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Drugs: Government Consultation Paper

My Lords, I apologise for missing the Minister’s opening of the debate and the contributions of the noble Lords, Lord Mancroft and Lord Cobbold. I was told the debate was starting at 6.30 pm and I had to go and earn a living. I apologise to the House for my late arrival but, even having arrived late, I have listened to some excellent contributions. I hope that I can add some value to the debate from my position. There is a sense of déjà vu or groundhog day whenever there is a drugs debate; the issue becomes one of legalisation versus prohibition. I do not want to go there, save to say that the remarks of the noble Lord, Lord Brooke of Alverthorpe, are common sense: we need to start from where we are as opposed to where we wish to be with our drugs policy. The question here is about treatment and, in that regard, I should declare an interest as a member of the ACMD, that much maligned but interesting group of people, and as the chief executive of the social care organisation, Turning Point, which I am told is the largest provider of substance misuse services in the voluntary and/or third sector in the country. We have a body of knowledge from which to speak and that is why I thought it would be useful to contribute to the debate. Turning Point provides services across the range, from tier one to tier four, and this includes both community and criminal justice services as well as residential services. For the majority of our service users, substance misuse is only one of a range of complex needs which contribute to their social exclusion. We need to take this on board in discussing the drug strategy if we are not simply to do what we have always done. If we do, as Einstein pointed out, we will get what we have always got, which is a sense that we have not moved much further from where we are. Let me give your Lordships some facts. Half of the people we see at our drug and alcohol services suffer from mental health problems. Around half of those accessing drug and alcohol services have mental health problems according to the Department of Health’s own figures on dual diagnosis, and 84 per cent of homeless people have drug or alcohol problems. Regardless of which side of the House you happen to sit, we need to acknowledge that the Government have made major strides in drug policy over the past 10 years. You may argue that getting people into treatment is not enough, but we would all agree that it is better than not having people in treatment. The Government have got more people into treatment with a significant programme of investment, and it is essential that they continue to invest in and improve the success of existing treatment approaches, and increase the numbers of people entering and completing treatment. I further agree with the comments of the noble Lord, Lord Brooke of Alverthorpe—the noble Lord, Lord Ramsbotham, also made these points—in relation to the criminal justice system and the balancing of investment to ensure that we do not get perverse incentives. I have received letters from fine, upstanding middle-class members of our community who have had sons and daughters commit crime in order to access treatment. It is not the intention, but there is a perception that there is a fast route to treatment through the criminal justice system which I would like to see rebalanced. So what do we do? Where are the solutions to be found? Let us take a forward looking, positive approach to what can be done. We need to deal with and manage better wrap-around care. It is time to build on the success of the past 10 years and not denigrate it for its failings. We need a new drug strategy which is ambitious for substance misusers and ambitious about their potential to re-enter and contribute positively to our communities. It is not always a dead-end for many of Turning Point’s and other services’ clients. The Government must build on the existing framework so that treatment encompasses the full complexity of substance misusers’ needs and provides wrap-around support to enable them to take a full role in society. The areas of people’s lives that need specific support are employment, housing support, healthcare and issues such as support on leaving the criminal justice system. My own organisation and others—I am not simply going to advertise Turning Point—have specific measurable outcome-focused programmes that have been shown to work, and require further investment and attention for those programmes to be rolled out so they are working everywhere, not just in the places that are lucky enough to have them. Those services are the stepping stone allowing current and former drug users to become citizens again—positive citizens—and that must be the aim of the Government’s drug strategy, along with moving them away from the social exclusion that substance misuse can create. Helping drug users into employment and providing stability links in with the Government’s agenda on increasing the number of people in paid employment, reducing benefit dependency and targets for social exclusion. It is imperative that people do not fall off the end of the conveyor belt of the treatment journey with no ongoing support. The drug strategy must make wrap-around care an essential part of a drug user’s treatment journey, not an add-on or an optional extra. There must be clear targets for commissioners and providers to prioritise these essential services to deliver more integrated and effective solutions in drug policy. If you simply set targets, they will be reached. We have all come across the concept of ““gaming””. What we know and what we need to learn is that organisations like mine need to add value. The point is not just to get someone into treatment but to get them into positive, active citizenship. We—and I personally—are not against the idea that noble Lords have mentioned of managing harmful drug addiction through treatment with alternatives like methadone. It is not a moral question, simply one about what works for the individual and their relationship with the treatment that is appropriate for them. Turning Point and others recommend an integrated approach to the treatment of substance misuse through extended interpretation of treatment to encompass these wrap-around services and aftercare support. I would also include financial advice and housing support as part of the integrated treatment process. We recommend that the new drugs strategy includes a target focused on the requirement to provide integrated aftercare support for substance misusers, built into their treatment plan. That must also include support for the more problematic users and specific aftercare support for offenders. Since the publication of the previous drugs strategy, patterns of drug use have changed. The new strategy needs to reflect that and develop new services to build on current provision. The increasingly complex needs of drug users, as the noble Baroness, Lady Finlay, mentioned, and the lack of tailored and flexible accessible services to respond to those changes are a significant challenge for the Government over the next 10 years. The Government must address the wholesale absence of treatment systems specifically for crack and stimulant users and for those with dual diagnosis of substance misuse and mental health problems. With half of substance misusers already having a mental health problem, as I have mentioned, the Government cannot afford to ignore the needs of that client group who may access services only when a crisis point has been reached, often becoming NHS ““frequent flyers””, clogging up A&E departments and becoming the very people who cost us the most. Users of other substances often turn up at our services simply because they have nowhere else to go. That includes those with problems with the stimulant khat, those using prescription drugs and steroid users. Alcohol misuse is a significant problem affecting individuals. It feels like déjà vu to say it, but we plead with the Government to take due care about what is said about alcohol. It is a significant challenge to the social infrastructure of this country and the Government need to pay attention to that. Alcohol services are less common than drug services and less likely to be part of a co-ordinated response with other agencies; for example, with children’s services. Turning Point’s own report identified that tonight one in 11 children will have gone home, if it can be called ““home””, to a place where their parents or carers are misusing alcohol. I emphasise that: tonight. We are calling for a national inquiry to investigate fully the scale of the problem and identify recommendations for service delivery to support those families. In order truly to come of age, the next drug strategy should be an integrated substance misuse strategy that covers all problematic substance use. It is essential that the new drug strategy addresses dual diagnosis—co-existing substance use and mental health problems—and acknowledges the Dual Diagnosis Good Practice Guide. In addition, the new drug strategy needs to turn its attention to blood-borne viruses. We at Turning Point are concerned that, despite the welcome and necessary increased investment in drug treatment, there has been an alarming increase in blood-borne viruses. We contacted nearly 900 injecting drug users across England and asked them about their injecting practices and blood-borne virus status as part of our report on blood-borne viruses, At the Sharp End. Our findings are truly alarming. There is a new generation of injecting drug users, using heroin and crack together, who are at greater risk of infection and may not have been tested or received treatment for their illness. We recommend that the new drug strategy sets out a clear commitment to reduce the transmission of HIV, hepatitis B and hepatitis C and improve access to treatment with clear targets to ensure delivery. This is a public health matter; it is not an issue just for the drug-using community; it will affect us all and the generation to come. We must act. In too many drug action teams there is an inadequate understanding of commissioning. Commissioning should be the means by which one understands the needs of the client, and/or the community in which they live, to build a platform for procuring appropriate services. That often does not happen. One gets cheap purchasing of the cheapest service, which is why residential services are not often focused on and there is often an odd mismatch between what NHS provides, because of its relationship with the commissioners, and what the voluntary and third sector provide. Commissioning must be clearly defined, and commissioners must be held accountable for the process of commissioning drug services. They must be able to audit and provide evidence of the methods that they have used to understand the needs of their community. I have a positive attitude toward the Government’s drug strategy. Much has been done that must be acknowledged, but there is much yet to do—to coin a phrase. I shall end with a story, because it is important that we bring the individual into the debate. I shall talk about someone who represents the aim of the Government’s drug strategy, which is to produce positive citizenship in our approach to treatment. Cathy is 27. She was referred to Turning Point’s employment and education support project, which supports current and former drug users who wish to access learning or work opportunities. She was on a methadone script, but continued to use heroin as well, partly through boredom and partly through the lack of proper continuing support. That happens a lot; whether one likes it or not, that is the reality. She wanted to go to the gym and return to study—substance misusers often say such things. We at Turning Point sat down with her and helped her work through the funding requirements for a passport to leisure and arranged an appointment for her to use Adult Directions software to help her to decide what course she wanted. We helped her engage with her fitness desires and to understand the realities of becoming involved in fitness programmes in colleges. We also made sure that at every point of potential failure she was supported to take the next step forward. To cut a long story short, Cathy is still on her course; she is doing a national diploma in animal management; she is enjoying it; she has stabilised her drug use and is no longer topping up her methadone with heroin, which is a big step towards total abstention from drug use that we must understand. She is due to start a work placement in conjunction with her course in January, and we will continue to support her in finding a suitable work place. Cathy has recently become engaged to her partner and is excited about the possibilities that her future now holds. We work with tens of thousands of potential Cathys. I urge the Government in their drug strategy to ensure that what we can do through wrap-around care helps all the other Cathys and people like her in this country.