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Drugs: Government Consultation Paper

My Lords, I am associated with several charities in the drug and alcohol field, but today I speak particularly as a trustee of Action on Addiction, which is well qualified to offer a meaningful contribution to the new strategy. It operates long-established treatment services in both the residential and non-residential sectors, such as Clouds House, which are acknowledged as some of the best in the country. It has facilitated cutting-edge research, and has shown leadership in the development of services for families affected by addiction, including children, through its Families Plus service. It has also established world-class courses for training addiction counsellors at its centre for addiction treatment studies. My contribution will probably be a little different from that of most who have spoken so far, as it focuses on the treatment, family support, workforce development and research sections of any new strategy. On the issues that others have addressed tonight, my view is that, regardless of whether we decriminalise drugs or have more effective enforcement, people will continue to suffer from addiction, and they need help to recover from it. After all, alcohol is legal and has been deregulated. Do we have addicts? Of course we do. We have an increasing number of addicts; there are four times as many addicts of alcohol as there have ever been addicts of drugs. We must bear some of those issues in mind when we consider how to deal with the nuts and bolts of addiction and with addicts, which is the purpose of my contribution. A significant amount of money has been invested over 10 years of drug treatment. As a result, we must acknowledge that more people have had access to some kind of treatment and, somewhat late in the day, we are starting to see a growing recognition of the need to provide proper support to families and carers, including children. In some areas, there have been clear improvements in commissioning and service provision. However, while some improvements have been made over the life of the current strategy, they are not wholesale across the board or deeply rooted, and much more needs to be done to ensure that we continue to make further progress both in treatment delivery and in the systems within which treatment services must operate. To do so, we must learn the lessons of the past 10 years and act accordingly, and I bring that home to the domestic scene rather than the international one. First, given the extent of the problem and its national impact, it is a scandal that so few people who need treatment for alcohol dependence are able to access it: currently, only one in five, according to Alcohol Concern. That is an over balancing of the direction of resources in the drug treatment field. I am not arguing that the amount of money spent on drug dependency should be reduced, but there should be a better relationship between expenditure on alcohol and drug addiction than we presently have instead of having separate silos. The national treatment agency is the National Treatment Agency for Substance Misuse, not only drug misuse, and if it is to continue it should be allowed to act according to that encompassing remit. We must avoid repeating the mistake of over investment on treatment obtained via the criminal justice system; most of the debate so far today has been about that. If things continue in the same way it will be at the expense of voluntary access to treatment. There must be a balance, otherwise we will continue to see the perverse situation of addicts committing crimes to get treatment and those who could otherwise have avoided the criminal justice system by entering treatment, being caught up in it. It is important that we avoid that. Treatment should be obtainable in a timely way that takes advantage of any appearance or increase in the addict’s motivation to change, something that the noble Baroness, Lady Finlay, has raised previously. We should continue to ensure that a harm reduction platform is secured in order to stabilise those with chaotic lifestyles that have such a widespread damaging impact. But we must ensure that the process does not stop there, as it has tended to do over the past 10 years, with thousands piling up in a methadone cul-de-sac. Everyone should be offered and encouraged to take the opportunity to make meaningful progress to a life completely free of drug dependency. High on my wish list would be a drug strategy that fostered independence and abstinence if possible, not a dependency on other drugs. Next, we must undo the equation that treatment inevitably and exclusively means medical prescription, and recognise that psychosocial interventions are, in the end, likely to play a key role in preventing relapse to illegal drug use. If we know that various forms of social support are key to sustaining recovery, we should ensure that we target adequate resources to that purpose. We must continue to ensure that pathways of care are commissioned, rather than unrelated treatment, rehabilitation and care episodes—where everything is dealt with separately and never brought back together through pathways of care. We must cease the obsession with outputs—numbers in treatment—and focus on outcomes and the quality of treatment inputs needed to achieve them. At the moment, ““in treatment”” can mean anything and very little, and result in the experience of being caught in a rapidly revolving door or endlessly treading water in a sea of prescriptions. It is all very well for the NTA to trumpet 180,000-plus people ““in treatment””, but that says nothing about the quality and effectiveness of that treatment. As the NTA itself has said, quantity without quality is a waste of resources. It also wastes lives and exacerbates and demoralises people. Commissioning and purchasing should be driven by the need to secure targets related to volume and price. The quality of commissioning, purchasing and care management needs significant improvement in many areas too. Training is essential to achieve this. For a start, there should be consistency across the country, and more controversially, I suggest that we should divest from poor quality, wasteful NHS services in this arena. I know that that will upset many of my noble friends within Government, but money is going in and in many instances it is not producing the results that it should. If that money was directed to the voluntary sector, we would see far better outcomes and value for money than we are at the moment. We should move funds to the voluntary sector, particularly into the residential services that were mentioned previously, and we should examine them to ensure that people are providing value for money and getting good results. In turn, they should be given the cash to ensure that beds are filled. Many of them were left empty last year and the same has happened this year. When people are crying out for treatment, it is a scandal that beds are left empty. They could be used to assist people to get back to sobriety. I move to a separate subject. We must rationalise the current wide variety of regulations and standards and produce a coherent, workable system that can be applied across all the models of care. I suggest that we should make a start in the area of residential treatment and see whether we can introduce some standardisation and commonality of approach. Gradually, we could then roll that out over a wider area. Further, if we want to make the most of the voluntary sector’s considerable expertise, we must be prepared to keep to the commitment that voluntary organisations are able to recover the full costs of providing services in line with voluntary sector compacts. We must rigorously examine the ratio of spending on bureaucracy to that of spending on actual service delivery and training. Why should good services that directly benefit people’s lives struggle for resources while new government agencies grow and grow, consuming funds? As an aside, we seem to have far more conferences and receptions. I suggest that a good start would be to halve the conferences and receptions planned for the coming year. We would then release a significant amount of money that could be put on the front line to assist addicts and their families. Turning to families, there are many more people affected by substance misuse than there are substance misusers. The evidence of the impact on their lives suggests that this constitutes a major public health issue and should be addressed as such. The health and cost benefits of providing proper support to families affected by substance misuse are likely to be very significant indeed. I would argue that that the key recommendations published in Hidden Harm should be implemented without delay. That would ensure that the 1.3 million children of substance misusers receive the help they desperately need. Action on Addiction has developed an effective brief intervention called M-PACT that supports these children, and which we are now aiming to make more widely available across the country. I would be happy to show the details of that intervention to my colleagues on the Front Bench if they would like to examine them in the context of the strategic review. A competent workforce is also essential to quality and effectiveness, but it is no good highlighting how important workforce development is, noting the continuing deficiencies in knowledge and skills, while at the same time failing to provide any tangible support to those like Action on Addiction’s Centre for Action Treatment Studies. We need to resist investment in short-term, superficial training, which has little lasting impact, in favour of courses that produce competent professionals with portable skills. We also need to see the further roll-out of treatment programme accreditation and schemes such as that organised by the European Association for the Treatment of Addiction. It is all about quality rather than numbers, because it will be quality that produces the desired results in the end. I believe that we have made some progress over the past 10 years—I am not as critical as some of the previous speakers in the debate—but there is much work to be done. If we begin to address some of the nuts and bolts issues in detail in the way I have endeavoured to address them, as well as looking at the wider national and international issues, we have a prospect of making more progress in the ensuing strategic period of the next 10 years.