly halved as funding has been redirected to other local government priorities. There has been an absence of political leadership and financial commitment to address the concerns of the sector, with very clear and obvious consequences. A range of treatment providers welcome Dame Carol’s review, fully endorse her recommendations for a whole system approach and told our group they were keen to seize this unique opportunity to rebuild and renew our treatment and recovery system. Jon Murray, an executive director at With You told us:

“This review represents a potentially defining moment in the course of drug treatment in the UK.”

Yasmin Batliwala, chair of the Westminster Drug Project said:

“This report has the potential to be a game changer!”

Karen Tyrell, executive director at Humankind added:

“Dame Carol Black has provided the map needed to get the sector back on course and we urge the government to employ their moral compass, invest accordingly and help us turn this ship around.”

For far too long, piecemeal investment through path- finders and pilot schemes failed to provide the stability for providers to develop the long-term plans, and recruit and retain the high-quality staff, that are needed to meet the ambitions laid out in the review. As recommended, ringfenced funding is essential for the sector to build and maintain a resilient support system for the hundreds of thousands of people who so desperately need and deserve those services. I sincerely hope that the Government will act on all of Dame Carol’s recommendations.

Photo of Ronnie Cowan Ronnie Cowan Shadow SNP Spokesperson (Infrastructure) 5:10 pm, 27th October 2021

Thank you for allowing me time to speak, Ms Fovargue. I congratulate Dan Carden on securing the debate.

Having read Dame Carol Black’s “Review of drugs part two” several times now and having listened to her present and answer questions on the report, I find myself increasingly frustrated, not with Dame Carol Black, but within myself. The inadequacies of the existing system are laid bare for all to see in the report. Crucial areas that must be addressed are explained and, as we have heard, 32 recommendations are detailed. Drug treatment, recovery support, funding, commissioning, diversion, employment, housing, mental and physical health, prevention, intervention and research—the report has recommendations on them all. It is right and proper that we tackle drug policy in that way. Patching will not do; we need reform on a grand scale, put into the hands of the people best placed to make it effective.

For too long, drugs have been designated as a matter for the judicial system, and our health services have been left to pick up the pieces. The report puts health at the heart of the solution and should be commended for doing so. However, apart from making recommendations, there is nothing that the report or I can do. That is the cause of my frustration. Dame Carol Black is absolutely clear that if the UK Government start to pick and choose which of her 32 recommendations to implement, it will not work. I applaud her for saying that. Too often we make do and mend with policies that have been ripped up and rewritten.

The Misuse of Drugs Act 1971 is a case in point. For 50 years, it has made the situation worse, but to expect the UK Government to have a sudden blinding flash of understanding and compassion would be naive. They will not implement many of the recommendations; they will pick a few, dress up a few others, pay lip service to some and ignore the rest. I say that with confidence and a heavy heart: confidence, because the UK Government just do not get the issue of drug addiction and harm—while the administration of the area continues to be held in the Home Office, the situation will not improve—and a heavy heart, because as people in the drug rehabilitation community keep telling me, “You keep on talking and we keep on dying.”

That is not Dame Carol Black’s fault. As my hon. Friend Tommy Sheppard mentioned, Dame Carol’s remit was deliberately precise. She was not allowed to recommend any new legislation, which in effect neuters her report. How can she be expected to identify improvements for a system that is tied up and gagged by the law if she cannot suggest some changes to the law? Dame Carol Black, however, had a good go at that by recommending a new structure for the mechanics of government which, if it were allowed to function, could within itself produce the required legislation. I am sure that Dame Carol Black would be happy with the outcome: she feeds in all the good ideas and the UK Government put them through a mincer, come up with a solution that she proposed, and implement it, taking the credit.

To be honest, I would be more than happy if that happened, but I just cannot see it, because one recommendation is the creation of a new central drugs unit. According to the report, that unit should be placed

“in whatever department or joint arrangement seems appropriate”.

Unless that Department is the Department of Health and Social Care, it is a non-starter.

The intransigence of the Home Office has been a feature of this UK Government, and I cannot see that changing any day now. I expect warm words for Dame Carol Black’s report, which could be seen as progress, but I do not expect that the UK Government will do anything other than launch inquiries, form committees, divert responsibility and talk about budgets and constraint. However, I am pleased that we have a Minister from the Department of Health and Social Care present, because historically the UK Home Office is where good ideas go to die.

At the start of Dame Carol Black’s report, as has been said already in the debate, but it is worth repeating— I love this quote—she states:

“Government faces an unavoidable choice: invest in tackling the problem or keep paying for the consequences. A whole-system approach is needed”.

She is absolutely correct. I say to the Minister, go on: agree to all 32 recommendations, fund them and put the power of implementation into the appropriate Departments, proving me 100% wrong—please.

Photo of Jon Ashworth Jon Ashworth Shadow Secretary of State for Health and Social Care 5:14 pm, 27th October 2021

It is a pleasure to see you in the Chair, Ms Fovargue. I commend all hon. Members who have spoken, with great insight and authority. They made many serious points, which I hope the Minister will respond to.

I pay particular tribute to my hon. Friend Dan Carden, for not only his superb presentation of the issues in the Black report but for the way in which he spoke with great eloquence and bravery about his personal story of addiction. I am not ashamed to say that it moved me to tears. I, too, have spoken about how addiction has affected my family and what it meant for me as a child growing up with a father who had a serious drink problem. I know that thousands of people who are, struggling with addiction, or see a loved one doing so, will have heard my hon. Friend’s speech. Although they may never get in touch with or meet him, his speech will have been a tremendous comfort to them, and we should all thank him for his bravery.

I will focus on the addiction crisis that we face as a country. I commend Dame Carol on her excellent report. Her 32 recommendations should be taken forward by the Government, and we need to hear from the Minister exactly what their attitude is to them. I offer to work with her on a cross-party basis on this public health crisis. In the last year, more than 7,000 people in England and Wales have died from alcohol-related causes. Alcohol-related liver disease is increasing. More and more people are dying from drug poisoning across England and Wales. There are, of course, particular issues in Scotland, which Members who represent Scottish constituencies rightly raised.

We are at risk of our society falling into a situation where deaths among those in their 40s and 50s are increasingly either the result of suicide or are drug or alcohol-related. They are called deaths of despair. For quite some time, this been a well known and tragic phenomenon in the United States, and we are at risk of seeing it become a feature here in the United Kingdom. My hon. Friend the Member for Liverpool, Walton is right that addiction is a national crisis, and spot on when he says that it is everywhere but well hidden.

We are having this debate on the day the Chancellor has presented his Budget, but even though this is a public health crisis, and we are still experiencing another public health crisis, public health did not feature in the Budget. As a number of Members have quoted, Dame Carol says:

“Government faces an unavoidable choice: invest in tackling the problem or keep paying for the consequences.”

The Chancellor ducked that choice today, and public health did not get the substantial increase in funding that it needs. As my hon. Friend Rachel Hopkins said, the Budget comes after real-terms cuts in recent years of £800 million to £1 billion, depending on how we calculate the figures. Those real-term cuts mean that drug and alcohol addiction services have lost £122 million in recent years—a 15% cut.

The Health Secretary likes to use Blackpool as an example of why we need to level up, pointing out the stalling life expectancy there. Blackpool, which has the highest mortality rate in the country for alcohol-related deaths and has the thirteenth highest number of deaths from drug poisoning, has had a £43 per person cut to public health funding in recent years. Manchester, which had the fifth highest number of deaths from drug poisoning in 2020, has had a £33 cut per person in public health funding in recent years. In 2020, Liverpool had the joint highest number of deaths from drug poisoning, with 89 people losing their lives, yet the city has had a £34 per person real-terms cut in public health funding. We look forward to the Minister telling us how local authority drug and alcohol addiction services are expected to cope if the cuts are not reversed—

Photo of Yvonne Fovargue Yvonne Fovargue Labour, Makerfield

Order. I am afraid I have to call the Minister.

Photo of Jon Ashworth Jon Ashworth Shadow Secretary of State for Health and Social Care

Will the Minister respond on the public health cuts? When will we see the investment in drug and alcohol addiction services that Dame Carol Black’s report calls for?

Photo of Maggie Throup Maggie Throup The Parliamentary Under-Secretary for Health and Social Care 5:20 pm, 27th October 2021

It is a pleasure to serve under your chairmanship, Ms Fovargue. I congratulate Dan Carden on securing this extremely important debate. I pay tribute to all his work on addiction and his openness regarding his personal experience in previous debates. As Jonathan Ashworth said, he brought many of us to tears. No doubt his example will serve as inspiration for others to take that crucial first step of coming forward to ask for help.

I thank all those working in the drug and alcohol addiction sector, particularly during the pandemic. I commend the work they do to help people through periods of their lives that are exceptionally difficult, often through no fault of their own. As the hon. Gentleman highlighted, the drug and alcohol addiction sector faces challenges. There is no hiding from it. Drug misuse deaths in England have been on the rise for many years and are currently the highest on record. That is true across most of the United Kingdom. Our neighbours are all grappling with this devastating issue, particularly Scotland, where deaths rates are the highest in Europe, as hon. Members have highlighted.

Drugs destroy lives, ruin families and tear apart communities. That is why in February 2019 the Home Secretary appointed Dame Carol Black to undertake an independent review of drugs. Part one was published on 27 February 2020, during the Government’s UK-wide drugs summit in Glasgow. It provided a detailed analysis of the challenges posed by drug supply and demand, including the first detailed analysis of the drugs market and the ways drugs fuel serious violence. After being commissioned by the Health Secretary, part two of Dame Carol Black’s independent review of drugs was published earlier this year, on 8 July. As hon. Members have highlighted, Dame Carol made it clear that tackling drug addiction needs to be more health focused. I am committed to making it so. I agree with the hon. Gentleman that now is the moment for change.

I would like to talk about the substantial action the Government have already taken and our commitment to go much further. Dame Carol has been a fantastic champion for better treatment and recovery services. I am very pleased she will be working closely with the Government as an independent advisor, holding us to account each step of the way and providing advice on how we can make real change. We are already making improvements to treatment and recovery through the £148 million crime package announced in January this year. Of that, £80 million has been allocated to local authorities for drug treatment and recovery services. This is the largest increase in drug treatment funding for 15 years, and it is already making a difference.

That funding allocation is being focused on increasing the number of treatment places for drug users in contact with the criminal justice system, diverting people away from custody and into treatment services and, crucially, making sure that we get more people into treatment after they are released from prison. It is also being used to fund additional in-patient detox beds, further residential rehabilitation places and the life-saving overdose medication naloxone. The additional treatment places are most needed, and they will benefit people with alcohol dependency as well as drug dependency.

The Government published our initial response to the findings of part one and part two of Dame Carol’s independent review on drugs on 27 July 2021. The response did not hold back in setting out our clear cross-Government commitment to this agenda and to taking effective action, given the urgency of addressing these issues. We committed to responding to Dame Carol’s review in full by the end of this year, and to set out a long-term drug strategy. That is exactly what we will do. I would like to reassure hon. Members that Dame Carol’s review will definitely not sit on the shelf.

As Dame Carol points out, we must work across the whole of Government to combat drug misuse and drive down drug supply and demand. That approach is absolutely key. That is why, in July this year, we established a new joint combating drugs unit, whose mission is to co-ordinate and drive a genuinely whole-of-Government approach to drug policy. The joint unit is already bringing together multiple Government Departments to tackle the problem across society. I am pleased that a number of staff from my Department have joined the unit, again ensuring that there is a health focus and that health lies at the heart of analysis and decision making.

Photo of Crispin Blunt Crispin Blunt Conservative, Reigate

I want the Minister to take up the offer to work together made by the Opposition spokesman, Jonathan Ashworth, and to work with colleagues such as me who take a specialist interest in this area. This should not be used as a political football in any circumstances. The crisis is too great and all of us stand ready to try to help her and her colleagues to deliver improvement in this area.

Photo of Maggie Throup Maggie Throup The Parliamentary Under-Secretary for Health and Social Care

I thank my hon. Friend for that intervention. He is right that this is too important an issue to become partisan over, and I completely accept the offer from the Opposition spokesman of joint working on this. We are all passionate about this important issue and we need to make sure that we get this right for individuals who can really benefit.

I thank the hon. Member for Liverpool, Walton for securing a debate on such an important issue. This Government are absolutely committed to ensuring that everyone with a drug problem can access the help and support that they need. He stated that support must always be compassionate and person-centred, and Rachael Maskell highlighted that the way forward is to have an individual-centred approach. We cannot have a one-size-fits-all approach. Our long-term plan will be set out in detail in our cross-Government drugs strategy, which will be published later this year.

We understand that there is still a lot of work to do. There are also huge challenges across the drug and alcohol sector. This cannot be fixed overnight and we cannot do it without the help of every single local authority in the country, as well as through truly collaborative cross-Government and cross-party work involving the NHS. As a number of hon. Members have mentioned, the voluntary sector plays an important part, too. I put on record my thanks to everybody who is making a huge difference, whether that is at a statutory or a voluntary level, to so many people’s lives and to their futures. I genuinely believe that by working together, we can make a huge difference, and I look forward to that in the future.

Photo of Dan Carden Dan Carden Labour, Liverpool, Walton 5:28 pm, 27th October 2021

I thank the Minister and right hon. and hon. Members for their kind comments, particularly, the Opposition spokesperson, my right hon. Friend Jonathan Ashworth. I will hold the Government to account on this issue. I want to see regular reports back. I want to see how the Government intend to implement Dame Carol’s 32 recommendations. I share the cross-party spirit that has been expressed on this matter, because in the end, this is about families and people up and down this country who, when things go wrong with addiction and with drug and alcohol problems, lose loved ones, always in the most dramatic and unfortunate circumstances. I welcome the Minister’s comments and look forward to holding the Government to account on this in future.

Question put and agreed to.

Resolved,

That this House
has considered Dame Carol Black’s independent review of drugs report.

Sitting adjourned.